The study set out to explore the influences of change on organisational culture in a private healthcare organisation of South Africa. The research was conducted at Life Healthcare, the largest private hospital group in South Africa. A survey questionnaire was constructed and used as a means of collecting data for the purpose of this study. The data was collected from a sample of 189 respondent managers using stratified probability sampling technique. Data analysis was conducted by applying descriptive and inferential statistical methods.

M.Cur (Professional Nursing) / This study of patient acuity level plans (PALP) to determine nursing levels for in-patients units was carried out by means of an exploratory, descriptive instrumental study within the context of a nursing situation with the literature study serving as background, a patient acuity level plan (PALP) was designed, according to accepted criteria, to find data on which to base post determination for nursing staff. This descriptive, instrumental study was done at a private research hospital in Johannesburg where all the patients and nursing staff (first- as welI as second-in-command) were involved. The patient acuity level plan (PALP) -instrument was designed by the researcher, and under supervision of the researcher it was implemented in seven nursing units in the hospital. (The instrument proved to be highly reliable i. e. 0,999). The difference between nursing post determination as recommended and determined by PALP, and nursing post determination as determined by means of a pragmatic subjective approach by the nursing service manager of the, hospital proved to be statistically insignificant. The PALP instrument showed, however, that more nursing staff were needed in four of the seven units. The quality of the nursing was not studied nor was a productivity study carried out. The grand total difference between the recommended and actual nursing hours needed for all the nursing units shows a statistically significant difference (p = 0,0001) on a 1% significance level. This instrument could also positively contribute towards a more cost-effective post determination in nursing.

Thesis (MCur)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: The critical care nurse works in an environment where patient need often shifts the parameters within which she or he practices. It is expected of a skilled critical care nurse to be able to make independent decisions and take action regarding patient care based on her or his knowledge and skills without discounting the parameters of her or his scope of practice. Practice experience has indicated that the critical care nurse is often uncertain about whether her or his clinical activities are protected by the regulations provided by the Nursing Council. This is more specifically true in the private hospital industry where medical advice or assistance is not always easily available. This situation led to the following research question: Do the available professional and legal guidelines provide an appropriate foundation to guide the practice of the registered critical care nurse in the private hospital sector critical care environment? A non-experimental descriptive study with a qualitative orientation was conducted in 19 private hospitals in the Western Cape. Through nonprobability, random sampling, 71 registered critical care nurses were included in the study. A questionnaire was designed and validated to collect the data. Quantitative data was analysed through Excel® while qualitative data was analysed thematically. It was found that the legal and professional guidelines in place at present do provide a foundation for the clinical activities of critical care nursing in the private hospital sector. It is suggested that it is rather the critical care nurses’ interpretation of the Scope of Practice (No.R.2598 of 30/11/1984 as amended) that limits their practice as opposed to the wording of the regulations. It is recommended that critical care nurses must determine nursing care parameters based on patient need, using the regulations as a foundation for critical, analytical and reflective practice rather than as a set of rules to be followed. Key words: Scope of practice, critical care practice, ICU nursing care, private hospital nursing practice. / AFRIKAANSE OPSOMMING: Die kritiekesorgverpleegkundige werk in ‘n omgewing waar pasiëntebehoeftes gereeld die parameters waarin sy of hy praktiseer, verskuif. Dit word van ’n bekwame kritiekesorgverpleegkundige verwag dat sy of hy onafhanklike besluite en aksies met betrekking tot pasiëntesorg, gebaseer op haar of sy kennis en vaardighede, sal neem sonder om die parameters van haar of sy bestek van praktyk te oorskry. Praktykondervinding het getoon dat die kritiekesorgverpleegkundige dikwels onseker is oor watter van haar of sy optredes deur die Regulasies, soos deur die Raad op Verpleging gespesifiseer word, beskerm word. Dit is nog meer spesifiek van toepassing in die privaathospitaal-industrie waar geneeskundige advies en bystand nie altyd maklik beskikbaar is nie. Die situasie het tot die volgende navorsingsvraag aanleiding gegee: Voorsien die beskikbare professionele en wetlike riglyne ’n geskikte grondslag om die praktyk van ’n geregistreerde kritiekesorgverpleegkundige in die privaatsektor- kritiekesorgomgewing te rig? ’n Nie-eksperimentele, beskrywende studie met ’n kwalitatiewe oriëntasie is in 19 hospitale in die Wes-Kaap onderneem. Deur nie-waarskynlikheids-, toevallige steekproefneming is 71 geregistreerde kritiekesorgverpleegkundiges in die studie ingesluit. ’n Vraelys is ontwerp en gevalideer om inligting in te samel. Kwantitatiewe data is deur middel van Excel ontleed terwyl kwalitatiewe data tematies ontleed is. Daar is gevind dat die wetlike en professionele riglyne wat tans beskikbaar is, ‘n grondslag bied vir die kliniese aktiwiteite van kritiekesorgverpleegkundiges in die privaathospitaal.. Dit word voorgestel dat dit die kritiekesorgverpleegkundige se interpretasie van die Bestek van Praktyk (No.R.2598 of 30/11/1984 soos aangepas) is wat hulle praktyk beperk, eerder as die bewoording van die regulasie self.

