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Dissertations / Theses on the topic 'Critical care environment'
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1
Xie, Hui. "The sound environment in critical care." Thesis, University of Sheffield, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.555221.
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It has been widely accepted that noise levels in hospitals are typically higher than the guidelines. This research aims to systematically investigate the sound field in critical care environment, develop the prediction models, and explore the acoustic effects on patients and staff. The Critical Care Units at two local NHS hospitals have been selected for case studies. Three core categories with plenty of interactions were identified by means of grounded theory for the acoustic environment, namely 'time-dependant sounds', 'role-dependant people' and 'departmental-dependant space', and the improvement strategies are limited but possible. Through a series of acoustic measurement, a diffuse field could be approximately assumed in the single-bed and multi-bed wards. The sound levels measured in the wards for each night are in excess of the WHO guided values by at least 20d8A. For both wards and U-shaped long corridor, if the relevant simulation parameters were set up appropriately, the agreement between measured and simulated RT as well as SPL is satisfactory, suggesting the feasibility of computer simulation for such spaces. A database comprised of quadratic equations was established with a good accuracy (±2.5d8) to predict the sound propagation along the U-shaped long space applicable to various geometric sizes. An effective observation method was designed for noise behaviour in the healthcare environment. Amongst the observed noise sources, talking was identified with the largest number of occurrences, shortest interval and the longest duration, followed by the monitor's alarm. Lognormal distribution was determined as the most appropriate statistical distribution for noise behaviours. Finally, an agent-based acoustic model was developed to integrate noise behaviours with the acoustic parameters. It is capable of replicating the complex and dynamic acoustic environment (±2dBA) as well as conducting what-if analysis. Two noise maps were produced to determine the noise sensitive areas, which would be useful to assist the decision making upon noise actions.
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Chang, Catherina Ivette. "Relationship between personality hardiness and critical care nurses' perception of stress and coping in the critical care environment." FIU Digital Commons, 2000. http://digitalcommons.fiu.edu/etd/2107.
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The purpose of this study was to determine the relationship between critical care nurses' perception of stress, their ability to cope with stress, and the hardiness personality they possess while working in the critical care environment. A non-experimental, descriptive, correlational survey design was applied to a convenience sample of 50 registered nurses employed in the critical care units of a South Florida health care facility. The data collection methods included a demographic survey, the Perceived Stress Scale, the Health-Related Hardiness Scale, and the COPE inventory. The results of this study demonstrated that critical care nurses are able to cope effectively despite their perception of high levels of stress. This study also determined that critical care nurses uphold high personality hardiness characteristics. The demographic variables of gender, age, years of nursing experience, years at present job, and level of education also revealed statistical significance. Further research is recommended to identify the influence of other variables such as culture, work hours, and level of job satisfaction in the critical care nurses' coping with stress and hardiness personality. The identification of instruments that may be capable of measuring any relationships between those possible variables and the constructs of hardiness and coping in the domain of nursing are also advocated, particularly in the critical care nursing population.
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Kalogeropoulos, Dimitris. "An intelligent clinical information management support system for the critical care medical environment." Thesis, City University London, 1999. http://openaccess.city.ac.uk/7714/.
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Significant advances have been achieved in the fields of medical informatics and artificial intelligence in medicine in the past three decades and, having demonstrated an ability to support clinical decisions, knowledge-based systems are becoming increasingly ubiquitous in various clinical settings. Nonetheless, few systems have so far been successful in entering routine use. On the one hand, primarily due to methodological difficulties and with very few exceptions, developers have failed to show that pertinent systems are effective in improving patient care. On the other hand, support systems have not been sufficiently well integrated into the routine information processing activity of the clinical users. As a consequence, their clinical utility is disputed and constructive assessmenist further hindered. This thesis describes the development of an intelligent clinical information management support system designed to overcome these obstacles through the adoption of an integrated approach, geared toward the solution of the problems encountered in the acquisition, organisation, review and interpretation of the clinical decision supporting information utilised in the process of monitoring intensive care unit patients with acid-base balance disorders. The system was developed to support this activity incrementally, using the methods of object-oriented analysis, design and implementation, with the active participation of a clinical advisor who assessed the functional and ergonomic compatibility of the system with the supported activity and the integration of a previously validated prototype knowledge-based data interpretation system, which could not evaluated in the clinical setting for the reasons described above.
4
Adams, Bernardene Lucreshia. "The experiences of registered nurses' of their work environment in a critical care unit." Thesis, Nelson Mandela Metropolitan University, 2009. http://hdl.handle.net/10948/1057.
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Critical care nursing is a vital and significant part of health care provision to critically ill patients. It is a specialty area of nursing that requires registered nurses who are highly motivated, knowledgeable and skilled to provide optimal care to critically ill patients. These patients are nursed in a complex environment consisting of specialised equipment (such as ventilators, defibrillators, intravenous pumps, and cardiac monitors) that is not found in any other field of nursing. Collegial support and an adequate registered nurse: patient ratio is vital in critical care units in order to provide optimal quality care to critically ill patients. However, an understaffed work environment, the demands of critical care nursing and other work-related problems, such as conflict with physicians, inadequate remuneration packages and an increased workload can cause serious distress and dissatisfaction amongst registered nurses in this specific environment (Carayon & Gürses, 2005:287). The objectives of this study therefore are to explore and describe the experiences of registered nurses of their work environment in a critical care unit and to make recommendations that will assist registered nurses working in a critical care unit. A qualitative, explorative, descriptive and contextual research design will be utilised. Data will be collected by means of semi-structured interviews and analysed according to the framework provided by Tesch (in Cresswell, 2003:192). Purposive sampling will be used to select a sample of registered nurses working in a critical care environment. Guba’s model (in Krefting, 1991) will be utilised to verify data and to ensure trustworthiness of the study. Ethical considerations will be adhered to throughout the study. Once data has been analysed, recommendations will be made that will assist registered nurses working in a critical care unit.
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Pretorius, Ronel. "Positive practice environments in critical care units : a grounded theory / Ronel Pretorius." Thesis, North-West University, 2009. http://hdl.handle.net/10394/4005.
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INTRODUCTION AND AIM:
The current shortage of nurses is a concern shared by the healthcare industry globally. Whilst the reasons for these shortages are varied and complex, a key factor among them seem to involve an unhealthy work environment. The demanding nature of the critical care environment presents a challenge to many nursing professionals and it carries the risk of a high turn over rate due to the stress and intensity of the critical care environment. The critical care nurse is responsible for caring for the most ill patients in hospitals and the acute shortage of critical care nurses contributes to the intensity and pressures of this environment. Little evidence exists of research conducted to explore and describe the practice environment of the critical care nurse in South Africa. The main aim of this research study was to construct a theory for positive practice environments in critical care units in South Africa, grounded in the views and perceptions of critical care nurses working in the private hospital context. In recognition of the fact that a positive practice environment is considered to be the foundation for the successful recruitment and retention of nurses, it was clear that issues related to staff shortages will not be resolved unless the unhealthy work environment of nurses is adequately addressed.
RESEARCH DESIGN AND METHOD:
A constructivist grounded theory design was selected to address the inquiry at hand. The study was divided into two phases and pragmatic plurality allowed the use of both quantitative and qualitative data collection methods to explore, describe and contextualise the data in order to achieve the overall aim of the study. In phase one, a checklist developed by the researcher was used to describe the demographic profile of the critical care units (n=31) that participated in the study. The perceptions of critical care nurses (n=298) regarding their current practice environment was explored and decribed by using a valid and reliable instrument, the Practice Environment Scale of the Nursing Work Index (PES-NWI).
In phase two, the elements of a positive practice environment were explored and described by means of intensive interviews with critical care nurses (n=6) working in the critical care environment. Concepts related to the phenomenon under investigation were identified by means of an inductive analysis of the data through a coding process and memo-writing. One core conceptual category and six related categories emerged out of the data. In the final phase of the theoretical sampling of the literature, a set of conclusions relevant to the phenomenon under study was constructed. The conclusions deduced from the empirical findings in both phases of the research process were integrated with those derived from the literature review to provide the foundation from which the theory was constructed.
FINDINGS:
The findings from the first phase of the research process provided information about the context in which the participants operate and assisted in discovering concepts considered relevant to the phenomenon under investigation. A grounded theory depicting the core conceptual category of "being in controi" and its relation to the other six categories was constructed from the data in order to explain a positive practice environment for critical care units in the private healthcare sector in South Africa.Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2010.
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Yanni, Julie. "The Impact of Internationally Recruited Nurses on the Critical Care Environment : A Phenomenological Study." Thesis, University of Kent, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.499709.
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Pattison, Natalie A. "Cancer patients' care at the end of life in a critical care environment : perspectives of families, patients and practitioners." Thesis, Northumbria University, 2011. http://nrl.northumbria.ac.uk/1009/.
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Innovations in cancer care requiring intensive support, and improved cancer patient survival in and out of critical care, have led to greater numbers of cancer patients than ever accessing critical care. Of these, however, a fair proportion will die. Current research points to around one in six patients dying in general critical care units and even higher numbers for cancer patients. End-of-life care (EOLC) for critically ill patients is problematic and rarely addressed beyond satisfaction or chart review studies, while palliative care is an established domain in cancer. It is not known whether dying, critically ill cancer patients experience good EOLC. In the context of a cancer critical care unit, this thesis explores the provision of EOLC for cancer patients in a critical care unit. Exploring measures for comfort care and palliative principles of care helped identify what is important for patients and families, and what those measures meant for all participants. The diagnosis of cancer and how it impacts on EOLC provision for critically ill cancer patients was also explored from the perspective of patients, families, doctors and nurses. A Heideggerian phenomenological interview approach was undertaken, in order to gain personal experiences. Families of those patients who died after decisions to forgo life-sustaining treatment (DFLSTs) were interviewed. Patients who have experienced critical care were also interviewed, since patients‘ views about EOL care provision are very rarely explored. Doctors and nurses also contribute their vision for, and experiences of, EOL care in a cancer critical care unit. Thirty one interviews with 37 participants were carried out. Cancer prognosis together with critical illness prognosis contributed to difficulties in deciding to move to, and enact EOLC. The nursing voice in DFLSTs was minimal and their role in EOLC depended on experience and confidence. Achieving a good death was possible through caring activities that made best use of technology to prevent prolonged dying. EOLC was an emotive experience. Decision-making and EOLC could be difficult to separate out which, in turn, affects prospects for EOLC. A continuum of dying in cancer critical illness is presented with different participants‘ experiences along that continuum. Three main themes included: Dual Prognostication; The Meaning of Decision-Making; and Care Practices at EOL: Choreographing a Good Death with two organising themes: Thinking the Unthinkable and Involvement in Care. These themes outlined the essence of moving along a continuum toward patients‘ deaths and the impact that had on opportunities for care and a good death. Nurses could use the care of patients dying in critical care as an opportunity to develop specialist knowledge and lead in care, but this requires mastery and reconciliation of both technology and EOLC. This work builds on Seymour‘s (2001) theory of a negotiated and natural death related to achieving a good death in critical care. Trajectories of dying, part of Seymour‘s (2001) theory, are extrapolated on with reference to Glaser and Strauss (1965) and Lofland (1978)‘s theories on dying trajectories. Nursing theory is developed through examination of Falk Rafael‘s (1996) and Locsin‘s (1998) theories of empowered caring. Implications and propositions are presented for nursing and wider practice around EOL care for critically ill cancer patients.
