Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 5 uppsatser.

Qualified nurses cannot perform tasks and procedures with confidence due to ineffective mentoring by a clinical nurse during training. Effective mentoring by the clinical nurse, with an additional accredited qualification in his/her field should assist in the development and confidence of the student nurse. The purpose of this study was to explore the learner’s experience of mentoring and facilitation by the clinical nurse, challenges and their view of the clinical nurse, and if this could be a predictive factor to their level of an independent nurse practitioner at the end of training. A non-experimental, descriptive qualitative design was used to identify the experience of the students and newly qualified nurses regarding the amount and quality of facilitation given by the clinical nurse in practice. The research population consisted of all categories of student nurses currently in training as well as qualified nurses within the past year from different facilities. An online semi-structured questionnaire survey was distributed among 45 participants and feedback received by 32 anonymous participants in the public and private sector. The findings of the study indicated that not all newly qualified nurses are able to practice as independent nurses, there’s a lack in mentoring and facilitation by clinical nurses during training and that a clinical nurse should have an additional qualification to better the learner experience. / Health Studies / M.A. (Nursing science)

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Background The imperative of clinical education in chiropractic is to endow students with the clinical competencies and professional attributes necessary for independent practice. The clinical practicum exposes chiropractic students to the realities, demands and expectations of patient care through immersion into the clinical learning environment. Various authors emphasise the importance of obtaining a student’s perspective of their experiences within this environment as it is essential to curriculum development and improvement, delivery of quality clinical education, and student satisfaction with their standard of education. Interestingly, unlike in other health professions’ disciplines, the clinical experiences of chiropractic students who have commenced their clinical practicum have scarcely been described in international literature. This study is the first of its kind to record the clinical experiences of chiropractic students during their clinical practicum in South Africa. Aim The aim of this study was to explore and describe the clinical experiences of first-time registered Master’s chiropractic students during their clinical practicum component at the Durban University of Technology Chiropractic Day Clinic in 2016. Method A qualitative, exploratory, descriptive approach was utilised. A purposive sample of 15 first-time registered Master’s chiropractic students was interviewed. Their clinical experiences during the clinical practicum were obtained through semi-structured interviews. Seven key questions, each relating to a specific aspect of the clinical practicum, were used to stimulate discussion. The data were recorded electronically and thereafter transcribed. Thematic analysis was used to interpret the data. Results Four main themes were identified, viz. undergraduate education and pre-clinical preparation; experiences within the clinical learning environment; inter-personal relationships in a clinical learning environment, and appraisal of the clinical practicum. Participants reported that the undergraduate and pre-clinical preparatory phase needed to be more practically orientated in order to provide relevance and cohesion to clinical learning. Significant experiences in the clinical learning environment included personal and professional growth and development, perceptions of preparedness for independent practice, perceptions of patient responses to chiropractic care, administrative duties and clinic infrastructure. The interpersonal relationships that contributed to the overall clinical experience were between students and their clinical supervisors, and students and the administrative staff. The appraisal of the clinical practicum included highlights and positive aspects that shaped the attitudes, values and philosophies of students, as well as the challenges and obstacles they encountered within the clinical learning environment. Conclusion This is the first South African study to document the clinical experiences of first-time registered Master’s chiropractic students. These clinical experiences were based on a variety of organisational and curriculum-orientated factors, as well as interpersonal dynamics. While students acknowledged and appreciated the critical importance of clinical education, and valued the learning opportunities within the clinical setting, they also provided constructive feedback on matters needing improvement to enhance the overall clinical experience. The lack of exposure to patient care prior to the commencement of the clinical practicum negatively impacted the clinical experiences. It is recommended that the findings of this study be utilised by the key stakeholders within chiropractic education to enhance chiropractic clinical education in South Africa. / M

