Background . Pregnancy is a natural physiological process that normally ends uneventfully. However, there are instances where admission to an intensive care (ICU) is required. Objectives . To determine the spectrum of disease requiring ICU admission in obstetric patients, condition on discharge, maternal mortality, and the cause of maternal death. Methods . A retrospective study of all pregnant and postpartum patients admitted from January 2008 to December 2011 was conducted. Outcome measures were the spectrum of disease, ICU interventions, and maternal outcomes. Results . In total, 210 patients were reviewed. The mean age was 28.15 (standard deviation (SD) 6.97) years. Twelve (5.7%) patients were admitted at a mean (SD) gestational age of 25.33 (6.56) weeks, 94.2% ( n =198) were postpartum, and 88.6% ( n =186) were post-caesarean section. Pre-existing cardiac disease (44.3%, n =93), eclampsia and preeclampsia (20%, n =42), obstetric haemorrhage (16.2%, n =34), and pulmonary oedema (6.2%, n =13) were the most common causes of admission. Sixty-one percent ( n =128) of patients received ventilatory support. The median length of ICU stay was 24 hours (range 1 - 17 days). Eighty-seven percent ( n =183) of the patients were haemodynamically stable. Maternal mortality was 9% ( n =19). Conclusion . Cardiac disease in pregnancy was the most common diagnosis in patients admitted to our ICU, followed by eclampsia and preeclampsia. Most of the patients (87.1%) were haemodynamically stable and needed minimal intervention, as confirmed by their short periods of stay in ICU. Although the mortality rate in our institution was higher than that observed in developed countries, it was lower than rates reported in other South African studies. This study has found that many of the patients were admitted to ICU for monitoring purposes only and did not require ICU level of care.
{"title":"Obstetric patients admitted to the intensive care unit of Dr George Mukhari Academic Hospital, Ga-Rankuwa, South Africa","authors":"M. Motiang","doi":"10.7196/279","DOIUrl":"https://doi.org/10.7196/279","url":null,"abstract":"Background . Pregnancy is a natural physiological process that normally ends uneventfully. However, there are instances where admission to an intensive care (ICU) is required. Objectives . To determine the spectrum of disease requiring ICU admission in obstetric patients, condition on discharge, maternal mortality, and the cause of maternal death. Methods . A retrospective study of all pregnant and postpartum patients admitted from January 2008 to December 2011 was conducted. Outcome measures were the spectrum of disease, ICU interventions, and maternal outcomes. Results . In total, 210 patients were reviewed. The mean age was 28.15 (standard deviation (SD) 6.97) years. Twelve (5.7%) patients were admitted at a mean (SD) gestational age of 25.33 (6.56) weeks, 94.2% ( n =198) were postpartum, and 88.6% ( n =186) were post-caesarean section. Pre-existing cardiac disease (44.3%, n =93), eclampsia and preeclampsia (20%, n =42), obstetric haemorrhage (16.2%, n =34), and pulmonary oedema (6.2%, n =13) were the most common causes of admission. Sixty-one percent ( n =128) of patients received ventilatory support. The median length of ICU stay was 24 hours (range 1 - 17 days). Eighty-seven percent ( n =183) of the patients were haemodynamically stable. Maternal mortality was 9% ( n =19). Conclusion . Cardiac disease in pregnancy was the most common diagnosis in patients admitted to our ICU, followed by eclampsia and preeclampsia. Most of the patients (87.1%) were haemodynamically stable and needed minimal intervention, as confirmed by their short periods of stay in ICU. Although the mortality rate in our institution was higher than that observed in developed countries, it was lower than rates reported in other South African studies. This study has found that many of the patients were admitted to ICU for monitoring purposes only and did not require ICU level of care.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"7 1","pages":"12-14"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84911025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Do not resuscitate (DNR) is the policy and practice of deliberately not attempting to resuscitate a person whose heart has stopped beating. Research on nursing care for patients designated with DNR orders has been conducted since the late 1980s; however, no study appears to have been carried out in the Rwandan setting. Purpose . The purpose of this study was to explore the lived experiences of nurses caring for a patient with a DNR order in an intensive care unit (ICU) in Kigali, Rwanda, in order to suggest nursing recommendations. Methods. Using a phenomenological approach, two semi-structured interviews were conducted with each participant to explore their lived experiences of caring for patients with DNR orders. The sample comprised six nurses from an ICU in a large tertiary-level hospital in Kigali, Rwanda. Results . The data were organised into categories based on a review of the data from the interviews of the six participants. The categories were: feeling emotional distress; barrier to optimal care; and not part of decision-making. Conclusion . DNR orders are a fairly new concept in Rwanda and the practice of DNR orders in ICU is very demanding for the staff, especially the ICU nurses. Additional education about DNR orders as well as policies to guide its implementation could assist ICU nurses in their difficult work.