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Willmore, Elizabeth Elouise. "Physician Behaviors, Nursing, and Other Obstacles in End-of-Life Care: Additional Critical Care Nurse Perceptions." BYU ScholarsArchive, 2020. https://scholarsarchive.byu.edu/etd/9061.
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Background: Critical Care Nurses (CCNs) frequently provide end of life (EOL) care in intensive care units (ICUs). Barriers to EOL care in ICUs exist and have been previously published, but qualitative reports from CCNs themselves remain scarce. Qualitative data exploring barriers faced during ICU EOL care may increase awareness of obstacles and help remove them. Objective: Excluding family experiences, what are the major themes recounted by CCNs when asked to share common obstacles experienced in providing ICU EOL care? Methods: Members of the American Association of Critical-Care Nurses were randomly surveyed and responses to a single qualitative question were used. Results: There were 104 participants who provided 146 responses reflecting EOL obstacles which were divided into 11 themes; 6 physician- related obstacles and 5 nursing-and-other related obstacles. Top three EOL ICU barrier themes were inadequate physician communication, physicians giving false hope and nursing-related obstacles. Conclusion: Poor physician communication is the main obstacle noted by CCNs during ICU EOL care followed by physicians giving false hope. Heavy patient workloads were also a major barrier in CCNs providing EOL care.
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John, Catharine M. "Evaluation of point of care testing versus central laboratory testing in the critical care environment of a district general hospital." Thesis, City University London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269293.
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Altman, Marian. "A Biobehavioral Approach to Examining Moral Distress in Critical Care Nurses." VCU Scholars Compass, 2017. https://scholarscompass.vcu.edu/etd/5148.
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Moral distress is a complex and challenging problem that may cause negative biopsycohosical and professional outcomes for critical care nurses. The purpose of this work was to explore the relationship between the ethical climate of the work environment and moral distress as experienced by critical care nurses; and to explore relationships among mediators of stress (nurse characteristics e.g. education (BSN, nonBSN), years certified as a critical care nurse, and tolerance of ambiguity) and their relationship with perceived stress, moral distress, health status and salivary alpha amylase. A descriptive correlational cross-sectional design was used for this pilot study of 100 critical care nurses working in adult intensive care units in one large academic medical center. Data were analyzed using descriptive statistics to characterize the sample and the model variables. Regression analysis using a stepwise regression model building technique was used to determine predictors of the study outcomes (moral distress, health status, and salivary alpha amylase). The findings demonstrate that the ethical characteristics of the work environment and perceived stress were predictive of moral distress, psychological/emotional outcomes and stress symptoms. Other variables thought to mediate these relationships were not significant. Future research is needed to find ways to prevent moral distress from occurring and to support nurses dealing with moral distress.
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Natafgi, Nabil M. "Improving care delivery in critical access hospitals: evaluating the quality environment and the 'critical' role of telemedicine on access and costs." Diss., University of Iowa, 2017. https://ir.uiowa.edu/etd/5577.
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Critical Access Hospitals (CAHs) – the predominant type of hospital operating in rural areas – play an integral role in the US healthcare system, providing care for over 7 million rural residents each year who might otherwise have no local access to urgent care or inpatient services. This dissertation examines three aspects of care delivery in CAHs – effectiveness, cost/efficiency, and access – each of which has separate implications for policy and practice.
The first study addresses effectiveness and evaluates the performance of CAHs on specific patient safety indicators compared to small Prospective Payment System (PPS) hospitals. A total of 35,674 discharges from 136 non-federal general hospitals with fewer than 50 beds were included in the analyses: 14,296 from 100 CAHs and 21,378 from 36 PPS hospitals. Outcome measures included six bivariate indicators of adverse events of surgical care that were developed from Agency for Healthcare Research and Quality Patient Safety Indicators. Multiple logistic regression models were developed to examine the relationship between hospital adverse events and CAH status. The results indicated that compared to PPS hospitals, CAHs are less likely to have any observed (unadjusted) adverse event on all six indicators, four of which are statistically significant. After adjusting for patient mix and hospital characteristics, CAHs perform better on three of the six indicators. Accounting for the number of discharges eliminated the differences between CAHs and PPS hospitals in the likelihood of adverse events across all indicators except one.
Tele-emergency (tele-ED) services can address several challenges facing emergency departments (EDs) in rural areas. The second study investigates access and characterizes the impact of a rural-ED-based telemedicine program on discharge disposition in terms of patient transfer, local hospital admission, and routine discharge. This study tests the hypothesis that telemedicine enhances access by allowing patients to receive care in the local community, and does so by looking at the probability of transfer and local admissions before and after telemedicine was implemented in CAHs. The results indicate that in the post-telemedicine period, patients were 38% less likely to be admitted to the local inpatient facility than to be routinely discharged [aOR=0.62, 95%CI=(0.57,0.67)] after adjusting for age, sex, race, time of visit, clinical diagnosis, CPT code, number of diagnoses, and admitting hospital.
The third study addresses cost and efficiency by modeling the financial implications of using the same telemedicine program to avoid transfers and estimating the costs and benefits associated with tele-ED implementation in CAHs. Analysis is based on 9,048 tele-ED encounters generated by the Avera eEmergency program in 85 rural hospitals across seven states between October 2009 and February 2014. For each non-transfer patient, physicians indicated whether the transfer was avoided because of tele-ED activation. The cost-benefit analysis is conducted from the hospital, patient, and societal perspectives, and includes technology costs, local hospital revenues, and patient-associated savings. The results show that 1,175 avoided transfers could be attributed to tele-ED. From a rural hospital perspective, tele-ED costs around $1,739 to avoid a single transfer but saves approximately $5,563 in avoided transportation and indirect patient costs. From a societal perspective, tele-ED results in a net savings of $3,823 per avoided transfer while accounting for tele-ED technology costs, hospital revenues, and patient-associated savings. This study highlights various stakeholder perspectives on the financial impact of tele-ED in avoiding patient transfers in rural EDs. Telemedicine has the potential to reduce the number of transfers of ED patients and generate some revenue for rural hospitals despite associated technology costs, while incurring substantial patient savings.
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Gray, C. J. "Electronic health record systems in a centralized computing services environment| critical success factors for implementation." Thesis, Robert Morris University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3628910.
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In 2009 the American Recovery and Reinvestment Act (ARRA) was signed into law. As part of ARRA, the HITECH Act set aside $29 billion in Medicare and Medicaid incentives for healthcare organizations. To collect these incentives, healthcare organizations must install an electronic health record (EHR) system and achieve meaningful use. Implementation of an EHR must be completed by 2015 in order to acquire any of the incentives available. Small medical practices consisting of one to five physicians are finding it easier to implement a cloud-based EHR system due to minimal upfront costs and no need for technical capabilities within the medical practice. This study was done using a modified Delphi technique developed by Roy Schmidt to find critical success factors for the implementation of electronic health record systems within a centralized computing services structure. For purposes of this study a centralized computing services structure was considered a cloud or cloud-based environment.
This study found that the top five critical success factors for the implementation were the following: (1) EHR Training – implementing a strong training / education process for EHR users; (2) Usability – practical application of EHR features in a real medical office setting; (3) Reliability – Specifically high levels of redundancy and system availability. If the system is down, patient safety is a risk, and that is an unacceptable norm; (4) Strong clinical representation in the project to ensure workflows, processes and education needs are met; (5) Support services such as deployment / implementation services, help desk, and online support. Of these five factors, four are actually related to usability of the system, and not necessarily strictly based on implementation. This leads us to believe that the success of an implementation is reliant upon user perception based on system usage.
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Dare, Ben. "Foundations of 'Ecological Reformation' : a critical study of Jürgen Moltmann's contributions towards a 'New Theological Architecture' for environment care." Thesis, Cardiff University, 2012. http://orca.cf.ac.uk/37723/.
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Jürgen Moltmann’s desire to see the relationship between humans and our natural environment improve is long-standing. In later years he called for a ‘new theological architecture’ to help facilitate an ‘ecological reformation’ of Christianity and society. While Moltmann did not claim to have created this new architecture, one of his work’s aims has clearly been to contribute towards it. To what extent has Moltmann been successful in this aim? Firstly, his doctrine of the Trinity provides the themes of love and relatedness which pervade and colour his whole project. These themes then interact with other key areas of Moltmann’s thought that inform this architecture: creation, God’s ongoing care and openness towards creation (largely pneumatology and christology), and eschatology. Each of these areas contribute to a theological architecture in which non-human creation, past, present, and future, is a full recipient of God’s uniting love and openness. Naturally this leads towards a consideration of the ecological reformation. Less positively, Moltmann’s discussion of God’s creating through self-restriction presents some problems for this architecture’s coherence, although Moltmann’s developing views on this do help provide a solution. Furthermore, analysis of the criticisms made by various commentators suggests that several debated areas are actually particularly productive for Moltmann’s contributions to the architecture. Other criticisms do highlight areas of concern and possible development, but do not present terminal problems. The potential for this architecture to address practice, not simply theory, increases through elements of Moltmann’s theological anthropology that challenge humanity’s behaviour. Those elements thus form a lens through which Moltmann’s wider contributions to the architecture more powerfully speak of the need for creation care. Therefore, while Moltmann’s contribution towards a new architecture for ecological reformation would be helped by certain modifications, nevertheless it is highly significant. Its wide scope makes it fertile for further contributions and development.
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Engwall, Marie. "En vårdande ljusmiljö inom intensivvård : Patienters upplevelser och effekter av en cyklisk belysningsintervention." Doctoral thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-11911.
