Portia J. Jordan

Endotracheal tube cuff pressure management in adult critical care units

Background. The monitoring of endotracheal tube (ETT) cuff pressure in intubated patients is important in preventing complications related to cuff over- and under-inflation. Objectives. To explore and describe the existing practice related to ETT cuff pressure management by professional nurses in adult critical care units (CCUs) in the public and private healthcare sectors. Method. A quantitative survey was used. Data were collected from professional nurses from adult CCUs in the public and private healthcare sectors in the Nelson Mandela Metropole, Eastern Cape, South Africa, using a structured self-administered questionnaire based on a literature review. Results. The survey response was 75% (100/134). Practice variances included the frequency of cuff pressure monitoring: only 52% of respondents performed cuff pressure measurements every 6 - 12 hours; 32% reported performing measurements at 2 - 4 hourly intervals; 15% only assessed cuff pressure when a leak occurred; and 1% never monitored cuff pressure. Of the 100 respondents, 37% used the cuff pressure measurement (CPM) method, 24% used the palpation method or listened to air leaks, and 22% used minimal occlusive volume (MOV). None of the respondents used the minimal leak technique (MLT). Only 20% of the respondents maintained cuff pressures at 18 - 22 mmHg. Thirty-one per cent indicated that they still performed the practice of cuff deflation and re-inflation before and after suctioning. There were incongruities related to the management of air leaks and the amount of air instilled. Conclusion. Practice variances were noted among the professional nurses, especially in the private healthcare sector. The lack of evidence-based clinical decision-making related to cuff pressure management in mechanically ventilated patients was evident. Best practice recommendations need to be used effectively when performing ETT cuff pressure management, to reduce practice variance, standardise safe patient care, and minimise complications.

A comprehensive literature review of guidelines facilitating transition of newly graduated nurses to professional nurses

Literature shows that successful transition of newly graduate nurses to professional nurses is imperative but does not always take place, resulting in difficulty in performance, cognizance or behaviour of a role as a nurse, affecting the quality of patient care negatively. No integrative literature review could be found to summarize available guidelines facilitating transition of final year nursing students to professional nurses. An extensive search of the literature by means of an integrative literature review was conducted in 2014 and updated in June 2017, following a five-step process. All relevant studies were subsequently appraised for rigour and quality using the AGREE II tool by two independent reviewers. Eight (n = 8) guidelines on transitions were independently extracted. After thematic analysis was done, three factors to facilitate transition of final year nursing students to professional nurses were found: 1) support for new graduates, 2) the graduates need for socialization and belonging, and 3) a positive clinical learning environment. The availability and implementation of guidelines on transition of final year nursing students by educational institutions and healthcare facilities could ease the transition from being final year nursing students to becoming professional nurses as well as improve retention of newly qualified professional nurses.

Implementation strategies for guidelines at ICUs: a systematic review

Purpose The purpose of this paper is to critically analyze empirical studies related to the implementation strategies for clinical practice guidelines (CPGs) in intensive care units (ICUs). Design/methodology/approach A systematic review with a narrative synthesis adapted from Popay et al.s method for a narrative synthesis was conducted. A search using CINAHL, Google Scholar, Academic search complete, Cochrane Register for Randomized Controlled Trials, MEDLINE via PUBMED and grey literature was conducted in 2014 and updated in 2016 (August). After reading the abstracts, titles and full-text articles, 11 ( n=11) research studies met the inclusion criteria. Findings After critical appraisal, using the Joanna Briggs Critical Appraisal Tools, eight randomized controlled trials conducted in adult and neonatal ICUs using implementation strategies remained. Popay et al.s method for narrative synthesis was adapted and used to analyze and synthesize the data and formulate concluding statements. Included studies found that multi-faceted strategies appear to be more effective than single strategies. Strategies mostly used were printed educational materials, information/ sessions, audit, feedback, use of champion leaders, educational outreach visits, and computer or internet usage. Practical training, monitoring visits and grand rounds were less used. Practical implications Findings can be used by clinicians to implement the best combination of multi-faceted implementation strategies in the ICUs in order to enhance the optimal use of CPGs. Originality/value No systematic review was previously done on the implementation strategies that should be used best for optimal CPG implementation in the ICU.

THE EXPERIENCES OF CRITICAL CARE NURSES WITH REGARD TO END-OF-LIFE ISSUES IN THE INTENSIVE CARE UNIT

Nurses in the intensive care unit might be faced with emotional conflict, stress and anxiety when dealing with end-of-life issues and thus need to be supported. In understanding the experiences of nurses, enhanced support can be given in order to assist nurses to deal better with end-of life issues in the intensive care unit. The purpose of the study was to explore and describe the experiences of nurses’ with regard to end-of-life issues in the intensive care unit. A qualitative, explorative, descriptive and contextual research design using a semi-structured interview approach was used. The target population for the study comprise twenty registered nurses in the intensive care unit. Of the twenty nurses, only nine were willing to participate in the study. Purposive sampling method was used to interview nine nurses in a private intensive care unit. Data collected was thematically analysed, using Tesch’s method. Four major themes were identified, namely: (1) conflicting emotions; (2) family relations; (3) multi-disciplinary team relations; and (4) supportive strategies when dealing with end-of-life issues. The study concluded that nurses experienced different emotions, conflict and stress when dealing with end-of-life issues in the intensive care unit. A need for supportive relations with family members, the multi-disciplinary team and support from management were reported. Immediate debriefing, enhancing communication amongst multi-disciplinary team members, having a permanent counsellor or pastoral counselling, an ethics committee and training programmes in place to address end-of-life issues are a few of the support strategies that can assist critical care nurses in dealing with end-of-life issues in the intensive care unit.Â

DUAL TRANSITIONS IN NURSING: A MILITARY PERSPECTIVE

Military nursing is characterized by diverse challenges, one of the more significant challenges being the dual transition whereby student nurses need to transition from student nurses to professional nurses and from candidate officers to officers. A military nurse has both nursing and military demands. Consequently, novice professional nurses feel inadequately prepared for the responsibilities and the role of a professional nurse. The purpose of this study was to explore and describe the experiences of final year nursing students with regard to dual transitions in the military health system. A qualitative, explorative, descriptive and contextual research design was used in the study. The target population comprised representatives of the South African Military Health Service (SAMHS) which inlcuded final year nursing students, novice professional nurses, unit managers and nurse educators. A purposive sampling method was used to interview a total of 41participants by means of four focus groups and 18 individual semi-structured interviews. The transcripts were analysed using Cresswell’s four step process. The final year nursing students particularly reiterated the inadequacy in the preparation for both the roles of the professional nurse and that of a military officer, highlighting the lack of clinical accompaniment due to shortage of staff, poor clinical exposure and limited clinical opportunities for experiential learning. The nurse educators alluded to the lack of support that they are not receiving from the unit managers in preparing the students. The unit managers cited the lack of competency of final year nursing students on completion and the military ranking system as impeding a successful transition.

Visitors in the intensive care unit

Patients are admitted to an intensive care unit (ICU) because their illness or injury may be life-threatening, requiring intense support and monitoring that cannot be given in the general wards. Critical illness is often sudden, unexpected and can change the lives of both the patient and family members in a matter of minutes. The everyday lives of family and close friends may come to an abrupt halt or be disrupted as they live in the uncertainty of not knowing whether the patient will survive. The ICU, a stressful, unfamiliar, alien and intimidating environment, often becomes the centre of peoples lives as they wait desperately for any signs of alterations or progress in the lives of their loved ones. The lives of the patients admitted to ICU are often in danger, which can lead to anxiety, depression and post-traumatic stress disorder in their family members.