Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Saudi Arabia has experienced a number of changes due to revolutionary new findings and technologies, discoveries and new research in the health care arena, which has proven and contradicted a new approach to health care delivery. Demands by patients who have become more educated, the emergence of new or modern disease profiles which demand a new way of approach and a quickening in the pace of change, hurled unfamiliar and often demanding and challenging conditions at management One such change, as addressed in this study, is the change from a paper-based patient record system to a computer based patient information system to which all healthcare professionals in the multidisciplinary team had access to. However, not all change is welcomed, accepted or viewed as necessary by those who have to carry out or use new technologies. Change is harsh, and part of the problem is identifying factors that influence change initiatives. This study addresses the perceptions of nursing personnel of the process of change from a paper-based to a computer based (Quadramed) patient record system. The study design used a quantitative and descriptive approach in which a structured, self-designed questionnaire was used to obtain data from 117 professional nurses at a selected healthcare facility in the Eastern province of the Kingdom of Saudi Arabia. The theoretical framework used for this study was the Model for Change Management as designed by the Prosci Institute for Research, also referred to as the ADKAR Model of Change Management (Awareness, Desire, Knowledge, Ability and Reinforcement). The major findings of this study revealed that 97.44% of the respondents were non-Saudi individuals, and were mainly from the Philippines (69.24%), with (95.65% being female with an average age of 37-42 years. Most (47%) were in possession of specialty qualifications in medical, surgical nursing and experience between 8-10 years, of which 2-3 years had been in Saudi Arabia. In regard to 61.3% of the respondents it was found that they had no prior knowledge of computerised patient records. The nurse managers played a vital role in providing the most information and support to adjust to the system. With reference to the aspect of patient safety, positive feedback about the QCPR was provided by the majority of respondents. Most of the respondents experienced change positively, and 70% indicated that being involved played a major role in their positive attitude. Recommendations include that reasons for change should be more clearly communicated, suggestions for change should be valued more by managers and rumours and uncertainties about change should be addressed as and when appropriate. / AFRIKAANSE OPSOMMING: Saoedi-Arabië het 'n aantal veranderinge ondervind as gevolg van revolusionêre nuwe bevindings en tegnologie, ontdekkings en nuwe navorsing in die gesondheidsorg arena, wat 'n nuwe benadering tot die lewering van gesondheidsorg bewys en weerspreek. Eise deur pasiënte wat meer geletterd is, en nuwe en moderne siekte profiele eis 'n nuwe benadering tot verandering. Die versnelling in die tempo van verandering is dikwels onbekend, veeleisend en uitdagende vir die bestuur van gesondheidsinstellings. Een so 'n verandering, soos dit in hierdie studie aangespreek word, is die verandering van 'n papier-gebaseerde na 'n rekenaar-gebaseerde pasiënt inligting stelsel wat aan alle lede van die multidissiplinêre gesondheidsorg span toegang verleen. Nogtans word nie alle verandering verwelkom, aanvaar of as nodig beskou deur diegene wat die dienste uitvoer of die nuwe tegnologie moet gebruik nie. Verandering is gekompliseerde proses, en deel van die probleem is die identifisering van faktore wat 'n invloed op die veranderings inisiatiewe het. Hierdie studie fokus op die persepsies van die verpleegpersoneel tydens die proses van verandering van 'n papier-gebaseerde tot 'n rekenaar gebaseerde (Quadramed) pasiënt rekord stelsel. Die studie-ontwerp gebruik 'n kwantitatiewe, beskrywende benadering wat 'n gestruktureerde, self-ontwerpte vraelys gebruik om data te verkry van 117 professionele verpleegsters by 'n geselekteerde gesondheidsorg fasiliteit in die Oostelike Provinsie van die Koninkryk van Saoedi-Arabië. Die teoretiese raamwerk wat gebruik word vir hierdie studie was die model vir veranderingsbestuur soos ontwerp deur die Prosci Instituut vir Navorsing, waarna ook verwys word as die “ADKAR Model of Change