Professional nurses' knowledge and clinical practice regarding patients with a traumatic brain injury in a tertiary hospital

Kiewiet, Jean (2019-12)

Thesis (MNur)--Stellenbosch University, 2019.

Thesis

ENGLISH SUMMARY : Background: Traumatic Brain Injury (TBI) is one of the main causes of disability and death worldwide. Even though the best chance of survival of patients with traumatic brain injuries will be in a neurocritical care unit, many patients with traumatic brain injuries are treated in nonspecialised critical care units. To date, minimal studies are available that report on professional nurses’ knowledge and clinical practices regarding caring of patients with traumatic brain injuries in South Africa. Aim and objectives: The aim of the study was to determine the knowledge and clinical practice of professional nurses caring for patients with TBI in a critical care unit (CCU) within a tertiary hospital in the Western Cape of South Africa. The objectives for the study were to: - Determine the knowledge of professional nurses caring for patients with TBI in a CCU. - Investigate the clinical practice of professional nurses caring for patients with TBI in a CCU. Research methodology: A quantitative descriptive study was conducted at a tertiary hospital in the Western Cape. The target population included all critical care nurses (N=98). Ethical approval was obtained from the Research Ethics Committee of Stellenbosch University (Reference: S17/07/120) and the tertiary hospital. Data was collected through a self-administering questionnaire and a pilot testing was conducted involving nine participants. The results from the pilot testing were excluded from the main study. Analysis was done with the assistance of a statistician from Medicine and Health Faculty of Stellenbosch University using Software for Statistics and Data Science (STATA) program. Results: A mean knowledge score percentage in CCU revealed 71% overall. Participants with a nursing degree were more knowledgeable than nurses with diploma and Masters/Honours degree. The knowledge score of nurses working in Neurocritical Care unit scored the highest percentage of 75% as total knowledge score and nurses within the Coronary Care unit had the lowest score of 66%. With regard to knowledge score of employment, it was evident that critical care nurses working for an agency have the highest knowledge score percentage of 75% compared to permanent staff of 71%. Only 17% of critical care nurses monitored End Tidal Carbon Dioxide (ETCO2) at all times in their unit. Knowledge of nurses regarding ETCO2 monitoring is limited in clinical practice. Clinical guidelines improve quality of care to decrease variations in clinical practices and 59.6% of critical care nurses stated that they had never come across guidelines and protocols with regard to the management of raised intracranial pressure in the critical care unit. Recommendations: Recommendations for this study include neurocritical care education, the amendments of protocols and guidelines, ETCO2 monitoring for all intubated patients, considering clinical competencies and rotation of critical care nurses. Conclusion: A better understanding of TBI may result from the study and assist mentors, educational and administration staff to promote quality care for TBI in critical care units. The focus should be on becoming better nurses, experts in caring for patients with TBI and the ability to make countless decisions in order to solve problems in clinical areas.

AFRIKAANSE OPSOMMING : Agtergrond: Traumatiese breinbesering (TBB) is wêreldwyd een van die hoofoorsake van gestremdheid en dood. Alhoewel die beste kans vir oorlewing van pasiënte met traumatiese breinbeserings in ’n neuro-intensiewe sorgeenheid is, word baie pasiënte met traumatiese breinbeserings in ongespesialiseerde intensiewe sorgeenhede behandel. Tot op datum is minimale studies beskikbaar wat verslag lewer oor professionele verpleegkennis en kliniese praktyke ten opsigte van die sorg van pasiënte met traumatiese breinbeserings in Suid-Afrika. Doelstelling en doelwitte: Die doel van die studie is om die kennis en kliniese praktyke van professionele verpleegsters wat pasiënte met TBB in ‘n intensiewe sorgeenheid (ISE), binne ‘n tersiêre hospitaal in die Wes-Kaap van Suid-Afrika te bepaal. Die doelwitte van die studie is om: - Die kennis van professionele verpleegsters wat pasiënte met TBB in ‘n ISE versorg, te bepaal - Die kliniese praktyk van professionele verpleegsters wat pasiënte met TBB in ‘n ISE versorg, te ondersoek. Navorsingsmetodologie: ‘n Kwantitatiewe beskrywende studie is by ‘n tersiêre hospitaal in die Wes-Kaap gedoen. Die teikenbevolking het alle intensiewe sorgverpleegsters ingesluit (N=98). Etiese goedkeuring is verkry van die Gesondheid- en navorsingsetiekkomitee aan die Universiteit van Stellenbosch (Verwysing: S17/07/120) en die tersiêre hospitaal. Data is gekollekteer deur n selfgeadministreerde vraelys en ‘n loodstudie wat deur die navorser versprei was is gedoen deur nege deelnemers te betrek. Die resultate van die loodstoets is nie by die hoofstudie ingesluit nie. Die data analise is met behulp van ‘n ervare statistikus gedoen wat gebruik gemaak het van die Sagteware vir Statistiek en Data Wetenskap (STATA) program. Resultate: n Gemiddelde kennistelling in ISE het 71% in geheel getoon. Deelnemers met ‘n verpleegkundegraad is meer kundig as verpleegsters met ‘n Diploma in Verpleegkunde en Meesters/Honneursgraad. Die kennistelling van verpleegsters wat in ‘n Neuro-intensiewe eenheid werk, het ‘n telling van 75% as totale kennis en verpleegsters binne die Koronêre Sorgeenheid het die laagste telling van 66% behaal. Met betrekking tot die kennistelling van indiensneming, was dit duidelik dat intensiewe sorgverpleegsters wat vir ‘n agentskap werk, die hoogste kennistellingpersentasie van 75% het, in vergelyking met 71% van die van permanente personeel. Slegs 17% van intensiewe sorgverpleegsters het Ent Tidale Koolstofdioksied (ETKD2) ten alle tye in hulle departement gemonitor. Verpleegsters se kennis ten opsigte van die monitering van ETKD2 is beperk in kliniese praktyke. Die toepassing van kliniese riglyne verbeter die kwaliteit van sorg om die variasies in kliniese praktyke te verminder en 59.6% van intensiewe sorgverpleegsters het gemeld dat hulle nog nooit op riglyne en protokol afgekom het, met betrekking tot die behandeling van intraskedeldrukking in die intensiewe sorgdepartement nie. Aanbevelings: Aanbevelings vir hierdie studie sluit in neuro-intensiewe sorgopleiding, die wysigings van protokol en riglyne, ETKO2 monitering van alle intubasie-pasiënte, met inagneming van kliniese vaardighede en rotering van intensiewe sorgverpleegsters. Gevolgtrekking: Hierdie ondersoek mag aanleiding gee tot ‘n beter begrip van TBB om sodoende mentors, opvoeders en administratiewe personeel te help om beter kwaliteitsorg te bied aan pasiënte met TBB in intensiewe sorgeenhede. Die fokus behoort te wees om beter verpleegsters te word en deskundiges te wees wat sorg vir pasiënte met TBB, asook om oor die vermoë te beskik om vele besluite te neem in die oplossing van probleme in kliniese areas.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/107246
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