Challenges encountered by critical care unit managers in the large intensive care units

Matlakala, Mokgadi C.; Bezuidenhout, Martie C.; Botha, Annali

doi:10.4102/curationis.v37i1.1146

Cited by 22 publications

(25 citation statements)

References 12 publications

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“…It is not only in this study that the participants complained about the lack of equipment, but Matlakala et al (2014:n.p) also found that unit managers agreed that the right equipment was not available and if it was, it would inevitably be of poor quality. Insufficient supplies of equipment are thus proving to be an obstacle related to material resources.…”

Section: Subtheme: Lack Of Equipmentmentioning

confidence: 55%

Experiences of registered nurses caring for patients with an open abdomen in an intensive care unit in Gauteng

Chipu

Kearns

Nel

2017

Health SA Gesondheid

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Section: Subtheme: Lack Of Equipmentmentioning

confidence: 55%

Experiences of registered nurses caring for patients with an open abdomen in an intensive care unit in Gauteng

Chipu

Kearns

Nel

2017

Health SA Gesondheid

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“…[56,58] In critical care settings, work complexity at the point of care places greater reliance on bedside nurses to provide mentorship and clinical support to junior colleagues. [22] Front line management, education and clinical support positions must therefore be incrementally increased and aligned to the size of the nursing workforce by modeling the ratio of these resources per each pod of ten to twelve beds. [15] Ensuring visibility, access and interaction with front-line leaders also positively affects the level of personal accomplishment and is a key determinant of nurses' intention to leave.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally for the hot-floor, approximately 13% more nurses intended to resign within 12-months and this was associated with a higher level of reported depersonalisation potentially due to the larger clinical workforce reducing the sense of cohesion. [22,66] Disconnected, or isolated, nurses experience poor collegial communication and increased emotional fatigue that manifests as an unfeeling, impersonal or callous response toward patients, family and colleagues. [23,67,68] Up to 48% of critical care nurses have been found to experience depersonalisation, the subsequent professional and social isolation of which may hinder participation, undermine teamwork and compound burnout.…”

Section: Discussionmentioning

confidence: 99%

“…[19] Transition to the hot-floor model requires structural changes to nursing management and education models, supervision and support, staff numbers, resourcing, rostering and staffing. [20][21][22] Key factors to be considered in determining appropriate models and resourcing include the enhanced hotfloor bed flexibility enabling higher patient volumes per bed and high unit occupancy, and the large clinical workforce. Maintaining appropriate staffing and skill-mix on a 24-hour basis, while optimising nurse outcomes, is a major challenge internationally in the ICU.…”

Section: Introductionmentioning

confidence: 99%

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Intensive care unit organisation and nurse outcomes: A cross-sectional study of traditional and “hot-floor” structures

Abbenbroek

Duffield

Elliott

2017

JHA

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Aim: To explore the relationship between the practice environment and nurse outcomes in two Intensive Care Unit (ICU) models. Background: Internationally the demand for intensive care is increasing. A large capacity multi-specialty integrated critical care service, the "hot-floor", is emerging as the preferred organisational model. Benefits include resource consolidation and improved utilisation, operational synergies, operational flexibility and demand management. A large clinical workforce with commensurate frontline management, education and support positions are required. The association between these factors, within the ICU hot-floor work environment, and nurse outcomes is not known. Methods: Registered nurses (RNs) working in two ICUs, one a hot-floor model and one traditional ICU, completed a structured questionnaire. Nurse perceptions of work-life and organisational factors, and dimensions of burnout were examined using the Practice Environment Scale-Nursing Work Index (PES-NWI) and Maslach's Burnout Inventory (MBI). Results: Units matched on service level characteristics, training accreditation, patient casemix, operational and clinical care processes. Nurses in had similar demographic characteristics, professional attributes and experience. Workforce structures were also similar though the hot-floor had relatively less dedicated resources for frontline nurse management and clinical education positions. Hot-floor nurses worked more paid overtime and were redeployed less frequently to external wards. Nurse manager leadership and support was less effective, and nurses expressed lower personal accomplishment. Conclusions: Improved demand management achieved through greater operational flexibility is a key driver for the hot-floor model. Planning for enhanced organisational effectiveness requires corresponding improvements in the work environment to optimise nurse retention to ensure organisational sustainability.

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“…Experiences and challenges of caring for critically ill patients in the ICUs have been reported in some studies globally and also in Africa including Nigeria and South Africa [11,12]. In Tanzania, needs of the family of critically ill patients and their satisfaction with care were reported [13].…”

Section: Data Collectionmentioning

confidence: 99%

Caring Critically Ill Patients in the General Wards in Tanzania: Experience of Nurses and Physicians

T¹,

Halima²

2018

Int J Crit Care Emerg Med

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Background: Studies in Tanzania have reported that many hospitals in the country have no intensive care unit (ICU) where critically ill patients could be managed thus critically ill patients are cared for with other non-critical patients. The aim of this study is to describe nurses and physicians' experience of caring critically ill patients in the general wards at the Regional hospital. Methods: A descriptive qualitative design was used. Purposeful sampling method was used to enroll 10 nurses and 5 physicians working in various departments at the regional hospital. Using semi-structured interview guide, 15 interviews were conducted. Qualitative content analysis framework guided analysis of data. Results: Three (3) major themes emerged from the data of nurses and physicians' experiences of providing care to critically ill patients at the regional hospital. These included; being present and staying close, being powerless and lacking caring abilities. Conclusion: Nurses and physicians at regional hospital face multifaceted experiences when caring critically ill patients. Lack of equipment supplies and medicine, lack of expertise in caring for critically ill patients and lack of a special room to care for the critically ill patients, made them feel powerless in providing appropriate and effective care to critically ill patients.

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Challenges encountered by critical care unit managers in the large intensive care units

Cited by 22 publications

References 12 publications

Experiences of registered nurses caring for patients with an open abdomen in an intensive care unit in Gauteng

Experiences of registered nurses caring for patients with an open abdomen in an intensive care unit in Gauteng

Intensive care unit organisation and nurse outcomes: A cross-sectional study of traditional and “hot-floor” structures

Caring Critically Ill Patients in the General Wards in Tanzania: Experience of Nurses and Physicians

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