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Det övergripande syftet med avhandlingen var att beskriva och undersöka patienters - vårdade inom intensivvård - upplevelser och effekter av en cyklisk belysningsintervention utifrån hälsa, välbefinnande och återhämtning. Metod: En intervention bestående av ett automatiskt styrt belysningssystem var installerat på ett intensivvårdsrum. Belysningsinterventionens mål var att efterlikna dagsljuset i styrka, kvalitet, och lokalisation. Ett ordinarie intensivvårdsrum fungerade som kontrollmiljö. I studie I eftersöktes i en systematisk litteratursammanställning tidigare forskningsresultat rörande cykliska belysningsinterventioner inom intensivvård. Belysningsmiljöerna i intervention- och kontrollmiljön bedömdes i studie I av besökare och i studie II av patienter samt jämfördes och analyserades statistiskt. Ljus och belysningsmätningar utfördes i både forsknings- och kontrollmiljön. I studie II undersöktes patienters upplevelser av den cykliska belysningsmiljön genom kvalitativa intervjuer vilka analyserade med innehållsanalys. I studie II mättes och jämfördes patienters sömn, dygnsrytm samt fysiologiska parametrar och analyserades statistiskt. I studie IV undersöktes och jämfördes patienternas självskattade återhämtning efter sex och tolv månader. Resultat: Cykliska belysningsinterventioner exponerade för vuxna patienter var få. Resultatet visade dock att interventioner med cykliskt ljus inom neonatal intensivvård kunde inverka positivt på förtidigt födda barns hälsa. Den cykliska interventionsmiljön bedömdes som mer trivsam och mätningar av belysningen utförda i interventionsmiljön visade på samstämmighet med europeiska rekommendationer. Belysningsnivåerna i kontrolmiljön var manuellt styrda och mätningarna visade på antingen för låga eller för höga belysningsnivåer under dagtid jämfört med europeiska rekommendationer. Patienterna bedömde den cykliska belysningsmiljön som starkare dagtid och under nattetid bedömdes belysningen i kontrolmiljön som mer varierande. Patienters individuella upplevelser av den cykliska belysningsinterventionen presenterades i fyra kategorier: en dynamisk belysningsmiljö, belysningens påverkan på patientens sömn, ljus/belysnings påverkan på dygnsrytm samt en lugnande belysning. Patienternas dygnsrytm stärktes inte av den cykliska belysningsmiljön under deras sista 24-timmarsperiod. Patienternas självrapporterade återhämtning efter intensivvård var bättre efter 12-månader efter utskrivning hos de som vårdats i interventionsmiljön. Slutsatser: Genom att studera de båda forskningsområdena vårdvetenskap och ljus/belysning tillsammans skapades ny kunskap till vårdvetenskapen. Trots svår sjukdom eller skada kunde patienterna bedöma och reflektera kring belysningsmiljön. Ämnesområdet lämpar sig väl för att undersökas med både kvantitativa och kvalitativa metoder.Aim: The overall aim of this thesis was to describe and evaluate patients’, who were cared for in the intensive care unit (ICU), experiences and effects concerning a cycled lighting intervention based on health, wellbeing and recovery. Methods: An automatically controlled cycled lighting intervention aimed to mimic natural light levels, quality and position throughout the day was evaluated. An ordinary lit room was used as a control. A multiple-method approach was used. In study I, there were three aspects: a systematic review of the previous research concerning cycled lighting interventions in the intensive care; visitor evaluations of the lighting environments in the intervention and ordinary room; and measurements of illuminance, luminance and irradiance in both conditions. In study II, the patients evaluated the lighting environment in the two rooms. Data were compared and analysed. Furthermore, patients’ experiences regarding the cycled lighting environment were investigated through qualitative interviews, which were subsequently analysed by content analysis. In study III, patients’ sleep, activity and physiological parameters were measured and compared. Study IV consisted of statistical analysis of a questionnaire concerning patients’ self-reported recovery six and 12 months after their ICU treatments. Results: The literature review on cycled lighting interventions in adult ICUs was rare but more common in the neonatal ICU (NICU). Findings showed that cycled lighting interventions improved health in preterm infants, but there were also non-significant results reported. The visitors reported the cycled lighting environment as more pleasant, and based on measurements, the lighting levels were at equivalent levels with European recommendations for hospitals. The lighting levels in the ordinary room were manually controlled and were reported as being either too low or too bright during the daytime. Patients evaluated the cycled lighting environment as brighter in daytime, and this was in coherence with the results from the measurements of illumination. Patients’ individual experiences concerning the cycled lighting environment were reported in four categories: a dynamic lighting environment, the impact of lighting on patients’ sleep, the impact of light/lighting on the circadian rhythm and the degree to which the lighting calmed them. Patients’ circadian rhythms were not further strengthened by the cycled lighting intervention during their final 24-period in the ICU. Twelve months after their ICU treatments, patients cared for in the intervention environment self-reported their recovery as significantly better than those who received treatment in the ordinary room. Conclusions: A multiple methodology was used to explore theresearch field from a wider perspective. Combining knowledge from both the lighting research field and caring science has brought new knowledge to both and especially to the practice of nursing. Despite their severe illnesses or injuries, patients were able to assess their experiences with the lighting environment and reflect on how the lighting was able to support their health. This thesis reports findings that indicate that environmental/lighting interventions may improvepatients’ health. Lighting interventions are harmless, safe, sustainable and, in comparison to technical and medical interventions, considerably cheaper. With this knowledge, we believe all vulnerable patients in the ICU should be surrounded by a lighting environment around the clock to support their health, wellbeing and recovery.
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O'Hara, Sullivan Susan. "Macrocognition in the Health Care Built Environment (m-HCBE): A Focused Ethnographic Study of 'Neighborhoods' in a Pediatric Intensive Care Unit: A Dissertation." eScholarship@UMMS, 2016. https://escholarship.umassmed.edu/gsn_diss/46.
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Objectives: The objectives of this research were to describe the interactions (formal and informal) in which macrocognitive functions occur and their location on a pediatric intensive care unit (PICU); describe challenges and facilitators of macrocognition using three constructs of space syntax (openness, connectivity, and visibility); and analyze the health care built environment (HCBE) using those constructs to explicate influences on macrocognition.
Background: In high reliability, complex industries, macrocognition is an approach to develop new knowledge among interprofessional team members. Although macrocognitive functions have been analyzed in multiple health care settings, the effect of the HCBE on those functions has not been directly studied. The theoretical framework, “Macrocognition in the Health Care Built Environment” (m-HCBE) addresses this relationship.
Methods: A focused ethnographic study was conducted, including observation and focus groups. Architectural drawing files used to create distance matrices and isovist field view analyses were compared to panoramic photographs and ethnographic data.
Results: Neighborhoods comprised of corner configurations with maximized visibility enhanced team interactions as well as observation of patients, offering the greatest opportunity for informal situated macrocognitive interactions (SMIs).
Conclusions: Results from this study support the intricate link between macrocognitive interactions and space syntax constructs within the HCBE. These findings help to advance the m-HCBE theory for improving physical space by designing new spaces or refining existing spaces, or for adapting IPT practices to maximize formal and informal SMI opportunities; this lays the groundwork for future research to improve safety and quality for patient and family care.
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Dolo, Lucy Mashishi. "Investigating the effect of an intervention on tracheal cuff pressure monitoring in the critical care environment of an academic hospital in Gauteng." Diss., University of Pretoria, 2015. http://hdl.handle.net/2263/53055.
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Tracheal cuff pressure monitoring plays a significant role in the care of patients in the critical care
environment. Most patients in critical care environment are intubated with cuffed tubes via the ore
or the naso-tracheal route, or a tracheostomy is performed. The purpose of the tracheal cuff is to
maintain a seal between the tube and the tracheal wall, to prevent volume loss and ensure
effective mechanical ventilation. Nurse practitioners in the critical care environment play a vital role
in monitoring tracheal cuff pressure, which is often neglected in clinical practice.
Purpose: To investigate the effect of an intervention on tracheal cuff pressure monitoring in the
critical care environment of an academic hospital in Gauteng.
Design and methods: A quantitative prospective non-experimental comparative design, with a
collaborative qualitative method. The study had a pre and post intervention phase to compare the
effect on an intervention.
Findings: The study findings during the pre-intervention phase revealed inconsistency in the
monitoring, night time monitoring poor and the found and the adjusted pressure documentation
poor. Most pressures found to be non-compliant and serious non-compliant. The post-intervention
results revealed an improvement in the night monitoring, but pressures were still found to be high.
The consistency in the frequency of monitoring remains poor. Recording of the found and adjusted
pressure had a small improvement.
Conclusion: Inconsistent cuff pressure monitoring is done in the critical care environment.
Comparing the continuous pressure monitoring, it shows that the frequency of monitoring need to
be re-looked. Continuous in-service training may have an effect on the practice and the use of
reminders can have an impact in the practice. Frequent clinical audits need to be conducted in
order to evaluate practice and have plans for improvement. Clinical relevance: If the practice of tracheal cuff pressure monitoring can be done according to
the revised guidelines, there might be an improved outcome of patients in the critical care
environment and reduced costs.Dissertation (MCur)--University of Pretoria, 2015.
Nursing Science
MCur
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Rippin, Allyn Sager. ""Challenging families": the roles of design and culture in nurse-family interactions in a high acuity intensive care unit." Thesis, Georgia Institute of Technology, 2011. http://hdl.handle.net/1853/43614.
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The trend towards patient-and family-centered care (PFCC) invites families of critically ill patients to participate more fully in the care and recovery of their loved ones through partnerships with the medical team and personalized care that respects the values, beliefs and experiences of the individual. In response to the growing needs of families, healthcare institutions are re-designing the way patient and family care is delivered in terms of policy, culture and the physical environment. Despite the many benefits that come with closer collaboration, nurses report that "challenging" families are a key source of workplace stress. This exploratory case study documents some of these challenges as perceived by staff nurses at Emory University Hospital's Neuro ICU while examining the role the built environment plays in shaping such perceptions. Through a series of ethnographic interviews and observational methodologies, the study identifies some of the challenges and benefits that come with balancing patient and family needs. Nurse strategies developed to reassert spatial and temporal control over work environments are also identified. The second phase of research compares communication patterns generated from two different ICUs to explore the link between unit design and the frequency and quality of nurse-family interactions. Findings suggest that space plays a role in moderating the degree of nurse exposure to the often unstructured and unpredictable aspects of family interactions. These encounters, set within a highly charged critical care setting, may contribute to these perceived challenges. Healthcare stands at an important moment of transition in which attitudes, behaviors and expectations are changing. Together these results reinforce the need for adequate tools, training and education to further support nurses in the transition to this new care culture.
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Levinsson, Agnes, and Lisa-Rebecka Willén. "Kommunikation som berör : En observationsstudie om sjuksköterskans kommunikation med närstående inne på patientrummet på IVA." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-20236.
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Patients in intensive care are often intubated, and therefore unable to speak, which leads to difficulties in communication. The ICU is a very stressful environment and can be experienced as foreign and frightening by both patients and their close ones. The ICU nurse’s caring responsibilities includes both the care of the critically ill patient and the support of relatives who are often in shock. This balance is not always straightforward, and acting professionally in both instances can lead to problems. The professional competence of an ICU nurse has been described as a calm surface, beneath which rages a conflict between medical and ethical issues. As such, communicating professionally with relatives is a challenge that rivals the nurse’s medical responsibilities.The aim of the study was to describe the significance of the nurse's communication with close relatives in the ICU patient room.The study was conducted using a qualitative and inductive approach. A non-participant, semi-structured, observational method was used. Seven observations were conducted.The results of the study are presented in five categories: to prioritise attention; be available for relatives; listen, inform, be sensitive and responsive; to value the meeting and to juxtapose between compassion and objectivity. We have found that the nurse possess the power to make a difference in how the relation between the nurse and close ones turns out and also that several factors can affect their relation.Program: Specialistsjuksköterskeutbildning med inriktning mot intensivvård
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Digné, Björn, and Per Heier. "Besides being bedside : Patientsäkerhet vid patientnära läkemedelshantering inom intensivvård." Thesis, Röda Korsets Högskola, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-664.
