Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Students undertake their clinical placement in various clinical settings for the exposure to and acquisition of skills related to that particular context. The operating room, for example, is a context that offers the opportunity to develop critical skills related to the perioperative care of the patient. Despite the numerous studies that have been undertaken in this field, few studies that have investigated the operating room as a clinical learning environment in the South African healthcare system have been published. The aim of this study was to determine students’ perceptions of the operating room as a clinical learning environment in a private hospital context. An exploratory, interpretive and descriptive design generating qualitative data was utilized. Data was collected from nursing students undertaking their training at a private nursing education institution. Ten nursing students participated in an open-ended questionnaire (N=10), and twelve students participated in the focus group discussion (N=12). From the results, four themes emerged, namely, ‘interpersonal factors’, ‘educational factors’, ‘private operating room context’, and ‘recommendations’. This study has highlighted some of the challenges experienced by students in the private sector operating room context. Despite the potential learning opportunities, the key findings reveal negative perceptions of students regarding learning experiences. However, the opinion that the operating room offers an opportunity to gain skills unique to this context, as well as facilitates the integration of theory and practice, was also expressed. Some students reported that the emphasis on profitability and cost to patient, and the lack of a mentoring process in this context posed a constraint to learning. Exploration into the specific preparatory needs of students specific to learning outcomes before operating room placement should be considered. It would also be necessary to improve collaboration between lecturers, mentors and theatre managers so that a structured teaching programme may be developed for students entering the perioperative environment. / AFRIKAANSE OPSOMMING: Studente onderneem hul kliniese plasing in verskeie kliniese omgewings vir die blootstelling aan en aanleer van vaardighede wat verband hou met daardie spesifieke konteks. Die operasiesaal, byvoorbeeld, is ’n kliniese omgewing wat die geleentheid bied om kritiese vaardighede te ontwikkel wat verband hou met die perioperatiewe versorging van die pasiënt. Ten spyte van die talle studies wat in die operasiesaal onderneem was, het slegs ’n paar studies uit ’n Suid-Afrikaanse gesondheidsorg oogpunt, die operasiesaal as ’n kliniese opleidings omgewing ondersoek. Die doel van hierdie studie was om studente se persepsies van die operasiesaal as ’n kliniese omgewing in ’n privaat hospitaal konteks te bepaal. ’n Ondersoekende, verklarende en beskrywende ontwerp wat kwalitatiewe data genereer, is gebruik. Data is ingesamel van verpleegstudente wat hul opleiding by ’n privaat verpleegonderrig instelling ontvang. Tien verpleegstudente (N=10) was genooi om ’n onbepaalde vraelys te voltooi en twaalf student (N=12) het aan die fokusgroep bespreking deelgeneem. Vier temas het na vore gekom, naamlik ‘interpersoonlike faktore’, ‘opvoedkundige faktore’, ‘privaat-operasiesaal konteks’, en ‘aanbevelings’. Hierdie studie het ’n paar van die uitdagings uitgelig wat die studente in ’n privaat sektor operasiesaal ondervind. Ten spyte van die potensiële leergeleenthede teenwoordig in die privaat sektor operasiesaal, toon die belangrikste bevindings egter die negatiewe persepsies van studente jeens hierdie kliniese omgewing. Die opinie is egter ook uitgespreek dat hierdie omgewing ook ’n geleentheid aanbied om unieke vaardighede aan te leer. Dit bied ook ’n geleentheid om teorie en praktiese kundigheid te integreer. Sommige studente rapporteer dat die klem op winsgewendheid en koste vir die pasiënt, asoók die gebrek aan mentorskap in hierdie kliniese omgewing ’n beperking plaas op die leerproses. Die spesifieke voorbereidings behoeftes van studente insake leeruitkomste voordat plasing in die operasiesaal omgewing geskied, moet eers deeglik ondersoek word. Dit is ook nodig om die nodige samewerking tussen dosente, mentors en operasiesaal bestuurders te verbeter sodat ’n gestruktureerde onderrig program ontwikkel kan word vir studente wat die perioperatiewe omgewing betree.