Background: Since the 1980s, Saudi Arabia’s socio economic transformation has led to vast social development. As a result there has been increased adoption of behaviours such as smoking and sedentary life styles, which pose a risk to health. It is anticipated that cancer incidence will double over the next two decades and it is thus vital that high quality of care is provided to meet the growing health care demands. Moreover, it is important that patients are satisfied with their care provision. This thesis begins with a narrative synthesis of the existing literature about patient satisfaction in the Saudi context and beyond. An evaluation of the key concepts for understanding patient satisfaction illuminated the lack of evidence about the assessment of patient satisfaction including specific key domains of the structure and process of care. This evaluation also indicated the need to further investigate the Saudi patient perspectives in oncology hospital setting. The aim of my study was to examine the extent to which clinical effectiveness impacts upon patient satisfaction in oncology ward settings in the Kingdom of Saudi Arabia (KSA). Methods: A sequential explanatory mixed methods design was employed. The Donabedian quality framework (1980) and Patient experience model (Reimann and Strech 2010) were used to assess patient satisfaction with quality of care provided. A quantitative phase was followed by a qualitative phase. In the first phase, the European Organisation for Research and Treatment of Cancer (EORTC) IN-PATSAT32 validated questionnaire was used to collect data from 100 adult oncology inpatients at a Cancer Centre in Riyadh. The second qualitative phase involved semi-structured telephone and face to face interviews with 22 adult oncology inpatients who previously answered the questionnaire. Synthesis occurred at the intersection of quantitative Phase 1 and qualitative Phase 2 data. The qualitative Phase 2 thus further explored the satisfaction scores of quantitative Phase1 to deepen the understanding of patient satisfaction in oncology ward settings in KSA. Findings: The main findings were that patient satisfaction levels are influenced by the clinical effectiveness of doctors and nurses, accessibility to health care and socio-demographic factors. Specifically, the interpersonal aspects of care were deemed core to patient experiences in oncology ward settings in KSA. It emerged that doctor-patient relationships, nurse shortages and language barriers are particular areas where changes could be made to improve care, thereby enhancing patient satisfaction. These findings contribute important new insights into the interpersonal aspects of care in the light of the underlying social and cultural contextual factors that influence patient satisfaction in the KSA. Conclusion: This study has provided new evidence supporting the need for stronger interpersonal relations and a more patient-centred approach in the oncology health system in KSA. In particular, the influential role of cultural issues in influencing patient satisfaction in oncology ward settings was apparent. Evidence provided by this research will make a substantial contribution to policy makers and hospital management teams in the KSA wanting to improve patient satisfaction in oncology wards and in other health care settings.

Background: previous studies have revealed that newly hired nurses experience stress and anxiety when entering a new clinical setting. Failure to support and prepare these nurses may affect their ability to deliver the required level of nursing care. Preceptorship is a time limited, organised clinical instructional programme, which promotes staff development, improves nursing education, reduces nursing shortages, promotes staff retention and decreases staff turnover. Little evidence expounds about how newly hired nurses perceive preceptorship. The impact of preceptorship on the clinical nursing care of newly hired experienced nurses has not been investigated or verified globally neither has it been investigated from a Saudi context. Aims and Objectives: the study aimed to explore the nature of preceptorship and its impact on clinical nursing care as perceived by the nurses who had taken part in a preceptorship programme in Saudi Arabia. The study elicited the participants' understanding and expectations of the preceptorship programme in an attempt to identify those factors that may be directly related to the success or failure of the programme. Furthermore, it aimed to examine the role of preceptorship in developing the clinical practice of newly hired experienced nurses. Methodology: a qualitative design based on the principles of naturalistic inquiry underpinned this study. Thirty national and international nurses of five different grades across wards in one Saudi hospital were first purposively and subsequently convenience sampled to take part in the study. Most participants were of international origin, possessing various levels of experience and education. Preceptees were younger and less experienced than other programme stakeholders. Data were generated using tape-recorded semi-structured individual and focus groups interviews. This action was also supported by a review of the hospital's preceptorship policy documents. All the interviews were transcribed verbatim and analysed concurrently using thematic analysis based on a constant comparative method. Findings and discussion: Six themes were derived from the interview data to generate an account of participants' experiences. Social learning theory was used as an explanatory framework for understanding the study's findings. Thus, preceptorship was seen as an important supportive, learning process, although inconsistencies were highlighted related to the participants' understanding and expectations of the programme. The duration of preceptorship was also contested with some needing longer than allocated. Hence, confusion arose regarding when preceptorship should begin and end due to ambiguities within the preceptorship policy documentation. Furthermore, participants perceived preceptorship had a mixed impact on clinical nursing care depending on preceptee/preceptor preparation and workload. Surprisingly recruitment was found to have the biggest impact on the success or failure of the preceptorship programme an unexpected and new finding highlighted by this study. Conclusion: preceptorship is important for the integration of newly hired experienced nurses into their new roles. The meaning of preceptorship as applied to each hospital needs to be defined and articulated clearly and concisely. In order to meet the objectives of preceptorship, policy documentation needs to be clearer, and recruitment processes need to be reviewed in order to match both preceptee experience and qualifications with organisational requirements.