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Bakgrund: Patienter inom intensivvården sviktar oftast i flera organsystem. Miljön inom intensivvården är stressfull, högteknologisk och intensivvårdssjuksköterskan måste alltid finnas tillgänglig. Inom intensivvårdssjuksköterskans ansvarsområde ligger läkemedelshantering. Tidigare forskning har visat att frekvensen av feladministrerade läkemedel är högre inom intensivvården än övrig sjukvård, dock saknas det tidigare forskning om läkemedelshantering på vårdsal inom intensivvården. Syfte: Syftet med denna studie är att belysa intensivvårdssjuksköterskors erfarenheter av fördelar och risker med läkemedelshantering på vårdsal. Metod: En fokusgruppsintervju genomfördes på en intensivvårdsavdelning i Mellansverige och en kvalitativ innehållsanalys, inspirerad av Graneheim och Lundman, användes för att analysera materialet. Resultat: Distraktion, trängsel, bristande hygien och ett behov av att visa hänsyn till patienten gjorde att arbetsmiljön inte var optimal. Trots detta var intensivvårdssjuksköterskorna positiva till läkemedelshantering på vårdsal. Att hantera läkemedel bedside gav intensivvårds-sjuksköterskorna en överblick som de upplevde ökade patientsäkerheten. Deltagarna upplevde dock att det tog tid att vänja sig med detta. Slutsats: Resultatet visar att läkemedelshantering på vårdsal inte är helt enkelt, speciellt inte för den oerfarna intensivvårdssjuksköterskan. Med tiden vande sig intensivvårdssjuksköterskorna med arbetsmiljön. Det upplevdes då som en fördel, patientsäkerhetsmässigt, att bereda läkemedel på vårdsal. Detta då de ständigt kunde vara nära patienten, dock upplevde intensivvårdssjuksköterskorna att det fanns flera faktorer i arbetsmiljön som inte var optimala. Klinisk betydelse: Denna studie belyser fördelar och risker med läkemedelshantering på vårdsal. Studien kan vidare ligga till grund för förbättringsarbete inom patientsäkerhet och läkemedelshantering på berörd avdelning och vidare forskning i ämnet. Detta är något som saknas i dagsläget.Background: Patients in critical care often falters in multiple organ systems. The environment in critical care is stressful, high-tech and the critical care nurse must always be available. Within the critical care nurses responsibility lays medication management. Previous research has shown that the frequency of incorrectly administrated drugs is higher in critical care than other health care settings, however, there is no previous research on medication management at the bedside in intensive care. Aim: The aim of this study is to highlight critical nurses’ experiences of the benefits and risks of medication management bedside. Method: A focus group interview was conducted in an intensive care unit in Mid Sweden and a qualitative content analysis, inspired by Granheim and Lundman, was used to analyze the material. Results: Distraction, overcrowding, lack of hygiene and the need to show respect to the patient contributed to that the work environment was not optimal. Despite this, critical care nurses were in favor of medication management bedside. Preparing drugs at the bedside gave the critical care nurses an overview that they experienced increased patient safety. Although the participants felt that it took a while to get used to this. Conclusion: The results show that bedside medication management is not entirely easy, especially not for the novice critical care nurse. Over time, the critical care nurses got used to the work environment. Preparing drugs at the bedside was perceived as a benefit in terms of patient safety, this because they always could be close to the patient. However, the critical care nurses felt that there were several factors in the work environment that was not optimal. Clinical relevance: This study highlights the benefits and risks of medication management at the bedside. The study can form the basis for improvements in patient safety and medication management on the affected ward and also further research on the subject. This is something that is missing at this date.
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Månsson, Jonas, and Magnus Johansson. "Strukturerad vilostund på intensivvårdsavdelning : En observationsstudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-74661.
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Bakgrund: Intensivvårdspatientens sömn nattetid är fragmenterad och blir i stor utsträckning störd, vilket gör att en vila på dagen behövs; en strukturerad vilostund. För återhämtning och läkning av sjukdomstillstånd är det viktigt att patienten får den vila denne behöver. Sömnbrist och brist på vila leder till svårigheter att komma ur respirator, längre sårläkning och i slutändan längre vistelsetid på intensivvårdsavdelningen. En strukturerad vilostund är en avsatt tid på dagen där meningen är att intensivvårdspatienten ska vila, utan att bli störd mer än vad sjukdomstillståndet tillåter. Det finns främjande åtgärder som kan utföras för att ge intensivvårdspatienten en god vilostund. Syfte: Syftet är att observera den strukturerade vilostunden inom intensivvården, med hjälp av fyra frågeställningar. Metod: Studien är gjord på två olika intensivvårdsavdelningar, vilket har genererat 41 observationer. Designen är en prospektiv observationsstudie med kvantitativ ansats. Analysen tolkas med deskriptiv och analytisk statistik. Resultat: Resultatet visar att de främjande åtgärder som observerats inte görs i full utsträckning. Den strukturerade vilostunden blir störd bland annat av samtal i vårdrummet och ljud från övervakningsutrustning. Den strukturerade vilostunden störs i snitt 25 gånger och den längsta sammanhängande tid utan störningsmoment är i snitt tio minuter, dock observerades som mest 67 störningsmoment. Den längsta sammanhängande vilan uppmättes till 48 minuter och den minsta vilan till tre minuter. Slutsats: Den strukturerade vilostunden störs frekvent, trots att riktlinjer finns för en strukturerad vilostund. Då det är frekventa störningar innebär det att möjligheten för vilan blir för kort för att gynna återhämtning och därmed risk för förlängt intensivvårdsbehov.Background: Patients sleep in the intensive care units (ICU) is fragmented. There is a need for a daytime rest, quiet time, to help the patient heal and recover from critical illness. Sleep deprivation and lack of rest might lead to difficulties of extubation, prolonged healing of wounds and it may result in prolonged stay in the ICU. A quiet time is a period during the day, where the goal is patient rest, without any unnecessary interruptions. There are promotional actions that can be used to make the patients’ rest as good as possible. Aim: The aim of this study is to observe the structured daytime rest in ICU, with the help of four questions. Method: This study is done at two ICU’s in Sweden, which has generated 41 observations. The design is a prospective quantitative observational study with descriptive and analytic statistics. Result: The result shows that the promotional actions observed aren’t used to the full extention. The daytime rest is interrupted, amongst other things, by conversations in the IC-room and from alarms of the surveillance equipment. The daytime rest is disturbed 25 times in mean, and the longest coherent rest fort the patient is ten minutes in mean. The top number for disturbances during the daytime rest is 67 times. The longest coherent rest was 48 minutes and the shortest rest three minutes. Conclusion: The daytime rest is frequently being disturbed in spite of there being a structured daytime rest protocol. This leads to that the possibility for a rest to recover is to short to do so, which can lead to a prolonged stay at the ICU.
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Almerud, Sofia. "Vigilance & Invisibility : Care in technologically intense environments." Doctoral thesis, Växjö : Växjö University Press, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:vxu:diva-1506.
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Ligad, Mark Brian. "Environmental stressors affecting sleep in critically ill patients." Honors in the Major Thesis, University of Central Florida, 2008. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1105.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Nursing
Nursing
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Vinjwa, Nobuzwe. "A critical investigation of selected Cape and Transkei environment study programmes in junior primary schools." Thesis, Rhodes University, 1993. http://hdl.handle.net/10962/d1003363.
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The introduction of Environment Study (ES) into the Junior Primary (JP) phase of the school was to facilitate the young learners' development of a sense of place, time and social identity. ES is important in the JP phase because it introduces pupils to the world around them and the environmental issues that affect their lives. ES in the JP phase can also provide pupils with the basic knowledge for survival in a changing world. ES in the JP phase is primarily designed to aid the pupils' development of a sense of identity. As with geography, it is concerned with space, place and time; and these are the criteria that should be taken into consideration in developing the child's sense of identity. Implementation of ES is largely influenced by the expertise and experience of the teachers, which will, in turn, influence their interpretation of the ES syllabus. The goals of ES require teachers to be able to use a variety of teaching strategies and to develop and use a variety of teaching resources. This study investigates existing ES programmes in a number of selected schools in the Cape, DET and Transkei in order to establish the extent to which pupils' developing sense of time, place and social identity are taken into consideration. Observations and interviews were conducted to assess the current ES syllabi for the Cape, DET and Transkei schools in relation to Catling's (1987) criteria; and to evaluate existing ES programmes in the six selected schools in the Grahamstown, Umtata and Mqanduli districts to ascertain the extent to which they met Catling's criteria. The results reveal that in all the Education Departments' syllabi, pupils' needs to developing a sense of time, place and social identity, as suggested by Catling's (1987) criteria, were considered only to a limited extent. Even in the syllabi where these were developed, it was by mere coincidence. Secondly, the programmes in the different schools observed did not meet Catling's criteria sufficiently, because the teachers were ignorant of Catling's criteria. Conclusions are drawn and recommendations made for teachers' awareness of Catling's criteria to be promoted, so that teachers can apply these in their teaching of ES; and for both Cape and Transkei ES programmes in the JP phase to be revised.
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Meierhofer, Sophie Elizabeth. "White shark cage diving in South Africa: a critical assessment of South Africa's regulatory framework." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25050.
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'White Shark Cage Diving' (WSCD) enables tourists to experience a face-to-face encounter with wild sharks in the open water. In order to attract the animals close to the cages, tour operators often use chum, bait, or decoys, which interferes with the natural habits of marine wildlife. These practices have great potential to adversely impact animals and the marine environment, with unknown long-term consequences. Globally, South Africa has the most extensive WSCD industry. The management is based on a policy paper and regulations published in 2008 by the Minister of Environmental Affairs (a ministry which also included Tourism). This thesis discusses the question of whether South Africa's WSCD industry is appropriately regulated in the light of today's best practices. South Africa's regulatory framework will be compared to the management arrangements of other jurisdiction where WSCD takes place. The ultimate objective of this thesis is to determine whether the South Africa's WSCD regime strikes a sustainable balance between commercial interests and the need to protect this elusive creature.
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Peng, Niang-Huei. "An exploration of the relationship between stress physiological signals and stress behaviors in preterm infants during periods of environmental stress in the intensive care unit." Diss., St. Louis, Mo. : University of Missouri--St. Louis, 2008. http://etd.umsl.edu/r2801.
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Al, Abasey Nidham Gabbar T. "Reformist framework of the foreign investment environment in the post-conflict : critical appraisal of Iraq case." Thesis, Bangor University, 2014. https://research.bangor.ac.uk/portal/en/theses/reformist-framework-of-the-foreign-investment-environment-in-the-postconflict--critical-appraisal-of-iraq-case(292c8280-905c-4748-8c5b-66afb766e864).html.
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Imad, Fadel. "Green Relationship." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3465.