{"title":"Lived experiences of Rwandan ICU nurses caring for patients with a do-not-resuscitate order","authors":"E. Nankundwa, P. Brysiewicz","doi":"10.7196/281","DOIUrl":"https://doi.org/10.7196/281","url":null,"abstract":"Background. Do not resuscitate (DNR) is the policy and practice of deliberately not attempting to resuscitate a person whose heart has stopped beating. Research on nursing care for patients designated with DNR orders has been conducted since the late 1980s; however, no study appears to have been carried out in the Rwandan setting. Purpose . The purpose of this study was to explore the lived experiences of nurses caring for a patient with a DNR order in an intensive care unit (ICU) in Kigali, Rwanda, in order to suggest nursing recommendations. Methods. Using a phenomenological approach, two semi-structured interviews were conducted with each participant to explore their lived experiences of caring for patients with DNR orders. The sample comprised six nurses from an ICU in a large tertiary-level hospital in Kigali, Rwanda. Results . The data were organised into categories based on a review of the data from the interviews of the six participants. The categories were: feeling emotional distress; barrier to optimal care; and not part of decision-making. Conclusion . DNR orders are a fairly new concept in Rwanda and the practice of DNR orders in ICU is very demanding for the staff, especially the ICU nurses. Additional education about DNR orders as well as policies to guide its implementation could assist ICU nurses in their difficult work.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"32 1","pages":"19-22"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86939151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-11DOI: 10.7196/SAJCC.2017.V33I1.280
D. Maharaj, H. Perrie, J. Scribante, F. Paruk
Background . Glycaemic control constitutes an important component in the management of critically ill patients. As such, all healthcare workers involved in the management of critically ill patients need to ensure that it is achieved adequately. To avoid glucose variability and to maintain normoglycaemia, evidence-based protocols are implemented to guide clinical care. However, it has been suggested that with the use of protocoldirected therapy, protocol-practice gaps are common and therefore protocol adherence must be audited regularly. The aim of this study was to evaluate adherence to the glucose control protocol by nurses in the cardiothoracic intensive care unit (ICU) at a tertiary academic hospital. Methods . A retrospective study involving the review of ICU charts of all post-cardiac surgery patients ≥16 years admitted to the cardiothoracic ICU during March 2011. A convenience sampling method was used. Results . A total of 741 glucose readings for 22 patients were evaluated. The median (interquartile range) glucose reading was 7.8 mmol/L (6.7 - 9.3 mmol/L). Overall, 411 (55.5%) protocol violations were recorded and 629 (84.9%) of the total readings were abnormal. Protocol violations were similar between the day and night staff; 188 (54.7%) and 223 (58.5%) were recorded, respectively ( p =0.256). Of the readings, 464 (62.6%) were conducted by ICU-trained nurses and 245 (33.2%) by non-ICU-trained nurses. There were fewer protocol violations recorded by the ICU-trained nurses compared with the non-ICU-trained nurses, i.e. 53.3% and 63.7%, respectively ( p <0.05). Conclusion . Adherence to the glucose-control protocol was suboptimal. These results may suggest that the training and education of healthcare workers in implementing protocols is an ongoing and dynamic process, and that there is a need for the regular evaluation of protocol adherence in order to identify protocol-practice gaps.
