The Southern African journal of critical care : the official journal of the Critical Care Society最新文献

Background: Caring in a critical care environment may be conceptualised differently compared with other nursing disciplines because of the patient's critical condition and the specialised staffing categories and skills. However, critical care nurses who prioritise caring can meaningfully connect with critically ill patient and their families, resulting in positive healthcare outcomes.

Objectives: To assess critical care nurses' orientations to caring for critically ill patient and their families.

Methods: A quantitative, descriptive, cross-sectional study was conducted with 139 purposively sampled critical care nurses working in a tertiary referral hospital in KwaZulu-Natal, South Africa. Data were collected using the Caring Assessment for Caregivers questionnaire, and analysis included descriptive and comparative statistics.

Results: The overall mean score of critical care nurses' orientations to caring was 116.01 (range of 25 - 125). Of the five subscales (dimensions), the dimension of 'Maintaining belief' had the highest mean score of 24.25 and the dimension of 'Being with' had the lowest mean score of 22.70 (range 5 - 25).

Conclusion: While critical care nurses reported high overall orientations to caring, lower mean scores on the subscale 'Being with' suggest that there are areas for critical care nurses to grow in their role as carers. Further research using qualitative approaches may shed valuable insights into how the critical care environment impacts the caring orientations of critical care nurses.

Contribution of the study: The study aims to highlight the orientations of critical care nurses to different areas of caring. In so doing management can provide specific support to nurses to strengthen their caring abilities.

Background: Healthcare-associated infections (HAI) are a major problem globally, contributing to prolonged hospital admissions and poor outcomes.

Objectives: To examine HAI incidence and risk factors in an intensive care unit (ICU) during high v. low occupancy periods.

Methods: This retrospective, descriptive analysis investigated HAI incidence among adult patients admitted to the ICU at Chris Hani Baragwanath (CHBH) during a high (H2019) and low (L2020) occupancy. Data were extracted from the clinical records of 440 eligible patients.

Results: We found an increased risk of HAI during H2019 compared with L2020 (relative risk (RR) 1.42, 95% confidence interval (CI) 1.03 - 1.94). The overall frequency density of HAI was 25/1 000 ICU days. There was no difference in the distribution of the site of infection (blood v. other) (p=0.27) or bacterial category (Gram stain) (p=0.62). Five organisms accounted for 89% of pathogens: Klebsiella (26%), Staphylococcus (21%), Acinetobacter (16%), Candida (16%) and Enterobacter (10%). The incidence of multidrug-resistant/extensively drug-resistant (MDR/XDR) organisms was 4.2-fold higher (95% CI 1.3 - 13.4) during H2019 compared with L2020. Logistic regression analysis revealed two independent predictors of nosocomial infection: ICU length of stay (odds ratio (OR) 1.12, 95% CI 1.02 - 1.22) and intercostal drain duration in days (OR 1.27, 95% CI 1.09 - 1.47).

Conclusion: High occupancy in the ICU was associated with an increased risk of HAI and a greater incidence of MDR and XDR pathogens. Increasing ICU length of stay and invasive device duration were independent predictors of HAI.

Contribution of the study: Hospital-acquired infections are a common problem and cause of morbidity and mortality in intensive care units and general wards globally. However, there is very little literature on the topic from low- and middle-income countries. This study aims to provide insite into the unique factors that contribute to these infections in the South African context.

Background: Necrotising enterocolitis (NEC) is life-threatening with a rising incidence due to improved neonatal care. While researchers' focus has shifted to causes, risk factors and preventative clinical strategies, little is known about the exact aetiology of NEC. Risk factors include the relationship between red blood cell transfusions (RBCTs) and the development of transfusion-associated NEC (TANEC) and peri-transfusion feeding, increasing the risk of TANEC.

Objectives: Evaluate the relationship between RBCT and peri-transfusion feeding practices and the development of TANEC in very low birthweight (VLBW) neonates over 5 years.

Methods: This was a retrospective analytical record review of all VLBW neonates admitted to two tertiary hospitals' neonatal units in Bloemfontein, South Africa (SA), from 1 January 2012 - 31 December 2016.

Results: The study population (n=1 426) had a median birthweight of 1 260 g and a median gestation age of 30 weeks. RBCTs were given to 41.9%, and NEC developed in 7.4%, of whom 47.6% had an RBCT (TANEC). Half (47.2%) were kept nil per os (NPO) around the transfusion. No association was found between NPO status and TANEC development (8.9% NPO patients, 7.9% non-NPO patients, p=0.6826). No significant differences regarding Modified Bell's Staging were found between neonates who developed TANEC v. NEC.

Conclusion: Optimising the administration of RBCTs and evidence-based feeding protocols is crucial in reducing TANEC's impact on premature neonates.

Contribution of the study: The study examines the link between red blood cell transfusion and transfusion-associated necrotising enterocolitis in very low birthweight neonates. It highlights the need for evidence-based feeding protocols to reduce transfusion-associated necrotising enterocolitis risk during transfusions. It calls for standardised clinical guidelines to improve neonatal outcomes and lower necrotising enterocolitis and transfusion-associated necrotising enterocolitis incidence.