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Green Relationship is a design solution attempting to raise awareness toward the environment and reduce consumerism. Waste generation and pollution have become major concerns of many governments, municipalities, organizations and individuals around the world since they are affecting human wellbeing and the environment. As an MFA student with VCUQatar, I chose to use design to contribute in protecting the environment hoping to make a difference in life. The thesis includes a research and a design component. The research explores the recycling programs and facilities in Qatar, the governmental and private sector actions toward waste generation and collection, as well as precedent solutions applied around the world. Furthermore, it includes a survey on recycling to gather and analyze the community’s feed back in order to come up with a solution that aims to change people’s behavior toward waste generation and to promote green lifestyle. The design component defines the Green Relationship as the personal connection between the individual and the silent partner, “the environment.” It fulfills the basic survival needs, “food and water,” and the one and only independency need, “oxygen.” The elements of the Green Relationship are the projection of the generic relationships elements we know of through the theory of “Humimicing” that I introduce in my thesis. Humimicing is the design theory that mimics human innate attributes and behaviors to develop design concepts to be applied in different industries. Every element of the Green Relationship is visualized through a different design discipline similar to its nature. Therefore, interactive, product and critical designs are the mediums used to represent Green Communication, Care and Ethics respectively through public installation, experimentation and conceptual design definition. The thesis methodology, which is “Make it Personal,” concludes in creating the Green Relationship that aims to change the behavior of individuals and ultimately to reach out to the wider community. Under the maxim, “Green is not just a color; it is a Lifestyle,” the thesis promotes the use of design to inspire people, designers and manufacturers to consume less and generate less waste in order to save natural resources and the environment.
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Allen, Skyler D. "The Influence of Debris Cages on Critical Submergence of Vertical Intakes in Reservoirs." DigitalCommons@USU, 2008. https://digitalcommons.usu.edu/etd/120.
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This study quantifies the influence of debris cages on critical submergence at vertical intakes in reservoir configurations. Four model debris cages were constructed of light panel material. A vertical intake protruding one pipe diameter above the floor of a model reservoir was tested in six configurations: open intake pipe, a debris grate placed directly over the intake pipe, and debris cages representing widths of 1.5*d and 2*d and heights of 1.5*c and 2*c, where d is diameter of the intake and c is height of intake above reservoir floor. A selection of top grating configurations and a submerged raft configuration were also tested for comparison.
Testing of the model debris cages indicates that the roof or top grate of a debris cage dominates the influence a debris cage has on the reduction of critical submergence of air-core vortices. The side grates of a debris cage have some influence on the formation of vortices. The spacing of bars in the top grate has an influence on air-core vortex development.
The presence of a debris cage at vertical intakes in still-water reservoirs reduces the critical submergence required to avoid air-core vortices and completely eliminates the air-core vortex for cases where the water surface elevation remains above the top grate of the debris cage. The potential exists for designing debris cages to fulfill a secondary function of air-core vortex suppression.
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Ndeke, Eunice Ngina. "A critical review of the development of sustainability indicators for the City of Cape Town : a focus on environmental and socio-economic sustainability." Thesis, Stellenbosch : Stellenbosch University, 2011. http://hdl.handle.net/10019.1/18078.
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Thesis (MPhil)--Stellenbosch University, 2011.ENGLISH ABSTRACT: Sustainable development has gained great interest at global, national and local community levels. For instance, governments, civil societies, the commercial sector as well as local communities have responded to the agreed framework of UNCED known as Agenda 21, developed at the „Earth Summit‟ held at Rio de Janeiro in 1992, inter alia through the development of indicators aimed at monitoring and evaluating the achievement of sustainable development. As a result, different tools to measure the level of sustainability have been developed and applied in many cities globally. These include different types of indicators, namely environmental, social, and economic performance monitoring indicators, as well as combined indices. Since cities are dynamic complex open systems with interrelated social, economic and environmental systems, and sustainable development cannot be absolutely achieved, integrated sustainable development indicators that concurrently address social, economic and environmental dimensions are crucial to aid in monitoring sustainable development particularly in any given urban system. This study gives an overview of these indicators and indices. The South Africa government has acknowledged in both its National Framework for Sustainable Development of September 2006 and the Draft National Strategy for Sustainable Development and Action Plan of May 2010 that like other cities globally, cities in this country face similar challenges particularly due to urbanisation. In this study, the focus is on evaluating the sustainability challenges of the City of Cape Town and the role sustainability indicators could play in helping to achieve sustainable development objectives. This is supported by a review of the so called „sustainable cities‟ and in particular how the Cities of Seattle (USA), Santa Monica (USA) and Curitiba (Brazil) have tried to address urban challenges. To meet the study objective of recommending the type and a process of developing indicators that will aid in improving sustainability in the City of Cape Town, selected indicators and indexes developed globally, nationally and for other cities are critically reviewed. Selected policies, plans and indicators developed by the South African national government, the Western Cape provincial government, and the City of Cape Town are reviewed. The review aims at investigating whether the existing policies and indicators were useful in addressing sustainability challenges particularly in the City of Cape Town. The review focuses on the policy objectives to assess whether the policies contradicted or were supportive of each other, the existence or lack thereof of gaps in the policies, and whether local communities and other stakeholders were involved in decision making processes. The findings suggests that although sustainable development is addressed in the policy documents of all three spheres of government in South Africa, the implementation has not yet been effective – and the City of Cape Town is no exception based on published reports such as the State of Cape Town Report. On the basis of the lessons derived from the success stories of cities like Seattle, Santa Monica, and Curitiba towards achieving sustainability, several recommendations are suggested to assist the City of Cape Town in developing, implementing, and reporting on sustainability indicators.
AFRIKAANSE OPSOMMING: Op internasionale, nasionale asook plaaslike gemeenskapsvlakke het volhoubare ontwikkeling groot belangstelling gelok. In reaksie op die ooreengekome raamwerk van UNCED, Agenda 21, ontwikkel by die “Earth Summit” (Rio de Janeiro, 1992), is aanwysers gemik op die monitering en implementering van volhoubare ontwikkeling deur regerings, burgerlike samelewings, die kommersiële sektor asook plaaslike gemeenskappe ontwikkel. Dit het gelei tot die ontwikkeling en implementering van verskillende instrumente vir die meet van volhoubaarheid in verskeie stede wêreldwyd. Hierdie instrumente sluit in verskillende aanwysers, ondermeer omgewings-, sosiale-, ekonomiese- en prestasie aanwysers asook gekombineerde indekse. Omdat stede dinamies komplekse ope sisteme met interafhanklike sosiale, ekonomiese en omgewingssisteme is, en volhoubare ontwikkeling nie absoluut bereikbaar is nie, is geintegreerde volhoubare ontwikkelings aanwysers wat sosiale, ekonomiese en omgewings dimensies gelyktydig aanspreek van kritieke belang in die monitering van volhoubare ontwikkeling, spesifiek in enige gegewe stedelike sisteem. In beide sy nasionale raamwerk vir volhoubare ontwikkeling (Julie 2008) en nasionale strategie vir volhoubare ontwikkeling en Aksie plan (weergawe van 20 Mei 2010) het die Suid Afrikaanse regering erken dat plaaslike stede, soos ander wêreldwyd, dieselfde uitdagings in die gesig staar veral as gevolg van verstedeliking. Die fokus van hierdie studie was die evaluering van die volhoubaarheids-uitdagings van die Stad Kaapstad en die moontlike rol wat volhoubaarheids-aanwysers kan speel in ʼn poging om volhoubare ontwikkelings doelwitte te bereik. Hierdie word ondersteun deur ʼn oorsig van die sogenaamde “volhoubare stede” en spesifiek hoe stede soos Seattle (VSA), Santa Monica (VSA), en Curitiba (Brasilië) stedelike uitdagings probeer aanspreek het. Ten einde die studie doelwit aangaande die aanbeveling van die ontwikkelingsproses van aanwysers en indekse vir die verbetering van volhoubaarheid in die Stad Kaapstad te bereik, is verskeie internasionale, nasionale sowel as stedelike volhoubare ontwikkelings indekse krities geëvalueer. Geselekteerde beleid, planne en aanwysers wat deur die Suid Afrikaanse Nasionale regering, die Wes Kaapse provinsiale regering en die Stad Kaapstad ontwikkel is, is ondersoek. Die doel van hierdie evaluasie was om vas te stel of bestaande beleid en aanwysers nuttig is, in die aanspreek van volhoubaarheids-uitdagings spesifiek in die Stad Kaapstad. Die fokus van die evaluasie was op beleidsdoelwitte ten einde te bepaal of: verskeie beleid teenstrydigheid toon of andersins ondersteunend is, die bestaan of gebrek aan leemtes in beleid en of plaaslike gemeenskappe en of ander belange groepe in die besluitnemingsproses betrokke is. Die bevindinge dui daarop dat alhoewel volhoubare ontwikkeling in beleidsdokumente van al drie sfere van die Suid Afrikaanse regering aangespreek word, die implementering daarvan nog nie so doeltreffend is nie - en gebaseer op gepubliseerde verslae soos die stand van Kaapstad, is die Stad van Kaapstad nie ʼn uitsondering nie. Na aanleiding van lesse geleer uit die sukses verhale van stede soos Seattle, Santa Monica en Curitiba in die bereiking van volhoubare ontwikkeling is verskeie aanbevelings gemaak om die Stad Kaapstad by te staan in die ontwikkeling, implementering, en rapportering van volhoubaarheids-aanwysers.
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Wolford, Jane N. "Architectural contextualism in the twentieth century, with particular reference to the architects E. Fay Jones and John Carl Warnecke." Diss., Georgia Institute of Technology, 2005. http://hdl.handle.net/1853/7082.
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A study of the importance, elements and techniques of architectural contextualism. Contextual architecture is here defined as architecture that creates relationships with its specific site or its broader physical or visual environment. This study posits the comprehensive definition of architectural contextualism on multiple levels: denotatively, connotatively, historically, philosophically, and in its aspects of critical regionalism. American architects adept at the practice of architectural contextualism during the mid-twentieth century offer principles and techniques. These architects are John Carl Warnecke, E. Fay Jones, and George White and others. This research has yielded the systematic, comprehensive definition of contextualism, a set of metrics which can be used as a basis of design and aid in the evaluation of the degree to which a building or set of buildings and their landscape are contextually congruent.
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Mukanya, Ronald. "Perceiving sustainability and practicing community based rehabilitation : a critical examination of the Western Cape Rehabilitation Centre (WCRC) as a case study." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/20323.
