African Journals Online
Health SA Gesondheid : interdisciplinary research journal

Volume 7, Issue 3, September 2002

'n Raamwerk vir die verpleging van die volwasse pasiënt op druk-gekontroleerde ventilasie in die kritiekesorgeenheid
Martin, M.Arries, E.Nel, E. 3-18

Abstract: The nurse functions as an independent practitioner, as part of the multi-disciplinary health team, during the delivery of nursing care to an adult patient on pressure-controlled ventilation in a critical care unit. Pressure controlled ventilation as a mode of mechanical ventilation is generally practiced in critical care units. Pressure controlled ventilation refers to a controlled mode of mechanical ventilation in which all breaths are pressure limited and time cycled, with no possibility for patient triggering, often achieved by sedation and / or paralysis (Hess & Kacmarek, 1996 : 20). Pressure-controlled ventilation is associated with a multiple of life-threathening complications such as barotrauma (Chlochesy, Breu, Cardin, Rudy & Whittaker, 1996 : 267 - 270). Therefore it is important to describe a framework according to which the nursing care of a patient on pressure-controlled ventilation in a critical care unit can be approached. Although general frameworks for the nursing care of a patient on mecahnical ventilation exists, no such specifc framework exists that describes the nursing needs of an adult patient on pressure controlled ventilation by the critical care nurse. Such a framework will be described in this article. The purpose of this article is to describe a framework for the nursing care of an adult patient on pressure-controlled ventilation in a critical care unit. An explorative, descriptive research-design (Mouton & Marais, 1990 : 44 - 46) was implemented to achieve this purpose. Based on a purposive study of both national and international literature and the triangulation thereof with other data-sources (Burns & Grove, 1993 : 277), like physicians and critical care nurses, a framework for the nursing care of an adult patient on pressure-controlled ventilation in a critical care unit is described. A cognitive analysis, that includes both inductive and deductive thinking strategies, is applied during the study of the literature. Trustworthiness in the study was ensured through the application of the following measures for trustworthiness, namely triangulation, prolonged engagement, peer-group discussion, referential adequacy, stepwise repeat, investigative auditing, and dense description (Lincoln & Guba, 1985 : 289 - 331). According to the framework described in this article, the nurse as independent practitioner functions as part of a multi-disciplinary health team during the nursing care of an adult patient on pressure-controlled ventilation in a critical care unit. The context in which the nurse functions during the nursing care of an adult patient on pressure-controlled ventilation in a critical care unit, guides his/her actions that he/she performs on the adult patient. As independent practitioner during the nursing care of an adult patient on pressure-controlled ventilation, the nurse is responsible and accountable to carry out certain clinical actions, that are applicable to the nursing care of an adult patient on pressure-controlled ventilation, based on a scientific-approach, through demonstration of certain abilities, within the legal-ethical, philosophical and management framework of his/her profession.

Kliniese verpleegsorgstandaarde vir die volwasse pasiënt op druk-gekontroleerde ventilasie in die kritiekesorgeenheid
Martin, M.Arries, E.Nel, E. 19-31

Abstract: The purpose of this article is to describe clinical nursing care standards for a patient on pressure-controlled ventilation in a critical care unit. Nursing practitioners working in the critical care unit are responsible for quality nursing care of the patient on pressure-controlled ventilation. To deliver quality nursing care to the adult patient on pressure-controlled ventilation, the use of clinical nursing care standards are of paramount importance. Clinical nursing care standards refer to descriptive statements that reflect the expected level of clinical performance by the critical care nurse during the nursing care of an adult patient on pressure-control ventilation in a critical care unit. Quality nursing care of an adult patient on pressure-controlled ventilation implies that certain characteristics of quality have been determined and are being adhered to. This nursing care occurs in relation to the health needs of an adult patient on pressure-controlled ventilation within the legal-ethical and managerial framework of critical care nursing and the health care institution (Gillies, 1994 : 97; Muller, 1998a : 3). However, in the South African nursing context there are no clinical nursing care standards for adult patients on pressure-controlled ventilation in critical care units. The following question can therefore be asked: "Which clinical nursing care standards should be formulated for an adult patient on pressure-controlled ventilation in a critical care unit?" An explorative, descriptive, standard-generating research design was followed in this study to formulate clinical nursing care standards for an adult patient on pressure-controlled ventilation in a critical care unit. The method of standard formulation was based on the method described by Muller (1990 : 49 - 53), consisting of a development phase and a quantification phase. In this study, only the development phase was implemented. The formulation of clinical nursing care standards for an adult patient on pressure-controlled ventilation in a critical care unit was based on a previous framework that was described on the basis of a literature study. In this way, the content validity of the clinical nursing care standards was ensured. Furthermore, the content validity of the clinical nursing care standards for an adult patient on pressure-controlled ventilation in a critical care unit was ensured by means of a peer group discussion that was held with clinical domain experts. During this discussion clinical nursing care standards were refined and reformulated. Seventeen clinical nursing care standards were formulated for an adult patient on pressure-controlled ventilation in a critical care unit.