Management” (Awareness, Desire, Knowledge, Ability and Reinforcement). Die belangrikste bevindings van hierdie studie het aan die lig gebring dat 97,44% van die respondente was nie-Saoedi-individue nie, en was hoofsaaklik van die Filippyne (69,24%), met (95,65%) vroue met 'n gemiddelde ouderdom van 37-42 jaar. Die meeste (47%) was in besit van gespesialiseerde kwalifikasies in mediese, chirurgiese verpleeging. Die meeste van die respondente het tussen 8-10 jaar ervaring in verpleegkunde gehad, waarvan 2-3 jaar in Saoedi-Arabië was. Met betrekking tot 61,3% van die respondente dit is gevind dat hulle geen vorige kennis van die gerekenariseerde pasiënt rekords gehad het nie. Die saal bestuurder het 'n belangrike rol gespeel in die verskaffing van die meeste inligting en ondersteuning om aan te pas tot die nuwe stelsel. Met verwysing na die aspek van die veiligheid van pasiënte, is positiewe terugvoer oor die QCPR voorsien deur die meerderheid van die respondente. Die meeste van die respondente het ook die verandering positief ervaar, en 70% het aangedui dat hul betrokkenheid 'n belangrike rol gespeel het in hul positiewe gesindheid. Aanbevelings sluit in dat die redes vir verandering duidelik gekommunikeer behoort te word, voorstelle vir verandering moet erkenning kry deur bestuurders en gerugte en onsekerhede oor verandering moet aangespreek word soos en wanneer toepaslik.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Healthcare organizations have implemented numerous safety initiatives to address errors due to the impact on the patient, families, healthcare provider and the organization as highlighted in the Institute of Medicine report. However, error identification, reporting and management remain a challenge. Nurses have been identified as the healthcare provider with the greatest potential for errors. Supportive work environments are needed to provide optimal care to the nurse who makes an error; which may be minor to severe repercussions. The patient is identified as the first victim and the nurse who makes the error as the second victim. How nurse errors are reported, managed and disclosed is dependent on the response of leaders and peers which may be in a shame and blame or just culture approach. The aim of the study was to assess error management in nursing amongst registered nurses working in a tertiary hospital in Saudi Arabia. The objectives were to identify the occurrence of nursing related errors, determine the current process of reporting nursing errors, describe the management of nursing errors and explore the factors impacting on the management of nursing errors. The research methodology for this study was a descriptive, quantitative approach which is applicable when exploring the unknown. Ethical approval was obtained from the Ethics Board, University of Stellenbosch and the Institutional Review Board, King Faisal Specialist Hospital and Research Centre (General Organization) -Jeddah (KFSH&RC-J). The population was registered nurses working in KFSH&RC-J and assigned to the job descriptions of Staff Nurse 1&2, Clinical Nurse Coordinators and Assistant/Head nurses. Sample was selected using proportional allocation for nationality and simple random selection for nursing specialty; 215 RNs from these three groups. Data was collected using a questionnaire developed by the researcher and analysis completed using SPSS and regression analysis to identify factors which influences the reporting and management of errors. Data was presented in the form of frequency tables and graphs using the EXCEL program to analyze the data. The main findings of the study; there was significant difference in nurse leaders and professional nurses ability to identify nursing errors; questioning of the practice of peers, views of a non-punitive environment and the ability to differentiate between error and negligence. The nurse executive was positively associated with the average positive responses received. RNs of Middle Eastern nationality and the Adult nursing division were found to be slightly more negative in their perceptions about error reporting and management than other respondents. Improvements are needed in the processes of error reporting and management which include education; leadership development, underreporting of errors, feedback and communication, nurse manager support and disclosure of errors. Recommendations are the implementation of the Just Culture principles within the organization and leadership development