This thesis portrays a research study undertaken to explore the unknown concept of electronic interprofessional documentation. Academic literature largely centers on multidisciplinary electronic documentation yet clinicians provide care using an integrated interprofessional model. Current design of electronic health records (EHRs) continue to propagate a deluge of data resulting from disparate siloed documentation. End users report challenges with finding data. Additionally, care planning and decision making are delayed. To bridge the gap between electronic design and interprofessional delivery of care, more understanding of shared documentation is required. The provenance of the design of this study is based on the concept of common ground and the framework for complex diverse data. Common ground is a shared communication space within a team with a shared purpose (Cioffi, Wilkes, Cummings, Warne, & Harrison, 2010). The framework for complex diverse data posits that data must be linked to other interconnected data; linked data enables connection of diverse pieces and insight-sharing within a team. A descriptive qualitative study was designed to answer the research question: What are the common data elements between disciplines? A case scenario of a patient with a fractured hip was created; participants generated clinical notes based on the video and patient record. The clinical notes were coded and results indicated numerous diverse common data elements. These were analyzed and major findings such as categories appropriate for use by all disciplines on admission and design implications for care planning throughout an acute care stay were identified. Further, as disciplines and care team members do have different documentation patterns, it is suggested attendance to differences in the entry of data yet maintaining a common ground in the display of patient information is vital. Finally suggestions such as duplicate checking for documentation through a common care plan that tracks assessments and completed interventions alongside planned interventions are made. Creation of a standardized interprofessional terminology is key in building the road leading to interprofessional electronic documentation. / Graduate

Most primary school learners experience everyday worries during their normal development. Children handle worries differently, and if they are not supported, their self-concept and psychosocial development could be influenced negatively. Parents and teachers are not always aware of what primary school learners worry about, or how they handle their worries. It is important that parents and teachers are made aware of this, so that children can be better supported in this regard. The aim of this study was to determine the everyday worries of primary school learners in a specific school in the Helderberg area, as well as how these worries are handled. This aim was addressed through a descriptive, qualitative research design. Thirty learners between the ages of ten and eleven in the specific school were involved through a simple random sample. Semi-structured one-on-one interviews were used to obtain a detailed picture of learners’ everyday worries and how they handle them. Interviews were held through the use of an interview schedule, which was compiled in accordance with a literature study, tested in a pilot study and adjusted where necessary. Interviews were transcribed and themes were identified according to Braun and Clarke’s method of thematic analysis. On intrapersonal level one worry was identified, namely about emotions that are experienced. On this level participants handled worries by preferring to be alone, trying not to think about worries, crying, writing or drawing in diary, through praying, eating or sleeping. On interpersonal level, worries about school, family, friends and loss were identified. On this level worries were handled through spending time with a family member, friends, the media, pets, or by asking for support from the school. Themes were divided into subthemes, supported with appropriate quotes from the interviews and controlled with literature. This study confirms existing literature in terms of the worries that primary school learners experience. With this study a contribution is being made to the identification of worries on inter- and intrapersonal level, as well as the handling of worries on these two levels. In the future this information can be used as a basis for the effective development of ways for parents and teachers to support children in this regard. Suggestions were made for parents and teachers to encourage children to talk about their worries, as well as to help them find effective ways in which to communicate and practice to handle these worries well. It is very important that parents and teachers are made aware of topics children are worried about and how they handle them, so that children can be better supported and assisted in this regard. / MA (Psychology), North-West University, Potchefstroom Campus, 2014