OBJECTIVES: Legislation and health policy enabling nurses and pharmacists to prescribe a comprehensive range of medicines has been in place in the UK since 2006. Our objective was to evaluate the clinical appropriateness of prescribing by these professionals. METHODS: A modified version of the Medication Appropriateness Index (MAI) was used by 10 medical, seven pharmacist and three nurse independent raters to evaluate a sample of 100 audio-recorded consultations in which a medicine was prescribed by a nurse or pharmacist. Raters were current prescribers with recognized experience in prescribing. Consultations were recorded in nine clinical practice settings in England. RESULTS: Raters' analysis indicated that, in the majority of instances, nurses and pharmacists were prescribing clinically appropriately on all of the ten MAI criteria (indication, effectiveness, dosage, directions, practicality, drug-drug interaction, drug-disease interaction, duplication, duration, cost). Highest mean 'inappropriate' ratings were given for correct directions (nurses 12%; pharmacists 11%) and the cost of the drug prescribed (nurses 16% pharmacists 22%). Analysis of raters' qualitative comments identified two main themes: positive views on the overall safety and effectiveness of prescribing episodes; and potential for improvement in nurses' and pharmacists' history-taking, assessment and diagnosis skills. CONCLUSIONS: Nurses and pharmacists are generally making clinically appropriate prescribing decisions. Decisions about the cost of drugs prescribed and assessment and diagnostic skills are areas for quality improvement.

No / OBJECTIVES: The aims of this study were to conduct the proof of concept study and to develop and evaluate an educational intervention that promotes the evidence-based supply of non-prescription medicines (NPMs). METHOD: An educational intervention was delivered to pharmacy assistants and pharmacists in three pharmacies in England. The intervention included the provision of summaries of evidence for the treatment of four minor ailments and resulted in the preparation of evidence-based portfolios for the treatment of the following ailments: athlete's foot, cough, nasal congestion and period pain. The effect of the intervention was evaluated using a combination of direct overt observation, vignettes, self-reported behaviour and interviews. KEY FINDINGS: Evaluation data were collected from the three pharmacies. Data were derived from 3 pharmacists and 13 assistants, of whom 10 (3 pharmacists; 7 assistants) attended the training event. Comparing pre- and post-intervention practice, 8/11 (pre-) versus 5/6 (post-) observed, 46/80 versus 62/80 vignette and 25/30 versus 39/40 self-reported recommendations were evidence based. Prior to the intervention, 3/16 participants understood the role of evidence regarding the supply of NPMs compared with 16/16 post-intervention. Participants reported relying upon experiential knowledge to inform their decision making prior to the educational intervention. Thereafter, the participants reported using evidence to a greater extent. Barriers and facilitators for evidence-based practice were also identified. CONCLUSION: A one-off educational intervention increased participants' self-reported awareness and potential application of evidence to inform their supply of NPMs. Further research is needed to assess the effectiveness, long-term impact, generalisability and cost-effectiveness of this intervention for a wider range of common conditions.

No / It is estimated that 820,000 people in the UK have dementia. Dementia costs the UK 17 billion a year and in the next 30 years this will treble to over pound50 billion a year. There is a need to raise competence of staff delivering care to people living with dementia across health, social and voluntary sector provision. Effective education and training will build capacity and improve staff knowledge. However, at present not enough is known about the experiences of staff involved in gaining the skills, knowledge and attitudes required to support provision of high quality care for people with dementia. This study was conducted within a large National Health Service Trust in the UK serving an urban, ethnically mixed population, in collaboration with a local university. The trust responded to government policy by seeking to identify staff training needs. The aim was to explore the experiences of staff working within a specialist mental health service in relation to development of skills for the provision of person-centred care for people with dementia. To achieve this, staff roles, experiences of dementia training and the ways in which staff feel they learn were explored through focus group interviews. Relatives' views of staff competencies necessary for effective care provision were also explored to supplement the data from staff. A total of 70 staff and 16 family carers participated and data were subjected to inductive thematic analysis. Five themes emerged: competency-based skills, beliefs, enablers and barriers and ways of learning. Findings suggested participants felt that skills for person-centred care were innate and could not be taught, while effective ways of learning were identified as learning by doing, learning from each other and learning from experience.