Introdução: Apesar do desenvolvimento tecnológico, permanece baixa a sobrevida hospitalar das vítimas de parada cardiorrespiratória extra-hospitalar. Há importante dúvida na literatura quanto à retenção de habilidades de ressuscitação cardiopulmonar (RCP) e a periodicidade adequada de treinamento para manutenção dessas habilidades. O presente estudo investigou a retenção, em alunos a partir de treinamento no primeiro semestre de ingresso no curso médico, das habilidades práticas de RCP até 42 meses após o referido treinamento. Métodos: Estudo de corte transversal, realizado com 298 alunos de graduação de uma faculdade de Medicina, treinados com base nas diretrizes de ressuscitação de 2010 da American Heart Association. Foram avaliados 205 alunos sem retreinamento das habilidades, divididos em quatro grupos conforme o tempo decorrido desde o treinamento de ingresso: 73 alunos após 1 mês, 55 após 18 meses, 41 após 30 meses e 36 após 42 meses. A análise da retenção das habilidades foi comparada com 93 alunos que referiram ter realizado retreinamento em RCP. Dezenove habilidades de RCP e nove potenciais erros de técnica na execução das ventilações pulmonares e compressões torácicas foram avaliados por meio de simulação realística e revisados com utilização de filmagem e avaliadores independentes. Resultados: A média de retenção das dezenove habilidades nos alunos sem retreinamento foi: 90% após 1 mês, 74% após 18 meses, 62% após 30 meses e 61% após 42 meses (p < 0,001). Nos alunos que referiram retreinamento, a retenção foi de 74% após 18 meses, 70% após 30 meses e 66% após 42 meses do treinamento inicial. Realizada curva de predição da retenção de habilidades, com estimativa de 80% das habilidades mantidas após 10 meses, 70% após 21 meses e 60% após 42 meses. A profundidade das compressões torácicas foi a habilidade com maior retenção ao longo do tempo (87,8%), sem diferença estatística entre os quatro grupos. Houve aumento da prevalência de compressões realizadas com menos de 5 cm de profundidade quando realizadas em frequência maior que 120 por minuto. A média da frequência de compressões torácicas obtidas nos grupos após 1, 18, 30 e 42 meses foi, respectivamente, 114, 114, 104 e 108 compressões por minuto; 104 (50,7%) alunos mantiveram frequência média entre 100-120 por minuto. As ventilações pulmonares apresentaram diminuição progressiva de retenção, de 93% após 1 mês até 19% após 42 meses (p < 0,001). Todos os alunos efetivaram o choque com o desfibrilador externo automático, porém com o grupo após 1 mês do treinamento com menor tempo para efetivação do choque e maior prevalência de posicionamento adequado das pás do desfibrilador. Conclusões: O presente estudo demonstrou diferentes níveis de retenção para as habilidades de RCP e diferentes níveis de decréscimo de tais habilidades ao longo de 42 meses. A profundidade das compressões torácicas e o uso do desfibrilador externo automático foram as habilidades com maior retenção ao longo do tempo. Treinamentos adicionais ao longo do curso de Medicina atenuaram a perda de habilidades, mas sem retorno ao desempenho observado após 1 mês do treinamento. Sugerimos que o intervalo mínimo de retreinamento para manutenção de pelo menos 70% das habilidades deva ser de 18 a 24 meses / Introduction: Despite technological development, the survival of victims of out-ofhospital cardiac arrest remains low. There are important questions in the literature regarding the retention of cardiopulmonary resuscitation (CPR) skills and the ideal frequency of retraining required to enhance retention of skills. This study investigated the retention of practical CPR skills by medical students over 42 months after training in the first semester of admission to the medical course. Methods: A cross-sectional study was conducted with 298 undergraduate medical students who were trained based on the 2010 American Heart Association resuscitation guidelines. A total of 205 students divided into four groups according to the time elapsed since the entrance training were evaluated without retraining (73 students after 1 month, 55 students after 18 months, 41 students after 30 months and 36 students after 42 months). The analysis of the retention of skills was compared to 93 students who reported having performed retraining in CPR. Nineteen CPR skills and nine potential technical errors in ventilations and chest compressions were evaluated by realistic simulation and reviewed using filming by independent examiners. Results: The mean retention of the nineteen skills in not retrained students was: 90% after 1 month, 74% after 18 months, 62% after 30 months and 61% after 42 