PhD (Health Sciences) / Department of Advanced Nursing Science

MCur / Department of Advanced Nursing Science / Background: The heavy workload of hospital nurses is a major problem globally. Nurses are experiencing higher workloads than ever before due to four main reasons, increased demand for nurses, inadequate appointment of new nurses, reduced staffing and increased overtime and reduction in patient length of stay. It is necessary for South Africa to find ways to reduce nursing workload and improve patient safety particularly in rural areas, to understand these effects of nursing workload on patient safety, the study was conducted with professional nurses from selected hospitals in Vhembe district, Limpopo Province. Purpose: The purpose of this study was to determine and to assess the effects of nurses‘ workloads on patient safety in the selected public hospitals, Vhembe District, Limpopo Province, South Africa. Methodology: Quantitative, exploratory descriptive design was adopted. Self-administered questionnaires were used for data collection from the sampled hospitals in Vhembe district. Hospitals were sampled based on the statistics of admitted patients in medical and surgical wards. Target population were professional nurses with at least two years working in the sampled wards. Ethical considerations were maintained. Results: There are several important consequences of high nursing workload. Findings show that a heavy nursing workload adversely affects patient safety. The study also shows that majority 80 (79.0%) of the respondents were overloaded by nursing responsibilities and this negatively affects nursing job satisfaction. As many as 55 (54.4%) indicated that such v workload contributes to high turnover and the nursing shortage. In addition to the higher patient acuity, work system factors and expectations also contribute to the nurses‘ workload: nurses are expected to perform non-professional tasks such as delivering and retrieving food trays; housekeeping duties; transporting patients; and ordering, coordinating, or performing ancillary services Conclusion: Nursing workload is affected by staffing levels and the patients‘ conditions, but also by the design of the nurses‘ work system. The study showed that a work situation above the assumed optimal level increases the risk for adverse events and patient mortality. However, the resources for nursing staff are limited in all public hospitals where the study focused. Professional nurses, therefore, must use available resources in the most optimal way. The study also recommended that there should be a creation of the nursing posts and the filling of all vacant positions in South Africa. Continuity of in-service training to empower professional nurses on patient safety was emphasised. / NRF

D.Cur. (Nursing Science) / A cost centre in a hospital setting was an identifiable department; such as a nursing care unit, where a nurse manager was also assigned the responsibilities of assuming the duties of a cost manager, e.g. managing the expenditure of that unit and being accountable for the costs. The cost centre was assigned an account number in the hospital accounting system for the purpose of controlling clinical and administrative costs, as well as accumulated expenses by that department (Cleverley & Cameron, 2003:437). The South African National Treasury prescribed expenditure control measures in Section 38 to ensure that expenditure should be accounted for, by appointing an accounting officer (South Africa: 1999). In the particular tertiary hospital complex environment, accounting officers were the appointed cost centre managers who were also the unit nurse managers of these nursing care units. These managers experienced difficulties in fulfilling their dual role in a cost centre management environment for which they had not received training. The purpose of the study was to develop a training programme for nurse managers also appointed as cost centre managers at a tertiary hospital complex in the Limpopo Province. In this study, a qualitative, descriptive, exploratory and contextual design was used. Homogenous purposive sampling was conducted from a population of thirty six (36) nurse managers appointed as cost centre managers. A focus group interview session in which nine (9) cost centre managers participated and twelve (12) cost centre managers participated in one-on-one unstructured interviews were conducted until saturation of data was reached. The central question posed was: “How is it for you as a cost centre manager in your nursing care unit executing dual role for CCMT and providing quality care to patients?” Participants were given an opportunity to describe their experiences about being appointed as cost centre managers in their working situation and while providing care to patients. Adapted phases of the development process of Meyer and Van Niekerk (2008) were used in developing the programme. The survey list of Practice Oriented theory of Dickoff, James and Wiedenbach (1968:434) and Malcolm Knowles’ adult learning (Graig, 1996:253) served as the point of departure for developing a context-specific training programme. Malcolm Knowles’ adult learning theory (Graig, 1996:253) acknowledged that adult learners had specific learning needs when compared to other learners.

