Challenges encountered by critical care unit managers in the large intensive care units

Patients' Satisfaction with Humane Care in Critical Care Units

Background:

It is important to assess the provision of care in a humane framework to achieve patients' holistic needs in Critical Care Units (CCUs) and to promote health outcomes. The aim of the current study was to determine patients' satisfaction with humane care in CCUs.

Materials and Methods:

In the current descriptive–analytical study, data were collected from 225 patients admitted to the CCUs of seven teaching hospitals in Lorestan Province, Iran, in 2017. The Persian version of the Revised Humane Caring Scale (P-RHCS) was used in this study. Data were analyzed using descriptive statistics and inferential statistics (independent t-test and one-way ANOVA).

Results:

The mean (SD) overall score of the P-RHCS was 4.61 (0.53), which indicated that patients were highly satisfied with humane care. The patients were most satisfied with “professional performance” [mean (SD) 4.72 (0.60)] and “interdisciplinary collaboration” [mean (SD) 4.72 (0.65)], and the least satisfied with “awareness of and contribution to self-care” [mean (SD) 4.23 (0.78)]. The findings revealed that patients' satisfaction with humane care depends on their demographic and clinical characteristics.

Conclusions:

Generally, patients were satisfied with humane care provided in CCUs; however, it is recommended that nurses' skills be reinforced, especially regarding information provision and effective communication with patients to improve health outcomes.

Job satisfaction of registered nurses in a private critical care unit in the Eastern Cape: A pilot study

BACKGROUND

Job satisfaction is influenced by factors that are interpersonal (between nurse and colleagues), intrapersonal (within the nurse) and extra-personal (external to the nurse).

AIM

The primary objective of this study was to explore and describe factors influencing the job satisfaction of registered nurses in a particular private critical care unit. The second objective was to make recommendations to enhance the job satisfaction of registered nurses in this private critical care unit.

SETTING

The population consisted of registered nurses in a private critical care unit in the Eastern Cape.

METHODS

This study utilised a quantitative descriptive design. Self-administered questionnaires were distributed amongst registered nurses in the critical care unit. Data were analysed and illustrated through tables.

RESULTS

Altogether, 39 registered nurses took part in the study. The majority of the participants (82%; n = 32) indicated that they enjoyed working with their team members. In addition, it was apparent that the majority (79%; n = 30) felt that they were sufficiently trained. Staff members felt that they had management support and felt satisfied at their workplace. Areas of concern included salaries, leave, debriefing and recognition.

CONCLUSION

The majority of the registered nurses in this private critical care unit were extremely satisfied with their job. However, there were areas where this could be improved. The high levels of satisfaction at this single critical care unit lead to the question whether this situation is common throughout the Eastern Cape, which opens the path for further research in this regard.

Ethical conflicts experienced by intensive care unit health professionals in a regional hospital, Limpopo province, South Africa

Background

Conflicts arise when healthcare providers disagree about providing optimal care to critically ill patients where resources and services are constrained.

Aim

This study investigated ethical conflicts experienced by intensive care unit (ICU) healthcare professionals working in a regional hospital, Limpopo province of South Africa.

Setting

The study was conducted at a rural public regional hospital in Vhembe district, Limpopo Province. Communities served by the hospital are poor and medically uninsured.

Methods

This study adopted a qualitative, exploratory and descriptive design. The target population comprised Health care professionals working in an ICU of the regional hospital. Purposive sample was selected and 17 unstructured interviews were conducted. Tesch’s method of data analysis was used. Ethical considerations were adhered to.

Results

Patients’ care needs were compromised because of the unavailability of beds and high-technology equipment, such as well-functioning ventilators. Doctors were not having the necessary skills required in the ICU as the majority were on community service/internship and nurses acted beyond their scope of practice because of a lack of adequately trained intensive care specialists. Infection control practices were overlooked and ‘use once’ pieces of equipment were reused. Conflicting values between nurses, patients and family of patients exist.

Conclusion

Lack of resources compromises provision of optimal and intensive care. Patients were prone to infections and their safety might have been compromised.