Most primary school learners experience everyday worries during their normal development. Children handle worries differently, and if they are not supported, their self-concept and psychosocial development could be influenced negatively. Parents and teachers are not always aware of what primary school learners worry about, or how they handle their worries. It is important that parents and teachers are made aware of this, so that children can be better supported in this regard. The aim of this study was to determine the everyday worries of primary school learners in a specific school in the Helderberg area, as well as how these worries are handled. This aim was addressed through a descriptive, qualitative research design. Thirty learners between the ages of ten and eleven in the specific school were involved through a simple random sample. Semi-structured one-on-one interviews were used to obtain a detailed picture of learners’ everyday worries and how they handle them. Interviews were held through the use of an interview schedule, which was compiled in accordance with a literature study, tested in a pilot study and adjusted where necessary. Interviews were transcribed and themes were identified according to Braun and Clarke’s method of thematic analysis. On intrapersonal level one worry was identified, namely about emotions that are experienced. On this level participants handled worries by preferring to be alone, trying not to think about worries, crying, writing or drawing in diary, through praying, eating or sleeping. On interpersonal level, worries about school, family, friends and loss were identified. On this level worries were handled through spending time with a family member, friends, the media, pets, or by asking for support from the school. Themes were divided into subthemes, supported with appropriate quotes from the interviews and controlled with literature. This study confirms existing literature in terms of the worries that primary school learners experience. With this study a contribution is being made to the identification of worries on inter- and intrapersonal level, as well as the handling of worries on these two levels. In the future this information can be used as a basis for the effective development of ways for parents and teachers to support children in this regard. Suggestions were made for parents and teachers to encourage children to talk about their worries, as well as to help them find effective ways in which to communicate and practice to handle these worries well. It is very important that parents and teachers are made aware of topics children are worried about and how they handle them, so that children can be better supported and assisted in this regard. / MA (Psychology), North-West University, Potchefstroom Campus, 2014

L’exercice du leadership stratégique de directions des soins infirmiers (DIRSI), dans une visée de qualité des soins infirmiers dans des établissements de santé, demeure peu documenté malgré l’impact important des soins infirmiers sur la performance des organisations. Ce type de leadership réfère à la capacité de la directrice des soins infirmiers (DSI) et de son équipe, positionnées aux échelons supérieurs dans l’organisation, de travailler stratégiquement avec d’autres directions pour dispenser des soins de qualité, efficaces et efficients aux personnes et à leurs proches. But de l’étude : Décrire l’exercice du leadership stratégique de DIRSI dans une visée de qualité des soins infirmiers, dans des établissements de santé du Québec, en utilisant un cadre de référence basé sur des éléments tirés de deux modèles soit : An Integrative Model of Strategic Leadership (Boal et Hooijberg, 2000) et Fitting Strategic Leadership Into the Strategic Framework (Hambrick, 1989). Méthodologie : Une recherche qualitative descriptive a été réalisée auprès de cadres infirmiers supérieurs et intermédiaires des DIRSI du Québec. L’échantillon était composé de trente-cinq (N=35) participantes issues de 18 DIRSI des 34 établissements de santé et des services sociaux, soit une participation de 53 % des DIRSI du Québec. Trois groupes de discussion et 31 entrevues semi-structurées ont été réalisés. Résultats : Il appert que pour exercer un leadership stratégique, les DIRSI devraient : 1) s’approprier le positionnement stratégique pour influencer la qualité des soins infirmiers, 2) développer et communiquer une vision claire de la qualité des soins, 3) faire des choix stratégiques, systématiques et mesurés, axés sur la qualité des soins infirmiers pour guider la contribution, 4) recadrer les rôles pour augmenter l’influence à l’égard de la qualité des soins infirmiers, 5) être partie prenante des processus décisionnels stratégiques, 6) développer la capacité politique pour influencer la qualité des soins infirmiers et 7) établir des alliances stratégiques et collaboratives axées sur la qualité des soins infirmiers. De plus, la crédibilité clinique et l’équipe formée aux cycles supérieurs et en nombre suffisant favorisent l’exercice du leadership stratégique de la DIRSI. La culture organisationnelle et la taille de l’établissement contraignent l’exercice du leadership stratégique de la DIRSI. Enfin, l’efficacité du leadership stratégique exercé par les DIRSI dépend de la capacité de celles-ci de trouver un juste équilibre dans la réalisation de la gouvernance des soins infirmiers (hiérarchique et transversale) en vue d’une contribution optimale à la qualité des soins infirmiers. Conclusion : Les résultats indiquent que l’exercice du leadership stratégique des DIRSI génère des zones d’influence qui permettent d’améliorer la contribution de celles-ci à la qualité des soins et même à la qualité globale des organisations. Les DIRSI pourront se référer à ces résultats pour continuer à développer des stratégies visant à améliorer la qualité des soins infirmiers dans des organisations en constante évolution et dont la complexité grandit / In spite of the significant impact of nursing on the performance of health care organizations, the practice of chief nursing offices’ strategic leadership oriented towards high quality of nursing care remains poorly documented. This type of leadership refers to the ability of the chief nursing officer and her team, positioned in the health care organization’s higher levels, to work strategically with other executives so as to provide effective and efficient health care to patients and their relatives. Aim of the study: To describe the strategic leadership practice of chief nursing offices