months (p < 0.001). In retraining students, retention was 74% after 18 months, 70% after 30 months, and 66% after 42 months of initial training, with statistical difference between the students with and without retraining in the 30-month group (p=0.005). The estimation of mean skill retention was 80% after 10 months, 70% after 21 months and 60% after 42 months. The depth of chest compressions was the skill with greater retention over time (87.8%), with no statistical difference among groups. There was an increase in the prevalence of compressions performed with less than 5 cm depth when performed at a frequency greater than 120 per minute. The mean chest compressions rate obtained in the groups after 1, 18, 30 and 42 months were 114, 114, 104 and 108 per minute, respectively, and 104 (50.7%) students maintained a mean frequency of 100-120 per minute. Pulmonary ventilation showed a progressive decrease in retention from 93% after 1 month to 19% after 42 months (p < 0.001). All students delivered the shock with the automated external defibrillator; however, for the group one month post-training, the time for the application of the shock was lower, and the prevalence of adequate positioning of the defibrillator pads was greater. Conclusion: This study showed different retention levels for CPR skills and different decrease levels of these skills over 42 months. Depth of chest compressions and use of automated external defibrillator were the skills with the highest retention over time. Additional training throughout the medical course attenuated the loss of skills, but no return to the initial performance achieved after 1 month. We suggest that the minimum retraining interval for maintenance of at least 70% of skills should be 18 to 24 months

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Made available in DSpace on 2016-04-27T13:10:26Z (GMT). No. of bitstreams: 1 Marcia Braga Cliquet.pdf: 2818491 bytes, checksum: cdbeaf5a4764478e70c1f9560994699f (MD5) Previous issue date: 2015-02-20 / Changes in the curriculum of medical courses in the world were defined in Brazil by the National Curriculum Guidelines for Undergraduate Medicine (DCNM) in 2001, aiming to cater for the needs of the national social reality through training of professionals in order to equip them with knowledge, competences and skills (general and specific) required for practice. The increasing prevalence of mental disorders in Brazil shows the importance of mental health education in shaping the current doctor. Primary Objective: To evaluate the presence of contents of Mental Health in the real curriculum comprising the first four years of medical course in the Faculty of Medical and Health Sciences of PUC-SP the Pontifical Catholic University of São Paulo. Methodology: A qualitative and quantitative study. We searched whether these contents were present or not in teaching plans, and in the activities developed through teaching strategies from August 2012 to July 2013. A questionnaire was used to assess the opinion of teachers about this. Results: The pedagogical design provides these contents, but doesn t correspond to the practice. In the teacher s opinion (62,50% of the total), the majority believe that contents of mental health were present in the curriculum (72,90%), but insufficient or even absent, and poorly explored (64,30%); yet, students experience (70%), but do not learn (80%). Using the Collective Subject Discourse confirmed that the contents are not frequent in the strategies and not adequately exploited (55,55%). The theory and practice are not integrated (30,43%), learning scenarios are unsuitable for this operation (21.10%), time/organization are not enough and teachers and students are unprepared to address (13,04%) are the many reasons to this situation. Conclusions: Mental health does not have its role established in the curriculum of the FCMS and there is no standard for this construction, is seldom present in the teaching learning strategies, causing a deficiency in the learning of these contents, this was corroborated by teachers. Inserting such contents is required to prepare medical students when exposed to issues related to mental health in the context biopsicosocioambiental according to new curriculum guidelines / Mudanças nos currículos dos cursos de medicina no mundo, definidas no Brasil pelas Diretrizes Curriculares Nacionais dos Cursos de Graduação em Medicina em 2001, propõem-se contemplar as necessidades da realidade social através da formação de profissionais dotados de conhecimentos, competências e habilidades gerais e específicas requeridas para o exercício profissional. A