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Thesis (MPhil)--Stellenbosch University, 2012.ENGLISH ABSTRACT: Problem Statement: From a sustainability point of view, hospitals offer their services without taking into consideration their impact on the environment, the interplay between various sectors, key elements of sustainable development and interconnectedness. This study represents an attempt to design a “virtual” green hospital facility that does more with fewer resources. Aims and Objectives: Contribute towards achieving sustainable and better quality healthcare services. To generate evidence and increase our understanding of the sustainability of hospital resource flows. Design a “virtual” green hospital. Research Method: The research approach consists of a comprehensive literature review, mixed with substantiated field research and interviews. The literature review provided an understanding, recommendations and interventions for the virtual project. These can be used to promote greater sustainability through WCRC’s healthcare system, energy efficiency and green hospital buildings. Interviews and questionnaires were used to collect the qualitative data. The interpretive technique was used to analyse the collected data. Consumption statistics of electricity, water and waste were used to collect the quantitative data. It was analysed using the green building rating tool. The rating tool awards points according to incorporated measures, and arrives at a total score after appropriate weighting. The green building rating tool was used to establish the rating of WCRC as it stands and what it could ideally be as a retrofit? The data was presented as demographic information in tables, charts and graphs, drawn from the collected data. Findings: The findings that emerged suggest that: a) green hospital buildings promote greater sustainability than the current modern healthcare hospital buildings at WCRC and retrofitting would promote greater sustainability; b) the majority of WCRC’s current healthcare provision is done in the conventional ‘business as usual approach’; c) the greatest weaknesses of the hospital is its heavy dependence (95% average) on nonrenewable energy sources of fuel, electricity and water; d) procurement isn’t focused in the bio-region; e) sustainability isn’t viewed as the cornerstone to influence policy; and f) the flow of resources gets conducted through socio-economic systems. Conclusion: The current design of the hospital needs to be retrofitted into a green building, which will promote greater sustainability. A higher rated green star building for WCRC would promote greater sustainability. Healthcare provision is done in the conventional ‘business as usual approach’. Therefore the healthcare system faces threats in the immediate future, which include the impact of climate change, over dependency on fossil fuels and increasing urban sprawl. A virtual green hospital is designed to reduce the overall impact of its built environment on human health and the natural environment by: • Efficiently using energy, water, and other resources; • Protecting occupant health and improving employee productivity; • Reducing waste, pollution and environmental degradation. Recommendations: In this sustainability criterion, a paradigm shift is required for WCRC hospital to go green and become sustainable. At a local scale WCRC needs to green the current hospital building by retrofitting. WCRC needs to energy switch from nonrenewables to sustainable renewable resources. Bioregional consumption and procurement needs to be practiced whilst establishing a local health movement to engage suppliers and focus on sustainability.
AFRIKAANSE OPSOMMING: Probleem stelling: Gesien van volhoubaarheids oogpunt, bied hospitale dienste aan sonder om te besin oor die impak op die omgeweing, die tussenspel tussen verskeie sektore, sleautel elemente van volhoubare ontwikkeling en die onderlinge aanknopings. Hierdie studie verteenwoordig ‘n poging om ‘n skyn groen hospitaal te ontwerp wat meer kan doen met minder hulpbronne. Oogmerk en Doelstellings: Om ‘n bydrae te lewer om ‘n volhoubare en beter kwaliteit gesondheidsdiens te bereik. Om bewyse te genereer en begrip aangaande die volhoubaarheid van hospitaal bronne vloei to verhoog/ Ontwerp van ‘n “skyn” groen hospitaal. Ondersoek Metode: Die benadering in die ondersoek bestaan uit ‘n omvattende literatuurstudie met ondersteunbare veld ondersoeke en onderhoude. Die literatuurstudie voorsien in die begrip, aanbevelings en tussentredes vir die skyn projek. Dit kan gebruik word om groter volhoubaarheid van die WKRS se gesondheidsisteem, energie effektiwiteit en groen hospitale te bevorder. Kwalitatiewe data was ingewin met behulp van onderhoude en vraelyste. Interpretasie was die tegniek wat gebruik was om data te analiseer. Verbruikstatistiek van elektrisiteit, water en afval was gebruik on kwantitatiewe data te kollekteer. Die analise daarvan was gedoen deur die gebruik van die groen gebou graderingsinstrument. Die graderingsinstrument ken punte toe volgens opgeneemde maatreëls en bepaal die finale gradering na gepaste afwegings. Die instrument was gebruik om die gradering van WKRS te bepaal soos dit is en wat die ideale terugbou sou wees. Die data word in tabelle en grafieke voorgelê soos wat dit verkry was van die gekollekteerde data. Bevindinge: Die bevindinge wat na vore gekom het dui aan dat: Groen hospitaal geboue bevorder groter volhoubaarheid dan die huidige moderne hospitaal geboue van WKRS en terugbouing sal groter volhoubaarheid bevorder. Die meerderheid van gesondheidsdiensvoorsiening deur WKRS geskied volgense die konvensionele benadering van “besigheid soos normal” Die grootste swakheid van die hospitaal is die swaar afhanklikheid van die hospitaal op nie-hernubare energie (95%) soos brandstof, elektrisiteit en water, Verkryging is nie gefokus op die bio-streek nie, Volhoubaarheid word nie beskou as die hoeksteen om belied te beinvloed nie en Die vloei van hulpbronne word herlei deur sosio-ekonomies sisteme. Sluiting: Die huidige ontwerp van die hospitaal moet terugverbou word na ‘n groen gebou wat groter volhoubaarheid sal bevorder. ‘n Hoër groenster bougradering vir WKRS sal groter volhoubaarheid bevorder. Voorsiening van gesondheidsdienste volgens die “besigheid soos normaal” benadering veroorsaak dat die gesondheids-sisteem bedreigiongs in die gesig staar soos die impak van klimaatsverandering, oorafhanklikheid van fosiel energie en verhoodge stadspreiding. Aanbevelings: Volgens die kriteria is ‘n paradigma verskuiwing nodig by WKRS om groen en volhoubaar te raak. Op ‘n plaaslike skaal is dit nodig vir WKRS om die huidige hospitaal terug te bou om groen te raak. Dit is nodig om energie veranderings te ondergaan van nie hernubare tot volhoubare, hernubare energie bronne. Die Biostreek verbruiking en verkryging moet gepraktiseer word terwyl plaaslike gesondheidsbewegings gevestig word om te onderhandel met verskaffers en te fokus op volhoubaarheid.
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Davies, Siân May. "The potential of a stratified ontology for developing materials in community-based coastal marine environmental education processes." Thesis, Rhodes University, 2009. http://hdl.handle.net/10962/d1003591.
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This study set out to explore the possibilities that the Critical Realist concept of a stratified ontology might have for environmental learning and materials development processes. This involved processes of ongoing contextual profiling; the use of picture-based resources and storytelling to support the engagement with the marine harvesting contexts of the villages of Hamburg and Ngqinisa, in the former Ciskei. At the heart of the study was the process of uncovering the empirical, the actual and the real in the context of a community of coastal marine harvesters whose lives and livelihoods are affected by poverty and a history of inequality, and more recently by issues such as HIV/AIDS. Their stories of existing practice changed as we engaged with picture-based narratives, gaining depth and focus in relation to sustainability issues. The learning processes associated with and emerging out of the research processes were enhanced through abductive use of metaphors and graphic illustrations, and through intra- and inter community exchanges, again using picture based narratives. As the study unfolded, the development of environmental education materials receded. Focus turned to how conceptual abstraction processes (of abduction (metaphor) and retroduction) and the stratified ontological framework allowed for learning across epistemological divides.
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Gilmore, Tim. "Evaluation of Various Inspiratory Times and Inflation Pressures During Airway Pressure Release Ventilation." Diss., NSUWorks, 2017. https://nsuworks.nova.edu/hpd_hs_stuetd/5.
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There are few recommendations on how best to apply certain modes of mechanical ventilation. The application of Airway Pressure Release Ventilation (APRV) includes strategic implementation of specific inspiratory times (I-times) and particular mean airway pressures (MAWP) neither of which is standardized. This study utilized a retrospective analysis of archived electronic health record data to evaluate the clinical outcomes of adult patients that had been placed on APRV for at least 8 hours. 68 adult subjects were evaluated as part of a convenient purposive sample. All outcomes of interest (surrogates) for short-term clinical outcomes to include the PaO2/FiO2 (P/F) ratio, Oxygen Index and Oxygen Saturation Index (OI; OSI), and Modified Sequential Organ Failure Assessment (MSOFA) scores showed improvement after at least 8 hours on APRV. Most notably, there was significant improvement in P/F ratio (p = .012) and OSI (p = .000). Results of regression analysis showed P low as a statistically significant negative predictor of pre-APRV P/F ratio with a higher initial P low coinciding with a lower P/F ratio. The regression analysis also showed MAWP as a significant positive predictor of post-APRV OSI and P high and P low as significant negative predictors of post-APRV MSOFA scores. In summary, it was found that settings for P high, Plow, and T low in addition to overall MAWP and Body Mass Index (BMI) had significant correlation to impact at least one of the short-term clinical outcomes measured.
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Moola, Shehnaaz. "Facilitating conscious awareness among critical care nurses." Thesis, 2004. http://hdl.handle.net/10500/2549.
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Critical care nurses experience stressful situations in their daily working environments. The question arises for nurses: are there adequate support systems in the critical care environment and what are critical care nurses doing to mantain their own health and well-being. Facilitating conscious awareness among critical care nurses could enhance their resiliency and their hardiness, strengthening their coping capacities in stressful working situations. The contextual framework adopted for this research was the Neuman Systems Model. A qualitative research approach (exploratory, descriptive and contextual) was used to explore and describe the stress experienced by critical care nurses. Focus group interviews were conducted with critical care nurses and individual interviews with nurse managers. The results revealed their perceptions and experiences about the effects of stress in the critical care environment, as well as some of their coping strategies.
Raising critical care nurses' levels of conscious awareness about their coping strategies with stressful events in their daily working lives, could enhance their resiliency and hardiness, enabling them to continue working effectively in stressful environments. This could enhance the general well-being of individual critical care nurses, the nursing care rendered to critically ill patients, and save money for the health care services by reducing turnover rates among critical care nurses.Health Studies
D.Litt. et Phil. (Health Studies)
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"Navigating the Patient Room: Critical Care Nurses' Interaction with the Designed Physical Environment." Doctoral diss., 2017. http://hdl.handle.net/2286/R.I.46309.
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abstract: The physical environment influences the physiology, psychology, and the societal interactions of those who experience it. The environment can also influence human behavior. Critical care nurses are in constant interaction with the physical environment surrounding their patients. High acuity ICU patients are vulnerable and at risk for harm, infection, and poor outcomes while the physical and cognitive workload of nurses presents a demanding and continuous challenge.
The goal of this qualitative study was to explore and understand the way critical care nurses navigate within the patient room and interact with its features. The study of critical care nurses interacting with the patient room environment was conducted in five critical care units at three tertiary care institutions in the Eastern United States, along with another unit in the pilot study at a community hospital in the Southwest United States. Nurses were observed in their typical work environment as they performed normal tasks and patient care activities for entire day and night shifts. The study involved ethnographic field observations, individual semi-structured participant interviews, and examination of photographs and floor plans.
The exploratory study resulted in a comprehensive model for nurse navigation that includes both cognitive and action components, along with a conceptual framework for nurse behavioral activity. Repetitive patterns of nurse movement were identified and named. The findings produced recommendations for nurses’ effective use of space and architectural design of ICU patient rooms to improve patient outcomes.Dissertation/Thesis
Doctoral Dissertation Nursing and Healthcare Innovation 2017
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Hyde, Elizabeth Maria Charlotta. "The knowledge of critical care nurses regarding legal liability issues." Diss., 2006. http://upetd.up.ac.za/thesis/available/etd-10152007-123802.
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Chauke, Vumbhoni. "Critical analysis of the law on duty of care to the environment in South Africa :challenges and prospects." Thesis, 2017. http://hdl.handle.net/10386/1903.