{"title":"Glycaemic control in a cardiothoracic surgical population: Exploring the protocol-practice gap","authors":"D. Maharaj, H. Perrie, J. Scribante, F. Paruk","doi":"10.7196/SAJCC.2017.V33I1.280","DOIUrl":"https://doi.org/10.7196/SAJCC.2017.V33I1.280","url":null,"abstract":"Background . Glycaemic control constitutes an important component in the management of critically ill patients. As such, all healthcare workers involved in the management of critically ill patients need to ensure that it is achieved adequately. To avoid glucose variability and to maintain normoglycaemia, evidence-based protocols are implemented to guide clinical care. However, it has been suggested that with the use of protocoldirected therapy, protocol-practice gaps are common and therefore protocol adherence must be audited regularly. The aim of this study was to evaluate adherence to the glucose control protocol by nurses in the cardiothoracic intensive care unit (ICU) at a tertiary academic hospital. Methods . A retrospective study involving the review of ICU charts of all post-cardiac surgery patients ≥16 years admitted to the cardiothoracic ICU during March 2011. A convenience sampling method was used. Results . A total of 741 glucose readings for 22 patients were evaluated. The median (interquartile range) glucose reading was 7.8 mmol/L (6.7 - 9.3 mmol/L). Overall, 411 (55.5%) protocol violations were recorded and 629 (84.9%) of the total readings were abnormal. Protocol violations were similar between the day and night staff; 188 (54.7%) and 223 (58.5%) were recorded, respectively ( p =0.256). Of the readings, 464 (62.6%) were conducted by ICU-trained nurses and 245 (33.2%) by non-ICU-trained nurses. There were fewer protocol violations recorded by the ICU-trained nurses compared with the non-ICU-trained nurses, i.e. 53.3% and 63.7%, respectively ( p <0.05). Conclusion . Adherence to the glucose-control protocol was suboptimal. These results may suggest that the training and education of healthcare workers in implementing protocols is an ongoing and dynamic process, and that there is a need for the regular evaluation of protocol adherence in order to identify protocol-practice gaps.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"8 1","pages":"4-7"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73161357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-11DOI: 10.7196/SAJCC.2017.V33I1.274
T. V. D. Heever, M. Spruyt
We report a case of generalised tetanus in a 50-year-old female patient after sustaining a wound to her right lower leg. She developed autonomic dysfunction, which included labile hypertension alternating with hypotension and sweating. The autonomic dysfunction was treated successfully with a combination of morphine sulphate infusion, magnesium sulphate, and clonidine. She also received adrenaline and phenylephrine infusions as needed for hypotension. We then discuss the pathophysiology, clinical features and treatment options of autonomic dysfunction.
{"title":"The treatment of autonomic dysfunction in tetanus","authors":"T. V. D. Heever, M. Spruyt","doi":"10.7196/SAJCC.2017.V33I1.274","DOIUrl":"https://doi.org/10.7196/SAJCC.2017.V33I1.274","url":null,"abstract":"We report a case of generalised tetanus in a 50-year-old female patient after sustaining a wound to her right lower leg. She developed autonomic dysfunction, which included labile hypertension alternating with hypotension and sweating. The autonomic dysfunction was treated successfully with a combination of morphine sulphate infusion, magnesium sulphate, and clonidine. She also received adrenaline and phenylephrine infusions as needed for hypotension. We then discuss the pathophysiology, clinical features and treatment options of autonomic dysfunction.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"25 1","pages":"28-31"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73024042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. V. Heerden, H. V. Aswegen, S. V. Vuuren, R. Roos, A. Dusé
Background . The delivery of aerosolised medication, as performed by nurses and physiotherapists in intensive care units (ICUs), forms an important component of patient care. Objectives. To determine the presence of contamination of nebulisers used within a ventilator circuit; to describe the protocol and clinical practice regarding decontamination and storage of these devices; and to identify micro-organisms colonising contaminated nebulisers and the surrounding air at patients’ bedsides. Methods . A cross-sectional multicentre observational study was conducted, including site and equipment sampling to determine contamination. ICU managers were interviewed to determine the decontamination and storage protocols used for nebulisers in their units. Swabs were taken from nebuliser chambers and streaked onto blood agar plates (BAPs). An air sampler was used to collect air samples from the surrounding bedside environment. The BAPs were incubated for bacterial and fungal contamination. Species of colonies observed in these samples were identified. Results. Sixty-one nebulisers from seven ICUs were sampled (Micro Mist n =37; Aeroneb n =24). Half of the nebulisers (Micro Mist ( n =19, 51.4%));Aeroneb ( n =12, 50%)) and most air samples ( n =60, 98%)) presented with contamination. All participating ICUs reported decontamination and storage protocols, but visual inspection of nebulisers suggested that the protocols were not observed. Nebulisers rinsed with alcohol and left open to the environment to dry had the lowest contamination rates. Coagulase-negative Staphylococcus species (spp.) were mostly found in the surrounding air and Aeroneb samples, and Enterococcus spp. were mostly found in the Micro Mist nebulisers. Conclusion . Although decontamination and storage protocols for nebulisers were in place, nebuliser and air contamination was high, possibly due to poor staff adherence