prevalência crescente das doenças mentais no Brasil mostra a importância do ensino de saúde mental na formação do médico atual. Objetivo primário: Avaliar a presença de conteúdos de Saúde Mental no currículo real, nos quatro primeiros anos do curso de medicina da Faculdade de Ciências Médicas e da Saúde (FCMS) da PUC-SP. Metodologia: Estudo qualiquantitativo. Pesquisou-se a presença ou não desses conteúdos nos Planos de Ensino e atividades desenvolvidas nas estratégias de ensino aprendizagem desenvolvidas no período de agosto de 2012 a julho de 2013 e avaliou-se as opiniões dos professores, utilizando um questionário. Resultados: O Projeto Pedagógico prevê estes conteúdos, mas, não há correspondência efetiva na prática. Na opinião dos professores (62,5% de respondedores), em sua maioria (72,9%), entenderam que conteúdos de Saúde Mental estavam presentes no currículo, mas insuficientes ou ausentes e pouco explorados (64,3%); ainda, que os alunos vivenciam (70%), mas não aprendem (80%). Com o Discurso do Sujeito Coletivo confirmou-se que os conteúdos estão pouco presentes nas estratégias e sua abordagem não é adequada (55,55%). A falta de integração entre teoria e prática (30,43%), os cenários de aprendizagem inadequados para sua exploração (21,1%), o tempo/organização curricular insuficientes (23,91%) e o despreparo de professores e alunos (13,04%) são os principais motivos. Conclusões: A Saúde Mental não tem seu papel estabelecido no currículo do curso de medicina da FCMS e não há uma padronização para sua construção, está pouco presente nas estratégias de ensino aprendizagem, gerando deficiência nos conteúdos de Saúde Mental, o que foi corroborado pelos professores. Inserir tais conteúdos é necessário para preparar os alunos do curso médico quando expostos a problemas relacionados à Saúde Mental no contexto biopsicosocioambiental em acordo às novas diretrizes curriculares

Thesis (MPhil)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: The practice of medicine has always been a big area of interest as a profession. The focus ranges depending on issues at hand - it may be on the educational, training, humanistic, economic, professional ethics and legal aspects. One area of medicine that is under the spotlight around the world is that of the maintenance of clinical competency, followed very closely and almost linked to professional ethics. This study follows the introduction of a system of Continuing Professional Development (hereinafter also referred to as CPD), in South Africa and an overview of how it has been introduced in a few other countries. The main areas of focus being the extrication of inherent values of CPD, relating this aspect to quality improvement in medical health care. The medical profession as well as most of the interested parties, has different perspectives regarding the fact that the system is regulated through legislation. There is also the doubt whether the CPD system will be effective in achieving the goals that it has been set to achieve. Although a system of Continuing Medical Education has been a tradition in all countries, which implies that the CPD system is not totally new as far as the educational principles are concerned, the values accruable need to be exploited. It is the possible success of this kind of evaluations that may foster more understanding of the inherent values in this CPD system. / AFRIKAANSE OPSOMMING: Beroepsgewys het die praktyk van geneeskunde nog altyd groot belangstelling gelok. Die fokus verskuif na gelang van die onderwerpe ter sprake. Dit wissel van opvoedkunde, opleiding, humanisme, ekonomie, en professionele etiek tot regsaspekte. Dwarsoor die wêreld word daar gefokus op die handhawing van kliniese vaardighede, gevolg deur professionele etiek wat ook daarin verweef is. Hierdie studie bespreek die instelling van 'n stelsel van Voortgesette Professionele Ontwikkeling (hierna verwys na as VPO) in Suid-Afrika asook oorsig oor die wyse waarop dit in 'n paar ander lande ingestel is. Die klem lê op die inherente waardes met betrekking tot die verbetering gehalte in mediese gesondheidsorg. Die mediese beroep, asook meeste van die belangegroepe het verskillende opvattings oor die feit dat die stelsel deur wetgewing gereguleer word. Daar is ook twyfel of die VPO-stelsel in sy vooropgestelde doelwitte sal slaag. Wat die opvoedkundige beginsels betref, is die VPO-stelsel nie totaal en al nuut nie. Alhoewel VPO in ander lande tradisie is, is dit nodig om die totstandkoming van waardes te ontgin. Die moontlike sukses van hierdie tipe van evaluasies mag dalk beter begrip ten opsigte van die inherente waardes in die VPO-stelsel bevorder.

