3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item An exploration of the views of healthcare providers on family witnessed resuscitation in an emergency department of a private hospital in Gauteng(2018) Ambelal, Mayush NarendraBackground: There has been an international move towards allowing family member presence during the resuscitation of a relative for many years, but not in South Africa. This practice is discouraged in many hospitals locally. There is a lack of formal protocols on allowing family member presence during resuscitative efforts. Communication with the family is left to a doctor and often only occurs once the patient has demised. Aim: The aim of this study was to explore the views of the healthcare providers on the practice of family member presence during the resuscitation of their relative in an emergency department in a private hospital setting in Gauteng. The results were intended to inform policy for future reference on the practice of family member presence during the resuscitation of their relative in an emergency department. Design: This study was carried out at a level two private hospital with a busy emergency unit which receives complex trauma and medical cases. A qualitative, exploratory, descriptive and contextual design was used for this study. A total of twenty four (n=24) multidisciplinary healthcare providers at the selected study site were selected. The sample size was determined by saturation of information during data collection. Open ended questions in an interview were used and the data recorded using an audio recorder. Tesch’s method was used to analyse the data collected. Measures of trustworthiness were applied to ensure rigor of the findings in this study. Findings: This study revealed five themes with nine sub themes. The five themes included perceptions of emergency room staff, buy in towards family member presence, concerns from staff, family emotions as perceived by staff and balancing your act. Conclusion: The findings of this study show that there is no consensus between the different healthcare providers on family witnessed resuscitation. Key words: Family member presence, resuscitation, witnessed resuscitation, perceptions and healthcare providers.Item The resuscitation skills profile of registrars in four major disciplines(2015) Ravid, Nadav BinyaminThe aim of this study was to describe the resuscitation skills profile and self-‐perceived adequacy of resuscitation skills of registrars in four major disciplines in the Faculty of Health Sciences at Wits: anaesthesiology, general surgery, orthopaedic surgery and obstetrics and gynaecology. The study focused mainly on the popular BLS, ACLS and ATLS resuscitation courses. A prospective, contextual, descriptive study design was used. An anonymous questionnaire was distributed to registrars. Information collected included demographics, resuscitation course qualifications, self-‐perceived adequacy of resuscitation skills, and any impediments to completing a resuscitation course. One hundred and ninety (n=190) participants were entered into the study. BLS, ACLS and ATLS courses were completed by 161, 133 and 106 participants respectively. There was a high inter-‐disciplinary difference in completion rates. Of participants who had completed BLS, ACLS and ATLS courses, 25.55%, 34.59%, 68.88% were current in their certification respectively. Registrars cited a lack of time (59.47%), cost (36.32%) and inability to take leave (28.42%) as the main impediments to completion of a resuscitation course. The majority of participants (65,79%, n=125) felt that their resuscitation skills were adequate. Registrars were less confident in managing anaphylaxis and dysrhythmia than inserting a CVP, or managing shock or airway. Registrars who had previously completed either ACLS or ATLS were more confident inserting a CVP (p=0.0024), managing dysrhythmia (p=0.0008) and managing an airway (p=0.0166) than those who had not completed any courses at all. While a high level of completion of BLS, ACLS and ATLS courses was found in the surveyed registrars, the rate of current certification was low. There was a high overall reported level of confidence in resuscitation skill. A number of impediments exist for registrars to complete resuscitation courses. More certification and re-‐certification in resuscitation courses is required.Item Perceptions and opinions of critical care nurses regarding family presence during resuscitation(2012-01-10) Le Goff, ChanelThe concept of family witnessed resuscitation in South African critical care areas is one that is rarely practiced. In the majority of cases family members are ushered away from the resuscitation area, and this task is usually one that is performed by the critical care nurse. Consequently, the critical care nurse in the South African public health sector is relatively inexperienced in family witnessed resuscitation. In addition to this, few institutions have written policies with regards to family presence. Hence, the importance of uncovering critical care nurses opinions and perceptions of family presence during resuscitation. Therefore, the aim of this study was to explore and describe a select group of critical care nurses perceptions and opinions regarding family presence during resuscitation. A qualitative study was undertaken in which one-on-one semi structured interviews were conducted as a means of data collection. The following question was asked of the participants, ‘As a critical care nurse, if your patient was been resuscitated, and the family members requested to be present, how would you feel?’. In addition to this the following question was asked of the participants with regards to written policy within the institution used in this study, ‘Is there a policy in place in this institution regarding family presence?’. A total of 11 interviews were conducted including participants of various cultures and previous experiences of family witnessed resuscitation. The data collection and analysis processes were integrated as each interview was directly transcribed following the interview. The data analysis process was guided by Tesch’s method for qualitative data analysis. Four nurses interviewed in this study felt that family witnessed resuscitation is unacceptable, and two were unsure. However, these nurses did waver with regards to this. Nine participants expressed reservations regarding family witnessed resuscitation including the potential traumatic effects that it could have on the family. In addition to this, four participants had concerns that family members might interfere with resuscitation efforts came to light. Six participants also feared that their own shortcomings might be exposed to family members should they observe resuscitation attempts. Three nurses in this study believe that family members may misinterpret issues pertaining to resuscitative efforts, and that the physical space at the bedside would be inadequate. Six participants pointed out that it is norm to ask family members to leave the resuscitation area, in part due to habit, and thus could be preventing family members being invited to the bedside. In addition to this, lack of policy guidelines may be acting as a barrier to allowing and facilitating nurses to invite family members to witness resuscitation. In contrast, five nurses in this study had accepting views on family witnessed resuscitation. This, despite the lack of previous experience these nurses had with regards to family witnessed resuscitation. And as mentioned, nurses did waver with regards to this. Psychological pre-preparation of the family emerged as a concern for three participants. Three of the eleven nurses interviewed would extend an offer to family members to be at the bedside during resuscitation. Four participants felt that a benefit to family witnessed resuscitation is the opportunity it may offer for closure for the family should the resuscitation attempt be unsuccessful. In concluding, the participants in this study are inexperienced in the field of family witnessed resuscitation, and most participants wavered with regards to their perceptions with regards to family witnessed resuscitation.