The Role of the Nurse Unit Manager Function on Nursing Work Performance: A Systematic Review

Introduction: The role of Nurse Unit Manager is to improve the nurses’ performance in the context of their professional services. This role consists of planning, organizing, actuating and controlling. The aim of this systematic review was to determine the influence of the nurse unit manager’s management functions related to the nurses’ performance.Methods: The literature search was conducted in the PubMed, Scopus, ProQuest, Science Direct and SAGE databases with the keywords ‘head nurses’, ‘management function’ and ‘nurse performance’. The articles were reviewed using the inclusion criteria, which was that the title and abstract was in accordance with the desired topic, that the article aimed to analyze the influence of the nurse unit manager’s management functions related to the nurses’ performance and that it was explained in English. The exclusion criteria were that the title, abstract and purpose of the article was not in accordance with the topic of focus. The search identified 15 relevant journals from the 276.303 articles published between 2014 and 2019.Results: The results indicate a significant relationship exists between the role of the nurse unit manager and nursing work performance.Conclusion: To improve the management function of the nurse unit manager, it is necessary to conduct training for the nurse unit manager to allow them to better understand the functions and role of the nurse unit manager.

Difficulties of unit managers in selected district hospitals in Cameroon

BACKGROUND

Being appointed to a managerial position because of one's clinical skills seems to be prestigious, even powerful. However, being a unit manager in a resource-constrained district hospital can be a daunting task. Also, managing a ward unit with no previous training in leadership and management can be very challenging.

OBJECTIVES

The purpose of this study was to describe the difficulties, in the day-to-day activities, of unit managers in selected Cameroonian district hospitals.

METHOD

A constructionist, descriptive Husserlian phenomenological inquiry was conducted to describe the difficulties of unit managers in two district hospitals. Ten unit managers were selected through a purposive sampling scheme, and then interviewed using semi-structured interviews. Coliazzi's qualitative data analysis method was used for analysis.

RESULTS

This study revealed that unit managers looked for assistance because it is not easy to be in their position. Their role implied facing difficulties and making sacrifices for something that is not even worth the trouble. Therefore, as a way to overcome their difficulties, they asked for assistance from the organisation, from their families and from God as strategies to face their difficulties.

CONCLUSION

The difficulties faced by unit managers in the selected district hospitals revealed the need to prepare nurses for managerial positions by ensuring they are trained as managers before commencing employment as a manager.

Challenges experienced by health care professionals working in resource-poor intensive care settings in the Limpopo province of South Africa

Background

Providing optimal care to critically ill patients poses challenges in resource-poor settings because of the lack of equipment, inadequately trained personnel and limited infrastructure.

Objectives

This study explored challenges experienced by health care professionals working in resource-poor intensive care units.

Method

A qualitative, explorative, descriptive design was used. The population comprised nurses and doctors working in an intensive care unit of one hospital in the Limpopo province of South Africa. A purposive sample was selected and 17 semi-structured interviews were conducted. Data were analysed using Tesch’s method. Ethical considerations were adhered to.

Results

Participants experienced challenges related to provision of suboptimal patient care, the challenge of non-adherence to protocols and/or instructions and the challenge of practising beyond the scope of practice.

Conclusion

Lack of resources resulted in providing suboptimal intensive patient care. Patients were prone to infections and their safety might be compromised.

Keywords

health care professionals; intensive care units; critically ill patients; resource-poor intensive care units.

Record-keeping: Challenges experienced by nurses in selected public hospitals

BACKGROUND

 Patients' records provide a trace of care processes that have occurred and are further used as communication amongst nurses for continued management of patients. Nurses have the responsibility to ensure that records are accurate and complete in order to effectively manage their patients. In hospitals, nurses have to record a wide range of information in the patient's records and this leads to increased workload on the part of nurses that compromises accurate record-keeping.

OBJECTIVES

 The purpose of this study was to explore and describe the challenges experienced by nurses with regard to record-keeping at selected public hospitals in the Vhembe district, Limpopo Province, South Africa.

METHOD

 A qualitative, explorative and descriptive research design was used. Nurses working in selected public hospitals were purposively selected and semi-structured interviews were conducted until data saturation was reached. Data were analysed using the Tesch's open-coding method.

RESULTS

 Nurses working in public hospitals experience record-keeping as a challenging activity owing to a variety of challenges which include lack of time to complete the records, increased patients' admission and shortage of recording material.

CONCLUSION

 Record-keeping is not done properly which is problematic, and it is recommended that there should be continuous training, monitoring and evaluation of nurses on record-keeping issues, supply of adequate recording materials and proper time management amongst nurses to improve record-keeping challenges. The need for comprehensive record-keeping remains fundamental in public hospitals in order to improve patient care.

Challenges with Surveillance of Healthcare-Associated Infections in Intensive Care Units in South Africa

Background

The incidence of healthcare-associated infections (HAIs) in the public health sector in South Africa is not known due to the lack of a surveillance system. We report on the challenges experienced in the implementation of a surveillance system for HAIs in intensive care units (ICUs).