The purpose of the study was to explore and describe the perceptions of the pupil nurses at their second year level towards clinical support at the private hospital in the Limpopo Province. Qualitative approach including exploratory, descriptive and contextual study design was followed. The target population for this study included pupil nurses at their second year level (n=20) following a two year programme leading to enrolment as a nurse from a private nursing education institution in the Limpopo Province. Data was collected utilizing written narratives, and focus group interviews. Field notes and audio tape were used to capture data. Data saturation was reached on twelve participants. Data were thematically analysed using Tesch’s method of open coding. The results revealed lack of clinical support. Lack of clinical support was attributed to inadequate educators for accompaniment, registered nurses’ uncaring attitude and not fulfilling their mentorship role, and pressure on pupil nurses to meet the high clinical demands. Pupil nurses were found not to be assuming full responsibilities over their practical learning. Therefore, it is mandatory as nurse educators, managers and researchers to take note of the gaps identified and intervene utilising recommendations provided to enhance clinical support. / Health Studies / M.A. (Nursing Science)

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)

Introdução: Apesar do desenvolvimento tecnológico, permanece baixa a sobrevida hospitalar das vítimas de parada cardiorrespiratória extra-hospitalar. Há importante dúvida na literatura quanto à retenção de habilidades de ressuscitação cardiopulmonar (RCP) e a periodicidade adequada de treinamento para manutenção dessas habilidades. O presente estudo investigou a retenção, em alunos a partir de treinamento no primeiro semestre de ingresso no curso médico, das habilidades práticas de RCP até 42 meses após o referido treinamento. Métodos: Estudo de corte transversal, realizado com 298 alunos de graduação de uma faculdade de Medicina, treinados com base nas diretrizes de ressuscitação de 2010 da American Heart Association. Foram avaliados 205 alunos sem retreinamento das habilidades, divididos em quatro grupos conforme o tempo decorrido desde o treinamento de ingresso: 73 alunos após 1 mês, 55 após 18 meses, 41 após 30 meses e 36 após 42 meses. A análise da retenção das habilidades foi comparada com 93 alunos que referiram ter realizado retreinamento em RCP. Dezenove habilidades de RCP e nove potenciais erros de técnica na execução das ventilações pulmonares e compressões torácicas foram avaliados por meio de simulação realística e revisados com utilização de filmagem e avaliadores independentes. Resultados: A média de retenção das dezenove habilidades nos alunos sem retreinamento foi: 90% após 1 mês, 74% após 18 meses, 62% após 30 meses e 61% após 42 meses (p < 0,001). Nos alunos que referiram retreinamento, a retenção foi de 74% após 18 meses, 70% após 30 meses e 66% após 42 meses do treinamento inicial. Realizada curva de predição da retenção de habilidades, com estimativa de 80% das habilidades mantidas após 10 meses, 70% após 21 meses e 60% após 42 meses. A profundidade das compressões torácicas foi a habilidade com maior retenção ao longo do tempo (87,8%), sem diferença estatística entre os quatro grupos. Houve aumento da prevalência de compressões realizadas com menos de 5 cm de profundidade quando realizadas em frequência maior que 120 por minuto. A média da frequência de compressões torácicas obtidas nos grupos após 1, 18, 30 e 42 meses foi, respectivamente, 114, 114, 104 e 108 compressões por minuto; 104 (50,7%) alunos mantiveram frequência média entre 100-120 por minuto. As ventilações pulmonares apresentaram diminuição progressiva de retenção, de 93% após 1 mês até 19% após 42 meses (p < 0,001). Todos os alunos efetivaram o choque com o desfibrilador externo automático, porém com o grupo após 1 mês do treinamento com menor tempo para efetivação do choque e maior prevalência de posicionamento adequado das pás do desfibrilador. Conclusões: O presente estudo demonstrou diferentes níveis de retenção para as habilidades de RCP e diferentes níveis de decréscimo de tais habilidades ao longo de 42 meses. A profundidade das compressões torácicas e o uso do desfibrilador externo automático foram as habilidades com maior retenção ao longo do tempo. Treinamentos adicionais ao longo do curso de Medicina atenuaram a perda de habilidades, mas sem retorno ao desempenho observado após 1 mês do treinamento. Sugerimos que o intervalo mínimo de retreinamento para manutenção de pelo menos 70% das habilidades deva ser de 18 a 24 meses / Introduction: Despite technological development, the survival of victims of out-ofhospital cardiac arrest remains low. There are important questions in the literature regarding the retention of cardiopulmonary resuscitation (CPR) skills and the ideal frequency of retraining required to enhance retention of skills. This study investigated the retention of practical CPR skills by medical students over 42 months after training in the first semester of admission to the medical course. Methods: A cross-sectional study was conducted with 298 undergraduate medical students who were trained based on the 2010 American Heart Association resuscitation guidelines. A total of 205 students divided into four groups according to the time