The aim of the study was to explore the perceptions of nurses regarding communication with nurse managers in the workplace. The design of the study was a generic qualitative. The methodology of choice was qualitative, explorative method. The sample was non-probability and the approach or technique used was purposive sampling method. It comprised of thirty nurses, ten of each category. The category was a component of professional nurses, enrolled nurses and enrolled nursing auxiliary nurses. The data collection method used in the study was in-depth interviews using a self-designed interview guide. Face to face interviews was conducted in a quiet room within the hospital ward as a natural setting. Data was collected using a voice recorder for the sake of protecting the missing of information which may be important. The data analysis was with the help of employing transcribing and coding of voice recorded data and observation noted during the collection of data. The data collection method used in the study was in-depth interviews using a self-designed interview guide. Face to face interviews was conducted in a quiet room within the hospital ward as a natural setting. Data was collected using a voice recorder for the sake of protecting the missing of information which may be important. The data analysis was with the help of employing transcribing and coding of voice recorded data and observation noted during the collection of data. The findings showed that there were dynamics in communication from all nurse categories and that also indicated that there was a need to conduct a research so that the root cause may be identified and suggestions to be put in place to curb the challenges. In conclusion it showed that communication is the key problem of all and it is a worldwide problem. / Health Studies / M.A. (Health Studies)

Study project (Mnutr) -- University of Stellenbosch, 2005. / ENGLISH ABSTRACT: Quality nursing care is characterised by clinical decisions based on critical and analytical thinking. The assessment, planning and implementation information which is used as basis for decision making must be recorded in the patient's record/file. The questlon is rai_sed whetherthe patient's record does indeed reflect critical and analytical thinking. The focus on the midwife's practices during professional conduct hearings which relate to intrapartum service delivery, led to the specific choice of population, namely intrapartum services delivery in Levell hospitals in the Western Cape. A non-experimental study whereby qualitative and quantitative data were collected, was performed in six (6) Levell hospitals. Check lists were compiled to evaluate the structure and facilities in which midwifery practice is executed. The records of 128 patients were analysed to specifically investigate the nature and extent of critical and analytical decisionmaking by midwives, and the extent to which the midwife really applies reflective practices. The results showed that record-keeping is not done optimally; that the partogram, which - - ---- is a comprehensive evaluation of the progress of_lab_2~1isJ not used and that the records did not indicate that the midwife applies critical and analytical thinking and acts accordingly. Recommendationsare that the proposals for the improvement of intrapartum service delivery, as made by Odendal (2004: ii-iv) and the Department of Health (2000: 42), are to receive immediate attention. It appears as if protocols and guidelines for emergency action and general safe practices do exist, but are not enforced. Continued inservice training receive priority attention. Core words: critical analytical thinking; midwife's practice and practices; intrapartum care service delivery / AFRIKAANSE OPSOMMING: Gehalte verpleegsorg word deur kliniese besluite wat op kritiese en analitiese denke gegrond word gekenmerk. In die pasient se rekord moet die ramings-, beplannings- en implementeringsgegewens gerekordeer word wat gebruik is as basis vir besluitneming. Die vraag ontstaan egter of die pasient se rekord wei kritiese en analitiese denke weerspieel. Die fokus op die vroedvrou se praktyke in professionele gedragsake wat met intrapartumsorgdienslewering verband hou, het tot die spesifieke keuse van die populasie, naamlik intrapartumsorgdienste in vlak 1-hospitale in die Wes-Kaapaanleiding gegee. 'n Nie-eksperimentele studie waartydens kwalitatiewe en kwantitatiewe data ingesamel is, is in ses (6) vlak 1- hospitale uitgevoer. Kontrolelyste is opgestel om die struktuur en fasiliteite waarbinne vroedvroupraktyke plaasvind, te evalueer. Die rekords van 128 pasiente is ontleed om spesifiek ondersoek in te stel na die aard en omvang van kritiese en analitiese besluitneming deur die vroedvrou, en tot watter mate die vroedvrou wei weldeurdagte praktyke toepas. Die resultate toon dat rekordhouding nie optimaal gedoen word nie; dat die partogram wat 'n omvattende evaluering van die kraamverloop is, nie gebruik word nie, en dat daar uit die rekords nie 'n aanduiding gevind kan word dat vroedvroue wei krities en analities dink en optree nie. Aanbevelings is dat die voorstelle ter verbetering van intrapartumsorgdienslewering 5005 gemaak deur Odendal (2004: iii-v) en die Departement van Gesondheid (2000: 42), indringend aandag moet geniet. Dit wil voorkom asof protokolle en riglyne vir noodoptrede en algemene veilige praktykvoering wei bestaan, maar nie toegepas word nie. Voortgesette indiensopleiding moet as 'n prioritieit aangespreek word. Kernwoorde: kritiese analitiese denke; vroedvroupraktykvoering; vroedvroupraktyke, intrapartumsorgdienslewering.

