3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Level of nurses' competence in mechanical ventilation in intensive care units of two tertiary health care institutions in Gauteng(2012) Botha, Margaret LynnStudies generally agree the survival of the mechanically ventilated patient in the ICU is largely reliant upon the competence of the nurse undertaking this highly specialized role (Alphonso,Quinones,Mishra,et al. 2004; Burns 2005) However, an audit undertaken by the Critical Care Society of Southern Africa (2004) revealed that 75 % of nurses working in ICU are inexperienced and do not hold an ICU qualification, and as such are unlikely to have acquired the level of competency required to care for the mechanically ventilated patient (Binnekade 2004). A high index of suspicion exists around the competence levels of nurses‟ currently working in ICU in SA as revealed by local studies (Khoza & Ehlers 1998; Scribante & Bhagwanjee 2003; Moeti, van Niekerk, van Velden, 2004; Morolong & Chabeli 2005; Windsor 2005; Perrie & Schmollgruber 2010). The purpose of the study was to determine and describe the level of competence with regard to mechanical ventilation, of nurses working in ICU, who have varying years of experience and training backgrounds, using study specific designed clinical vignettes, in two tertiary healthcare institutions in Gauteng. A descriptive two phase design was utilized for the study. Phase one comprised the development and validation of three clinical vignettes to determine the level of competence of nurses working in ICU‟s with regard to mechanical ventilation. A modified Delphi technique technique using purposively sampled experts from medical technical and nursing backgrounds was used to validate the three clinical vignettes. Content validity was strengthened by computing CVI of the instrument. In Phase two consecutive sampling was used, and data collection comprised of participants (n=136) completing three validated clinical vignettes in the ICU‟s of two tertiary healthcare institutions in Gauteng. All nurses who participated in the study completed the same three clinical vignettes and demographic data. Nurses‟ perceptions regarding their own level of competence with regard to mechanical ventilation were quantified and compared with actual scores achieved in the clinical vignettes. Descriptive and inferential statistics were used to analyse the data. The level of significance was set at <0,05 and confidence levels at 95%. The competency indicator for the vignettes was set at 75% by the expert group, and nurses‟ level of competence was graded according to vignette score outcomes using a grading scale. Statistical assistance was obtained from a statistician from the Medical Research Council (MRC). Results: Results of the study showed that nurses regardless of training background, age, or experience showed a poor level of knowledge, the average score being 48% for ICU qualified nurses and 31% for non-ICU qualified nurses. There was a small significant difference between ICU qualified and non-ICU qualified nurses‟ competence levels in mechanical ventilation when analysed using a two tailed- t- test (p=0.039). Nurses also experienced a misperception regarding their own competence levels in mechanical ventilation when compared to their actual competence levels as determined by three clinical vignettes.Item The effect of penetrating trunk trauma and mechanical ventilation on the recovery of adult survivors after hospital discharge(2009-02-12T13:01:29Z) Van Aswegen, HelenaABSTRACT South Africa has a high incidence of violence and death due to unnatural causes. Gunshot and/or multiple stab wounds to the trunk are consequently injuries commonly seen in South African hospitals. Penetrating injuries often necessitate explorative surgical intervention to identify and treat injuries to the internal organs. Patients are managed in the intensive care unit and frequently return to theatre for abdominal lavage prior to eventual wound closure. Critical illness with prolonged mechanical ventilation and immobilization results in some degree of muscle dysfunction. Survivors of critical illness suffer from poor functional capabilities and decreased quality of life. No formal rehabilitation programmes exist in South Africa for these patients following discharge. Purpose: To determine if patients that survived penetrating trunk trauma recover adequately spontaneously following critical illness over the first six months following discharge from the hospital. Methods: A prospective, observational study was conducted. Patients with penetrating trunk trauma were recruited from four intensive care units in Johannesburg. Patients who received mechanical ventilation < 5 days were placed in Group 1 and those who received mechanical ventilation 5 days were placed in Group 2. Lung function tests, dynamometry, quality of life, six-minute walk distance and oxygen uptake tests were performed over six months following discharge from the hospital. The obtained results for dynamometry, exercise capacity and quality of life were compared between groups and to that measured for a healthy (age and sex-matched) control group. Results and Discussion: No pulmonary function abnormalities were detected for subjects in Groups 1 or 2. Distance walked during 6MWD test was significantly reduced for subjects in Group 2 compared to the control group [one-month (p = 0.00), three-months (p = 0.00)]. Morbidity correlated significantly with distance walked by subjects in Group 2 during 6MWD test [three-months (p = 0.03), six-months (p = 0.02)]. No statistically significant differences were found between subjects during the VO2peak test although subjects in Group 1 performed better clinically than those in Group 2. At one-month there was a significant reduction in upper and lower limb strength for subjects in Group 2 compared to those in Group 1 and the controls (p = 0.00 – 0.04). Similar results were detected at the three- and six-month assessments. ICU and hospital length of stay did demonstrate a significant relationship with muscle strength at one and three months following discharge for subjects in Group 2. Severity of illness and morbidity in ICU did not have a significant relation to muscle strength for subjects in Groups 1 or 2 at any of the assessments. Subjects in Group 1 had a significant reduction in right deltoid and triceps strength compared to the controls at one-month (p = 0.00 respectively) only. No significant differences in upper and lower limb muscle strength were detected between the control group and subjects in Group 1 three and six months after discharge. Subjects in both groups had similar limitations in physical and mental aspects of quality of life one-month after discharge. Subjects in Group 1 reported a quality of life comparable to the control group by three-months. Subjects in Group 2 had significant limitations in the physical components of quality of life at three- and six-months compared to those in Group 1 and the controls [p = 0.00 – 0.02]. Conclusion: Subjects in Group 1 recovered adequately on their own within three months after discharge from hospital with regard to muscle strength, exercise capacity and all aspects of quality of life. Subjects in Group 2 presented with significant limitations in exercise capacity, muscle strength and the physical aspects of quality of life even at six months after discharge. Impaired function was related to the duration of critical illness and immobility. A physiotherapist-led rehabilitation programme may be indicated for survivors of penetrating trunk trauma that received prolonged mechanical ventilation to address cardiovascular endurance and peripheral muscle strength retraining between one and three months after discharge to address the physical disabilities observed in these subjects.