3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item The knowledge level of critical care nurses about cardiopulmonary resuscitation guidelines at a University affiliated public sector hospital in Johannesburg(2017) Moepeng, MphoBackground: Cardiac arrest remains a leading cause of sudden death worldwide. Provision of high quality CPR, in case of cardiac arrest, increases chances of patient survival, therefore, nurses as front-line patient caregivers are expected to be knowledgeable and skilful in providing CPR to cardiac arrest victims. Objective: The goal of this study was to investigate critical care nurses’ knowledge of evidence based guidelines for cardiopulmonary resuscitation in a university affiliated public sector hospital in Johannesburg, and to establish if there is an association between qualification (Trauma and Emergency nurses and Intensive Care nurses) and years of experience (<10 years and >10 years) on knowledge of evidence-based guidelines of cardiopulmonary resuscitation. Methodology: A descriptive cross-sectional survey design was utilised in this study to elicit the knowledge of critical care nurses on the current cardiopulmonary resuscitation guidelines. The setting for this study was the two adult emergency departments (Trauma and Medical) and five (n=5) adult Intensive Care Units of a 1,200 bed capacity public sector hospital in Johannesburg. The ICUs included Trauma, Cardiothoracic, Coronary care, Neurosurgery and multidisciplinary or general units. The population of the study involved all critical care registered nurses currently working in the adult Emergency Departments and Intensive Care Units, and all nurses with specialty education and training in Trauma and Emergency Nursing and Intensive Care Nursing were eligible for participation in this study. The total sample of registered critical care nurses (N=96) was used. In this study, a non-probability purposive sampling method was used to select participants. The data collection tool was a self-administered questionnaire with two parts. The first section collected demographic data of the participants, while the second section employed 20 multiple choice questions based on the latest AHA guidelines for adult CPR. The knowledge level of critical care nurses was classified as sufficient for participants who answered correctly at least 17 of 20 questions (>85%) and insufficient for less than 17 out of 20 questions (total score <85%), according to the AHA accreditation criteria. Reliability was determined by means of a pilot study, and validity through a panel of experts. Results: Nurses had insufficient knowledge of the current AHA guidelines for cardiopulmonary resuscitation as none could attain the minimum score of 85% .There was no association between post-basic specialisation, years of nursing experience and scoring in the CPR knowledge test. In conclusion, all critical care nurses had insufficient knowledge of the current AHA guidelines for CPR.Item Factors affecting intensive care nurses in providing oral care in the intensive care units of a Public Sector Tertiary Hospital in Johannesburg(2018) Adiakpantin, Afiamma GabrielBackground: evidence-based oral care prevents ventilator associated pneumonia. However, not all intensive care nurses provide this level of care. Although several studies have been undertaken to identify factors that affect the provision of oral care, none of these studies looked at the situation in South Africa. Aim: the purpose of this study was to explore and describe the factors that affect intensive care nurses in providing oral care in the intensive care units of a public sector hospital in Johannesburg. Design: an explorative - descriptive qualitative and contextual design was used. Methods: participants were recruited by convenience maximum variation sampling, from the population of certified intensive care nurses working in four (n=4) adult intensive care units of one public sector hospital in Johannesburg. Data was collected by audiotaping nineteen (n=19) participants using semi-structured one-to-one interviews. Verbatim transcripts were analysed by Braun and Clarke’s thematic analysis; trustworthiness ensured following the criterion of Lincoln and Guba; ethical considerations were applied. Results: this study reveals oral care education is perceived by senior nurses to have been completed in basic nursing school and not meant for specialist training. Oral care for the intubated patient is based on common sense. There is lack of knowledge on the characteristics of lotions used, prevention of complications during oral care and preventive strategies for ventilator associated pneumonia. Even though participants acknowledge the goal for oral care to be preventing ventilator associated pneumonia, contextual factors greatly affect its provision. Recommendations: improved human and material resources is required to facilitate the process involved in nurses’ provision of oral care for intubated patients to prevent ventilator associated pneumonia. Improved staffing, facilitation of learning and the development of specific intensive care nursing skill for oral care on the intubated patient through multi-strategy education and clinical research is recommended. Conclusion: the attitude of nurses and the hospital management to oral care is a strong determinant to its provision in the intensive care unit.Item Cultural competence of critical care nurses: a South African context(2017) Naicker, YogiambalSouth Africa has emerged as the rainbow nation. The Changing demographics within the country has resulted in cultural diversity within the health care system, including the Critical Care units. The purpose of this study was to investigate the level of cultural competence of Critical Care nurses working in culturally diverse Critical Care units in South Africa, in order to make recommendations of whether the skills of cultural competence can assist Critical Care nurses in caring for the needs of culturally diverse patients and their family members. The setting for the study is the members of the Critical Care Society of Southern Africa (CCSSA). A non-experimental, exploratory, descriptive and cross-sectional survey design was used in this study. A non-probability convenience sampling method was utilised. Data was collected by means of a self-administered questionnaire developed by Schim, Doorenbos, Benkert and Miller (2007) which explored the knowledge, feelings and actions of Critical Care nurses’ and skills of cultural competence, inclusive of cultural awareness and sensitivity and cultural behaviour. The questionnaire was administered via an on-line survey using RED CAP with feedback responses from participants via email. Findings in the study revealed 43.6% of the nurses rated themselves as very competent, 42.3% as somewhat competent and 17% as somewhat incompetent. In regard to the nurse respondent’s cultural awareness and sensitivity, the total mean score