Injury surveillance at a level I trauma centre in Johannesburg, South Africa: research

An analysis of 16 357 trauma patients seen over a one year period at the trauma casualty of an academic hospital in Johannesburg was carried out to determine the profile of injuries sustained by victims in the Johannesburg region. A retrospective survey was conducted between January and December 2001 to compile a composite trauma morbidity and mortality profile, and to create baseline data for future comparison. The objectives of the survey were: to describe the frequencies, distribution and categories of injuries; to assess, on admission to the trauma casualty, the severity of injuries according to the TRISS method; and the outcomes and/or placement of patients after initial treatment in the trauma casualty. Guided by a structured checklist, data were collected by reviewing trauma registers and patients' documents. The TRISS method was used to determine injury severity and descriptive statistics were used to present and describe the results. A preview of the survey results indicates that males are a high-risk category for trauma, particularly over weekends, during their nocturnal activities. More than two thirds of all patients sorted in the 16-35 year age group. Injuries to the limbs and head and neck regions accounted for the highest percentage of cases with assault or interpersonal violence a major cause in an estimated 70% of cases. More than 60% of a random sample of 163 patients had sustained serious injuries with an ISS between 16 and 75; the majority however had a survival probability (Ps) of > 50%. This paper describes the methodology and results of the survey in relation to a proposed long-term injury surveillance project. 'n Analise van 16 357 trauma-pasiënte gesien in 'n een-jaar periode in die trauma-ongevalle van 'n akademiese hospitaal in Johannesburg, is uitgevoer ten einde 'n profiel van beserings wat opgedoen is deur slagoffers, in die Johannesburg-area, te bepaal. 'n Retrospektiewe opname is gebruik om 'n omvattende trauma-morbiditeit en mortaliteitsprofiel saam te stel, en om basislyndata vir toekomstige vergelykings te genereer. Die fokus van die opname was gerig op frekwensie, verspreiding en kategorisering van beserings, die ernstigheidsgraad van beserings (ISS), asook die uitkoms en plasing van pasiënte na inisiële behandeling in die trauma-ongevalle. 'n Gestruktureerde kontrolelys is gebruik om data te versamel deur die evaluering van traumaregisters en dokumentasie van pasiënte. Die TRISS-metode is gebruik om te bepaal wat die ernstigheidsgraad van die beserings was. Verder is beskrywende statistiek gebruik om die data aan te bied en te beskryf. Die resultate van die opname dui aan dat mans in die hoërisiko-kategorie vir trauma val, veral tydens naweke en gedurende nagtelike aktiwiteite. Meer as tweederdes van alle pasiënte val in die 16- 35 jaar ouderdomsgroep. Beserings aan die ledemate, kop- en nekarea het in die meeste gevalle voorgekom. In ongeveer 70% van die gevalle was aanranding of interpersoonlike geweld die hoofoorsaak van hierdie beserings. Meer as 60% van 'n ewekansige steekproef van 163 pasiënte het ernstige beserings opgedoen, met 'n ISS van tussen 16 en 75. Die meerderheid het egter 'n oorlewingsmoontlikheid (Ps ) van > 50% gehad. Hierdie artikel beskryf die metodologie en resultate van die opname in die konteks van 'n voorgestelde projek vir die waarneming van langtermynbeserings. (Health SA Gesondheid: interdisciplinary research journal: 2003 8(3): 3-12

South African critical care nurses' views on end-of-life decision-making and practices.

BACKGROUND: Care of patients at the end-of-life (EOL) may be influenced by the experiences, attitudes and beliefs of nurses involved in their direct care. AIM: To investigate South African critical care nurses' experiences and perceptions of EOL care. DESIGN: Cross-sectional survey. METHODS: South African critical care nurses completed a modified version of the 'VENICE' survey tool. Data were collected concerning: attitudes towards EOL care; involvement in EOL decision-making; and beliefs about EOL practices. RESULTS: Of 149 surveys distributed, 100 were returned (response rate 67%). Seventy-six percent stated that they had had direct involvement in EOL care of patients, but a minority (29%) had participated in EOL decision-making processes. Whilst most nurses (86%) were committed to family involvement in EOL decisions, less than two thirds (62%) reported this as routine practice. When withdrawing treatment, around half (54%) of the respondents indicated they would decrease the inspired oxygen level to room air, and the majority (84%) recommended giving effective pain relief. Continued nutritional support (84%) and hydration (85%) were advocated, with most nurses (62%) indicating that they were against keeping patients deeply sedated. Most respondents (68%) felt patients should remain in intensive care at the end of life, with the majority (72%) supporting open-visiting, no restriction on number of family members visiting (70%), and the practising of religious or traditional cultural EOL rituals (93%). CONCLUSIONS: The involvement of Johannesburg critical nurses in EOL care discussions and decisions is infrequent despite their participation in care delivery and definite views about the process. RELEVANCE TO CLINICAL PRACTICE: Use of formal guidelines and education is recommended to increase the nurses' involvement in and their confidence in participating in EOL decisions. Educators, managers, senior nurses and other members of the multi-disciplinary team should collaborate to enable critical care nurses to become more involved in EOL care

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

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.</p

Barriers and facilitators to end-of-life care in the adult intensive care unit: A scoping review

