ARTICLE A profile of postgraduate critical care research in South Africa

Department of Anaesthesiology, University of the Witwatersrand, Johannesburg Juan Scribante, MCur Sats Bhagwanjee, FCA (SA) (Crit Care)

It is an accepted premise today, nationally and • determine in which publications the research has November 2006, 22, Vol. No. 2 SAJCC internationally, that critical care nurses are accountable been published. for setting standards of quality with regard to critical A quantitative research design was used. Approval 78 care nursing, and should contribute to the body of to conduct the study was obtained from the Ethics practice by undertaking and Committee of the University of the Witwatersrand. implementing research.1-3 A purposeful sampling method was used in this study: Critical care contributes to the advancement of critical care knowledge and promotes • all the universities that offer a postgraduate better patient care and the adoption of best or better programme in critical care nursing were invited to practices,3 all of which address important challenges take part; and currently faced by critical care nursing in South Africa. • all postgraduate research projects that were completed during the 6-year period 2000 - 2005 were Every year a significant number of critical care nursing included. research studies are undertaken at a postgraduate level in South Africa. However, there is no generally available The respective critical care nursing postgraduate profile of this research and it is generally not known if programme leader at each university was asked to and where it is published and/or presented. complete a ‘participant’s information and consent form’. Only the nursing departments that gave consent Given the current challenges to critical care, it is were included in the study. important that the profile of critical care nursing research, the extent to which this research is The critical care nursing programme leader at each communicated to the critical care community, and the university completed an electronic questionnaire. The communication channels used are determined. questionnaire asked the following questions: • title of each research project completed during the Methodology study period • the final submission date The aim of the study was to compile a profile of • whether the research completed was for a masters or postgraduate critical care nursing research completed doctorate level programme in the nursing departments of South African universities during the 6-year period 2000 - 2005 and to • the focus of the research (e.g. clinical, education, determine the extent to which this research contributes management) to the development of a unique body of specialist South • whether the research was published and the details African nursing knowledge. thereof, and • whether the research was presented and the details The objectives of the study were to: thereof. • determine the number of projects completed at The data were entered into a database and analysed masters and doctorate levels respectively using descriptive analysis techniques. • determine whether there has been an increase or a decrease in the number of research projects that have Study results been completed over the 5-year period Postgraduate critical care nursing programmes are • determine the focus of the research (e.g. clinical, offered at 10 universities and all the universities education, management) took part in the study. During the period 2000 - 2005 • determine at which national and international forums three doctorate projects and 74 masters projects were the research has been presented, and completed. The majority of the masters projects were

Pg 78-84.indd 78 11/16/06 1:51:34 PM SAJCC

November 2006, Vol. 22, No. 2 79 11/16/06 1:51:34 PM Based on 9 is that in general intensive care 5-8 postgraduate research? Is research done just to obtain a qualification, or is it to contribute to the body of critical care nursing practice? Should the Critical Care Society promote their support to disseminate critical care nursing research more actively? Why are critical care nurses undertaking • This study was undertaken as a contribution to facilitate the dissemination of critical care research. A evidence-based solutions. One such initiative is the Clinical Trials Group (CTG), currently being established by the Critical Care Society, which can potentially make a contribution to this process. The communication of research results is the first step in the process of research dissemination. the results of this study, only 18.2% of the research projects were presented at national and international forums, and only 15.6% were published. The majority of the articles were published in South African journals of which only one is ISI accredited. The Critical Care Society of Southern Africa offers financial assistance for its members to present at their annual congress and also offers substantial financial awards for the best respective nursing presentation and the best nursing publication submitted for review. Regardless of these incentives, very few nurses present at congresses and publish their research results. Certain questions consequently arose: • • nursing practitioners, which implies a need for more critical care nurses to obtain appropriate postgraduate qualifications. It is also generally known that critical care nurses with postgraduate qualifications are not involved in direct critical care nursing. Communication with programme leaders indicates that many postgraduate students are frustrated by their career prospects as currently little – if any – professional and financial credit is given for postgraduate critical care nursing qualifications. This acts as a powerful disincentive for enrolling in clinical postgraduate programmes. Problems in critical care nursing in South Africa have been highlighted at various forums recently. One of the problem areas that has been highlighted by various postgraduate studies nursing staff show alarmingly low levels of the expected knowledge required in order to discharge their day-to- day critical care nursing responsibilities. There is an urgent need for identification of important research needs/areas in critical care nursing, such as the low level of knowledge of critical care nurses indicated above, and to address these problems with private sector in June 2003. Although not all these units will employ an advanced nursing practitioner, there is nevertheless a major shortage of suitably qualified 4