Thesis (M.Phil.)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: The aim of this research is to identify the various levels of health care units, their relationships and the problems hindering an effective referral system. To achieve this goal, use is made of a case study of the West Rand area in Gauteng. The standpoint is that, to achieve Primary Health for all South Africans referral systems within health care units and levels must be reciprocal. It is argued that for Primary Health Care to be successful, it must satisfy the goal of affordability appropriateness and accessibility. Results from the research revealed that four health care levels, namely traditional healers, health NGOs, Clinics, and Hospitals. Though there is some degree of referral in the study area, it was observed that referrals in the study area were not reciprocal. Amongst the major problems identified as hindering an effective referral system in the study area, include lack of cooperation between health institutions, poor health infrastructure and communication network as well as lack of other health paraphernalia. The research also found that government policy towards some of the health institutions (Traditional healers) contributes to the inefficiency of proper referrals in the study area. / AFRIKAANSE OPSOMMING: Die oogmerk van hierdie ondersoek is om die verskillende vlakke van gesondheidsorgeenhede, hulonderlinge verbande en die probleme wat doeltreffende verwysings in die wiele ry, te identifiseer. Dit word gedoen aan die hand van 'n gevallestudie van die Wes-Randarea in Gauteng. Die uitgangspunt is dat doeltreffende Primêre Gesondheid vir alle Suid- Afrikaners afhang van resiprokale verwysingsisteme tussen gesondheidsorgeenhede en -vlakke. Suksesvolle Primêre Gesondheidsorg vereis bekostigbaarheid, toepaslikheid en toeganklikheid. Die ondersoek het vier gesondheidsorgvlakke aan die lig gebring: tradisionele genesers, gesondheids-nie-regerings-organisasies, klinieke en hospitale. Hoewel daar 'n mate van onderfinge verwysing in die studie-area bestaan, was dit nie wederkerig nie. Onder die vernaamste struikelblokke vir 'n doeltreffende verwysingsisteem tel swak samewerking tussen gesondheidsinstellings, gebrekkige gesondheidsinfrastruktuur en kommunikasienetwerk, en 'n skaarste aan ander gesondheidsmiddelle. Die ondersoek het ook bevind dat regeringsbeleid aangaande sommige van die gesondheidsinstellings (tradisionele genesers) bydra tot die ondoeltreffendheid van verwysings in die studie-area.

