Southern African Journal of Critical Care
SAJCC is the official journal of the Critical Care Society and is sent to the members of CCS, intensive care nurses, paramedics and medical practitioners.
|Publisher||Health and Medical Publishing Group (HMPG)|
|Coverage||Vol 20 Issue 1 Aug 2004 - current|
Transportation of blood in a helicopter emergency medical service : the importance of specialised equipment
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.
Objective. To investigate whether a simple and cost-effective method of storage in a typical HEMS operation would provide an adequate thermal environment for blood.
Methods. 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.
The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers : a Delphi study
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.
Critical care nursing practice and education in Rwanda is a young specialty. There are very few critical care nurses practising in either hospital or academic settings, and typically nurses taking care of critically ill patients receive only a brief period of informal education prior to practising. Intensive care units are found predominantly in the state tertiary hospitals, located primarily in Kigali city. The purpose of this article is to describe the current state of critical care nursing in Rwanda, including challenges and opportunities faced by these nurses, as well as recent initiatives under way in an attempt to address these difficulties. This article is based on a review of the published and grey literature relevant to the healthcare system and the disease profile of Rwanda, as well as the evolution of critical care nursing in Rwanda. In addition, the experience of the first author in critical nursing in Rwanda helped to guide the development of the article.
Barriers to implementing evidence-based practice in a private intensive care unit in the Eastern Cape
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.
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.