elapsed since the entrance training were evaluated without retraining (73 students after 1 month, 55 students after 18 months, 41 students after 30 months and 36 students after 42 months). The analysis of the retention of skills was compared to 93 students who reported having performed retraining in CPR. Nineteen CPR skills and nine potential technical errors in ventilations and chest compressions were evaluated by realistic simulation and reviewed using filming by independent examiners. Results: The mean retention of the nineteen skills in not retrained students was: 90% after 1 month, 74% after 18 months, 62% after 30 months and 61% after 42 months (p < 0.001). In retraining students, retention was 74% after 18 months, 70% after 30 months, and 66% after 42 months of initial training, with statistical difference between the students with and without retraining in the 30-month group (p=0.005). The estimation of mean skill retention was 80% after 10 months, 70% after 21 months and 60% after 42 months. The depth of chest compressions was the skill with greater retention over time (87.8%), with no statistical difference among groups. There was an increase in the prevalence of compressions performed with less than 5 cm depth when performed at a frequency greater than 120 per minute. The mean chest compressions rate obtained in the groups after 1, 18, 30 and 42 months were 114, 114, 104 and 108 per minute, respectively, and 104 (50.7%) students maintained a mean frequency of 100-120 per minute. Pulmonary ventilation showed a progressive decrease in retention from 93% after 1 month to 19% after 42 months (p < 0.001). All students delivered the shock with the automated external defibrillator; however, for the group one month post-training, the time for the application of the shock was lower, and the prevalence of adequate positioning of the defibrillator pads was greater. Conclusion: This study showed different retention levels for CPR skills and different decrease levels of these skills over 42 months. Depth of chest compressions and use of automated external defibrillator were the skills with the highest retention over time. Additional training throughout the medical course attenuated the loss of skills, but no return to the initial performance achieved after 1 month. We suggest that the minimum retraining interval for maintenance of at least 70% of skills should be 18 to 24 months

Submitted by Raquel Vergara Gondran (raquelvergara38@yahoo.com.br) on 2016-03-09T22:14:56Z No. of bitstreams: 1 dlenice.pdf: 1516345 bytes, checksum: 930c729b0216458e24773e1f6778bc27 (MD5) / Approved for entry into archive by Lilian M. Silva (lilianmadeirasilva@hotmail.com) on 2016-03-13T15:54:53Z (GMT) No. of bitstreams: 1 dlenice.pdf: 1516345 bytes, checksum: 930c729b0216458e24773e1f6778bc27 (MD5) / Made available in DSpace on 2016-03-13T15:54:53Z (GMT). No. of bitstreams: 1 dlenice.pdf: 1516345 bytes, checksum: 930c729b0216458e24773e1f6778bc27 (MD5) Previous issue date: 2013 / Este estudo teve por objetivo analisar o trabalho do enfermeiro sob a ótica da produção de cuidados em saúde e do exercício da clínica. Para sua realização, optou-se pela utilização do referencial filosófico de Deleuze e Guattari devido às suas convicções acerca de um modo de pensar interconectado. Para tanto, foi realizada uma pesquisa qualitativa e exploratória, na forma de Estudo de Caso, em uma unidade de internação cirúrgica de um hospital universitário, tendo como unidade de análise um grupo de seis enfermeiros dessa mesma unidade de internação. Utilizou-se a observação não participante, a pesquisa documental e a entrevista em profundidade como métodos de coleta de dados. Os dados foram analisados, de acordo com a análise textual discursiva. O projeto dessa pesquisa, elaborado consoante às diretrizes da Resolução196/96 do Conselho Nacional de Saúde, foi aprovado sob parecer n° 87/2012. Obteve-se como um dos principais resultados que o resgate da clínica como saber pode ser um mecanismo de fortalecimento da Enfermagem capaz de propiciar um cuidar que, concomitantemente, legitima a autonomia e a visibilidade das ações de enfermagem. Verificou-se que o modelo clínico/biomédico de assistência traz em suas raízes conhecimentos advindos da clínica como ciência arborífica que, quando incorporados ao trabalho do enfermeiro, possibilitam cuidados resolutivos e coerentes às necessidades de saúde da clientela assistida e ao contexto de trabalho. Os cuidados de enfermagem são instituídos pelo enfermeiro de maneiras distintas e dependentes de conhecimento clínico: seja a partir de conexões diretas com o paciente, assim como, com a criação de linhas de fuga com outros membros da equipe de saúde multiprofissional. Atua como base para a conexão de outros saberes e práticas que expandem o fazer do enfermeiro, por meio de interligações com o ambiente. Deste modo, existe a formação de rizomas, por meio de linhas de fuga que partem da própria estrutura arborífica. Os rizomas são fundamentados e transformados, com base nas necessidades que emergem da prática clínica do enfermeiro e demonstram a capacidade desse profissional de superar o modelo clínico/biomédico hegemônico de assistência, confirmando a tese de que: o trabalho da enfermagem é organizado segundo duas perspectivas interconectadas e interdependentes: a perspectiva do modelo clínico, que compõe a estrutura-mestre da sua prática e equipara-se à