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: BACKGROUND Post anesthesia discharge criteria scoring systems have been used successfully to aid discharge from the post anesthetic care unit (PACU) for over 40 years. They do not replace, but rather act in conjunction with good clinical judgment, and provide concise, standardized documentation of a patient’s readiness for discharge. 1,2,3,4,5 In order to improve patient safety, provide clear documentation and to aid future audit, a discharge criteria scoring system was developed for use in our PACU (Addendum A). It is a modification of the Aldrete Scoring System and the modified Post Anesthetic Discharge Scoring System (PADSS) proposed by Chung.1 There is a steadily increasing patient burden on the existing medical infrastructure in South Africa. Tygerberg Academic Hospital is no exception, and because of the high demand on our theatre services, optimal efficiency is essential. We speculated that our discharge criteria scoring system might increase the efficiency of our PACU when compared to the traditional time based system. The more healthy patients, undergoing minor procedures, could potentially spend less time in PACU, allowing the nurses to focus on problem cases. Increasing the speed of transit might also help prevent delays in theatre due to lack of bed space in PACU. Our primary endpoint was to compare the duration of time spent by patients in the PACU at Tygerberg Academic Hospital, from the moment they are admitted, to the time they are discharged to the ward, before and after the introduction of a discharge criteria scoring system. While planning the audit, one of the factors that staff identified as contributing to delayed discharge from PACU, was the time it took for the wards to collect their patients. A secondary objective, therefore, was to assess the amount of time that elapsed between calling the ward to collect the patient, and the patient leaving PACU. METHODS AND MATERIALS Prior to commencing the audit, approval was obtained from the Human Research Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch and Tygerberg Academic Hospital. The Audit, its purpose and possible benefits, was discussed with representatives of the nurses working in PACU, and written consent was obtained from those who would be involved in the data collection (Addendum B). Audit forms (Addendum C), collection boxes, and posters reminding staff to participate in the audit were prepared. Our first audit was performed over approximately a week in August 2012. During this period, the traditional time-based discharge system was still in operation. Data was captured from 327 patients. Audit forms were placed in a collection box, which was cleared daily by the primary investigator. The discharge criteria scoring system was introduced to the PACU staff in January 2013. The nurses were trained in its use, and a one month period was allowed for all involved to become accustomed to the new system. A second audit was performed in February 2013, again over a week, during which we gathered data from 313 patients. RESULTS The median value of the time spent by patients in the PACU decreased from 1 hour 25 minutes, to 1 hour 15 minutes, after introduction of the discharge criteria scoring system. This was statistically significant (p-value = 0.003). The median time between calling the ward to collect a patient, and the patient leaving recovery, was 15 minutes. CONCLUSION The main finding of the study was that the introduction of a discharge criteria scoring system decreased the median duration of time spent by patients in the post anesthetic care unit at Tygerberg Academic Hospital. / AFRIKAANSE OPSOMMING: AGTERGROND Puntestelsels as ontslag kriteria na narkose, word vir die afgelope 40 jaar suksesvol gebruik as maatstaf om pasiënte uit die herstelkamer te ontslaan. Hierdie kriteria vervang nie goeie kliniese oordeel nie, maar is ’n addisionele hulpmiddel om te bepaal of die pasiënt gereed is vir ontslag en om noukeurige, gestandardiseerde dokumentasie te verseker. 1,2,3,4,5 'n Nuwe puntestelsel vir ontslag is vir die herstelkamer van Tygerberg Akademiese Hospitaal ontwikkel om pasiëntesorg en dokumentasie te verbeter, asook om ouditering in die toekoms te vergemaklik (Addendum A). Hiervoor is die Aldrete Scoring System en die gemodifiseerde PADSS, voorgestel deur Chung, aangepas. 1 Die bestaande mediese infrastruktuur in Suid-Afrika beleef tans ‘n geleidelike toename in die getal pasiënte. Tygerberg Akademiese Hospitaal is geen uitsondering nie en as gevolg van die hoë aanvraag na ons teaterdienste, is uiterste doeltreffendheid noodsaaklik. Ons vermoede was dat hierdie aangepaste puntestelsel doeltreffendheid in die herstelkamer sou verbeter in vergelyking met die meer tradisionele tyd-gebaseerde sisteem. Gesonde pasiënte wat kleiner prosedures ondergaan, sal waarskynlik na ’n korter periode ontslaan kan word wat die verpleegpersoneel in staat sal stel om meer aandag aan probleem gevalle te gee. Bespoediging van die pasiëntvloei behoort onnodige vertragings van teatergevalle weens 'n tekort aan beddens in die herstelkamer, te beperk. Die primêre doel van die studie was om te bepaal of die gebruik van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal, die tydperk wat die pasiënt in die herstelkamer deurbring, verkort. Die herstelkamer verpleegsters het beweer dat die saal personeel ‘n lang tyd gevat het om hulle pasiente in herstelkamer te kom haal. Vervolgens is 'n sekondêre doelwit ingesluit om die tydperk te bepaal