Community nurses' perceptions of and exposure to children with severe disabilities and their primary caregivers
Bornman, J.Alant, E. 32-55

Abstract: In primary health care clinics nurses are faced with individuals of different ages with different problems, ranging from minor ailments to severe disabilities. Particularly vulnerable are those with severe disabilities, with specific reference to those with communication and intellectual impairments because of their inability to articulate their needs, feelings and rights. Community nurses are often the first contact that primary caregivers (parents) of children with severe disabilities (CSDs) have with health professionals and they often remain the only professionals who support and assist these caregivers. It is therefore clear that these nurses need to be equipped with the necessary knowledge and skills to assist caregivers in dealing with their CSDs. This is a descriptive study aimed at determining community nurses' perceptions regarding disability and their exposure to CSDs. Quantitative (questionnaire) and qualitative (focus groups) methods were used to obtain data. Results indicated that nurses regarded their knowledge and skills in dealing with CSDs and their caregivers as inadequate, despite the fact that they were exposed to them and were expected to provide services to them. A need for knowledge and skill training in this regard was identified.

Die dwelmmiddelafhanklike pasient se belewenis van sy herstelproses na ontslag en voltooiing van 'n herstelprogram
Overbeeck, M.Poggenpoel, M.Gmeiner, A. 56-67

Abstract: Drug dependency is acknowledged worldwide as one of the major mental health problems. It seems that drug dependent patients experience various obstacles in striving after mental health. The recovery process requires a shift from the rigid behaviour and intellectual processes that accompany them, to internal processes accompanied by a change in inner experiences. The objective of this research was to explore and describe the drug dependent person's recovery process after discharge, and the completion of a recovery programme within a specific private rehabilitation centre. The research design was qualitative, explorative, descriptive and contextual in nature. In-depth, phenomenological interviews, as well as focused individual interviews, were conducted to gather data. Data was analysed using Tesch's descriptive method, where all the data were analysed in eight steps. Field notes were taken and analysed together with the data. A literature control was then done to validate and recontextualise the data. Guba and Lincoln's model for trustworthiness was applied to ensure the trustworthiness of the research and strict ethical measures were adhered to, since the research addressed a very sensi- tive topic. The themes identified indicate obstacles, as well as facilitating elements, in the drug dependent patients' experience of their recovery processes and these obstacles should be addressed by mobilising resources

A cognitive-relaxation-visualisation intervention for anxiety in women with breast cancer
Linde, C.D.Stuart, A.D. 68-78

Abstract: The aim of this study was twofold. Firstly, to design a cognitive-relaxation-visualisation intervention with the aim of reducing both overt and covert anxiety associated with the diagnosis and treatment of breast cancer. In addition to the creation of a suitable intervention, the aim of the present study was to ascertain the efficacy of the intervention in two groups of randomly selected female subjects, the one group (N = 72) being pre-diagnosis (awaiting mammogram results) and the other group (N = 16) being post-diagnosis (beginning radiation therapy). A Solomon four group design was used for the pre-diagnosis group and a pre-test - post-test control group design was utilised for the post-diagnosis group. The IPAT Anxiety Scale was used to measure the variables of overt and covert anxiety. Qualitative information regarding the intervention was obtained by means of a delayed interview. The results indicated that while the intervention had the effect of reducing anxiety for both groups, a pre-test sensitisation effect was also observed in the pre-diagnosis group. It emerged that patients had perceived the presence of an empathic individual at the time of diagnosis and early in treatment as being of greatest value in reducing anxiety.

Risk awareness and sexual relationships among youth in the Johannesburg area
Netswera, F.G. 79-88

Abstract: The increase in the reported rate of the human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS) and sexually transmitted infections among the youth of South Africa has led to a rise in awareness campaigns to combat these epidemics. If health awareness campaigns have an effect on behavioural change, one would expect the youth to abstain from sex and be involved in stable sexual relationships. This quantitative survey, conducted among a sample of 226 Johannesburg youths, was aimed at ascertaining their exposure to sex risks and their stability in sexual relationships. Data was collected by means of a questionnaire, and descriptive as well as inferential statistical analyses were computed using the Statistical Package for Social Sciences (SPSS). The results revealed a quarter of respondents to have been engaged in risky sexual activities and males in general to be riskier and more sexually active than women.

Factors affecting behaviours that address HIV risk among a sample of junior secondary school students in the Northern Province, South Africa
Peltzer, K. 89-93

Abstract: The purpose of this study was to identify factors affecting HIV risk reduction among junior secondary school pupils in South Africa. The sample included 441 Grade 10 Secondary School pupils in the age range of 16 to 25 years (M age 16.3 yr, SD = 2.3) from three rural schools in one region of the Northern Province of South Africa. Measures of the following were included : sexual behaviour and condom use, knowledge about correct condom use, intention of condom use, behavioural norms, attitudes, normative beliefs, and subjective norms about condoms, HIV / AIDS vulnerability (likelihood to get it) and severity of the illness in the country, and condom use self-efficacy. Bivariate analysis found positive significant relations between age at first vaginal intercourse, HIV / AIDS susceptibility and severity, attitudes towards condoms, normative beliefs to use condoms as well as subjective norms to use condoms and the HIV / AIDS risk index; inversely related were correct condom knowledge and condom use intention. Regression analysis indicated that inversely correct condom knowledge score, age at first vaginal sex and HIV / AIDS severity were found to be predictive for HIV / AIDS risk behaviour explaining 53% of the variance.