Masters Degrees (Nursing and Midwifery)

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Browsing Masters Degrees (Nursing and Midwifery) by browse.metadata.advisor "Cohen, Mary Anthea"

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    Perceptions and experiences of registered professional nurses in the recognition of unexpected clinical deterioration in children in wards
    (Stellenbosch : Stellenbosch University, 2013-03) Wortley, Suzanne; Cohen, Mary Anthea; Stellenberg, E. L.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
    ENGLISH ABSTRACT: Unnoticed deterioration in the clinical condition of children in ward areas can lead to near or actual cardiopulmonary arrest. Children suffering from a cardiac arrest in hospital often display abnormal physiological parameters hours prior to this event occurring (i.e., within a 24 hour period). Prevention of cardiopulmonary arrest in the wards lies in the ability of nursing and medical staff to be able to identify these abnormal physiological parameters, i.e., early signs of deterioration, and to intervene prior to this event. This study aimed to identify nurses’ experiences with regards to current knowledge, clinical practice and training in the recognition of clinical deterioration in children. It could then be determined whether a formal guideline on the early recognition of clinical deterioration in children would be perceived as being beneficial by the respondents in this study. The research question that guided this study was “what are the perceptions and experiences of registered professional nurses working in paediatric wards with regards to their recognition of unexpected clinical deterioration in children?” An exploratory descriptive study, utilising a qualitative approach was applied. The target population consisted of all registered professional nurses working in paediatric wards in academic hospitals in the Western Cape, South Africa. Ethical approval was obtained. Informed written consent was obtained from the participants. The purposive sampling method was used to select the participants (n=17) who met the criteria. Five focus group interviews were conducted to collect the data, using an interview guide. The planned methodology with its instrumentation and procedures was verified through a pilot study that was conducted on the first focus group interview. The steps of the research process included transcribing the collected data verbatim from the audio recordings and the field notes, and then analysing the data by summarising and packaging the data, identifying themes and trends in the data and verifying and drawing conclusions. The analysis themes identified were based on Donabedian’s conceptual framework, comprising Structure (the environment in which the care takes place), Process (method by which the care takes place), and Quality Assurance (the planned, organised evaluation of the patient care which has been rendered). The findings showed that the increased level of severity of illness of children nursed in paediatric wards, as well as staff shortages, gaps in training on resuscitation and clinical deterioration, limited ICU beds and staff, lack of adequate monitoring and emergency equipment in the wards, and inexperienced staff are all factors that were identified that increase the risk of staff not being able to detect clinical deterioration in children nursed in paediatric wards. Teamwork among nursing staff and other medical professionals, as well as parental involvement in the care of the children, assisted staff in being able to detect clinical deterioration. Most participants were unfamiliar with ‘early warning systems’ and reported that there are no paediatric ‘early warning scores’ (PEWS) in place. They believed such a system would be beneficial; however they had concerns regarding the time it would take to score a patient, the training involved, and the ease of use of such a tool and system. Recommendations for addressing non-recognition of clinical deterioration by nurses in paediatric wards such as appropriate knowledge and skill updating, were put forward in the study.