To explore the views of the intensive care unit (ICU) nurse managers regarding nurse staffing in the large ICUs.
A qualitative design was used to explore the views of the ICU managers. Four ...individual interviews were conducted with ICU managers. The interviews were audio recorded; transcribed verbatim and content data analysis was undertaken. The settings were ICUs of four private hospitals in the Tshwane metropolitan area in Gauteng Province, South Africa.
Two themes that emerged from the data were shortage of competent and trained nurses and problems with agency nurses. Shortage of competent and trained nurses was associated with the global shortage of nurses; and led to increased patient-to-nurse ratios and the use of other categories of nurses, other than professional nurses. The problems with agency nurses were lack of ICU experience and lack of commitment to their professional work. These brought about risks in the provision of quality nursing care.
Adequate numbers of competent and committed nurses is essential for efficient patient care and favourable outcomes in the ICUs.
The findings demonstrate the importance of provision of ICU trained nurses for patient care, rather than nurse staffing simply to balance the numbers.
The newer beta-lactam-inhibitor combination (BLIC) antibiotics are available in South Africa (SA) for the treatment of carbapenemresistant Enterobacterales infections. We describe the successful use ...of ceftazidime-avibactam (CA) for the treatment of a child with persistent carbapenem-resistant Serratia marcescens bacteraemia, and the challenges faced using this lifesaving antibiotic, including access to susceptibility testing, procurement process, cost and complexity of deciding when, how and for how long to use it. Furthermore, the burden of carbapenem resistance is increasing in SA, and inappropriate use of CA and other newer BLIC antibiotics, such as ceftolozanetazobactam, will inevitably endanger their longevity. A careful balance must be struck between removing unnecessary obstacles and delays in initiating these antibiotics for life-threatening infections, and additional antimicrobial stewardship-guided interventions aimed at preserving their therapeutic use.
Introduction: Rural radiographers require, over and above traditional radiographic expertise, additional competencies which to a certain degree are unique however not limited to rural practice. ...Previous studies, however, have focused more attention primarily on other rural health professionals such as doctors and nurses leaving a research need in this field. This article focuses on the additional competencies that may be required for rural radiographers. Aim: To investigate and identify additional core competencies required by radiographers working in rural hospitals of KwaZulu-Natal in order to propose a continuous professional development strategy aimed at rural radiographers. Methods: An exploratory sequential design was utilised with qualitative (Phase I) and quantitative (Phase II) strands involving seven participants and 109 respondents, respectively. Only radiographers working in rural KwaZulu-Natal hospitals were included in the study. The four major themes and categories identified in Phase I were used to develop data collection instrument for Phase II of the study. Results: Collectively, the results revealed that there were a number of additional core competencies such as, but not limited to, teamwork, ability to do basic obstetric ultrasound scans, leadership, management and reporting on plain radiographs, all of which are required by rural radiographers. In 2014 when these competencies were checked against a single curriculum, it was found that majority of them were either partially covered or not at all covered. Conclusion: The study provides additional information on context specific core competencies and, therefore, may act as a catalyst to influence the future of radiographers working in rural areas of South Africa.
Highlights • Prenatal maternal alcohol use affects both sexes similarly on most variables. • Girls had significantly more overall dysmorphology and worse cognitive outcomes. • Prenatal bingeing of 6+ ...drinks is associated with fewer males alive at age seven. • Controlling for 13 covariates, girls have a higher probability for fetal alcohol spectrum disorders (FASD).
Aim
To illustrate the need for and suggest strategies that will enhance sustainable management of a large intensive care unit (ICU).
Background
The challenges faced by intensive care nursing in South ...Africa are well documented. However, there appear to be no strategies available to assist nurses to manage large ICUs or for ICU managers to deal with problems as they arise.
Methods
Data sources to illustrate the need for strategies were challenges described by ICU managers in the management of large ICUs. A purposive sample of managers was included in individual interviews during compilation of evidence regarding the challenges experienced in the management of large ICUs. The challenges were presented at the Critical Care Society of Southern Africa Congress held on 28 August to 2 September 2012 in Sun City North‐West province, South Africa.