regarding the quality of nursing care in the health care organizations of Quebec. This is done using a frame of reference based on elements from two models: An Integrative Model of Strategic Leadership (Boal et Hooijberg, 2000) and Fitting Strategic Leadership Into the Strategic Framework (Hambrick, 1989). Method: A qualitative descriptive research was conducted among senior and middle managers of Quebec’s chief nursing offices. The sample consisted of thirty-five (N=35) participants from 18 chief nursing offices out of the 34 health care organizations, corresponding to a participation of 53% of Quebec’s chief nursing offices. Three focus groups as well as 31 semi-structured interviews were conducted. Findings: It appears that in order to practice strategic leadership, chief nursing offices should: 1) take ownership of their strategic positioning to influence the quality of nursing care, 2) develop and communicate a clear vision of quality nursing care, 3) make strategic, systematic and measured, choices focused on the quality of nursing care to guide the contribution, 4) reframe the roles to increase the influence regarding the quality of nursing care, 5) be involved in strategic decision-making process, 6) develop political capacity to influence the quality of nursing care and 7) establish strategic and collaborative alliances focussed on the quality of nursing care. Moreover, the clinical credibility and a team comprising an adequate number of educated (graduate-level) people, promotes the strategic leadership practice of chief nursing offices. The culture and size of the organization are the organizational components that constrain the practice of chief nursing offices’ strategic leadership. Finally, the efficiency of the strategic leadership practiced by the chief nursing offices depends on their ability to strike the right balance between hierarchical and transversal governance for an optimal contribution to the quality of nursing care. Conclusion: Results indicate that the practice of strategic leadership generates influential areas, allowing not only the improvement of the chief nursing offices’ contribution to the quality of nursing care, but also to the overall quality of the organizations. Chief nursing offices can refer to these results in order to continue the development of strategies aimed at improving the quality of nursing care in constantly evolving organizations of increasing complexity. / El ejercicio del liderazgo estratégico por parte de las direcciones de enfermería, centrado en la calidad de los cuidados de enfermería ha sido poco documentado, no obstante el impacto que este genera en la eficiencia global de los establecimientos de salud. Este tipo de liderazgo se refiere a la capacidad de la directora de enfermería y de su equipo, ubicados en los altos mandos de la organización, de trabajar estratégicamente con otras direcciones para garantizar una prestación de cuidados de enfermería, de calidad, eficientes y eficaces a la persona y a su entorno. Objetivo: Describir el ejercicio del liderazgo estratégico de las direcciones de enfermería, centrado en la calidad de los cuidados de enfermería, en los establecimientos de salud de Quebec, utilizando algunos elementos de dos modelos: An Integrative Model of Strategic Leadership (Boal et Hooijberg, 2000) y Fitting Strategic Leadership Into the Strategic Framework (Hambrick, 1989). Método: Estudio cualitativo de tipo descriptivo realizado con enfermeras administrativas de nivel superior e intermedio, de las direcciones de enfermería del Quebec. La muestra ha sido constituida por treinta y cinco (N=35) participantes provenientes de 18 de los 34 establecimientos de salud lo que representa el 53 % de las direcciones de enfermería del Quebec. Tres grupos de discusión y 31 entrevistas semi-estructuradas fueron realizados. Resultados: Se constata que para ejercer liderazgo estratégico, las direcciones de enfermería deberían : 1) apoderarse el posicionamiento estratégico para influenciar la calidad del cuidado de enfermería, 2) desarrollar y comunicar una visión clara de la calidad del cuidado de enfermería, 3) tomar opciones estratégicas, sistemáticas y medibles, centradas en la calidad del cuidado de enfermería, 4) alinear los roles para aumentar la influencia en la calidad del cuidado de enfermería, 5) desarrollar la capacidad política para influenciar la calidad del cuidado de enfermería, 6) ser parte integrante de los procesos decisionales estratégicos y 7) establecer alianzas estratégicas y colaborativas enfocadas en la calidad del cuidado de enfermería. Además, se constata que la credibilidad clínica y el equipo formado con estudios universitarios de nivel superior y en número suficiente favorecen el ejercicio de liderazgo estratégico de las direcciones de enfermería. Por otra parte, la cultura organizacional y el tamaño del establecimiento obstaculizan el ejercicio de liderazgo estratégico de las direcciones de enfermería. Finalmente, la eficacia de liderazgo estratégico de las direcciones de enfermería depende de su capacidad para ejercer una gobernanza de enfermería equilibrada (jerárquica y transversal) contribuyendo de manera óptima a la calidad de los cuidados de enfermería. Conclusión: los resultados indican que el ejercicio de liderazgo estratégico por parte de las direcciones de enfermería genera zonas de influencia permitiéndoles mejorar su contribución a la calidad de los cuidados de enfermería e incluso la gestión de la calidad total de las organizaciones de salud. Las direcciones de enfermería podrán referirse a estos resultados para continuar desarrollando estrategias enfocadas en la mejora continua de la calidad de los cuidados de enfermería en organizaciones que están en constantes cambios cada día más complejos.