The Competencies of the Shift Leader in the Intensive Care Unit Setting; in a Private Hospital Group in South Africa

Newly qualified intensive care nurses are forced into positions of authority and responsibility as shift leaders at an early stage and are not given a chance to consolidate their new knowledge with practice. They have to be responsible and accountable not only for their own actions; but also for those of their staff. The purpose of this study was to explore and describe the competencies of the shift leader in the intensive care unit setting to determine whether there is a gap between what is expected of the shift leader and what is happening in reality. A quantitative; descriptive design was used and cluster sampling was implemented. Questionnaires were used to gather data from three clusters; comprising 11 hospitals from a single private hospital group. Of the 251 questionnaires that were handed out to intensive care personnel (including trained and non-trained staff); 98 were returned; resulting in a response rate of 39. An in-depth literature study and submission of questionnaires to experts before being administered to respondents ensured validity and reliability. Results were used to describe a typology of the competencies of the shift leader in the intensive care setting and indicated that respondents classified competencies related to the application of the nursing process in the intensive care unit in all its facets as essential competencies. None were classified as a critical competency and only four were classified as specific competencies. All respondents in the three clusters regarded their shift leaders as competent

Percutaneous Injuries in Doctors in the School of Medicine; University of the Free State: Prevalence; Reporting and Adherence to Precautionary and Management Procedures

"Background: Despite the official precautionary measures against percutaneous injuries; incidents still occur. Consequently; it is possible that healthcare workers could contract infections like HBV; HCV; HGV (hepatitis B; C and G viruses) and HIV (human immune deficiency virus). The most serious problem lies in the fact that percutaneous injuries are often underestimated; resulting in non-reporting of the incident. The aim of this study was to determine the incidence of percutaneous injuries in doctors in the School of Medicine at the University of the Free State (UFS); whether the incidents were reported; and the reasons for non-reporting. The use of gloves during procedures was also evaluated. Methods: A mainly descriptive study design was used. Questionnaires were administered from October 2006 through January 2007 to collect information. Participants were selected randomly; and the respondents were divided into surgical and non-surgical groups. Results: The respondents fulfilled the following roles and/or functions in their respective departments of employment: 35 (67.3) were registrars; 12 (23.1) were specialists/consultants; four (7.7) were medical officers; and one (1.9) was exclusively involved in student training. Two of the respondents did not indicate their roles and functions in their respective departments. A total of 82 incidents of percutaneous injuries occurred. Although the surgical groups handled sharp objects more frequently per week than the non-surgical groups (p-value = 0.04); more incidents occurred in the non- surgical groups (p-value = 0.02). Only 39 (47.6) of the incidents were reported; while 44.4of the respondents were aware of the correct reporting procedures. The reasons given for the non-reporting of these incidents were ""too busy"" (58.1); ""did not think it was serious"" (48.8); and ""was not aware of the reporting procedures"" (7). Only 13.7of the respondents indicated that they always used gloves when drawing blood; 17.4used them when injections were administered; and 22.4used gloves during intravenous cannulation. However; 86.8of the respondents wore gloves when they used a scalpel or any other incision object. The respondents (n = 51) suggested that the three most important precautionary measures to take into consideration when working with sharp objects were (i) the use of gloves (23/51; 45.1); (ii) never recapping a needle (9/51; 17.6); and (iii) keeping the container for disposing of sharp objects close at hand (6/51; 11.8). Conclusions: Despite the risk of percutaneous injuries; non-reporting still occurs. Although the rate of reporting these incidents could be compared with international findings published in the literature; it remains too low. Drastic measures should be taken to ensure that physicians are informed of the hazards of percutaneous injuries; as well as of the appropriate mechanisms of reporting these incidents."

