/library/oar/handle/123456789/39708 2026-11-07T13:21:56Z /library/oar/handle/123456789/41610 Title: Looking after adults with a percutaneous endoscopic gastrostomy (PEG) tube in the community : exploring the perceived needs of informal carers : a grounded theory approach Abstract: Background The PEG tube is introduced to provide a means for feeding to those individuals who have an inadequate oral intake which occurs due to dysphagia or that are not able to get enough food through their mouth to maintain an adequate nutrition status. Informal caregivers are generally involved in the care of community-based individuals who are dependent on tube feeding. Objectives To explore the perceived support needs of informal carers of adults who receive enteral tube feeding via percutaneous endoscopic gastrostomy tube living in Gozo. Design This study adopted a qualitative approach based on in-depth interviews, drawing upon principles of Grounded Theory. Setting The study took place in Gozo. Data generation and analysis took place concurrently and iteratively. Participants Participants were selected according to a set of criteria. Seven female informal carers were interviewed. These informal carers were caring for a person that have become dependent on tube feeding. Methods This study used analytic procedures in line with grounded theory methods involving coding and constant comparison of data which lead to the development of a theory about the perceived support and the coping process involved. Results The perceived needs and support that the informal carers expressed during the interviews were explored.Three categories were elicited from the findings which were: the “ Perceived Impact of the new situation”, the “ Perceived Help or Hindrance from the social environment” and “ Adjusting to the new Role”. These categories have contributed to the emergent theory. Conclusion The support received throughout the new role was given a great importance by the caregivers and it was evidently seen that to be able to adjust to the new situation, support played an important role. Recommendations for practice and future research based on the findings elicited from this study are presented. Description: M.SC.NURSING 2018-01-01T00:00:00Z /library/oar/handle/123456789/40872 Title: Whole body vibration therapy to lower the risk of falls in adults Abstract: Background Information: Falls, making up to approximately one third of admissions to the Accident and Emergency (A&E) Departments in Malta and Gozo, are not being given enough attention, and locally there are currently no falls prevention programmes. Whole body vibration therapy (WBVT) involves a horizontal plate vibrating at a set frequency and amplitude. These vibrations are then transmitted throughout the whole body, inducing muscle contraction and relaxation, exposing the user to passive exercise. The Formulated Research Question: Can WBVT lower the risk of falls in adults over 60 years of age? The PICO Elements: The population studied: males and females over 60 years. The intervention: WBVT with no comparison. The outcome: is to analyze whether WBVT lowers the risk of falls among the studied population. Method: An inclusion/exclusion criterion was established. Only articles published within the past ten years, performed on humans over 60 years, and published in the English language were included. Studies performed on animals or individuals who have suffered/suffer from neural, osteoporotic or muscular conditions, were excluded. A thorough search trail on Medline (ProQuest), Biomed central, SAGE Journals, PubMed, HyDi and EBSCO Host was carried out using the keyterms. Results: A total of 41 possible eligible articles were recovered. After reading the titles and abstracts of all these articles, and comparing them to Evans’ (2003) Hierarchy of Evidence, six articles (four systematic reviews and two randomised controlled trials), were considered as being valid for the search. These were then critically appraised using the Critical Appraisal Skills Programme (2017) tools. Conclusion: After interpreting the results of all papers, it was concluded that three or more weekly sessions of whole body vibration using a high frequency and amplitude, is effective in lowering the risk of falls in older adults. However, this should be further researched and guidelines on the optimal parameters used should be issued. Recommendations for Practice: Recommendations include educating healthcare professionals, those working within the hospital and community settings, about the high incidence of falls and possible treatments like WBVT. Other recommendations include the participation of nurse-led clinics, educating the community about the subject in day centres, leaflets and mass media. Description: B.SC.(HONS)NURSING 2018-01-01T00:00:00Z /library/oar/handle/123456789/40871 Title: The effectiveness of passive leg raising in the prediction of fluid responsiveness Abstract: Overview of the topic: In critically-ill patients with inadequate tissue perfusion, fluid resuscitation with the aim of establishing haemodynamic stability is essential. However, fluid administration is not always requisite. Clinical studies have indicated that only half of these patients respond to the fluids administered (Marik, 2009). Passive leg raising (PLR) has recently been suggested as a test for predicting preload responsiveness. In this dissertation, the effectiveness of PLR in the prediction of fluid responsiveness will be studied. The research question: For critically-ill patients with inadequate tissue perfusion, does the use of the passive leg raising test predict fluid responsiveness, thus