The purpose of this study was to investigate challenges experienced by nurses in the use of electronic whiteboards at one private hospital in the Gauteng province in South Africa. The researcher had observed a continuation of use of the manual dry-erase patient whiteboards in parallel to the use of new the electronic whiteboards in a ward, yet the electronic whiteboard had been implemented to replace the manual system in order to improve service delivery. A descriptive, quantitative study design was used for the study, with n=83 participants being voluntarily surveyed at the hospital over a one month period. The major findings were that the new electronic whiteboards were not always online which necessitated a parallel manual system as backup. Secondly, 47.5% of the respondents requested more training on the whiteboards. A needs assessment to determine training requirements and further investigation into the frequent unavailability of the electronic whiteboards is recommended / Health Studies / M.A. (Public Health - with specialisation in Medical Informatics)

In recent years, South Africa has seen increasing cultural diversification with regard to the appointment of managers in private healthcare facilities. However, research conducted in this area remains extremely limited. The aim of the present study was to explore and describe cultural values and leadership styles of middle managers at a private sector hospital in the Eastern Cape. Hofstede’s (1980, a ) model of cultural values served as a theoretical framework to conceptualise this study. The study was qualitative in nature and made use of in-depth research interviews conducted with a diverse sample of middle managers. The researcher made use of homogeneous and convenience sampling and utilised five participants. The qualitative data was analysed using Tesch’s (1990, in De Vos, 2002) method of analysis. Results revealed that despite the differences in personal culture, most of the managers are similar in their leadership styles and are also affected by the organizational culture. The results of the study contribute to a better understanding of the influence of cultural values and leadership styles in South Africa and will thereby benefit health institutions in their dealings with their modern day multi-cultural management staff.

The purpose of this study was to investigate challenges experienced by nurses in the use of electronic whiteboards at one private hospital in the Gauteng province in South Africa. The researcher had observed a continuation of use of the manual dry-erase patient whiteboards in parallel to the use of new the electronic whiteboards in a ward, yet the electronic whiteboard had been implemented to replace the manual system in order to improve service delivery. A descriptive, quantitative study design was used for the study, with n=83 participants being voluntarily surveyed at the hospital over a one month period. The major findings were that the new electronic whiteboards were not always online which necessitated a parallel manual system as backup. Secondly, 47.5% of the respondents requested more training on the whiteboards. A needs assessment to determine training requirements and further investigation into the frequent unavailability of the electronic whiteboards is recommended / Health Studies / M.A. (Public Health - with specialisation in Medical Informatics)

Triage assessment of patients on arrival at the emergency unit is an essential function in quality emergency care provision. Triage is the process of sorting and prioritising patients according to their level of acuity. This study was performed within an emergency unit that experienced serious problems with the sorting of patients on their arrival. After implementation of the Cape Triage Score, a questionnaire was distributed amongst staff utilising the new triage system. The investigation sought to answer specific questions concerning the triage nurse's roles, competencies required and strengths and weaknesses of the implemented system. The study also suggests guidelines to improve the triage system within the unit. The triage system was received well by participants. The roles of the triage nurse are multifaceted and extensive competencies are required. The strengths of the implemented triage system outweighed the weaknesses as perceived by the respondents. Guidelines for implementing triage in emergency units are provided. / Health Studies / M.A. (Health Studies)

Triage assessment of patients on arrival at the emergency unit is an essential function in quality emergency care provision. Triage is the process of sorting and prioritising patients according to their level of acuity. This study was performed within an emergency unit that experienced serious problems with the sorting of patients on their arrival. After implementation of the Cape Triage Score, a questionnaire was distributed amongst staff utilising the new triage system. The investigation sought to answer specific questions concerning the triage nurse's roles, competencies required and strengths and weaknesses of the implemented system. The study also suggests guidelines to improve the triage system within the unit. The triage system was received well by participants. The roles of the triage nurse are multifaceted and extensive competencies are required. The strengths of the implemented triage system outweighed the weaknesses as perceived by the respondents. Guidelines for implementing triage in emergency units are provided. / Health Studies / M.A. (Health Studies)