estrutura arborescente do referencial de Deleuze e Guattari, que é representada pelos saberes biológico, fisiológico, patológico e farmacológico; e a perspectiva caracterizada por uma estrutura rizomática, composta por elementos múltiplos e heterogêneos, que pode ser representada por aspectos que interferem no ambiente em que o paciente está inserido, seja no âmbito social, familiar, de trabalho, entre outros. Deste modo, o modelo clínico de assistência organiza-se como uma estrutura centrada que possibilita a resolutividade das necessidades biológicas e atua como base para a conexão de outros saberes e práticas que expandem o fazer do enfermeiro, por meio de interligações com o ambiente, resultando em uma prática clínica mais próxima do que se considera/denomina integralidade. / This study aimed at analyzing the nurse's work in the perspective of health care production and clinical practice. For carrying out this study, Deleuze and Guattari's philosophical reference was chosen for their convictions about an interconnected way of thinking. Therefore, a qualitative and exploratory case study was performed in a surgery unit of a university hospital, and a group of six nurses from this unit were taken as unit of analysis. Data were collected through non-participant observation, documentary research and depth interview. They were analyzed according to the discursive textual analysis. The project of this research was set up in accordance with Resolution n. 196/96 of the National Health Council and approved by the opinion n. 87/2012. One of the main results indicated that the revival of clinical practice as knowledge might be a strengthening mechanism in Nursing which would provide a sort of health care which concurrently legitimates autonomy and visibility of nursing actions. It was determined that the clinical/biomedical model of health care has in its roots knowledges based on clinical practice as an arborescent science. When such knowledges are incorporated in the nurse's work, they enable resolutive health care which is coherent to clientele's health needs and to the work context. Nursing cares are distinctively instituted by the nurse and depend on clinical knowledge from direct connections with patients as well as by creating lines of flight with other members of the multi professional health team. The clinical model of health care acts as a basis for the connection of other knowledges and practices which expand the nurse's practices through interconnections with the working environment. This way, the creation of rhizomes occurs through lines of flight which comes from the very arborescent structure. The rhizomes are founded and transformed according to the needs which arise from the nurse's clinical practice and show the professional's capacity to overcome the hegemonic clinical/biomedical model of health care. This confirms the thesis that the nursing work is organized according to two interconnected and interdependent perspectives. First, the perspective of clinical model, which forms the main structure of the nursing practice and is on the level with the arborescent structure of Deleuze and Guattari's referential, which on its turn is represented by biological, physiological, pathological and pharmacological knowledges. Second, the perspective characterized by a rhizomatic structure, formed by multiple and heterogeneous elements, which can be represented by the aspects that interfere in patient's environment - be it social, family, work or other. This way, the clinical model of health care is organized as a centralized structure that enables resolutivity of biological needs and acts as a basis for connecting other knowledges and practices that expand the nurse's practice through interconnections with the work environment. As a result, clinical practice gets closer to what is considered as or called integrality. / Este estudio tuvo como objetivo analizar el trabajo de enfermeros bajo la óptica de la producción de asistencias en la salud y del ejercicio de la clínica. Para su realización se optó por el uso del referencial filosófico de Deleuze y Guattari debido a sus convicciones acerca de un modo de pensar interconectado. Para eso fue realizada una investigación cualitativa y exploratoria con la forma de estudio de caso en una unidad de internación quirúrgica de un hospital universitario, teniendo como unidad de análisis un grupo de seis enfermeros de esa unidad de internación. Se usó observación no participativa, investigación documental y entrevista en profundidad como métodos de recopilación de datos. Los mismos fueron analizados de acuerdo con el análisis textual discursivo. El proyecto de esta investigación, elaborado de acuerdo con las directrices de la Resolución 196/96 del Consejo Nacional de Salud, fue aprobado por el Dictamen N° 87/2012. Uno de los principales resultados obtenidos fue que el rescate de la clínica como un saber puede ser un mecanismo de fortalecimiento de la enfermería, capaz de proporcionar una asistencia que, concomitantemente, legitima la autonomía y la visibilidad de las acciones de enfermería. Se verificó que el modelo clínico/biomédico de asistencia posee en sus raíces conocimientos provenientes de la clínica como ciencia arborífica que al ser incorporados al trabajo de los enfermeros hacen posibles asistencias resolutivas y coherentes con las necesidades de salud de la clientela asistida y con el contexto