7 16 9 24 7 13 Number of completed projects Number of postgraduate projects completed every year

Year 2000 2001 2002 2003 2004 2005

Table I. Discussion Internationally there is an acknowledgement that nursing research, and specifically nurse- led intervention research, is making a significant contribution to the advancement of quality . Only 14 (18.2%) of the 77 projects were presented at national and international congresses. dateTo the results of 12 (15.6%) of the 77 projects have been published. It is also notable that only one programme leader maintains a primary research focus area dealing with the requisite knowledge of critical care nurses. Conversely, some of the other programme leaders accepted research topics from a broader spectrum of interests. responding to the questionnaire were not intimately involved with the specific studies and could therefore not definitively classify the research without investing considerable time and effort. Judging by the responses it would seem that the majority of the projects had a clinical focus. The question pertaining to the focus of the critical care nursing research project was in most cases not answered appropriately because many of the persons completed projects could be identified for the 6-year period (Table I). mini dissertations or research reports. The contribution of the different programmes varied and 65% of the masters projects were completed at four of the universities. No trend of an increase or decrease in the number of Africa, 2005 – unpublished) revealed that there were 444 critical care and high-care units in the public and nursing practitioners in critical care units in South Africa. Internationally it is the accepted norm for advanced practitioners to have postgraduate qualifications. The South African national audit of critical care resources (Critical Care Society of Southern Africa, Audit of ICU and High Care Resources in South Currently there is a movement to introduce advanced Pg 78-84.indd 79 Pg 78-84.indd 80

80 SAJCC November 2006, Vol. 22, No. 2 effective critical care services. care critical effective of delivery the in problems the address to management and authorities allow and education nursing care critical improve to educators care critical help also will initiatives These practice. clinical improve to available evidence of aware becoming country the throughout units in teams care critical to contribute will efforts Such documentation. of process this maintain and formalise to is CTG the of objectives the of One Table in given is 2005 - 2000 period the for research nursing care critical postgraduate completed all of list Table II. II. Table of treatment from critically ill patient in an intensive care unit care intensive an in patient ill critically from treatment of withdrawal the of experience nurses’ Registered University Metropolitan Mandela Nelson title project and University Stellenbosch University Stellenbosch hospitals state in environment care intensive the in stress causing factors of perceptions nurses’ Registered keto-acidosis diabetic with patients of management the to related knowledge nurses' Registered ventilation mechanical on patients for caring the to related principles control infection of knowledge nurses’ Registered units care critical in placement initial on nurses registered of experiences The patients ill critically from treatment life-supporting of withdrawal the of experience nurses’ Registered intoxication herbal with patients ill critically of management Nursing unit care critical the in one loved a with family the of needs accompaniment The assessment neurological of utilisation and understanding nurses’ Registered ventilator mechanical a on patient a of experience lived The unit neonatology care critical a in infant an with parents of accompaniment Nursing environment work their of experiences specialists' nursing care Critical in the private hospital industry hospital private the in nurse registered trained critical a of practice of scope the into investigation An units care intensive in patients ventilated mechanically long-term for caring of experience lived Nurses' study phenomenologic A patient. a of death unexpected sudden the of experience nurses' care Critical period convalescent the during survivors myocardial first-time of wives of experience lived The Town Cape of University hospital private a in nurse care critical registered a of practice of scope the into investigation An Ireland Dublin, in hospital a in algorithm cardiothoracic fast-track a of efficacy the of Examination area Mafikeng greater the in injuries brain traumatic with patients polytrauma for standards outcome Nursing education nursing care critical outcomes-based for improvement quality of process A unit care intensive neonatal a in process control infection effective an of implementation the influencing Factors