A non-experimental, explorative, descriptive, quantitative study was undertaken. The purpose was to explore and describe the views of preceptors and preceptees regarding the fulfillment of the role of the preceptor in selected clinical nursing practice settings in the Botswana context. The study included 72 preceptors and 200 nursing students/preceptees who voluntarily agreed to participate in the study. A questionnaire was used to collect data. Data was analysed by using descriptive and inferential statistics. The findings of this study indicated that there were numerous constraints that interfered with the preceptor role in accompaniment of the preceptee. These constraints included the lack of desirable characteristics and time to plan learning opportunities, inadequate use of teaching strategies and inadequate knowledge on preceptee evaluation. Recommendations were stated for improvements in the future role of the preceptor in clinical practice settings Limitations of this study were also highlighted. / Health Studies / M.A.(Health studies)

Submitted in fulfillment for the requirements of M Technology : Nursing, Department of Nursing, Durban University of Technology, Durban, South Africa, 2015. / Background All nursing students need to undergo clinical training for them to be competent practitioners when they qualify. According to the South African Nursing Council (SANC) training facilities are accredited only if the clinical training component is effective. Therefore, it is important that students are accompanied in order for them to grow professionally and have values as future health care professionals. In nursing education, a student throughout the nursing training course receives instruction both theoretically and clinically in the subjects prescribed in the curriculum by the SANC. Clinical instruction is effected through clinical teaching and learning, which is a requirement by the nursing regulatory body, the SANC. For an undergraduate programme a student has to spend a minimum of 1000 hours per year in clinical placement to meet programme outcomes. It is the responsibility of all nursing schools, colleges and universities to ensure that each student meets these requirements. For this to be effective it has to be facilitated by lecturers and clinical instructors, through teaching and learning strategies to enable students to perform the clinical skill with knowledge and eventual competence. Therefore, clinical instructors are there to ensure that the students are competent in all skills, such as cognitive, affective as well as psychomotor skills. This will be beneficial to the programme in reduction of rates of failure and dropout and again by producing competent practitioners. A positive relationship and collaboration between the clinical training institutions and clinical placement facilities is vital for student achievement, especially because the clinical instructors assist students in correlating theory and practice. This study sought to assess the clinical training component of an undergraduate programme at this UoT in KwaZulu Natal. Findings may inform an improved clinical instruction programme as no such study had been undertaken. Methods A qualitative and quantitative design was used to explore feelings, perceptions as well as experiences of staff and student nurses with regard to clinical training component. Stratified random sampling was used to select student nurses according to levels of training and questionnaires were used to collect data. All permanently employed staff who had been working over six months were selected since they were directly or indirectly involved in the clinical facilitation. A focus group interview was conducted for the clinical instructors and questionnaires were used for the lecturers to collect data. Themes and sub-themes emerged and on analysis they were compared to the findings from the quantitative survey. Results and discussion The results revealed that collaboration of clinical placement facilities and training institutions is important for student’s support since all parties are able to communicate freely and students benefit. Students stated that they did not get enough support since the clinical facilitators were short staffed and they were also allocated to facilities that were far from the campus. The respondents cited problems during clinical accompaniments as there were very high expectations by staff members in the placement areas regarding student support. Lecturers were also expected to involve themselves in clinical accompaniment to bridge theory-practice gap. The employment of mentors will assist in student support as the mentors will be at placement areas and the staff and students easily contact them. Conclusion From the interviews the researcher managed to come up with important aspects that should be included in an accompaniment tool when developed, which should be user friendly to both lecturers and clinical facilitators. It will thus assist students with critical skills including critical thinking when performing any patient related nursing skill. It was recommended that the UoT management support staff by attending to their concerns including finding more clinical placement facilities close to the campus.