Aim and objectives. Although many international sources in literature describe the treatment regimes for the management of adult female rape survivors, very few actually evaluate if the care that is implemented, are beneficial and supportive towards an optimal level of health. The researcher initiated this study to specifically determine what the experiences of adult female rape survivors were with regards to the management they received from health care workers in the emergency care environment. This information that was gathered was then incorporated into the writing of recommendations for health care services towards the improvement of patient-centred care. Method. A qualitative phenomenological methodology guided the research process in which ten semi-structured voluntary interviews was held with adult female rape survivors. This study was conducted in a private hospital in Gauteng, South Africa, which is at the top of the international statistics list for the incidence of rape. Findings. Patient management with regards to accessibility to health care services, the forensic examination and the use of medications proved to be a major concern. Participants in this study emphasized the value and importance of the physical presence of family members or significant others. A positive attitude from these support-givers improved the patient’s psychological state, memory and co-operation. Prolonged waiting times in all areas of management contributed to an increased level of anxiety, where as the prompt and competent interventions by empathetic multi-disciplinary team members had improved patient satisfaction. Various patient responses after the rape incident warranted that minimal, but yet effective and professional health care workers be involved in rape survivor management. Confidentiality and honest, effective communication that is based on patient preference, should guide all interventions. Conclusion. The medical management of adult female rape survivors in this hospital compared favorably to international standards, however, the need to improve the level of specific patient-centred care exists in order to ultimately facilitate a better quality of service provision. Copyright / Dissertation (MCur)--University of Pretoria, 2009. / Nursing Science / unrestricted

The A&E unit is a unique environment with unique problems, including those problems pertaining to the documentation of the nursing care provided to the critically ill or injured patient. In such a hectic and turbulent environment where minutes can be the decider between life and death, saving the patient’s life takes priority over record keeping, and crucial information is not recorded. The aim of this study was to develop a nursing record tool to record the management of critically ill or injured patients in an accident and emergency (A&E) unit. The researcher used the collaborative inputs of three different groups of experts in the field of A&E nursing and record keeping to reach this aim. The study was descriptive, explorative and contextual in nature, and a qualitative approach was used. The A&E nurse practitioners views were incorporated into a final nursing record tool that could be used in the A&E unit for critically ill or injured patient for the first six hours of resuscitation. The compiled nursing record tool was comprehensive and included a prehospital management section to ensure the continuity of care in the emergency environment. Although more comprehensive as the current tool, the use of tick-off prompts shortened the time spend to complete this nursing record tool and, in doing so, increased the retaining of crucial information that could enhance the quality and ensure the continuity of care pertaining the critically ill or injured patient in the changing emergency environment. / Dissertation (MCur)--University of Pretoria, 2009. / Nursing Science / unrestricted

The critical illness/injury of a family member warranting an admission to an A&E unit can predispose a family to psychological and physiological needs. The patient-centred-care approach rendered in an A&E unit focuses on the patient as a priority, resulting in the family’s needs being neglected during a crisis situation. Based on the Family Resilience Framework, the aim of this study was to assess the needs of the families of the critically ill/injured patients in an A&E unit. Based on the identified needs, recommendations were made with regard to a family-centred-care approach as a relevant resilience-based strategy suitable to these families. The research adopted a quantitative, non-experimental, exploratory and descriptive design. A purposive convenience sample of 100 participants was recruited over a period of four months. The data were collected by means of a structured interview schedule. The study revealed that the five main domains of family needs identified by the respondents as very important was, in order of priority, the need for communication, support, meaning, comfort and proximity. The findings supported the need to initiate and foster a family-centred-care approach in the A&E unit, which could guide the nurse practitioners in supporting the affected families, which in turn could enable these families to become resilient. Copyright / Dissertation (MCur)--University of Pretoria, 2010. / Nursing Science / unrestricted