Evidence-Based Nursing Interventions and Guidelines for Prone Positioning of Adult; Ventilated Patients: a Systematic Review

Although the prone positioning of a critically ill patient poses a challenge to nursing interventions; it remains the responsibility of nurses to develop a way to provide the same basic and intensive care to those patients lying prone as to those lying supine. The purpose of this study was firstly to conduct a systematic review of the literature as explora-tion and description of the evidence in support of the beneficial nursing interventions during prone positioning of ventilated patients; and secondly to develop evidence-based nursing guidelines for the nursing process. This exploratory; descriptive and retrospective systematic review includes data from 45 clinical trials; with a total population of 2 148 patients. Data was extracted onto data abstraction forms; assessed for methodological quality and finally summarised in evidence tables. All statistical calculations for the meta-analysis were performed by the RevMan 4.2.8 program. Prone positioning showed significant (p 0.0001) increases in the partial pressure of oxygen in arterial blood (PaO2) weighted mean difference (WMD CI = 11.36; 31.8). The effects of complications; oxygenation and haemodynamic outcomes compared with the different prone-positioning protocols produced in conclusive results. Nursing guidelines for prone positioning were developed based on the best available evidence. The lack of related articles on nursing care of prone positioning was a drawback. Based on these results; recommendations are made towards further study on the nursing care of prone-positioned patients

Patients with Coronary Artery Disease : Maintaining Planned Lifestyle Adaptations

The purpose of this study was to describe how patients with coronary artery disease; who have had one or more cardiac interventions; were maintaining their planned lifestyle adaptations at four months after the intervention. Furthermore; the study aimed to develop guidelines to further assist patients in maintaining lifestyle adaptations. A descriptive study was undertaken using the survey method. The population consisted of 65 participants (42 males; 23 females) from five private hospitals in Gauteng. The questions for a questionnaire were derived from a conceptual framework. The participants first completed the questionnaire immediately before they were discharged; and again over the telephone four months after the intervention. Descriptive statistics were used to analyse the data obtained. The results showed that patients suffering from coronary artery disease do adapt their lifestyle after interventions; but most patients find it problematic to stop smoking. It is essential for patients with coronary artery disease to maintain lifestyle adaptations to ensure further health and prevention of recurrence of the same problems. These adaptations should be a lifelong commitment

Viral Infections In Children Receiving Anticancer Chemotherapy

OBJECTIVE: To determine the presence of bacterial and viral infectious agents in children with fever during anticancer chemotherapy. DESIGN: Analysis of data obtained during a prospective cohort study. SETTING: The pediatric oncology unit of Tygerberg Children's Hospital; Cape Town. SUBJECTS: All patients up to the age of 15 years who deve- loped fever secondary to anticancer chemotherapy from February 9th 2000 to April 9th 2001. OUTCOME MEASURES: Viruses were isolated or antigens detected on venous blood samples; nasopharyngeal aspirates; throat swabs; urine and feces where possible. Blood for aerobic and anaerobic culture was obtained from an indwelling intravenous catheter and/or a peripheral vein. RESULTS: Thirty-four children were analyzed for a total of 102 febrile episodes. The absolute neutrophil count on admission was below 0.5*109/L in 57 (56) episodes and thus considered neutropenic. Thirty-five viral isolates were identified in 31 (30) febrile episodes: HSV-1 (n=14); HSV-2 (n=2); CMV (n=10); rotavirus (n=5); adenovirus (n=2); Para influenza type 3 (n=1) and hepatitis B (n=1). The blood culture was positive in 24 (24) febrile episodes. Within these; a combined viral and bacterial infection was demonstrated in 6 (6) episodes. Infections were more frequent in neutropenic compared to non-neutropenic episodes; however; this was not significant. CONCLUSIONS: Viral infections clearly are an important cause of fever in children receiving anticancer therapy and may occur together with a bacterial infection. Diagnostic tests for viral infections should be used more frequently and could be of considerable value in evaluating fever and establishing appropriate treatment in these patients

Common Opportunistic Infections in HIV Infected Infants and Children : Part 2 Non-Respiratory Infections

Increased susceptibility to infections is the major cause of disease; end organ damage and death in human immunodeficiency virus (HIV)-infected children. This article will focus on prevention; diagnosis and management of the most common and less common severe infections that are specifically associated with HIV-related immune compromise; as well as some aspects relating to immune reconstitution inflammatory syndrome (IRIS)