vandat die saalpersoneel in kennis gestel word, totdat die pasiënt die herstelkamer verlaat. METODE Goedkeuring is verkry van die Menslike Navorsing en Etiese Komitee van die Gesondheidswetenskap Fakulteit van die Universiteit van Stellenbosch en Tygerberg Akademiese Hospitaal voor die aanvang van die studie. Die studie, asook die doel en moontlike voordele daarvan is vooraf bepsreek met verteenwoordigers van die herstelkamer verpleegpersoneel en skriftelike toestemming is verkry van al die deelnemers wat betrokke sou wees by die data versameling (Addendum B). Oudit vorms (Addendum C), versamelhouers en inligtingsplakkate vir die betrokke personeel is voorberei. Die aanvanklike oudit is in Augustus 2012 oor 'n periode van ongeveer een week uitgevoer. Tydens hierdie oudit is die tradisionele tydgebaseerde sisteem gebruik. Inligting van 327 pasiёnte is versamel. Die oudit vorms is in die versamelbokse geplaas en is daagliks deur die primêre navorser verwyder. Die aangepaste puntestelsel as ontslag kriteria, is in Januarie 2013 in die herstelkamer geïmplementeer. Die verpleegpersoneel het opleiding ontvang waarna die aangepaste puntestelsel vir een maand gebruik is om te verseker dat die personeel vertroud is daarmee. In Februarie 2013, is ‘n tweede oudit oor ‘n tydperk van een week uitgevoer, waartydens inligting van 313 pasiёnte versamel is. RESULTATE Na die implementering van die aangepaste puntestelsel as ontslag kriteria, het die mediane tyd wat pasiënte in die herstelkamer deurbring afgeneem van 1 uur en 25 minute tot 1 uur en 15 minute. Hierdie afname is statities betekenisvol (p-waarde = 0.003) Die mediane tyd vandat die saal in kennis gestel is totdat die pasiënt die herstelkamer verlaat, was 15 minute. GEVOLGTREKKING Die hoof bevinding van die studie is dat die mediane tydperk wat die pasiënte in die herstelkamer deurbring verminder is deur die implementering van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal.

Thesis (MBA)--University of Stellenbosch, 2010. / The aim of this research report is to identify and quantify the cost drivers of three district hospitals in the Western Cape, namely Knysna Hospital, Oudtshoorn Hospital and Mossel Bay Hospital, and to simultaneously measure value-driven performance indicators. An environmental scan identified various driving forces that would significantly affect change in the healthcare industry such as the brain drain of health professionals, consumerism and cost containment and efficiency initiatives. The Department of Health’s understanding of the eighth Batho Pele principle of value for money is generally understood as providing quality health care within prescribed cost limits. An attempt is made to establish the effect of the quadruple burden of disease (the HIV/AIDS pandemic, persistent infectious diseases, injury arising from violence and road traffic collisions and emerging chronic conditions) on hospital expenditure in the Eden District. Research identified Mossel Bay as a high TB burden area known as a TB “hotspot” and it is a recognized immigration transit point en route to Cape Town. The population analyses revealed that Mossel Bay is the growth point of the Eden District, showing extraordinary growth of 25% between 2007 and 2009. Personnel costs: This study revealed that personnel costs are responsible for the overwhelming majority of the total expenditure of the district hospitals.Staff numbers, occupation specific dispensation (OSD) implementation and annual wage negotiations are the cost drivers of personnel costs. This study also found a clear correlation between an over-expenditure in personnel expenses and over-expenditure in the total expenditure of all three hospitals. Health care costs: Expenditure on blood products is considered a major cost driver of clinical expenses. Laboratory expenditure is clearly the largest cost driver for clinical expenses at all three hospitals. Together with laboratory expenses, medicine and medical supplies are the cost drivers for clinical expenses. Costs not related to health care: The three most significant administrative expenses are communication, stationery and printing as well as travel and subsistence allowances. The cost driver for subsistence and travel expenses is the number of vehicles followed by the preference of vehicle, which in turn determines the daily tariff and the kilometre tariff. This study revealed that Knysna Municipality has the cheapest electricity cost of the three towns. It is clear that cost and consumption of electricity and water are the two variables that affect municipal service expenditure the most. Equity: When the district hospital expenditure is combined with the primary health care expenditure in the three sub-districts, the figures show that Oudtshoorn is spending 3% more than its equitable share of the total budget at a higher cost of R978 per capita, in excess of R100 above the district average. Efficiency: The cost per patient day equivalent (PDE) per economic classification for all three hospitals is less than the average cost per PDE of the district hospitals in the Western Cape. The cost/PDE of Oudtshoorn Hospital is considerably higher than that of Knysna and Mossel Bay in all economic classifications, with the single exception of the agency cost of Mossel Bay Hospital. The cost of health care always reflects a combination of price, quantity and value, and it is impossible to consider individual cost drivers in isolation. Several cost-saving initiatives and managerial control measures are recommended.