MPH / Department of Public Health

MCur / Department of Advanced Nursing Science / Background: Perinatal and neonatal mortality rates remain high in South Africa especially in rural areas and townships where the majority of poor people live. With regard to perinatal and neonatal mortality, South Africa like many other developing countries has failed to achieve MDG 4 and 5 by 2015 regardless of many efforts by the governments. To achieve the SDG which replaced MDGs for child health, it is necessary for the South African public and private health care to reduce substantially perinatal and new born deaths, particularly in rural areas. There are many factors that contribute to a high perinatal mortality rate in public hospitals in rural areas. To understand these factors, a study was conducted with midwives from selected public hospitals in Limpopo, Vhembe district which experiences the highest perinatal mortality rates in South Africa. Purpose and methodology: The purpose of this research study was to assess factors contributing to high perinatal mortality rates in the selected public hospitals in Vhembe district. A quantitative, descriptive, exploratory and cross-sectional design was used to collect data from the sampled hospitals in the Vhembe district. Hospitals were purposively sampled based on the statistics of monthly deliveries. The target population consisted of all registered midwives who had been working in the maternity units for at least two years. Cochrane's formula was used to determine the sample from the target population for each hospital. A random sample of 110 respondents was selected upon which a questionnaire was administered to each by the researcher. Responses from the close-ended and open-ended questions was grouped and analysed quantitatively by means of Statistical Package for Social Sciences 23.0 (SPSS). Results and findings: Results were presented in frequency tables and graphs revealed that most of the midwives lacked knowledge and skills in a number of key areas needed for them to operate efficiently in the maternity wards. There was also high staff turnover which led to a few midwives being overworked. The utilisation of guidelines and protocols in maternity was left to individual midwives as the hospitals did not evaluate the use of it. Conclusions: Lack of key skills in assisting women in labour, and poor use of guidelines and understaffing were the main contributing factors to high perinatal mortality rates in the selected public hospitals of Vhembe district. Midwife attitudes were not a contributory factor. / NRF

PhD (Nursing Science) / Department of Advanced Nursing Science / State patients are admitted to the psychiatric hospital after being declared as such by a court of law in South Africa. After successful rehabilitation of state patients at the psychiatric hospital, they need to be reintegrated into their families. Perceptions of family members of male state patients regarding reintegration including development of a model to support such reintegration, is not largely explored in the scientific body of knowledge. The aim of this study was to develop a model to support reintegration of state patients into their families in Limpopo Province, South Africa. A qualitative approach using descriptive, explorative, and contextual designs was adopted for this study. The study population was family members whose relatives are male state patients admitted and recorded in the admission register of Hayani Hospital, in Limpopo Province. The study was conducted in two phases of which phase one was a situational analysis, and phase two was the development of the model to reintegrate male state patients into their families. This study was conceptualized within the Social Ecological Model (SEM) of human behaviour (Stokols, 2013), the grounded theory for model development outlined in Dickoff et al. (1968), and the approaches outlined in Chinn and Kramer (2008); Walker and Avant (1995). Model evaluation was done by a group of health professionals, some of whom are advanced psychiatric nurses who are doing masters and doctoral studies, and one doctoral graduate who is also an advanced psychiatric nurse. Presentations were made to this group during peer review sessions who in turn gave critical comments regarding the developed model to support reintegration of male state patients until the final model was accepted. Non-probability purposive and convenient sampling were used to sample a hospital and 10 family members of Venda-speaking male state patients. In-depth individual interviews were used as the instrument to collect data which was pretested on one family member who did not form part of the study. Data was analysed using thematic analysis approach. Data was co-coded by an independent doctoral degree graduate to ensure trustworthiness. Conducting home visits by health professionals came up strongly during data analysis. Credibility, dependability, confirmability and transferability to ensure trustworthiness of the study, as well as ethical considerations were adhered to. The findings of the study yielded two themes, being perceptions of participants regarding reintegration of male state patients, and perceptions of participants regarding the support needed from family members to reintegrate male state patients. During phase one, the results indicated that family members accept reintegration and also that they indicated the kind of support needed, that lead to phase two of developing a model to reintegrate male state patients. The study was restricted to only one hospital in the Vhembe District out of the five districts of the Limpopo Province.The researcher acknowledges that this study was contextual and that only family members of male state patients were interviewed, the perceptions of family members of female state patients were not heard. The study concluded that there are perceptions that family members of male state patients have regarding reintegration of these patients into their families. Furthermore, family members of male state patients can describe the kind of support that they need in order to reintegrate male state patients into their families. This should be done using the developed model that should involve family members and the community. The study recommends that psychiatric hospitals should implement the model involving family members of male state patients. Furthermore, a longitudinal study should be conducted for a period of 3-5 years to check the effectiveness of the model. / NRF

PhD / Department of Public Health / See the attached abstract

Department of Nutrition / MSCPNT

Department of Advanced Nursing Science / MCur

MPH / Department of Public Health