to address error reporting and management. The need to develop a national database for error reporting in Saudi Arabia is recommended. Nursing errors occurred in one tertiary hospital in Saudi Arabia and an on-line system is available to report errors. However, nurses do not report errors as they fear being blamed and shamed. The process of error management within the organization has not been clearly defined. / AFRIKAANSE OPSOMMING: Gesondheidsorganisasies het talle veiligheids inisiatiewe geïmplementeer om foute aan te spreek weens die invloed wat dit het op die pasiënt, families, die gesondheidsverskaffer en die organisasie soos uitgelig in die Mediese Verslag van die Instituut. Nietemin, die identifisering van foute, verslaggewing en bestuur bly ’n uitdaging. Verpleegsters is geïdentifiseer as die gesondheidsverskaffers wat oor die grootste potensiaal beskik om foute te begaan. Ondersteunende werkomgewings word benodig om optimale sorg aan die verpleegster te verskaf wat ’n fout van ’n mindere aard tot die met ernstige gevolge begaan. Die pasiënt word geïdentifiseer as die eerste slagoffer en die verpleegster wat die fout begaan as die tweede slagoffer. Die manier hoedat verpleegfoute gerapporteer, bestuur en openbaar gemaak word, is afhanklik van die reaksies van leiers en portuurgroepe wat ’n skaamte- en blameerbenadering of “just culture”-benadering kan wees. Die doel van die studie was om die hantering van verpleegfoute tussen geregistreerde vepleegkundiges wat in n tersiêre hospital in Saudi werk te ondersoek. Die doelwitte is om die voorkoms van verpleegverwante foute te identifiseer, die huidige proses van verslaggewing van verpleegfoute te bepaal, die bestuur van verpleegfoute te beskryf en die faktore te ondersoek wat ’n impak het op die bestuur van verpleegfoute. Die navorsingsmetodologie vir hierdie studie is ’n beskrywende, kwantitatiewe benadering wat van toepassing is wanneer die onbekende ondersoek word. Etiese goedkeuring is verkry van die Etiese Raad aan die Universiteit Stellenbosch en die Institusionele Beoordelingsraad, King Faisal Specialist Hospitaal en Navorsingssentrum (Algemene Organisasie) – Jeddah (KFSH & RC-J). Die teikengroep is geregistreerde verpleegsters wat werk in KFSH & RC-J aan wie die posbeskrywing van stafverpleegster 1 & 2 toegeken is, Kliniese Verpleegkoördineerders en Assistent/Hoofverpleegsters. Die steekproef is geselekteer deur gebruik te maak van proporsionele toekenning vir nasionaliteit en ’n eenvoudige ewekansige steekproef vir verpleegspesialiteit; 215 geregistreerde verpleegsters van hierdie drie groepe. Data is gekollekteer deur gebruik te maak van ’n vraelys wat deur die navorser ontwikkel is en die analise is voltooi deur gebruik te maak van SPSS en regressie-analise om faktore te identifiseer wat verslaggewing en bestuur van foute beïnvloed. Data is aangebied in die vorm van frekwensie-tabelle en grafieke deur gebruik te maak van die EXCEL-program om die data te analiseer. Die vernaamste bevindinge van die studie is dat daar beduidende verskille tussen verpleegleiers en professionele verpleegsters se vermoë is om verpleegfoute te identifiseer; bevraagtekening van die praktyke van portuurgroepe; beskouinge van nie-strafgerigte omgewing en die vermoë om te onderskei tussen foute en nalatigheid. Die verpleegeksekuteur is positief geassosieer met die gemiddelde positiewe response wat ontvang is. Geregistreerde verpleegsters van Midde-Oostelike nasionaliteit en die Volwasse Verpleegafdeling is gevind om effens meer negatief te wees in hulle persepsies van fouteverslaggewing en bestuur, as ander respondente. Verbeterings is nodig in die prosesse van verslaggewing van foute en bestuur daarvan wat opvoeding daarvan insluit; leierskapontwikkeling, onderverslaggewing van foute, terugvoer en kommunikasie, ondersteuning van verpleegbestuur en bekendmaking van foute. Aanbevelings is die implementering van die “Just”-kultuur beginsels binne die organisasie en leierskap ontwikkeling om die verslag van foute en bestuur aan te spreek. Die behoefte om ’n nasionale databasis te ontwikkel vir die verslag van foute in Saoedi-Arabië word aanbeveel. Verpleegfoute het in een tersiêre hospitaal in Saoedi-Arabië plaasgevind en ’n aanlyn sisteem is beskikbaar gestel om foute te rapporteer. Nietemin, verpleegsters rapporteer nie foute nie, want hulle vrees om geblameer te word en beskaamd te staan. Hierdie proses van foutebestuur binne die organisasie is nog nie duidelik gedefinieer nie.