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Thesis (LLM.) -- University of Limpopo, 2017.Considering that South Africa is part of the world initiatives to ensure maximum protection of the environment for the sake of the present and future generations, if the environment is abused or degraded, there is need to sanction perpetrators accordingly. Reasonable measures should be taken to prevent harm from occurring to the environment or those harms that cannot reasonably be avoided or stopped, be minimized and steps taken to rectify such harm to the environment. Environmental care and management is principally recognised and regulated by the National Environmental Management Act 107 of 1998. This framework imposes a general duty of care for the environment (that is, every person has the duty to avoid pollution and environmental degradation). Both implementers and enforcers rely on this duty when enforcing environmental obligations. The duty of care has a retrospective effect, meaning that it is imposed on anyone who causes, has caused or may cause significant pollution or degradation to the environment. This study highlights the consequences for violating the duty of care as enshrined in NEMA particularly by people who are destroying the environment in the name of development. It argues for stringent implementation and enforcement mechanisms in order to bring perpetrators to justice. The study further deals with comparative analysis between South Africa, Australia and England where lessons are derived to help South Africa better its environmental laws and policies to ensure maximum protection of the environment.
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De, Kock Juliana. "A collaborative approach towards enhancing synergy in a critical care unit in Gauteng." Thesis, 2013. http://hdl.handle.net/10500/13368.
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In today’s world healthcare all over the world is profoundly challenged by rapid
technological advancements, violence, terrorism, diverse cultures, proliferating chronic
diseases, and the worst nursing shortage. In addition to these complex and daunting
challenges healthcare continue to focus the attention on hospitals to review and modify
the way care is delivered to patients. As key role players and consistent members of the
multidisciplinary team critical care nurses are uniquely positioned to modify and review
the quality of patient care through synergy between the patients’ needs, the nurses’
competencies, and the critical care environment.
A collaborative approach towards enhancing synergy in a CCU was undertaken in a
CCU in a private hospital in Gauteng. The study was guided by the American
Association for Critical Care Nurses Synergy Model for Patient Care and conducted
within the critical social theory paradigm. The nature of the research was descriptive,
explorative and contextual and both qualitative and quantitative approaches were used.
Action research cycles were followed to assess existing synergy between the patients’
needs, the nurses’ competencies and the characteristics of the environment in the CCU.
An action plan was formulated and implemented towards enhancing synergy in the
CCU. The implemented plan was adjusted based on observations and reflections
following each of the five cycles of the projectHealth Studies
D. Litt. et Phil. (Health Studies)
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Rosinhas, Ana Sofia Novais. "Ambiente da prática clínica dos enfermeiros: estudo exploratório realizado num serviço de medicina intensiva da região norte de Portugal." Master's thesis, 2020. http://hdl.handle.net/1822/67323.
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Dissertação de mestrado em Enfermagem da Pessoa em Situação CríticaIntrodução: O ambiente onde a prática clínica de enfermagem se desenvolve é um dos principais indicadores da qualidade em saúde e da qualidade dos cuidados de enfermagem, não obstante da importância que assume para as organizações. Em contextos de Medicina Intensiva, nomeadamente em Serviços de Cuidados Intensivos, caracterizados por serem ambientes de trabalho altamente complexos e exigentes, os enfermeiros assumem um papel importante como prestadores e gestores de cuidados quando se pretende o alcance de elevados padrões da qualidade dos cuidados. Tais ambientes têm um impacto significativo na saúde ocupacional e bem-estar dos enfermeiros e na segurança e qualidade dos cuidados prestados à pessoa em situação crítica, considerando que ambientes da prática pobres estão associados a resultados negativos para os profissionais, tais como burnout, insatisfação no trabalho, maior absentismo e menor comprometimento com a profissão. A ambientes desfavoráveis à prática de enfermagem são, também, atribuídos a diminuição da qualidade dos cuidados prestados, maior taxa de altas precoces e maior insatisfação da pessoa com os cuidados de enfermagem. Objetivo: Caracterizar o ambiente da prática clínica dos enfermeiros num Serviço de Medicina Intensiva. Metodologia: Trata-se de um estudo descritivo, exploratório, correlacional e transversal, com uma abordagem quantitativa, envolvendo 70 enfermeiros de um Serviço de Medicina Intensiva de um Hospital Universitário do Norte de Portugal. A colheita de dados foi efetuada através da aplicação de um questionário sociodemográfico e do instrumento Practice Environment Scale of Nursing Work Index (PES-NWI). Foram cumpridos os pressupostos éticos inerentes a uma investigação científica. Os dados obtidos, foram tratados e analisados através de estatística descritiva e inferencial com recurso ao SPSS (versão 25). Resultados: Os enfermeiros do Serviço de Medicina Intensiva em estudo consideram o ambiente da prática clínica como misto (média global de 2.32). As dimensões “Fundamentos de enfermagem para a qualidade dos cuidados” (2.66) e “Relações colegiais entre médicos e enfermeiros” (2.51), obtiveram as médias mais elevadas, sendo consideradas favoráveis. Ao invés, as dimensões “Participação dos enfermeiros nos assuntos do Hospital” (1.95), “Capacidade de gestão, liderança e suporte aos enfermeiros” (2.25) e “Adequação de recursos humanos e de materiais” (2.24), obtiveram médias inferiores a 2.50, tendo sido consideradas desfavoráveis. Os itens da totalidade do instrumento com média superior e inferior de concordância dos enfermeiros com os ambientes de trabalho foram o “Trabalhase com enfermeiros competentes a nível clínico” e “Existe oportunidade dos enfermeiros participarem nas decisões de política interna”, respetivamente. A dimensão “Capacidade de gestão, liderança e suporte aos enfermeiros” apresentou uma forte correlação significativa com a dimensão “Participação dos enfermeiros nas políticas do hospital”. A “área de formação avançada” apresentou uma relação estatisticamente significativa com as dimensões “Relações colegiais entre médicos e enfermeiros”, “Participação dos enfermeiros nas políticas do hospital” e “Capacidade de gestão, liderança e suporte dos enfermeiros”. A “categoria profissional” apresentou uma relação estatisticamente significativa com a “Adequação de recursos humanos e de materiais”. A “opção pela mesma profissão (enfermeiro)” apresentou relação estatisticamente significativa com a “Participação dos enfermeiros nas políticas do hospital”. Conclusão: Ambientes da prática profissional dos enfermeiros favoráveis promovem a sua valorização, o seu compromisso e motivação para o exercício da profissão, a sua participação mais efetiva na tomada de decisão ao nível estratégico e operacional e uma liderança de enfermagem mais efetiva e com maior reconhecimento por parte da equipa multiprofissional. Pensa-se que os resultados deste estudo podem contribuir para melhorar a qualidade e a segurança dos cuidados, ajudando a encontrar estratégias capazes de aumentar a satisfação e motivação profissional dos enfermeiros. Ao destacar-se as áreas sensíveis dos ambientes da prática clínica de enfermagem em Serviços de Medicina Intensiva pode-se contribuir para a obtenção de resultados positivos para a prática profissional dos enfermeiros, para as pessoas enquanto beneficiárias dos cuidados prestados e para a concretização dos objetivos das organizações.
Introduction: The practice work environment of nurses is one of the main indicators of quality in healthcare and in the quality of care given by nurses, non-regardless, the importance it assumes for the organizations. In Intensive Medicine Services, especially in Intensive Care Units, characterized for being complex and high demanding environments, nurses assume a very important role in the care given, when high standards of care are expected. Such environments have a significant impact on the occupational health and wellbeing of nurses and in the safety and quality of care of critically ill patients, as poor work environments are associated with negative outcomes for nurses, such as burnout, job dissatisfaction, increased absenteeism and decreased work engagement. To poor nurse’s work environments are, also, associated lower-quality care, increased number of patients not prepared for discharge and increased patient dissatisfaction with care given by nurses. Objectives: To characterize the practice work environment of nurses in an Intensive Medicine Service. Methodology: This is a descriptive, exploratory, correlational and cross-sectional study with a quantitative approach, involving 70 nurses from an Intensive Medicine Service of a University Hospital in Northern Portugal. Data was collected through the application of a sociodemographic questionnaire and the Practice Environment Scale of the Nursing Work Index (PES – NWI) to nurses. Ethical procedures were ensured. Data was analysed using descriptive and inferential statistics. Results: Nurses from the Intensive Medicine Service perceived their practice work environment as mixed (overall mean of 2.32). The dimensions “Nursing foundations for quality of care” (2.66) and “Collegial Nurse-Physician relations” (2.51), were considered as favourable, as their overall mean was greater than 2.50 and the dimensions “Nurse participation in hospital affairs” (1.95), “Nurse manager ability, leadership and support of nurses” (2.25) and “Staffing and resource adequacy” (2.24) were considered as unfavourable with an overall mean lower than 2.50. The items of the entire instrument with higher and lower level of nurses’ agreement with practice environment were “Working with nurses who are clinically competent” and “Opportunity of nurses to participate policy decisions”, respectively. The dimension “Nurse manager ability, leadership and support of nurses” showed a strong correlation with the dimension “Nurse participation in hospital affairs”. The “Advanced training skills” of nurses in critical care field presented a statistically significant relation with the dimensions “Collegial Nurse-Physician relations”, “Nurse participation in hospital affairs” and “Nurse manager ability, leadership and support of nurses”. The “Nurse professional category” showed a statistically significant relation with the “Staffing and resource adequacy”. The “Option for the same profession (Nurse)” showed a statistically significant relation with the “Nurse participation in hospital affairs”. Conclusion: Favourable nurses’ professional practice environments promotes their appreciation, commitment and motivation to nursing practice, their more effective participation in decision-making process at strategic and operational levels and a strong and more effective nursing leadership, with greater recognition from the multiprofessional team. It is believed that the results of this study can contribute to improve the quality and safety of care, helping to find strategies capable of increasing nurses' satisfaction and professional motivation. By highlighting the sensitive areas of the clinical nursing practice environments in Intensive Care Services, one can contribute to obtain positive results for the professional practice of nurses, for people as beneficiaries of the care provided and for the achievement of organizations’ goals.
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Van, Graan Anna Catharina. "Clinical judgement in nursing : a teaching-learning strategy for South African undergraduate nursing students / Anna Catharina van Graan." Thesis, 2014. http://hdl.handle.net/10394/15686.
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Recent reforms in the South African health care and educational system were founded in the ideal that the country would produce independent, critical thinkers. Nurses need to cope with diversity in a more creative way, defining their role in a complex, uncertain, rapidly changing health care environment. Learning facilitators are held accountable for finding adequate learning experiences to prepare nursing students for such practice demands so that newly qualified nurses do meet expectations for entry level clinical judgement ability. Quality clinical judgement is therefore imperative as an identified characteristic of newly qualified professional nurses.
There is a scarceness of information on the concept of clinical judgement especially within the South African nursing environment. Relevant information in this regard can assist in clarifying the meaning, which will facilitate a common understanding of the concept within the clinical nursing environment. This in turn can lead to the formulation of a teaching-learning strategy to facilitate clinical judgement in undergraduate nursing students, which would be of benefit in the nursing care environment.