背景。由重症监护病房(icu)的护士和物理治疗师提供雾化药物，是患者护理的重要组成部分。目标。确定呼吸机回路内使用的雾化器是否受到污染;描述有关这些设备的净化和储存的方案和临床实践;并识别在病人床边被污染的雾化器和周围空气中的微生物。方法。进行了一项横断面多中心观察研究，包括现场和设备取样以确定污染情况。访谈了ICU管理人员，以确定其单位使用的雾化器的净化和储存方案。从喷雾器室中取出拭子并将其纹在血琼脂板(BAPs)上。采用空气采样器采集床边周围环境的空气样本。对BAPs进行细菌和真菌污染孵育。鉴定了这些样品中所观察到的菌落种类。结果。从7个icu中抽取61个雾化器(Micro Mist n =37;Aeroneb n =24)。一半的雾化器(Micro Mist (n =19, 51.4%);Aeroneb (n =12, 50%))和大多数空气样本(n =60, 98%))存在污染。所有参与的icu都报告了净化和储存规程，但对雾化器的目视检查表明没有遵守规程。用酒精冲洗并晾干的雾化器污染率最低。凝固酶阴性葡萄球菌多见于周围空气和Aeroneb样品中，肠球菌多见于Micro Mist雾化器中。结论。虽然雾化器的净化和储存协议已经到位，但雾化器和空气污染很高，可能是由于工作人员的依从性差
{"title":"Contamination of nebulisers and surrounding air at the bedside of mechanically ventilated patients","authors":"L. V. Heerden, H. V. Aswegen, S. V. Vuuren, R. Roos, A. Dusé","doi":"10.7196/295","DOIUrl":"https://doi.org/10.7196/295","url":null,"abstract":"Background . The delivery of aerosolised medication, as performed by nurses and physiotherapists in intensive care units (ICUs), forms an important component of patient care. Objectives. To determine the presence of contamination of nebulisers used within a ventilator circuit; to describe the protocol and clinical practice regarding decontamination and storage of these devices; and to identify micro-organisms colonising contaminated nebulisers and the surrounding air at patients’ bedsides. Methods . A cross-sectional multicentre observational study was conducted, including site and equipment sampling to determine contamination. ICU managers were interviewed to determine the decontamination and storage protocols used for nebulisers in their units. Swabs were taken from nebuliser chambers and streaked onto blood agar plates (BAPs). An air sampler was used to collect air samples from the surrounding bedside environment. The BAPs were incubated for bacterial and fungal contamination. Species of colonies observed in these samples were identified. Results. Sixty-one nebulisers from seven ICUs were sampled (Micro Mist n =37; Aeroneb n =24). Half of the nebulisers (Micro Mist ( n =19, 51.4%));Aeroneb ( n =12, 50%)) and most air samples ( n =60, 98%)) presented with contamination. All participating ICUs reported decontamination and storage protocols, but visual inspection of nebulisers suggested that the protocols were not observed. Nebulisers rinsed with alcohol and left open to the environment to dry had the lowest contamination rates. Coagulase-negative Staphylococcus species (spp.) were mostly found in the surrounding air and Aeroneb samples, and Enterococcus spp. were mostly found in the Micro Mist nebulisers. Conclusion . Although decontamination and storage protocols for nebulisers were in place, nebuliser and air contamination was high, possibly due to poor staff adherence","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"32 1","pages":"23-27"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81692737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-10DOI: 10.7196/SAJCC.2016.V32I2.268
Christopher Stein, Eduardo Caetano
Background . Administration of blood in the pre-hospital environment is becoming more feasible, particularly in helicopter emergency medical services (HEMS) during primary response and critical care transfers of major trauma patients. The main challenge in this environment is maintaining a suitable thermal environment for blood transport during missions that may last several hours. Aim . To investigate whether a simple and cost-effective method of storage in a typical HEMS operation would provide an adequate thermal environment for blood. Method . A commercially available cooler box and ice packs were used to simulate a blood transport environment during HEMS missions over three summer and three winter months. In-box temperature was monitored using an electronic thermometer and data logger. Results . Temperature data were recorded during 146 missions with a mean duration of 02:01:35 (95% confidence interval 01:46:25 - 02:16:46). A total of 344 temperature observations were done in the summer months and 384 in the winter months. All mean temperatures recorded in the cooler box were within the required 1 - 6°C range; however, of the total temperature observations recorded, 30% (102/344) during summer were >6°C while 8% (32/384) during winter were >6°C and 15% (59/384) were <1°C. The maximum temperature recorded overall was 13°C and the minimum was −3°C. Conclusion . Low-cost, non-specialised materials used in a HEMS operation were not adequate for the safe transport of blood.