Results
Five strategies are suggested for the challenges identified: divide the units into sections; develop a highly skilled and effective nursing workforce to ensure delivery of quality nursing care; create a culture to retain an effective ICU nursing team; manage assets; and determine the needs of ICU nurses.
Conclusion
ICUs need measures to drive the desired strategies into actions to continuously improve the management of the unit. Future research should be aimed at investigating the effectiveness of the strategies identified.
Implications for nursing management
This research highlights issues relating to large ICUs and the strategies will assist ICU managers to deal with problems related to large unit sizes, shortage of trained ICU nurses, use of agency nurses, shortage of equipment and supplies and stressors in the ICU. The article will make a contribution to the body of nursing literature on management of ICUs.
Objective
To investigate gestational age and growth at birth as predictors of fetal alcohol spectrum disorders (FASD).
Methods
The sample analyzed here comprises 737 randomly selected children who ...were assessed for growth, dysmorphology, and neurobehavior at 7 years of age. Maternal interviews were conducted to ascertain prenatal alcohol exposure and other maternal risk factors. Birth data originated from clinic records and the data at 7 years of age originated from population‐based, in‐school studies. Binary linear regression assessed the relationship between preterm birth, small for gestational age (SGA), and their combination on the odds of a specific FASD diagnosis or any FASD.
Results
Among children diagnosed with FASD at 7 years of age (n = 255), a review of birth records indicated that 18.4% were born preterm, 51.4% were SGA, and 5.9% were both preterm and SGA. When compared to non‐FASD controls (n = 482), the birth percentages born preterm, SGA, and both preterm and SGA were respectively 12.0%, 27.7%, and 0.5%. Mothers of children with FASD reported more drinking during all trimesters, higher gravidity, lower educational attainment, and older age at pregnancy. After controlling for usual drinks per drinking day in the first trimester, number of trimesters of drinking, maternal education, tobacco use, and maternal age, the odds ratio of an FASD diagnosis by age 7 was significantly associated with SGA (OR = 2.16, 95% CI: 1.35 to 3.45). SGA was also significantly associated with each of the 3 most common specific diagnoses within the FASD continuum: fetal alcohol syndrome (FAS; OR = 3.1), partial FAS (OR = 2.1), and alcohol‐related neurodevelopmental disorder (OR = 2.0).
Conclusion
SGA is a robust early indicator for FASD in this random sample of children assessed at 7 years of age.
Among children diagnosed with FASD at seven years of age, 18.4% were born preterm, 51.4% were small‐for‐gestational‐age (SGA), and 5.9% were both preterm and SGA, compared to 12%, 28%, and 0.5% for non‐FASD controls. After controlling for the usual number of drinks per drinking day in 1st trimester, the number of trimesters drank, maternal education, tobacco use, and maternal age, the odds ratio of an FASD diagnosis by age seven was significantly associated with SGA (OR=2.16, 95% CI:1.35‐3.45).
•90% of mothers breastfed for an average of 19.9 months.•71% of mothers who breastfed used alcohol simultaneously.•42 to 48% of mothers of normal controls drank and breastfed.•Maternal drinking while ...breastfeeding limits physical and neurobehavioral outcomes.•Alcohol use during the breastfeeding period is not recommended.
Determine any effects that maternal alcohol consumption during the breastfeeding period has on child outcomes.
Population-based samples of children with fetal alcohol spectrum disorders (FASD), normally-developing children, and their mothers were analyzed for differences in child outcomes.
Ninety percent (90%) of mothers breastfed for an average of 19.9 months. Of mothers who drank postpartum and breastfed (MDPB), 47% breastfed for 12 months or more. In case control analyses, children of MDPB were significantly lighter, had lower verbal IQ scores, and more anomalies in comparisons controlling for prenatal alcohol exposure and final FASD diagnosis. Utilizing a stepwise logistic regression model adjusting for nine confounders of prenatal drinking and other maternal risks, MDPB were 6.4 times more likely to have a child with FASD than breastfeeding mothers who abstained from alcohol while breastfeeding.
Alcohol use during the period of breastfeeding was found to significantly compromise a child’s development.