The digital expansion in medicine and healthcare has been immense and extremely valuable. The biggest concern in the face of this inevitable growth is how we manage to keep contact with our patients and preserve the human touch so essential in healing. Digital healthcare should not be about technology replacing clinicians. Instead, it should be about augmenting and supplementing healthcare providers to improve the ways in which we deliver personalised healthcare. It is vital that we focus on how we can revitalise the patient-clinician relationship in this digital age.

Background: Evidence-based guidelines can assist critical care nurses in promoting best practices, including those related to endotracheal tube cuff pressure management. However, these guidelines require tailored strategies to enhance their implementation, uptake, and sustained use in practice.

Objectives: To evaluate Malawian critical care nurses' views on the implementation of an endotracheal tube cuff pressure management guideline to enhance sustained guideline use.

Methods: An explorative-descriptive survey design was employed, using a questionnaire with closed- and open-ended questions that was distributed after implementation of an educational intervention based on an endotracheal tube cuff pressure management guideline. The questionnaire had a Cronbach's alpha score of 0.85.

Results: A total of 47 nurses working in four public and two private hospital intensive care units in Malawi participated. Quantitative findings showed that the majority of the participants (92%) indicated that the strategies used for the group that received the full intervention including both active (monitoring visits) and passive (a half-day educational session using a PowerPoint presentation, and a printed guideline and algorithm) strategies (intervention 1 group) were useful, clear and applicable and enhanced implementation of the guideline. These results were statistically significant (mean (standard deviation) 1.86 (0.84); t=6.07; p<0.0005). Qualitative data revealed three major themes related to recommendations for uptake and sustained use of the guideline in nursing practice: the guideline needs to be translated, updated, and made available to ICU staff; implementation strategies (continuous supervision and follow-up); and facilitating factors for successful implementation (education and training on guideline content, resources, and commitment to best practices).

Conclusion: The study highlighted that although the implementation strategies used were positively received by participants, they need to be further tailored to their context to enhance guideline uptake and sustained use in practice. Further study is required to ensure that tailored implementation strategies facilitate guideline uptake and sustained use, specifically in resource-constrained contexts.

Contributions of the study: The study findings can be used by nurses and academics when developing educational interventions for critical care units to enhance implementation of guidelines in this context.

Background: Despite the implementation of intervention strategies, incidents in specialised care units remain high and are of serious concern, worldwide.

Objectives: To assess the healthcare professionals' perception of knowledge and implementation of patient safety incident (PSI) reporting and learning guidelines in specialised care units of three selected public hospitals in KwaZulu-Natal, South Africa.

Methods: The study used a descriptive, cross-sectional survey design. A purposive sample targeted 237 healthcare professionals. An online structured questionnaire collected the data. Descriptive and inferential statistics were used to analyse data.

Results: A total of 181 questionnaires were returned, yielding a response rate of 76%. Notably, 83% of respondents had high-perceived knowledge of the PSI reporting and learning guidelines, while 98% had low perceptions of their implementation. The current unit (p=0.002) and shift of the day (p=0.008) were factors associated with the perception of good knowledge of PSI reporting and learning guidelines, as indicated by a p-value ≤0.05. The respondents' age (p=0.05), current unit (p=0.015), and shift of the day (p=0.000) were significantly associated with the perception of poor implementation of the PSI reporting and learning guidelines.

Conclusion: The respondents demonstrated a good perception of knowledge of PSI reporting and learning guidelines; however, the perception of the implementation was poor. Therefore, a revised implementation strategy coupled with periodical in-service training for healthcare professionals is recommended, to foster and facilitate effective adherence to PSI reporting and learning guidelines.

Contributions of the study: This study highlights the healthcare professionals' perception of knowledge and implementation of the Patient Safety Incident reporting and learning guidelines in specialised care units in South Africa. The results identified weaknesses in the implementation of the guidelines; hence the necessity for the development of effective strategies to improve patient safety.

Background: There are limited data on the clinical characteristics and outcomes of patients with myasthenia gravis (MG) admitted to the intensive care unit (ICU) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).

Objectives: The aim was to study the clinical characteristics and outcomes of patients with MG admitted to the CMJAH over two decades.

Methods: A retrospective study was undertaken of patients with MG admitted to the multidisciplinary ICU of CMJAH over a 20-year period, from 1998 to 2017. Demographic data, clinical features, management and outcomes of patients were assessed and reviewed from the case records.

Results: Thirty-four patients with MG were admitted to the ICU during this period: 24 female and 10 male. The mean age ± SD was 37.4 ± 13.0 years, with a range of 16 - 66 years. Four patients were human immunodeficiency virus (HIV)-positive. The mean length of stay (LOS) in ICU was 10.6 ± 20.1 days, ranging from 1 to 115 days. Two patients were diagnosed with MG in the ICU after failure to wean from the ventilator. Overall, 22 patients were intubated and ventilated on admission. Morbidities included self-extubation, aspiration pneumonia and iatrogenic pneumothorax. History of thymectomy was present in 12 patients. The treatments received for MG included pyridostigmine (73.5%), corticosteroids (55.9%), azathioprine (35.3%), plasmapheresis (26.5%) and intravenous immunoglobulin (8.8%). The overall mortality in the ICU was 5.9%.

Conclusion: MG is a serious disorder with considerable morbidity and mortality. It is, however, a potentially manageable disease, provided that appropriate ICU resources are available.

Contributions of the study: This study provides further insight into the characteristics and outcomes of myasthenia gravis patients in ICU, within a South African context.