Shelley Schmollgruber

Psychological sequelae following ICU admission at a level 1 academic South African hospital

Purpose. The purpose of this research was to determine the extent to which anxiety symptoms, depressive symptoms and post-traumatic stress (PTS) symptoms were experienced by a sample of patients after discharge from intensive care units (ICUs). The participants had a mean stay of 3 days in ICUs in a level 1 academic hospital in Gauteng, South Africa. Methods. A prospective, quantitative, cross-sectional, descriptive design was used to investigate these variables. A preliminary record review of the hospital’s ICU bed occupancy for the previous year was 1 596. The total study sample was 98 (N=98) to ensure that a power of at least 95% accuracy was acquired for the 0.05 level of significance testing. The instruments used in the structured interview were the Hospital Anxiety and Depression Scale (HADS) developed by Zigmond and Snaith (1983) and the Experience after Treatment in Intensive Care 7-Item scale (ETIC-7) developed by Scragg, Jones and Fauvel (2001). Data were analysed using STATA 10. Findings. Just under half the sample population (48%) had symptoms of anxiety, more than a quarter had symptoms of depression (28%), and 32% had symptoms of PTS. Furthermore, it was elicited that 58% of the sample had combined anxiety and depressive symptoms severe enough to have a ‘possible clinical disorder’. An unexpected finding of this study was that patients who had memory of physical restraints in the ICU were six times more likely to develop symptoms of PTS than those with no memory of physical restraint. Conclusions. It was observed in this study that a significant number of ICU patients returning to the community develop psychological sequelae related to their admission and the treatments necessary, e.g. mechanical ventilation. This psychological distress can affect patients’ physical recovery (by an altered and decreased immune function), their quality of life and their functioning in the family and in society. Clinical relevance. The prevalence of psychological sequelae after treatment in an ICU was found to be high. At present ICU staff in South Africa have limited evidence on which to base decisions about improvements to critical care practice and the psychological sequelae following treatments in an ICU. Critical illness and the recovery from it do not end at the ICU door, and patients should be identified , followed up and offered the necessary support.

An integrative review of South African cancer nursing research published from 2002–2012

BACKGROUND This integrative review aimed to quantify the publication output of South African cancer nursing research conducted between 2002 and 2012 and to identify key trends relevant to cancer nurse researchers. OBJECTIVES To describe the publication output of cancer nursing research in terms of the journals of publication, authors, focus, participants and methods used, to explore whether the published work was funded and to assess the quality of the studies published. METHODS An integrative review was conducted using the key words South Africa in combination with cancer nursing and oncology nursing to search the databases Pubmed, PsycINFO, CINAHL, Sabinet, Web of Science, Medline and OvidSP. A data extraction sheet was developed to document the required information from each paper and all publications were reviewed independently by the authors. RESULTS A total of 181 publications for potential inclusion were identified and 26 papers were included in this review. Cervical cancer, specifically the prevention of this disease, was the most popular diagnostic focus and theme of investigation. Most of the studies were descriptive and none of the studies met the criteria of the highest quality. CONCLUSION Nursing added to the body of knowledge regarding the primary and secondary prevention of cancer. There is a need for work on both men and women diagnosed withthe most common cancers, as well as the family and care giver. There is also a need for multidisciplinary work using complex interventions focusing on symptom management to improve patient outcomes.

End-of-life care in intensive care units

Ethical theories have been posited since the dawn of civilisation. We all approach moral decisions informed by our historical, family and cultural backgrounds, augmented in turn by our personal and professional experience. Theories and practice reflect the beliefs, values and knowledge of the ages, refined, modified and reinstated to address present ethical concerns. Platonic and Aristotlean ethics were modified in the ensuing centuries: theorists constructed models based on natural law, seeing humankind as a link in the chain of being - stretching from God Himself to the smallest of inanimate beings.

Predictive validity of pressure risk assessment scales in a private sector trauma intensive care unit

Background. Risk assessment scales are considered essential tools in pressure ulcer prevention, but none of them have been tested for predictive validity (sensitivity, specificity and positive and negative predictive value) in intensive care, especially in the South African context. Purpose. To compare the sensitivity, specificity and predictive value of a pressure ulcer risk assessment scale developed for intensive care unit patients (research scale) with the one that was currently being used in the research unit (control scale). Method. Sixty-six patients were assessed over a period of 3 months. Pressure ulcer risk was calculated on a weekly basis using both assessment scales. Predictive risk was compared with the actual outcome (pressure ulcer development) in order to determine the sensitivity and specificity of each scale. Results. Twenty-five (38%) of the sampled patients developed pressure ulcers. There was significant asymmetry (p < 0.05) between the two scales, with the control scale having a tendency to classify more patients as being at risk. The two scales matched well for sensitivity, but the research scale had a higher specificity (71% v. 29%) and positive predictive value (63% v. 44%). Conclusion. It was concluded that the research scale is superior to the control scale, as it was able to predict risk with more accuracy.

Advancing nursing scholarship: the Mozambique model

ABSTRACT Background: Despite the importance of Human Resources for Health for the development and functioning of health systems worldwide, many countries continue to be plagued by poor health systems and a lack of adequate health care. Health systems failures may be attributed to both quantitative and qualitative nursing shortages including the lack of advanced skills to lead health initiatives, to conduct research and to educate other nurses. The response by development partners is usually framed around the production of skilled nurses through the processes of up-skilling and scaling-up. The outcome is expanded practice but with scant attention to the professional advancement of nurses. Objectives: In this paper we present a two-phased capacity development model that adopted professionalization strategies to advance nursing scholarship and consequent postgraduate specialization of the first cohort of nurses in Mozambique. The main objectives were to: develop and implement a clinical course work master’s degree in nursing; and ensure sustainability by capacitating the host institution to continue with the master’s programme following graduation. Methods: Rigorous processes for project discussions, negotiations and monitoring were necessary amid limited resources and a challenging political climate. Forging in-country partnerships, sustaining alliances and government investment are thus key to the success of the Mozambique model. Outcomes: Notwithstanding some difficulties, the process unfolded over a five-year period, graduating the first cohort of 11 senior nurses with a master’s degree, specializing either in critical care and trauma nursing, or maternal and neonatal health. Conclusions: Bridging the skills gap between generalist and specialist nurses is essential for them to manage complex and high acuity cases and to reverse associated morbidity and mortality. We conclude that this model serves as a professionalization strategy to advance nurses’ scholarship of clinical practice, research and teaching.

Global connection of critical care nursing organizations : editorial

The Critical Care Society of Southern Africa has recently become an associate member of the World Federation of Critical Care Nursing (WFCCN), and we now have a representative on that bodys Council. The motivation was put forward by critical care nurses following a presentation by Professor Ged Williams, President of the WFCCN, at the annual Society conference in Durban. South Africa has a proud history of critical care nursing. The CCSSA has inspired critical care nursing leadership and development, by offering them a home within one of the largest medical organisations.