Customer comfort is an important factor in developing and maintaining relationships between customers and service providers. For example, it plays essential roles in selecting service provider. In spite of its importance, the concept of comfort has not been fully explained in the service marketing literature. Although, comfort has been discussed as a fundamental element in healthcare, its role in developing and maintaining customer relationships has not been fully explored in the boarder marketing literature. The present study focuses on the concept of comfort (physical and psychological) as a crucial factor in marketing health care services, particularly in Saudi private hospitals This thesis examines a number of the antecedents and consequences of physical and psychological aspects of comfort in the marketing arena. Antecedents investigated included: functional and technical dimensions of service quality, the environmental and social aspects of hospital life and service costs (monetary and non-monetary). Patients’ satisfaction was the consequence of customer comfort explored in this thesis. When the relationships between the physical and psychological aspects of comfort and their antecedents were examined, it was concluded that a number of these constructs were shown to have positive effects in the concept of comfort in Saudi private hospitals. For example, the construct of functional service quality appears to have a positive effect in the perception of psychological comfort. The construct of technical service quality, such as staff behaviours, also tends to have a positive effect in the perception of psychological comfort. The social and environmental aspects of hospital life stood out as the only construct that has a positive effect in the perception of physical comfort. While the monetary and non-monetary costs of the service were VII found to have no effect in the perceptions of both physical and psychological comfort. In testing the consequence of the physical and psychological aspects of comfort, it was found that psychological comfort tends to have a positive effect in satisfaction. Finally, the findings showed that the technical dimension of service quality appears to have significant effects in the perceptions of both psychological comfort and satisfaction. This implies that the technical dimension of service quality tends to promote psychological comfort and satisfaction for Saudi patients. The perception of physical and psychological comfort in Saudi private hospitals is also influenced by the roles of the Islamic religion which is based on the holy Quran and Sunnah of Profit Mohammed (peace be upon Him). In addition to the basic dimensions of comfort, these roles can be used to shape the perceptions of the concept of comfort. It may be useful for Saudi private hospitals to direct their efforts towards promoting patients’ comfort and satisfaction by providing healthcare quality experience that focuses on the functional and technical dimensions of healthcare services, the environmental and social aspects of hospitals and the costs of their services. Data has been collected using an established questionnaire to examine the relationship between comfort, service quality, hospital life and costs.

The study was conducted with the aim of assessing the Saudi Arabian cultural knowledge among the non-Muslim nurses. These nurses work in the obstetric units at the King Faisal Specialist Hospital and Research Centre, Jeddah and come from different cultural groups and are caring for the Saudi Arabian Muslim women. In order for care to be congruent, comprehensive and of a high quality, the patients' needs should be met at the best attainable level. Nurses in all health care settings are expected to demonstrate knowledge of the culture that they serve in order to eliminate barriers. Data analysis was facilitated with the use of the SPSS 11.5 computer program. The study findings may suggest the development of educational guidelines, which will direct the activities of an educational intervention. / Health Studies / M.A. (Health Studies))

The study was conducted with the aim of assessing the Saudi Arabian cultural knowledge among the non-Muslim nurses. These nurses work in the obstetric units at the King Faisal Specialist Hospital and Research Centre, Jeddah and come from different cultural groups and are caring for the Saudi Arabian Muslim women. In order for care to be congruent, comprehensive and of a high quality, the patients' needs should be met at the best attainable level. Nurses in all health care settings are expected to demonstrate knowledge of the culture that they serve in order to eliminate barriers. Data analysis was facilitated with the use of the SPSS 11.5 computer program. The study findings may suggest the development of educational guidelines, which will direct the activities of an educational intervention. / Health Studies / M.A. (Health Studies))