Completed postgraduate critical care nursing research, 2000 - 2005 - 2000 research, nursing care critical postgraduate Completed

Year completed Year

II. II. 2000 2001 2005 2005 2005 2003 2003 2003 2002 2002 2001 2001 2005 2004 2003 2001 2005 2004 2001 2001 2000

Australian critical care nurses are successfully doing doing successfully are nurses care critical Australian Chaboyer by study A barriers. these overcome to place in measures putting towards work actively must we but Africa, South in research nursing care critical hinder that barriers are There research. nursing care critical self-initiated include to made be will attempt an year Next universities. African South various the at conducted research nursing care critical postgraduate includes only currently database research nursing care critical a towards attempt first This

Masters Level Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters PhD Masters

Congress name Congress CCSSA, Sun City 2005 2005 City Sun CCSSA, 2003 Town Cape CCSSA,

et al et details Publication

. Curationis 3 SAJCC concluded that that concluded Health RSA Health 11/16/06 1:51:35 PM SAJCC

November 2006, Vol. 22, No. 2 81 11/16/06 1:51:35 PM

Curationis International Journal of Trauma Nursing Curationis Curationis Health RSA Health RSA Curationis Africa Journal of Nursing and Midwifery

Publication details

International AIDS Congress, Durban 2000 RUDASA, Sabie 2003 Conference Of African Honor Society, Swaziland 2002 CCSSA, Durban 2004 International Trauma Congress, Durban 2003 CCSSA, CCSSA, Cape Town 2003 WONCA, Australia 2002 Congress name CCSSA, Sun City 2001 CCSSA, Cape Town 2004

Masters Masters Masters Masters Masters PhD Masters Masters Masters Masters PhD Masters Masters Masters Level Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters

2002 2003 2003 2003 2003 2005 2001 2003 2000 2003 2003 2003 2005 2001 2001 2001 2001 2002 2003 2003 2005 2002 2000

Year completed

Completed postgraduate critical care nursing research, 2000 - 2005 (continued)

y of medical doctors’ views on cadaveric organ oring the fear of contracting HIV/AIDS among trauma analysis of patients’ awareness and attitude concerning end-of-life issues The development of an intervention model for managing abrupt death trajectories in KwaZulu-Natal level I emergency departments The attitudes and perceptions of health care professionals to alternatives to blood transfusion: a case with Jehovah's Witness patients in a critical care setting The health education needs of the patient and family upon discharge after myocardial infarction The knowledge and practice of ICU practitioners with regard to the instillation of normal saline solution during endotracheal suctioning A descriptive survey of factors that facilitate adherence to haemodialysis therapy among patients with chronic renal failure An An exploratory study of the lived experiences of critical care nurses with Muslim traditional illness practices Closed suctioning system of endotracheal tube: The practice and perception of intensive care nurses in UAE Surve Witnessed resuscitation – exploring the attitudes and practices of the emergency staff working in level one emergency departments in the province of KwaZulu-Natal A health system's analysis of the interface between the tertiary and peripheral health care services Toepassings van infeksie beheermaatreëls in kritiekesorgeenhede Exploring the trauma nurse's lived experiences of dealing with violent death of their clients Stress among critical care nurses in Abu-Dhabi hospitals The influence of a pre-programme study guide for the diploma in critical care University of KwaZulu-Natal Expl ‘n Uitkoms gebaseerde leerbegeleidingsbenadering vir die preseptor in intensiewe sorgeenhede Kliniese bevoegdheid van die kritiekesorgverpleegkundige tydens die verpleging van 'n pasiënt op 'n IABP The perception of health care professionals regarding blood conservation in the private health sector Verpleeg standaarde vir 'n pasiënt met 'n abdominale aneurisme na 'n endovaskulêre stent-herstel Die belewenis van koronêre vatomleidings pasiënte na blootstelling aan 'n pre-operatiewe onderrigprogram Riglyne vir die respiratoriese hantering van die kardio-chirurgiese pasiënt post-ekstubasie Standaarde van die volwasse pasiënt op druk-gekontroleerde ventilasie in kritieke sorg-eenhede University and project title University of Johannesburg Die gebruik van outotransfusies in die kardio-torakale pasiënt donation and transplantation nurses in KwaZulu-Natal Table II. Pg 78-84.indd 81 Pg 78-84.indd 82