preventing fluid overload? PICO elements: (P) critically-ill adult patients with inadequate tissue perfusion, (I) passive leg raising test, (C) no intervention, (O) prediction of fluid responsiveness, prevention of fluid overload. Inclusion criteria: Adults, English language full-text papers published from 2006 to date, patients showing signs of inadequate tissue perfusion. Exclusion criteria: Paediatrics, Pregnant women, patients with contraindications to PLR and patients with amputated lower limbs. Search outcomes: Combined keywords and alternative terms were searched in six databases. A total of eight key prospective cohort studies were identified. Methods of appraisal: The cohort study checklist from the CASP programme was used to critically appraise the articles. Results: Overall, PLR showed a good diagnostic performance in prediction of fluid responsiveness. However, heterogeneity between studies created some inconsistencies. Hence, it can be concluded that these results should be interpreted vigilantly. Implications and recommendations: Further research is still required due to the low number of studies published to date. Moreover, further education needs to be provided to health care professionals working in intensive care regarding the early detection of signs of inadequate tissue perfusion and the appropriate technique for PLR. Description: B.SC.(HONS)NURSING 2018-01-01T00:00:00Z /library/oar/handle/123456789/40865 Title: Nurses’ and nurse managers’ perceived transformational leadership behavioural practices: a survey Abstract: Background: In the last two decades, the continuous and progressive changes sweeping healthcare rendered it more difficult to function properly. Thus, an effective leadership is needed to successfully reach long-term goals. Recently, change has driven the healthcare system to lean towards a more transformational leadership style. The latter has been considered to be effective in promoting change in organisations, where the leader guides the followers towards a common vision. Local research on this topic was seen to be lacking, therefore the present study was inspired to fill this gap in local literature. Rationale for narrowing the research to charge nurses and staff nurses rather than the whole managerial system was to see whether transformational leadership style is being practised in ward or unit settings. Aim of the study: The aim of this research study was to identify and compare the perceived transformational leadership behavioural practices of charge nurses and the staff nurses under their direct supervision. Design: A quantitative, descriptive, comparative survey design was chosen for this study. Participants: All charge nurses and staff nurses (registered and enrolled nurses) both male and female at any age and at any level of education working in wards/units within six different health entities in Malta and Gozo. Methods: Quantitative data were collected using a mixed mode survey design, mainly an online and paper survey methods. The Survey Monkey online platform was used to create links to an online survey. An information letter with a link to the online survey was sent electronically to five hospitals including the oncology centre, large public acute, mental health and rehabilitation hospitals in Malta and the public acute hospital in Gozo. The long-term facility utilized the paper survey method as internet access to this entity was not possible. Data collected included the perceived transformational leadership behavioural practices of staff nurses and their immediate charge nurses, which were then compared between these two groups, different clinical settings and health entities. Data were entered into SPSS version 25 for analysis. A purposive sampling method was utilized. The total target population invited to participate in this study included 151 charge nurses and 1950 staff nurses. Results: This study achieved a response rate of 15% (n=315), including both charge nurses and staff nurses. Results show significant difference between these two variables’ perceptions in all five factors including ‘model the way’, ‘inspire a shared vision’, ‘challenge the process’, ‘enable others to act’ and ‘encourage the heart’. However, charge nurses scored higher than staff nurses. Among the ‘acute care wards’ and ‘long-term care wards’, all factors were significantly high but still differed significantly. Additionally, the ‘long-term care wards’ scored higher than the ‘acute care wards’. ‘Model the way’ was the most perceived factor among ‘long-term care wards’ while ‘enable others to act’ was the most perceived factor among ‘acute care wards’. Findings for the ‘acute care hospitals’ and ‘long-term care hospitals’ were consistent with the results reported for the wards. Conclusion: Transformational leadership style is highly perceived among local charge nurses and staff nurses. According to the data collected, the findings show that the nurses in Malta and Gozo are practicing transformational leadership style. The present study also concludes that transformational leadership style is more readily perceived by the ‘long-term care hospital’ rather than ‘acute care hospitals’. This shows that in hospital environments where there is less turnover rates of patients and less critical situations like the long-term care hospital, charge nurses work closer with their nurses by setting a personal example and standing up for one’s beliefs. Meanwhile, the ‘acute care hospitals’, perceive more behaviour which leans towards commitment and accountability, creating ownership and ensuring security. Description: M.SC.NURSING 2018-01-01T00:00:00Z