3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Pain assessment and management in the critically ill unconscious patient in the adult intensive care units(2010-06-25T11:02:25Z) Ofori, Bridget SenanuCritically ill patients are particularly vulnerable to pain as a result of the severity of their disease conditions, diagnostic and treatment interventions but pain management is not considered a priority in the Intensive Care Unit (ICU) team (Holden, 1991: Walsh & Ford, 1992). Pain causes complications in the ICU patient, which increases their ICU stay and cost of ICU treatment (Pooler-Lunse & Price, 1992). The purpose of this study was to describe the parameters identified by ICU nurses that can be used to assess pain in the critically ill unconscious patient in the adult Intensive Care Units and whether these parameters are considered by the ICU nurses when managing the unconscious patients’ pain. The objectives of the study were to describe the parameters identified by ICU nurses that can be used for assessing pain in unconscious patients and to determine whether these parameters were considered by ICU nurses when managing the unconscious patient’s pain. A non-experimental, descriptive, prospective, comparative, two part design was used for the study. The sample comprised of ICU nurses (n = 40) in four adult ICU’s and the unconscious patients (n = 40) they nursed. Part one involved the nurses’ responses to a self administered Likert-type questionnaire about parameters that could be indicative of pain in the unconscious patient and part two involved a prospective record review of the unconscious patients ICU charts. A comparison was then done between these two parts to determine if the parameters identified by ICU nurses that could be indicative of pain in the unconscious patient, were considered in their management of the unconscious patients pain. Descriptive statistics were used to analyse data. Of the responses elicited from the questionnaire, ICU nurses agreed that raised blood pressure, pyrexia, increased respiratory rate, dilated pupils and increased heart rate could all be indicative of pain in the unconscious patient but these did not influence their management of the unconscious patient’s pain.Item Psychological sequelae following treatment in intensive care(2010-02-22T11:25:20Z) Hatchett, Cindy FAnxiety, depressive and post-traumatic stress (PTS) symptoms have been identified in many patients following ICU treatment (Rattray, Johnston & Wildsmith 2005). The Intensive Care Unit (ICU) is a stressful environment and patients may be left with long standing psychological symptoms that impair their quality of life (Scragg, Jones & Fauvel 2001). There is a dearth of research on early assessment of the psychological sequelae following treatment in ICU in South Africa and interventions required to aid in the recovery process. Post-traumatic stress symptoms do not appear to decrease over time after ICU discharge (Jones et al 2001, Rattray et al 2005), indeed they may endure for a number of years (Kapfhammer et al 2004) causing the patients significant suffering. The purpose of this study was to investigate the prevalence of symptoms of anxiety, depression and post-traumatic stress in patients, at their first follow up visit in the outpatient department at a level one academic hospital in Johannesburg, South Africa. A prospective, quantitative, cross-sectional, descriptive format was used to investigate these variables. The total sample number was 98 and the instruments used in the structured interview were the Hospital Anxiety and Depression Scale (HADS) and the Experience After Treatment in ICU –7 (ETIC-7). The prevalence of symptoms of anxiety in this sample population was 48%, depression 28% and post-traumatic stress 32%. Fifty-eight percent of the sample had combined anxiety and depression scores severe enough to have a ‘possible clinical disorder’.Item Validation of the simplified therapeutic intervention scoring system in the intensive care units of a public sector hospital in Johannesburg(2009-11-10T09:24:24Z) Kisorio, Leah ChepkoechPurpose: To introduce the simplified therapeutic intervention scoring system (TISS-28), the original therapeutic intervention scoring system (TISS-76) and simplified acute physiological score (SAPS) version II in critically ill adult patients, in order to describe the validity and reliability of TISS-28 as a suitable measure of quantifying nursing workload in the adult intensive care units (ICU) of a public sector hospital in Johannesburg. Objectives: To describe the profile of patient admissions to the intensive care units, to investigate the impact of the patients’ profile on the requirements for nursing workload and to validate the use of TISS-28 as a measure of quantifying nursing workload in this setting. Design: A non-experimental, comparative descriptive, correlational and prospective two-staged design was utilized to meet the study objectives. Stage I involved face and content validation of TISS-28 by a panel of ICU nurse experts (n=6). Stage II involved assessment of concurrent and construct validity as well as inter-rater reliability of TISS-28 using participants (n=105) drawn from trauma, cardiothoracic and multidisciplinary ICUs. Data necessary for the calculation of TISS-28, TISS-76 and SAPS II were recorded for each patient in the ICU at 24 and 48 hours after admission and in the wards after discharge within 24-48 hours. Descriptive and inferential statistics were used to analyze data. Results: Content Validity Index (CVI) of 0.93 was found for TISS-28. A significant positive correlation was found between TISS-28 and TISS-76 scores (r = 0.7857, p = 0.0001) as well as TISS-28 and SAPS II scores (r = 0.2098, p = 0.0317). A significant difference was found between TISS-28 scores among patients in the ICU and patients in the ward (t = 25.59, p = 0.0001; t = 21.48, p = 0.0001) respectively. A significant correlation was found between the data collected from a sample of patients by the researcher and the expert assistant researcher with an intra-class correlation coefficient of 0.99 and a p-value of 0.0001. Conclusions: The findings support validity and reliability of TISS-28 hence its feasibility for use in South African ICUs. Recommendations for nursing education, practice, management and research are proposed.