{"title":"Transportation of blood in a helicopter emergency medical service: The importance of specialised equipment","authors":"Christopher Stein, Eduardo Caetano","doi":"10.7196/SAJCC.2016.V32I2.268","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I2.268","url":null,"abstract":"Background . Administration of blood in the pre-hospital environment is becoming more feasible, particularly in helicopter emergency medical services (HEMS) during primary response and critical care transfers of major trauma patients. The main challenge in this environment is maintaining a suitable thermal environment for blood transport during missions that may last several hours. Aim . To investigate whether a simple and cost-effective method of storage in a typical HEMS operation would provide an adequate thermal environment for blood. Method . A commercially available cooler box and ice packs were used to simulate a blood transport environment during HEMS missions over three summer and three winter months. In-box temperature was monitored using an electronic thermometer and data logger. Results . Temperature data were recorded during 146 missions with a mean duration of 02:01:35 (95% confidence interval 01:46:25 - 02:16:46). A total of 344 temperature observations were done in the summer months and 384 in the winter months. All mean temperatures recorded in the cooler box were within the required 1 - 6°C range; however, of the total temperature observations recorded, 30% (102/344) during summer were >6°C while 8% (32/384) during winter were >6°C and 15% (59/384) were <1°C. The maximum temperature recorded overall was 13°C and the minimum was −3°C. Conclusion . Low-cost, non-specialised materials used in a HEMS operation were not adequate for the safe transport of blood.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"37 1","pages":"62-63"},"PeriodicalIF":0.0,"publicationDate":"2016-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81292339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-10DOI: 10.7196/SAJCC.2016.V32I2.298
J. Beer, P. Brysiewicz
Background . The unexpected admission of a loved one to an intensive care unit (ICU) may have a negative effect on the everyday lives of family members, as they have had little time to adjust. Hence, it is imperative for healthcare professionals to promote optimal outcomes for both the patient and family members during admission for critical illness. Objective . To explore and describe the needs of families during critical illness and to develop methods to provide family care during a critical illness of a loved one. Methods . The Strauss and Corbin grounded theory approach was used. In-depth interviews with 16 intensive care nurses, 6 doctors and 9 family members in private and public settings were completed. Results . Five codes emerged using the characteristic coding in grounded theory. These were identified as information sharing; reassurance; striving for consolation; garnering of resources; and cultural and religious co-operation. Conclusion . This study elicited the needs of family members of ICU patients. Methods tailored around these needs were presented to support family members during a critical illness.