The objective of this study was addressed in three phases. The first phase of this research analysed the concept of clinical judgement through various data sources and a review of literature to clarify the meaning and facilitate a common understanding through identification of the characteristics and to develop a connotative (theoretical) definition of the concept. The second phase of the research investigated professional nurses‟ understanding of the meaning of clinical judgement, as well as the factors that influence the development of clinical judgement within the nursing environment. During the third phase a conceptual framework for an enabling teaching-learning environment was constructed from a modern day constructivist approach to facilitate clinical judgement. The section included a description and diagrammatic presentation of the framework. The conceptual framework formed the scientific basis from which a teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African nursing environment was synthesised.
A qualitative design was used for the study. During the first phase (manuscript 1) an explorative, descriptive qualitative design was used to discover the complexity and meaning of the phenomenon. Multiple data sources and search engines were consulted for the time frame 1982-2013. An extensive concept analysis resulted in a theoretical definition of the concept „clinical judgement‟, a complex cognitive skill to evaluate patient treatment alternatives within the clinical nursing environment. The second phase (manuscript 2) is qualitative in nature and explored professional nurses‟ understanding of clinical judgement, as well as the factors influencing the development of clinical judgement in undergraduate nursing students.
The findings emphasised clinical judgement as skill within the nursing environment. This assisted in the development of teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African Nursing environment as the third phase (manuscript 3). Such an environment should impact positively to promotion of autonomous and accountable nursing care.PhD (Nursing), North-West University, Potchefstroom Campus, 2015
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Martin, Sanne Henninger. "The relationship between nurses' environmental and psychological empowerment and psychological strain in critical care work environments." 2007. http://www.lib.ncsu.edu/theses/available/etd-07112007-171151/unrestricted/etd.pdf.
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Guirardello, Edinêis de Brito. "Factors in the critical care and medical-surgical environments that increase requirements for directed attention." 1993. http://catalog.hathitrust.org/api/volumes/oclc/31095564.html.
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Thesis (M.S.)--University of Wisconsin-Madison, 1993.Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 36-38).
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"Critical Communication: Observing How ICU Environments Impact Nurse Communication." Master's thesis, 2011. http://hdl.handle.net/2286/R.I.9187.
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abstract: The goal of this research was to contribute to the understanding of how the physical design of Intensive Care Unit (ICU) environments may be improved to enhance nursing communication, and in turn, the quality and safety of patient outcomes. This study was guided by two research questions: (1) What are the major characteristics of nurse communication in a hybrid ICU nurse station design? (2) What are the factors in the built environment that enhance or hinder nurse communication in a hybrid ICU nurse station design? The research design was exploratory and qualitative. Observations were conducted in two ICUs with hybrid nurse station layouts. Participant observation was used to systematically observe and document nurse communication and the physical attributes of the ICU nurse work environment that affect communication. Literature, observations, and information regarding staffing and design about the selected ICUs were analyzed for the generation of concepts and the exploration of significant themes. Results show that nurse interactions with other staff members varied within the different zones of the ICU pod. A biaxial map illustrates four key types of core nurse communication interactions: At ease, On guard, In motion, and On the edge. The quadrants representing barriers to nurse communication are On guard and On the edge, and included interactions with other staff members in the pod. The quadrants representing facilitators to nurse communication are At ease and In motion. The hybrid nurse station layout supported nurse-nurse communication, but not communication interactions with other staff members present on the pod. The results provide a broad understanding of how nurse communication is affected by the environment in which nurses work, and allows for the emergence of design opportunities to enhance nurse communication.Dissertation/Thesis
M.S.D. Design 2011
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"Understanding Adaptive Behaviors in Complex Clinical Environments." Doctoral diss., 2012. http://hdl.handle.net/2286/R.I.15044.
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abstract: Critical care environments are complex in nature. Fluctuating team dynamics and the plethora of technology and equipment create unforeseen demands on clinicians. Such environments become chaotic very quickly due to the chronic exposure to unpredictable clusters of events. In order to cope with this complexity, clinicians tend to develop ad-hoc adaptations to function in an effective manner. It is these adaptations or "deviations" from expected behaviors that provide insight into the processes that shape the overall behavior of the complex system. The research described in this manuscript examines the cognitive basis of clinicians' adaptive mechanisms and presents a methodology for studying the same. Examining interactions in complex systems is difficult due to the disassociation between the nature of the environment and the tools available to analyze underlying processes. In this work, the use of a mixed methodology framework to study trauma critical care, a complex environment, is presented. The hybrid framework supplements existing methods of data collection (qualitative observations) with quantitative methods (use of electronic tags) to capture activities in the complex system. Quantitative models of activities (using Hidden Markov Modeling) and theoretical models of deviations were developed to support this mixed methodology framework. The quantitative activity models developed were tested with a set of fifteen simulated activities that represent workflow in trauma care. A mean recognition rate of 87.5% was obtained in automatically recognizing activities. Theoretical models, on the other hand, were developed using field observations of 30 trauma cases. The analysis of the classification schema (with substantial inter-rater reliability) and 161 deviations identified shows that expertise and role played by the clinician in the trauma team influences the nature of deviations made (p<0.01). The results shows that while expert clinicians deviate to innovate, deviations of novices often result in errors. Experts' flexibility and adaptiveness allow their deviations to generate innovative ideas, in particular when dynamic adjustments are required in complex situations. The findings suggest that while adherence to protocols and standards is important for novice practitioners to reduce medical errors and ensure patient safety, there is strong need for training novices in coping with complex situations as well.Dissertation/Thesis
Ph.D. Biomedical Informatics 2012
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Penney, Wendy University of Ballarat. "A critical ethnographic study of older people participating in their health care in acute hospital environments." 2005. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/12705.
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"While consumer participation is the focus of 21st century health policy, little is known about this concept from the perspectives of people who require acute hospital services. [...]This project set out to explore older people's perspective of participating in their care. Adopting critical ethnographic method, field work included observation of the inpatient experience. Following discharge home people were interviewed about their experiences including what helped and what hindered participation in their care. Similarly nurses involved in [...] a hospital experience were invited to be involved in individual and focus group discussions aimed at defining how they believed they facilitated people to participate as well as barriers that prevent this style of care."Doctor of Philosophy
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Penney, Wendy. "A critical ethnographic study of older people participating in their health care in acute hospital environments." 2005. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/15381.
Full textAbstract:
"While consumer participation is the focus of 21st century health policy, little is known about this concept from the perspectives of people who require acute hospital services. [...]This project set out to explore older people's perspective of participating in their care. Adopting critical ethnographic method, field work included observation of the inpatient experience. Following discharge home people were interviewed about their experiences including what helped and what hindered participation in their care. Similarly nurses involved in [...] a hospital experience were invited to be involved in individual and focus group discussions aimed at defining how they believed they facilitated people to participate as well as barriers that prevent this style of care."Doctor of Philosophy
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Luckett, Sidney. "Critical systematic engagements with rural development and nature conservation organizations." Thesis, 2004. http://hdl.handle.net/10413/2984.
Full textAbstract:
This collection of papers represents the author's maturing reflection on systemic engagements with three different organizations within the latter half of the first decade in post-Apartheid South Africa. The first two papers deal with two different systemic engagements: the first with a rural community development organization in a rural area of KwaZulu-Natal south of Durban and the second with the implementation of a district health system by a provincial health authority, also in KwaZulu-Natal. The last three are concerned with the theoretical and practical aspects of a single critical systems intervention (CSI) for policy development within the KwaZulu-Natal Nature Conservation Service, a parastatal nature conservation organization. The first paper, Designing a Management System for a Rural community Development Organization Using a Systemic Action Research Process describes the use of Soft Systems Methodology (SSM) for the development of a Human Activity System (HAS) Model, that is, a conceptual model of purposeful human activities, to facilitate debate regarding a 'problem situation' faced by the community development organization. A Critical Systems Intervention to Improve the Implementation of a District Health System in KwaZulu-Natal is the second paper. As the title suggests, this paper describes a Critical Systems Intervention in a district health system implementation process. By using Concept Maps and Sign-Graph diagrams with SSM this paper contributes theoretically to the growing body of literature on methodological pluralism. Paper 3, Towards a critical systems approach to policy formulation in organizations contributes to the literature on organizational policy. It is noted in this paper that whilst there is a substantial body of literature on organizational strategy as well as on public policy, there is a dearth of literature on organizational policy. The thrust of the paper is twofold. Firstly, it draws a distinction and shows the relationship between organizational policy and organizational strategy. Secondly, building on this distinction, it develops a critical systems approach to policy formulation. Paper 4, Environmental Paradigms, Biodiversity Conservation and Critical Systems Thinking develops a framework of environmental paradigms which may be used for any CSI in nature management as a tool for values clarification. The collection concludes with Paper 5, A Critical Systems Intervention for Policy Development within a Nature Conservation Organization. It discusses the process undertaken in the nature conservation organization - Ezemvelo KwaZulu-Natal Wildlife - intervention and shows how the approach to policy formulation (developed in Paper 3) and the framework for environmental paradigms (developed in Paper 4) were used in the intervention.Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.
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Hallatt, Trevor Winston. "A critical evaluation of the quality of biodiversity inputs to environmental impact assessments in areas with high biodiversity value : experience from the Cape Floristic Region / Trevor Winston Hallat." Thesis, 2014. http://hdl.handle.net/10394/11031.
Full textAbstract:
Biodiversity considerations form an essential component of Environmental Impact
Assessment (EIA), especially in areas with both a high biodiversity value and development
pressure such as the Cape Floristic Region (CFR) in South Africa. Limited research has
been conducted within the South African context on the quality of biodiversity inputs to EIA.
The aim of this research was to evaluate the quality of biodiversity input to EIA in the CFR.
To address this aim, a customised review package was generated to evaluate the quality of
26 Biodiversity Impact Assessment (BIA) reports in the CFR. The results were then
compared with international trends of biodiversity input to EIA in order to show how prevalent
such trends are within an area with high biodiversity value. This comparison showed that the
quality of biodiversity input to EIA in the CFR generally concur with inadequacies identified in
international EIA literature. Typically, significant weaknesses identified during the review
were the lack of public participation and an insufficient evaluation of alternatives. Specialists
also failed to develop adequate monitoring programmes. Furthermore, a very pertinent
limitation was that, in general, assessments are conducted during inappropriate seasons and
over insufficient time periods. However, some variations to the international trends are also
present within the Region. For example, a particular strength was that a precautionary
approach was adopted by most of the specialists to avoid negative impacts on biodiversity.
In addition, specialists did not merely focus on lower levels (species and habitats) of
biodiversity, but incorporated ecological processes in assessment techniques. The
inadequacies identified in this dissertation pose particular challenges for biodiversity
management and conservation practices. The development and implementation of
mechanisms such as Best Practice Guidelines and improved biodiversity related legislation is
proposed to improve biodiversity input to EIA.M Environmental Management, North-West University, Potchefstroom Campus, 2014