The Karoo basin of South Africa exposes a succession of Upper Permian to Lower Triassic terrestrial strata containing abundant terrestrial vertebrate fossils. Paleomagnetic/magnetostratigraphic and ...carbon-isotope data allow sections to be correlated across the basin. With this stratigraphy, the vertebrate fossil data show a gradual extinction in the Upper Permian punctuated by an enhanced extinction pulse at the Permian-Triassic boundary interval, particularly among the dicynodont therapsids, coinciding with negative carbon-isotope anomalies.
Patients perceive the intensive care unit (ICU) as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and therefore should be ...avoided in cardiac surgery patients. The aim of the study on which this article is based was to describe cardiac surgery patients’ experiences of music as a therapeutic intervention in the ICU of a public hospital. The objectives of this article were to introduce and then expose the cardiac patients to music as part of their routine postoperative care and to explore and describe their experiences of the music intervention. The findings of the research are to be the basis for making recommendations for the inclusion of music as part of the routine postoperative care received by cardiac surgery patients in the ICU. A qualitative research methodology, using a contextual, explorative and descriptive research design, was adopted. The population of the study was cardiac surgery patients admitted to the ICU of a public hospital. An unstructured interview was conducted with each participant and content analysis and coding procedures were used to analyse the data. Four main themes were identified in the results, namely practical and operational aspects of the music sessions; participants’ experiences; discomfort due to therapeutic apparatus and the ICU environment; and the role of music and recommendations for music as a therapeutic intervention. Participants’ experiences were mainly positive. Results focused on experiences of the music and also on the participants’ experiences of the operational aspects of the therapy, as well as factors within and around the participants.Pasiënte se persepsie van die intensiewesorgeenheid (ISE) is dat dit ’nstresvolle en angswekkende omgewing is. Die fisiologiese effekte van stres en angs is skadelik en daarom moet dit vermy word in die geval van pasiënte wat hartchirurgie ondergaan. Die doel van die studie waarop hierdie artikel gebaseer is, was om hartchirurgiepasiënte se ervaring van musiek as ’n terapeutiese intervensie in die ISE van ’nopenbare hospitaal te beskryf. Die doelwitte van hierdie studie was om hartchirurgiepasiënte bekend te stel aan musiek as deel van hul roetine- postoperatiewe sorg en hulle dan daaraan bloot te stel om sodoende hulle ervarings van die musiekintervensie te ondersoek en beskryf. Die bevindinge van die navorsing sal gebruik word om aanbevelings te maak vir die insluiting van musiek as deel van die roetine- postoperatiewe sorg wat hartchirurgiepasiënte in die ISE ontvang. ’nKwalitatiewe navorsingsmetodologie, met behulp van ’nkontekstuele, verkennende en beskrywende ontwerp, is gebruik. Die populasie van die studie was hartchirurgiepasiënte in die ISE van ’nopenbare hospitaal. ’nOngestruktureerde onderhoud is met elke deelnemer gevoer en inhoud-analise en koderingprosedures is gebruik om die data te ontleed. Vier hooftemas is in die resultate geïdentifiseer, naamlik praktiese en operasionele aspekte van die musieksessies; die deelnemers se ervarings; ongemak as gevolg van terapeutiese apparaat en die ISE-omgewing; asook die rol van musiek en aanbevelings vir musiek as ’nterapeutiese intervensie. Deelnemers se ervarings was hoofsaaklik positief. Die resultate het gefokus op die deelnemers se ervaring van die musiek asook hul ervaring van die operasionele aspekte van die terapie, sowel as faktore binne en rondom die deelnemers.
Whilst comprehensive post-discharge interventions have been successful in reducing readmissions in our setting, they are possibly not sustainable due to limited resources. We assessed the impact of a ...more cost-effective telephone-based intervention on readmissions in a developing country over 12 months. 100 patients with severe mental illness were randomized to facilitated care or treatment as usual. All were interviewed prior to discharge and after 12 months. Facilitated care consisted of structured telephonic interviews and motivational support to patients and families. At 12 months no significant differences in either readmissions (p = 0.10) or days in hospital (p = 0.44) could be demonstrated. Substance use was high (64%), particularly methamphetamine (44%) in both groups. The intervention did not have any impact on inpatient usage in our setting. Though this study was limited by its small sample size, the results indicated that affordable post-discharge services may not be comprehensive enough to reduce readmission rates and would have to be tailored to the distinct population of dual diagnosis patients identified in this study.
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