{"title":"The needs of family members of intensive care unit patients : a grounded theory study","authors":"J. Beer, P. Brysiewicz","doi":"10.7196/SAJCC.2016.V32I2.298","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I2.298","url":null,"abstract":"Background . The unexpected admission of a loved one to an intensive care unit (ICU) may have a negative effect on the everyday lives of family members, as they have had little time to adjust. Hence, it is imperative for healthcare professionals to promote optimal outcomes for both the patient and family members during admission for critical illness. Objective . To explore and describe the needs of families during critical illness and to develop methods to provide family care during a critical illness of a loved one. Methods . The Strauss and Corbin grounded theory approach was used. In-depth interviews with 16 intensive care nurses, 6 doctors and 9 family members in private and public settings were completed. Results . Five codes emerged using the characteristic coding in grounded theory. These were identified as information sharing; reassurance; striving for consolation; garnering of resources; and cultural and religious co-operation. Conclusion . This study elicited the needs of family members of ICU patients. Methods tailored around these needs were presented to support family members during a critical illness.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"2 1","pages":"44-49"},"PeriodicalIF":0.0,"publicationDate":"2016-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72855133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-10DOI: 10.7196/SAJCC.2016.v32i2.304
L. Michell
Burnout syndrome (BOS) is a common problem, affecting 25 60% of healthcare professionals (HCPs) working in the intensive care unit (ICU).[1] Recently an American Critical Care Societies’ collaborative statement called for action to improve the ICU working environment.[2] The core symptoms of BOS are emotional exhaustion, depersonalisations and perceived lack of personal accomplishment.[2] In a previous issue of this journal we published an editorial, ‘Crash and burn’, highlighting the problem of BOS and the closely associated condition of post-traumatic stress disorder in ICU personnel.[3] Several studies have identified stressful interactions with relatives as a factor that adds to the burden of this demanding workplace. The response of burnt-out doctors and nurses is to avoid or minimise contact with the relatives, particularly if they are perceived to be demanding or ‘difficult’. Understanding the needs of families can help us support families and, in doing so, help ourselves. Even when we are managing the most hopeless ICU patient, job satisfaction can be achieved by knowing that we have done the best we could to help a family cope with a stressful situation. In this issue we publish a study which used a grounded theory approach to establish the needs of the families of ICU patients.[4] Common themes that emerged were the need for information sharing, reassurance, consolidation, resources, and cultural and religious awareness. Helping families that have been thrust into an unfamiliar and frightening situation to survive emotionally requires an understanding of the coping mechanisms relatives adopt. Establishing trust between HCPs and relatives is the first essential step. This is not achieved if discordant information is being supplied. De Beer and Brysiewicz’s study[4] highlights the problem of contradictory information being supplied by different members of the ICU team. An earlier study[5] conducted in French ICUs also showed that consistent information was the most important factor associated with family satisfaction. Communication is a two-way street and involves not only informing the relatives of the patient’s condition in an appropriate and compassionate way but also listening to family members and allowing them time to voice their fears and concerns. Family conferences where relatives talk more than the doctor are rated as more satisfactory by the family.[6] The need for reassurance was another key theme that emergend from the study. This is not such a simple need to meet in the critically ill. It is our human instinct to reassure, and families are keen to grasp at any straw offered. Unfortunately, we have all seen apparently improving patients suddenly deteriorate, and the ensuing blame games that may follow. The opposite extreme, of being overly pessimistic, is also not appropriate as we should not deny the ‘right to hope’ as long as there is some justification for this. Perhaps the best approach is one of cautious optimism, while
{"title":"Care or burn in the ICU","authors":"L. Michell","doi":"10.7196/SAJCC.2016.v32i2.304","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.v32i2.304","url":null,"abstract":"Burnout syndrome (BOS) is a common problem, affecting 25 60% of healthcare professionals (HCPs) working in the intensive care unit (ICU).[1] Recently an American Critical Care Societies’ collaborative statement called for action to improve the ICU working environment.[2] The core symptoms of BOS are emotional exhaustion, depersonalisations and perceived lack of personal accomplishment.[2] In a previous issue of this journal we published an editorial, ‘Crash and burn’, highlighting the problem of BOS and the closely associated condition of post-traumatic stress disorder in ICU personnel.[3] Several studies have identified stressful interactions with relatives as a factor that adds to the burden of this demanding workplace. The response of burnt-out doctors and nurses is to avoid or minimise contact with the relatives, particularly if they are perceived to be demanding or ‘difficult’. Understanding the needs of families can help us support families and, in doing so, help ourselves. Even when we are managing the most hopeless ICU patient, job satisfaction can be achieved by knowing that we have done the best we could to help a family cope with a stressful situation. In this issue we publish a study which used a grounded theory approach to establish the needs of the families of ICU patients.[4] Common themes that emerged were the need for information sharing, reassurance, consolidation, resources, and cultural and religious awareness. Helping families that have been thrust into an unfamiliar and frightening situation to survive emotionally requires an understanding of the coping mechanisms relatives adopt. Establishing trust between HCPs and relatives is the first essential step. This is not achieved if discordant information is being supplied. De Beer and Brysiewicz’s study[4] highlights the problem of contradictory information being supplied by different members of the ICU team. An earlier study[5] conducted in French ICUs also showed that consistent information was the most important factor associated with family satisfaction. Communication is a two-way street and involves not only informing the relatives of the patient’s condition in an appropriate and compassionate way but also listening to family members and allowing them time to voice their fears and concerns. Family conferences where relatives talk more than the doctor are rated as more satisfactory by the family.