Methods

A passive, paper-based surveillance system was piloted in eight ICUs to measure the incidence of ventilator-associated pneumonia, catheter-associated urinary tract infection, and central line-associated bloodstream infection. Extensive consultation with the ICU clinical and nursing managers informed the development of the surveillance system. The Plan-Do-Study-Act method was utilized to guide the implementation of the surveillance.

Results

The intended outputs of the surveillance system were not fully realized due to incomplete data. The organizational culture did not promote the collection of surveillance data. Nurses felt that the surveillance form added to their workload, and the infection control practitioners were unable to adequately supervise the process due to competing work demands.

Conclusions

A manual system that adds to the administrative workload of nurses is not an effective method of measuring the burden of HAIs. Change management is required to promote an organizational culture that supports accurate data collection for HAIs.

A survey of next of kin needs of trauma patients admitted to Intensive Care Units in South Africa

AIM

To conduct a cross-sectional survey of next of kin needs of critically injured trauma patients admitted to Intensive Care Units in South Africa.

METHODS

The needs of next of kin of trauma patients (in public and private hospitals) who were critically injured and required admission to Intensive Care Units were surveyed at two points: on admission within first 24hours and on Day 3/day of transfer if earlier.

RESULTS

A total of 162 next of kin participated (114 from state and 48 from private) and Critical Care Family Needs Inventory subscale scores obtained at admission and at Day 3/day of transfer if earlier indicated a trend toward reporting increased needs. In all the needs ratings, the top domains were those of Assurance and Information.

CONCLUSION

The next of kin have a great number of needs that are currently not being met (both in the state and the private hospital and these needs actually increase over time. This study can help nurses understand the needs of next of kin in the Intensive Care Unit and that these needs change over the hospitalization period.

Intensive care unit nurse managers' views regarding nurse staffing in their units in South Africa

AIM

To explore the views of the intensive care unit (ICU) nurse managers regarding nurse staffing in the large ICUs.

DESIGN AND METHODS

A qualitative design was used to explore the views of the ICU managers. Four individual interviews were conducted with ICU managers. The interviews were audio recorded; transcribed verbatim and content data analysis was undertaken. The settings were ICUs of four private hospitals in the Tshwane metropolitan area in Gauteng Province, South Africa.

RESULTS

Two themes that emerged from the data were shortage of competent and trained nurses and problems with agency nurses. Shortage of competent and trained nurses was associated with the global shortage of nurses; and led to increased patient-to-nurse ratios and the use of other categories of nurses, other than professional nurses. The problems with agency nurses were lack of ICU experience and lack of commitment to their professional work. These brought about risks in the provision of quality nursing care.

CONCLUSIONS

Adequate numbers of competent and committed nurses is essential for efficient patient care and favourable outcomes in the ICUs.

CLINICAL IMPLICATIONS

The findings demonstrate the importance of provision of ICU trained nurses for patient care, rather than nurse staffing simply to balance the numbers.

Application and applicability of non-invasive risk models for predicting undiagnosed prevalent diabetes in Africa: A systematic literature search

BACKGROUND AND PURPOSE

Prediction algorithms are increasingly advocated in diabetes screening strategies, particularly in developing countries. We conducted a systematic review to assess the application and applicability of existing non-invasive prevalent diabetes risk models to populations within Africa.

DESIGN

systematic review data sources A systematic search of English literatures in Medline via PubMed from 1999 until June, 2014. Study selection Included studies had to report on the development, validation or implementation of a model that was primarily constructed to predict prevalent undiagnosed diabetes using non-laboratory based predictors.

DATA EXTRACTION

Data were extracted on the type of statistical model, type and range of predictors in the model, performance measures in both internal and external validation, and whether the model was developed from, validated or implemented in an African population.

RESULTS

Twenty-three studies reporting on non-invasive prevalent diabetes models were identified. Ten from Europe (some with multiethnic populations), nine models were developed among Asian population, two from the USA and two from the Middle-East. The c-statistics for these models ranged from 0.65 to 0.88 in the development studies, and from 0.63 to 0.80 in the validation studies. Twenty models were validated, and none in Africa. Among predictors commonly included in models, parental/family history of diabetes and personal history of hypertension appear to be more prone to measurement errors in the African context.

CONCLUSION

Existing prevalent diabetes prediction models have not been applied to African populations, and issues with the measurement of key predictors make their applicability likely inaccurate.