82 SAJCC November 2006, Vol. 22, No. 2 Table II. II. Table The use of sodium bicarbonate in the critically ill cardiothoracic patient cardiothoracic ill critically the in bicarbonate sodium of use The Gauteng northern in units care critical in nurses registered of coping of Ways patients adult ill critically of needs support Professional hours 48 first the during injuries chest blunt with patients to given care of Profile Witwatersrand the of University Bloemfontein Hospital, Universitas in conditions congenital cardiac of prevalence The ontvang pynbeheer epidurale wat pasiënte van verpleegsorg van Opname eenhede intensiewesorg in onderwaterdreineringstelsel torakale geslote van Evaluering is gaswisseling alveolêre van aanduidend wat data gemete op omleiding kardiopulmonêre van effek post-operatiewe Die b Die State Free the of University students nursing care critical of experiences practical and theoretical the of description A pasiënte heupvervangingschirurgie by proses rehabilitasie II fase in inligtingverskaffing van effek Die wards hospital private in working nurses registered of knowledge resuscitation Cardiopulmonary therapy pulsation counter pump balloon intra-aortic regarding nurses care critical of knowledge The syndromes coronary acute regarding nurses care acute of knowledge The Africa South of University Gauteng in hospital private a in programme debriefing structured a regarding nurses emergency and accident of perceptions The pasiënte intensiewesorg van monitering die in delirium vir beramingsinstrument 'n van gebruik Die graphics ventilator of interpretation the on nurses care critical for programme educational An patients surgical cardiothoracic to delivery oxygen of method post-extubation as cannulas nasal of use The counselling bereavement regarding Gauteng, in unit care critical a in working nurses of needs The calorimetry indirect by measured as metabolism patient's ill critically the on procedures nursing routine selected of effects The Gauteng in hospitals private two in emergencies oncological with patients nursing when nurses care critical by needed Skills Gauteng northern in hospitals private in adults in emergencies airway postoperative regarding knowledge nurses' room Recovery Gauteng in hospital a in ntibiotics a used commonly most the regarding knowledge nurses care Critical Africa South in environment care emergency the in situations threatening life in nurse A&E the of competencies Core resuscitation cardiopulmonary regarding hospital Gauteng a of units care critical the in working nurses care acute of knowledge The Gauteng in hospital a in patients care critical of members family of needs Knowledge Gauteng in hospital a in patients of members family of rehabilitation cardiac regarding needs Information Pretoria of University care) (crit nursing med-surg the completed who those and for registered nurses of Experiences University of Limpopo – Medunsa Campus Medunsa – Limpopo of University title project and University epaling van pasiënte se gemak tydens meganiese ventilasie meganiese tydens gemak se pasiënte van epaling

Completed postgraduate critical care nursing research, 2000 - 2005 (continued) 2005 - 2000 research, nursing care critical postgraduate Completed

Year completed Year

2003 2004 2003 2001 2003 2002 2000 2001 2001 2001 2004 2003 2001 2000 2000 2005 2005 2005 2003 2003 2003 2003 2003 2003 2002 2002 2002 2004

Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters Masters

Level Masters Masters

Congress name Congress CCSSA, Sun City 2005 City Sun CCSSA, 2005 City Sun CCSSA, 2004 Durban CCSSA, Sun City 2005 City Sun 2006 Bloemfontein CCSSA, Durban 2004 & 2004 Durban CCSSA, & 2005 City Sun CCSSA,

Publication details Publication SAJA Curationis 11/16/06 1:51:35 PM Pg 78-84.indd 84

84 SAJCC November 2006, Vol. 22, No. 2 improve) their position in the critical care team. care critical the in position their improve) (and maintain nurses care critical that ensure to way objective an is This disseminated. be must results research importantly more but research, undertake to responsibility the take must nurses care Critical difference. a make can research nursing care Critical qualifications. postgraduate with nurses for path career a place in put urgently should private) and (public authorities the and programmes postgraduate care critical offering universities The problems. our to solutions novel find we that and nursing evidence-based practise nurses that ensure will research implementing and Undertaking nurse. individual the and nursing of development the to fundamental is research Nursing Conclusion results. research the disseminating effectively are and research important Table II. II. Table research action An room: emergency and pre-hospital within nurse emergency the of role The changes lifestyle of comparison a disease: artery coronary with patients of Rehabilitation unit care intensive the in oximetry pulse and measurement gas blood arterial of Comparison patients unit care intensive in scales assessment risk ulcer pressure two of comparison A title project and University

Completed postgraduate critical care nursing research, 2000 - 2005 (continued) 2005 - 2000 research, nursing care critical postgraduate Completed

completed

2005 2005 2004 2004 Year

4. 9. 2. 3. 5. 8. 7. 6. 1.

updating the respective data. respective the updating in me assists reader the that ask and advance in apologise I date, to up not or correct fully not is presented information the of any If hand. at readily not was requested information the that and received been had request information an such time first the was this that clear was it cases many In universities. respective the by author the to provided Note. Naylor MD. Nursing intervention research and quality of care. of quality and research intervention Nursing MD. Naylor Fitch MI. Beyond publication (Editorial). publication Beyond MI. Fitch International Council of Nurses. 1992 Guidelines on Specialisation in Nursing. Geneva: Nursing. in Specialisation on Guidelines 1992 Nurses. of Council International Australian critical care nursing. care critical Australian of case W,the SV,Chaboyer knowledge: Dunn speciality Developing J. Najman 1992. ICN, nurse. care critical African Cochuis Y. The knowledge of registered nurses working in the critical care units of units care critical the in working nurses registered of Y.knowledge Cochuis The South African Journal of Anaesthesiology of Journal African South Africa. South Gauteng, Northern in hospitals private in adults in emergencies airway postoperative regarding knowledge nurses’ room VanRecovery T,ADH. Huysteen Botha 2002. Africa, Southern of University dissertation, Masters operation. graft bypass coronary after catheters artery pulmonary and venous central of monitoring Nurses’ M. Ellis 2002. Africa, Southern of University therapy.dissertation, counterpulsation Masters balloonpump intra-aortic regarding nurses care critical of knowledge The PJ. Oosthuizen 2002. Pretoria, of University dissertation, Masters resuscitation. cardiopulmonary regarding hospital Gauteng a 52: Scribante J, Muller ME, Lipman J. Professional-ethical responsibilities of the South the of responsibilities Professional-ethical J. Lipman ME, Muller J, Scribante Level 380-385. Masters Masters Masters Masters The information presented in this article was was article this in presented information The

Edge, 2005 Edge, the on Practice Clinical & name Congress CCSSA, Sun City 2005 2005 City Sun CCSSA, S Afr Med J Med Afr S

Intensive and Critical Care Nursing Care Critical and Intensive 1995; Journal of Advanced Nursing Advanced of Journal 2004;

85: Publication details Publication

10: 420-421. 9-13.

Nursing Research Nursing 2000; SAJCC 2004; 16: 48 13-17. (1): 1. (1): 2003; 11/16/06 1:51:36 PM