Rapid changes in the healthcare environment increase the need for nurse practitioners to be motivated, knowledgeable and skilled in order to ensure quality patient care. Accident and emergency units are challenging environments and by ensuring that nurse practitioners work in an enabling environment, they should be motivated, skilled and knowledgeable and be able to think critically to enhance their own professional growth and emancipated practice. This in turn may increase the nurse practitioners’ job satisfaction, which in turn encourage job retention and may influence patient outcomes positively. A journey towards a shared vision namely “emancipatory practice development” was undertaken in an accident and emergency unit of a Level III public hospital. Following the diagnosis of an emergency situation, action research was applied to change the perceived toxic environment to an enabling environment. The study was conducted within the critical social theory paradigm and descriptive, explorative and contextual in nature. Both qualitative and quantitative approaches were utilised. Throughout the action research for practitioners project, collaboration enhanced the emancipation of the nurse leaders, as key drivers of the process, as well as the nurse practitioners. Short and long-term actions were planned, implemented and amended based on observations and reflection following each cycle of the project. During this process a toxic environment was changed to an enabling environment, in which nurse practitioners were retained and additional spin-offs followed. Guidelines for the application and implementation of the process as utilised in this study were compiled to guide others who experience similar challenges. / Health Sciences / D.Litt. et Phil. (Health Studies)

Rapid changes in the healthcare environment increase the need for nurse practitioners to be motivated, knowledgeable and skilled in order to ensure quality patient care. Accident and emergency units are challenging environments and by ensuring that nurse practitioners work in an enabling environment, they should be motivated, skilled and knowledgeable and be able to think critically to enhance their own professional growth and emancipated practice. This in turn may increase the nurse practitioners’ job satisfaction, which in turn encourage job retention and may influence patient outcomes positively. A journey towards a shared vision namely “emancipatory practice development” was undertaken in an accident and emergency unit of a Level III public hospital. Following the diagnosis of an emergency situation, action research was applied to change the perceived toxic environment to an enabling environment. The study was conducted within the critical social theory paradigm and descriptive, explorative and contextual in nature. Both qualitative and quantitative approaches were utilised. Throughout the action research for practitioners project, collaboration enhanced the emancipation of the nurse leaders, as key drivers of the process, as well as the nurse practitioners. Short and long-term actions were planned, implemented and amended based on observations and reflection following each cycle of the project. During this process a toxic environment was changed to an enabling environment, in which nurse practitioners were retained and additional spin-offs followed. Guidelines for the application and implementation of the process as utilised in this study were compiled to guide others who experience similar challenges. / Health Sciences / D.Litt. et Phil. (Health Studies)

Introduction: Working in the hospital accident and emergency unit is perceived to be very stressful. However, minimal or no organizational support measures are made available to enable the nurses working in these hospital units to cope effectively with stressful incidents. The purpose of the study was to develop strategies to enhance the support systems of nurses in the accident and emergency unit. Method: The study used a qualitative approach to explore the experiences of and describe the coping strategies used by nurses working in the accident and emergency units of regional urban hospitals at KwaZulu-Natal, in South Africa. Fourteen participants were interviewed in the accident and emergency units of four (4) hospitals. Data were collected through in-depth individual interviews. The data were analysed manually following the steps explained by Creswell (2009:186). Findings: The interviews led to the description of the nurses’ experiences in the accident and emergency units. Four themes emerged from the findings of the interviews, and included working under pressure and stressful conditions, the need for safety and security, limited resources and psychological and emotional problems. Among the problems discussed within the themes, there was anger that was directed by the patients and their relatives to the nurses; absenteeism that contributed to an increase in work pressure; emotional disturbance; lack of physical security; and lack of continuous support from the hospital management. Conclusion: Five strategies were developed to generate a support systems for the nurses whose hospital units formed part of the study and were as follows: develop or strengthen an existing employee assistant program (EAP) specifically for counselling and support of the nurses within the unit; address staff absenteeism through the provision of extra staff through overtime or agency work; enforce attendance of monthly debriefing sessions; strengthen the security system through increasing and evenly distributing the security staff; and give attention to all the problems and provide a quick response. The strategies developed are trusted to remain as a point of reference whenever a need arises. / Health Studies / D. Litt. et Phil. (Health Studies)