Aim: To identify qualitative studies that describe the barriers and facilitators nurses perceive and experience when delivering end-of-life care in the Adult Intensive Care Unit. Design: The design was a scoping review that followed the Joanna Briggs Institute methodology. Methods: There were four selected databases searched electronically to identify published qualitative studies. Data extraction was with a standard data extraction tool and independently extracted by two reviewers. Results: In total, 20 qualitative studies were eligible for result extraction. The majority of studies (19; 95%) presented findings on the barriers to end-of-life care, and a few (11; 55%) focused on the facilitators of end-of-life care. The provision of adequate end-of-life care training and education for nurses, formulation of policies and guidelines in the ICU, and working with family members are vital measures to enhancing the quality of care patients and families receive at the end of life. No Patient or Public Contribution: In this study no patient and members of the public were involved. Only published existing literature was used, hence, no patient or public contribution was needed

Moral distress experienced by intensive care nurses

Background. Moral distress is experienced when nurses experience conflict while making an ethical decision. This is magnified when the decisions are about withholding or withdrawing life-sustaining treatment.Objective. To explore and describe nurses’ experiences of situations that involve end-of-life care and evoke moral distress in the intensive care units (ICUs) of two public tertiary-level hospitals in South Africa (SA), the personal consequences of these situations and the means employed to manage their distress. Methods. An exploratory, descriptive design was used. A short survey/interview guide was administered to registered and enrolled nurses (N=100) employed in the ICUs from two academic-affiliated, specialist public hospitals. Results. A total of 65 completed surveys were collected. Of these, 32 responses were judged not to be describing moral distress while 33 clearly described moral distress and were included and analysed by means of initial content analysis. The findings were presented in five major categories: (i) collegial incompetence or inexperience; (ii) resource constraints; (iii) end-of-life issues; (iv) lack of consultation, communication and negotiation; and (v) support. Conclusion. The study found that nurses experienced considerable moral distress. This is compounded in an environment where gender, professional and social status inhibit the nurses’ assertiveness, ‘voice’ and influence in the healthcare system. Parallels can be drawn between the microcosm of the ICU and the macrocosm of the SA social and ethical character

The effect of normal saline instillation on cardiorespiratory parameters in intubated cardiothoracic patients

Objective. The objective of this study was to describe the effect of normal saline instillation (NSI) on cardiorespiratory parameters in intubated cardiothoracic patients. Methods. A comparative design was employed to meet the study objectives. Simple random sampling was used to assign patients to study groups, namely a research group (non-NSI) and a control group (NSI). The data-capturing tool was based on the literature review. Descriptive and comparative statistics were employed to analyse the data. Findings were assessed according to p&lt;0.05.Results. Findings indicated that there were no statistically significant differences in heart rate, blood pressure, arterial partial pressure of oxygen (PaO2), arterial oxygen saturation as measured by blood gas analyser (SaO2) and serum bicarbonate level (HCO3 –) when NSI was used or not used during endotracheal suctioning (p=0.05). Statistically significant differences were found in pH and patient return rate to baseline arterial oxygen saturation as measured by pulse oximetry (SpO2) after 30 minutes of suctioning: 63.6% of patients in the NSI group failed to return to baseline SpO2 v. 37.5% of patients in the non-NSI group (χ2 p=0.035; Fisher’s exact p=0.048). There was a decrease in pH when NSI was used during suctioning. Although these differences were statistically significant, clinically they were not significant.Conclusion. It can be concluded that NSI had no effect on cardiorespiratory parameters in intubated cardiothoracic patients. Even though the patient population was at high risk of haemodynamic disturbance and hypoxia during this manoeuvre, there was no meaningful clinical effect; however, the sample size was too small to establish safetyÂ

Effectiveness of handover practices between emergency department and intensive care unit nurses

Background: Nurses from the emergency department (ED) and the intensive care unit (ICU) must interact during the handover procedure. Factors such as unit boundaries, the interaction between different specialities, patient acuities, and treatment adjustments generate specific negotiating and teamwork problems during the transition of patients from ED to ICU. Objective: This study aimed to describe the opinions of nurses regarding the effectiveness of handover practices between nurses in the ED and ICU in a major academic hospital in Gauteng province, South Africa. Method: An analytical cross-sectional survey design was used. Data were collected using a 16-item handover evaluation tool. It comprises two sections (1) biographical details and (2) 16 statements about handover quality divided into five constructs, namely information transfer, shared understanding, working atmosphere, overall handover quality, and circumstances of handover. Data analysis was done utilising descriptive and non-parametric statistics. Results: The majority (51.8%; n = 115) of the handovers occurred during the day. Out of 171 nurses, there were specialist practice emergency (19.2%; n = 33) and intensive care (28.0%; n = 48) nurses. There was statistical significance in information transfer between the ED and ICU nurses. (Me = 4.0, p < 0.05), compared to ICU nurses (Me = 3.0). Nurse specialist and non-specialist nurses' handovers differed statistically significantly on 12 of the 16 items on the rating scale, compared to 10 for non-specialist nurses' handovers. Conclusion: The study showed that ED and ICU nurses have significantly different requirements and expectations for handover procedures. In addition to completed documentation, subtle interpretations of the information provided and received also impact the need. The ED and ICU nurses would need to agree on the contents of a structured handover framework because different specialities and departments have varied expectations to achieve an effective handover