was 5.29 (SD 0.60), which showed a moderately high level of cultural awareness and sensitivity. In regard to the nurse respondent’s cultural behaviours, the total mean score was 4.06 (SD 1.30), which showed a moderate level of cultural competence. Cultural competence may well be the solution to improving quality of health care, improving patient outcomes and decreasing health care disparities.Item The development of a clinical portfolio as a learning approach for intensive care nurses in a private nursing education institution in Gauteng(2016) Potgieter, LizelleClinical portfolios guide clinical learning experiences and assess the student’s attainment of programme outcomes. The researcher perceived a need to redesign the portfolio of the Diploma in Critical Care Nursing (General) programme offered by a private nursing education institution in Gauteng. The researcher experienced that neither the student nor the educator utilised the clinical portfolio effectively in the development and transformation of the intensive care nursing student at the private nursing education institution. The purpose of the study was to improve the structure and enhance the use of clinical portfolios as a learning approach and as an assessment strategy in intensive care nursing education. The study objectives for the study was: Stage 1: to solicit the opinion of students and their educators on the quality of the existing clinical portfolio and their recommendations for the design and utilization of a revised clinical portfolio; Stage 2: to design a revised clinical portfolio for intensive care nursing students based on educator and student opinion and literature review; Stage 3: to solicit the opinion of nursing education experts on the revised clinical portfolio and to make changes as required. This study is a shortened intervention research with qualitative methods for data collection from intensive care nursing students, lecturers, clinical facilitators, and nursing education experts. A content analysis (Tesch, 1990) was used for data analysis. The setting for this study was set in a private nursing education institution in Gauteng that offers the intensive care programme. Purposive sampling was used to select participants of the three focus groups. Students were not as concerned about the structure of the clinical portfolio as they were concerned about how the portfolio assists them in reaching their outcomes. Small changes were recommended. Educators and the literature were more concerned about the structure of the clinical portfolio and less concerned about the process of application. The clinical portfolio was redesigned to improve its function as a learning approach and is ready for piloting in a larger sample group. Students have concrete ideas about how to deal with some of their frustrations working in the clinical field but do not really know how to structure a clinical portfolio. The educators were in a much better position to comment on the structure of the clinical portfolio and what must be considered to improve clinical learning. Different interview protocols should be used for students, educators and educator experts.Item Nurses' perceptions of nurse-nurse collaboration in the intensive care units of a public sector hospital in Johannesburg(2015) Ndundu, Lonely DebraCollaboration is an interpersonal relationship among colleagues sharing the same goal, power, authority and decision making (Dougherty & Larson, 2010). Collaboration is described as a marker of a nurses’ ability as well as a professional obligation. However, current clinical practice indicates that, as nurses attempt to collaborate with each other, they also employ aggressive, hostile and intimidating behaviours that may result in tension among senior and junior nurses. This carries the risk of medical errors that will lead to poor patient outcomes and job dissatisfaction. This study sought to determine the extent and nature of collaboration practices among nurses in the intensive care settings, with an intention of making recommendations for clinical practice and education. The setting for the study was the Intensive Care Units (ICU’s) (n=5); trauma, cardiothoracic, coronary care, general and neurosurgical units of a public sector and tertiary level hospital in Johannesburg. A non-experimental, descriptive and quantitative study design was utilized in the study. The sample comprised of 112 (n=112) nurses working in the intensive care setting. Non-probability, convenience sampling was employed in this study. Data was collected using a structured questionnaire developed from the Nurse-Nurse Collaboration Scale, which has 35 items on a four-point Likert type scale. The instrument is divided into five subscales of problem solving, communication, coordination, shared process and professionalism. Data was analyzed using factor analysis and descriptive statistics. The data was then analyzed using descriptive and inferential statistics. Statistical assistance was sought from the biomedical statistician at the Medical Research Council (MRC) South Africa. Generally, in this study the results have shown that nurses have more positive perceptions and attitudes about collaboration in the Intensive Care Units, as evidenced by the frequency scores with nurses responding more positively to the five subscales even though some missing data was identified on some of the responses. However, the subscales of communication, shared process, coordination and professionalism scored higher; most of the participants either agreed or strongly agreed to all these items compared to conflict management in item 1.1, where the majority disagreed ignoring the issue pretending it will go away. In item 1.2, the majority agreed to withdraw from conflict; similarly for item 1.5 disagreements between nurses were ignored, or avoided. Correct conflict management amongst nurses is very important for effective delivery of care and collegial working relationships; nurses’ are urged to learn the skills of resolving conflict amicably by compromising in order to consider the interests of all parties. These results showed that females dominate the nursing profession with males being a minority and no differences in collaboration were observed. Participants’ responses for work experience were examined to determine if there was any impact on how nurses perceive collaboration between senior and junior nurses. However, the study results indicated there was a statistically significantly (p<0.05) difference in perceptions of collaboration practices in two of the five subscales; namely communication and shared process between junior and senior nurses in the Intensive Care units. In their responses to an open-ended question, nurses felt that some of their roles overlapped creating confusion as to who was supposed to do what and as a result, it became difficult to maintain effective collaboration amongst team members, compromising the delivery of patient care.