[6] The need for reassurance was another key theme that emergend from the study. This is not such a simple need to meet in the critically ill. It is our human instinct to reassure, and families are keen to grasp at any straw offered. Unfortunately, we have all seen apparently improving patients suddenly deteriorate, and the ensuing blame games that may follow. The opposite extreme, of being overly pessimistic, is also not appropriate as we should not deny the ‘right to hope’ as long as there is some justification for this. Perhaps the best approach is one of cautious optimism, while ","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"11 1","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2016-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82972085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-01DOI: 10.7196/SAJCC.2016.V32I2.253
P. Jordan, C. Bowers, D. Morton
Background . Evidence-based practices (EBPs) have been promoted to enhance the delivery of patient care, reduce cost, increase patient and family satisfaction and contribute to professional development. Individual and organisational barriers can hamper the implementation of EBP, which can be detrimental to healthcare delivery. Objective . To determine the individual and organisational implementation barriers of EBP among nurses in a private intensive care unit (ICU). Methods . A quantitative research design was used to collect data from nurses in a private ICU in the Eastern Cape Province, South Africa. The structured questionnaire (Cronbach’s alpha: 0.72) was administered to 70 respondents, with a response rate of 93%. Results . Barriers at individual level were identified, and include lack of familiarity with EBP, individual perceptions that underpin clinical decision-making, lack of access to information required for EBP, inadequate sources to access evidence, inability to synthesise the literature available, and resistance to change. Barriers related to organisational support, change and operations were identified. Conclusion . Although the findings were similar to other studies, this study showed that nurses younger than 40 years of age were more familiar with the concepts of EBP. Physicians were perceived as not being very supportive of EBP implementation. In order to enhance healthcare delivery in the ICUs, nurse managers need to take cognisance of the individual and organisational barriers that might hamper the implementation of EBP.
{"title":"Barriers to implementing evidence-based practice in a private intensive care unit in the Eastern Cape","authors":"P. Jordan, C. Bowers, D. Morton","doi":"10.7196/SAJCC.2016.V32I2.253","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I2.253","url":null,"abstract":"Background . Evidence-based practices (EBPs) have been promoted to enhance the delivery of patient care, reduce cost, increase patient and family satisfaction and contribute to professional development. Individual and organisational barriers can hamper the implementation of EBP, which can be detrimental to healthcare delivery. Objective . To determine the individual and organisational implementation barriers of EBP among nurses in a private intensive care unit (ICU). Methods . A quantitative research design was used to collect data from nurses in a private ICU in the Eastern Cape Province, South Africa. The structured questionnaire (Cronbach’s alpha: 0.72) was administered to 70 respondents, with a response rate of 93%. Results . Barriers at individual level were identified, and include lack of familiarity with EBP, individual perceptions that underpin clinical decision-making, lack of access to information required for EBP, inadequate sources to access evidence, inability to synthesise the literature available, and resistance to change. Barriers related to organisational support, change and operations were identified. Conclusion . Although the findings were similar to other studies, this study showed that nurses younger than 40 years of age were more familiar with the concepts of EBP. Physicians were perceived as not being very supportive of EBP implementation. In order to enhance healthcare delivery in the ICUs, nurse managers need to take cognisance of the individual and organisational barriers that might hamper the implementation of EBP.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"27 1","pages":"50-54"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88378933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-01DOI: 10.7196/SAJCC.2016.V32I2.275
M. Venter, W. Stassen
Background . Critical care transfers (CCT) refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft) of patients who are of high acuity. In South Africa (SA), advanced life support (ALS) paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim . The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods . A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample ( n =7), consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results . After three rounds, consensus was obtained in 70% (57/81) of procedures and medications. Many of these items are not currently within the scope of paramedics’ training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion . Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners.
{"title":"The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study","authors":"M. Venter, W. Stassen","doi":"10.7196/SAJCC.2016.V32I2.275","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I2.275","url":null,"abstract":"Background . Critical care transfers (CCT) refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft) of patients who are of high acuity. In South Africa (SA), advanced life support (ALS) paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim . The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods . A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample ( n =7), consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results . After three rounds, consensus was obtained in 70% (57/81) of procedures and medications. Many of these items are not currently within the scope of paramedics’ training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion . Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"96 1","pages":"58-61"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80454048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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