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- Southern African Journal of Critical Care
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- Volume 24, Issue 2, 2008
Southern African Journal of Critical Care - Volume 24, Issue 2, 2008
Volume 24, Issue 2, 2008
Author Maureen CoombsSource: Southern African Journal of Critical Care 24, pp 42 –44 (2008)More Less
Author Nicola A. FoucheSource: Southern African Journal of Critical Care 24, pp 46 –49 (2008)More Less
Benner's model of skill acquisition, based on ascending levels of proficiency, was originally developed by Dreyfus and Dreyfus, Benner and Dreyfus, all of whom claimed that the model could be generalised for nursing. Benner used the model originally proposed by Dreyfus and Dreyfus (1980) and described nurses as passing through five levels of development: Novice, Advanced Beginner, Competent, Proficient and Expert (see 'Benner's Stages of Clinical Competence' overleaf). Each step builds on the previous one as abstract principles are refined and expanded by experience and the learner gains clinical expertise.
Author C.A. CarterSource: Southern African Journal of Critical Care 24, pp 50 –55 (2008)More Less
Introduction. The lack of critical care resources in South Africa can result in critically ill patients being nursed in the wards. Ward staff often lack the knowledge and skills to care for these patients adequately. Studies done internationally have revealed that ward patients often receive sub-optimal care before admission to the intensive care unit, with possible causes being cited as institutional failure, lack of knowledge, failure to appreciate urgency, and failure to seek advice. Furthermore, patients prematurely discharged from the ICU to the wards have an increased mortality rate. Internationally the critical care community is responding to these findings by taking steps to become proactive rather than reactive. This shift has led to the development of various approaches to assist in the recognition and early treatment of the deteriorating patient in the general wards. One such approach, introduced in the UK in 2000, is the Critical Care Outreach Programme instituted by the Department of Health as part of the Modernisation Programme. Reports in the literature suggest that this programme has positively impacted on emergency ICU admissions, ICU readmission rates, in-hospital mortality, and an improved level of knowledge and skills among ward nurses. An adapted form of this programme has been introduced in an urban public hospital in KwaZulu-Natal.
Method. A Critical Care Outreach Nurse was appointed at the target hospital to introduce the programme. The adapted form of the programme was introduced in two phases. Phase 1 consisted of following up of patients discharged from the ICU to the wards, and phase 2 incorporated the introduction of the Modified Early Warning Scoring System (MEWS) and referral algorithm to the surgical wards in the hospital. Owing to staff constraints the main focus of the programme was empowerment through knowledge. In this way a training programme was developed and implemented.
Results. Compliance with the scoring system was initially problematic but improved with the introduction of new forms. Night staff appears to be less compliant than day staff in the majority of wards. Respiration, the most sensitive indicator of critical illness, is recorded at 20 breaths/min in 77% of cases. Although the calculation of MEWS scores has improved it is still done inaccurately in 9% of cases. Scoring urine output is also problematic. Poor communication and lack of resources when managing acutely ill patients may potentially impact on the success of the scoring system. The nursing staff have generally responded positively to the MEWS, but there still appears to be a lack of awareness among medical staff.
Conclusion. Introduction of MEWS into the general wards in South Africa is potentially achievable but requires ongoing evaluation. The introduction of MEWS and Outreach may create a unique opportunity to improve the quality of care rendered to the patient in the general wards by relationship building and the sharing of ICU knowledge and skill through education and training.
Source: Southern African Journal of Critical Care 24, pp 56 –60 (2008)More Less
Study aim. To describe the profile and selected outcomes of coronary artery bypass graft (CABG) patients admitted to both private and public hospitals in the Cape metropolitan area.
Design. A prospective descriptive study design with a multi-centre observational approach was followed.
Method. Only patients undergoing isolated CABG surgery were included in the study. Demographic data, preoperative medical status, and intra-operative and postoperative information were collected using a self-designed structured initial assessment tool. Relationships between different variables were analysed by means of analysis of variance (ANOVA), correlations, linear and logistic regressions.
Results. 245 patients were admitted to the seven hospitals that provide CABG surgery in the Cape metropolitan area. The mean age of the sample was 60 (±10) years. The mean length of stay (LOS) of the total cohort was 12.1 (±5.5) days, with patients in the state hospitals staying longer (13.4 (±7.1) days) than private patients (11.7 (±4.8) days). Patients aged ≥60 years were twice as likely to have a LOS >12 days (odds ratio 2.49; 95% confidence interval 1.33 - 4.65). The development of a pleural effusion or pneumothorax was associated with an increased LOS (p<0.01). At least one postoperative pulmonary complication (PPC) was reported in 65% of the population.
Conclusion. Patients in this cohort were younger than in developed countries. Age≥60 years was a predictor of LOS of more than 12 days. Patients were most likely to develop a PPC on day 3 after CABG surgery.
Author Yolanda L. WalshSource: Southern African Journal of Critical Care 24, pp 61 –64 (2008)More Less
A sustained increase in intra-abdominal pressure (IAP) may result in abdominal compartment syndrome (ACS). This is a well documented complication in critically ill patients, but there appears to be a reluctance to routinely measure IAP in patients at high risk of developing intra-abdominal hypertension (IAH) and ACS. This may be due to a lack of clinical skills or perceived complexity of the procedure.