de trabajo. Las asistencias de enfermería son proporcionadas por los enfermeros de modos distintos y dependientes del conocimiento clínico: sea a partir de conexiones directas con los pacientes como con la creación de líneas de fuga con otros miembros del equipo de salud multiprofesional. Por lo tanto, existe la formación de rizomas por medio de líneas de fuga que parten de la propia estructura arborífica. Los rizomas son fundamentados y transformados con base en las necesidades que surgen de la práctica clínica de los enfermeros y demuestran la capacidad de esos profesionales para superar el modelo clínico/biomédico hegemónico de asistencia, confirmando la tesis de que el trabajo de la enfermería se organiza de acuerdo con dos perspectivas interconectadas e interdependientes: la perspectiva del modelo clínico, que compone la estructura maestra de su práctica y se equipara a la estructura arborescente del referencial de Deleuze y Guattari que es representada por los saberes biológico, fisiológico, patológico y farmacológico; y la perspectiva caracterizada por una estructura rizomática, compuesta por elementos múltiples y heterogéneos, que puede ser representada por aspectos que interfieren en el ambiente en que el paciente está inserido, sea en el ámbito social, familiar o de trabajo, entre otros. De ese modo, el modelo clínico de asistencia se organiza como una estructura centrada que hace posible la resolutividad de las necesidades biológicas y actúa como base para la conexión de otros saberes y prácticas que expanden el hacer de los enfermeros por medio de interligaciones con el ambiente, resultando en una práctica clínica más próxima de lo que se considera/denomina integralidad.

Submitted in fulfillment of the requirements for the Degree of Master of Health Sciences in Radiography, Durban University of Technology, 2017. / Background The current scope of practice for diagnostic radiographers, does not allow them to administer intravenous contrast media (IVCM) since there are no formal training guidelines accredited by the Health Professions Council of South Africa (HPCSA) (Koch 2014: 26). In selected countries abroad, radiographers are allowed to administer IVCM and have thus received the necessary and accredited training to do so. In view of this, the South African radiographer’s scope of practice is not on par with the selected countries. The radiologists in South Africa (SA) who are currently responsible for the administration of IVCM have issued a position statement which supports, in principle, the idea of radiographers administering IVCM should they receive the necessary and appropriate training to do so (RSSA 2011: 1-2). The aim of this research study was, therefore, to investigate the radiologists’ perspectives regarding the theoretical knowledge, clinical competencies and medico legal responsibilities required by radiographers in order to effectively administer IVCM. This research study provides input for the development of national training guidelines for radiographers to administer IVCM. Research Methodology A quantitative, descriptive study was conducted by targeting qualified radiologists residing and practicing within the province of KwaZulu Natal (KZN). Ethical approval was obtained from the Durban University of Technology’s (DUT) Institutional Research and Ethics Committee (IREC). All the participants were contacted in their personal capacity. The research tool was an online survey administered through SurveyMonkey which included questions and statements relating to the administration of IVCM and was structured so as to meet the study objectives. The research tool was evaluated and amended by an expert focus group to ensure reliability and validity. Confidentiality was maintained and all the data obtained during this research study was password protected. Results and discussion Fifty-nine radiologists (60.8 percent) participated in this study. Twelve respondents, however, were excluded due to incomplete surveys. The final response rate, therefore, was 48.5 percent (n=47) of which 72.3 percent of the respondents were from the private sector. Results illustrated the radiologists’ agreement regarding the theoretical, clinical/practical and medico legal training components for inclusion in the further training of radiographers to administer IVCM. Most respondents supported the inclusion of three assessments: theoretical (87.2 percent), clinical (93.6 percent) and a record of clinical competencies (95.7 percent). The assessments were considered equally important in terms of percentage weighting. The overall results compared favorably to the current international trends and practice standards of radiographers administering IVCM. Conclusion and Recommendations The study, in providing key data for the development of training guidelines for radiographers to administer IVCM, has demonstrated the importance of higher education (HE) and training in addressing transformation in health services with particular reference to professional scopes of practice. Furthermore, it reinforces the need for local research that will inform HE and training and hence a scope of practice that meets local needs. It was recommended that future studies should include those HE institutions offering training in Radiography as well as their stakeholders for the design and transformation of a national curriculum for radiographers to administer IVCM. / M