Thesis (MBA)--Stellenbosch University, 2013. / The South African Northern Cape Department of Health has many challenges to overcome in order to provide the province with quality public health care. One of these challenges is the recruitment and retention of foreign doctors in order to maintain and improve on the population’s access to physicians. Due to the lack of locally trained physicians willing to work and settle in the Northern Cape Province, the Department of Health in the province have been employing foreign-trained physicians to fill the gap in providing adequate medical care to its population. This study examined how well foreign doctors have integrated into the Northern Cape public health care system. It further identified, described and explored the factors that might influence the integration of these foreign physicians. This was done in order to make recommendations to improve the existing retention strategies of the Northern Cape Department of Health. This research utilised the mixed-method of research by obtaining secondary qualitative as well as primary quantitative data. The qualitative data were obtained through a literature review. Questionnaires informed by the literature review were utilised in order to obtain the primary quantitative data. The data obtained were subjected to a statistical analysis.The results indicated that the needs of the foreign doctors were generally met and the factors pertaining to work, community and family aspects of integration did not have an overtly negative or positive influence on integration. The results pertaining to rurality were not as prominent as expected. The main factors identified related to relational (professional as well as personal) factors. The researcher concluded that relational factors contributed the most as they had an influence on all the categories of possible factors that might influence integration. This finding stressed that the social phenomena that influence integration should not be overlooked. The implementation of interventions to improve integration and retention should be accompanied by a detailed examination of the factors that affect the recruitment, integration and retention of the workforce in a country/region. This research could be an important step towards achieving this goal for the Northern Cape Department of Health.

Thesis (PhD)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: District hospitals play a pivotal role in the district health system of the Western Cape and other provinces of South Africa. It is a dual role, supporting both primary health care services and serving as a gateway to higher levels of care. Most district hospitals are in rural areas, staffed by generalist medical practitioners who provide health services often supplied by specialists in urban areas. There is a paucity of research and published material on the scope of practice of district hospital practitioners in South Africa, as well as the factors influencing the performance of their duties. There were two main objectives for this study. Firstly, to identify the professional knowledge and skills of medical practitioners delivering district hospital services in the Western Cape and to compare these with service platform needs. Secondly, to use the information gathered to make recommendations regarding human resource development and appropriate education and training and continuing professional development of these doctors. The study was conducted in three phases to ensure coherent evolution of investigation, co-ordination and response. Phase One was a comprehensive survey, utilising district hospital data, medical officer questionnaires and in-depth interviews to determine the professional knowledge and skills of medical practitioners working in district hospitals in the Western Cape. This information gathering endeavour resulted in a skills and knowledge compendium being formulated. It established that the spectrum of functions required of these doctors was extremely wide - ranging from the management of undifferentiated problems to performing complex surgical procedures, as well as providing a vital public health function. Two main factors influenced their performance, namely their working conditions and the education and training which they received.In common with rural practice in other countries, it was apparent that the working environment had a major impact on attitudes and functioning. These findings were developed into a conceptual framework depicting the negative influences that can build up and result in these doctors opting out of rural practice. In addition, other influences were established having a profound effect on doctors’ satisfaction, mainly in the realm of education and training. This gave rise to a second more comprehensive framework being evolved, encapsulating the positive and negative factors enhancing or retarding efficiency and satisfaction in the workplace. Phase Two of the study consisted of the validation of the findings of the basic research data. In keeping with the second aim of the study, the education and training perspectives of rural and district hospital practice were explored. The deficiencies exposed have implications for undergraduate and postgraduate education and training, as well as for continuing professional development programmes. Phase Three concentrated on the exploration of ways and means of defining and maintaining ongoing professional competence for district hospital practice. This was approached by using the data captured in Phase One and refined in Phase Two to pose a series of educational problems to a group of experts. Using the Delphi Technique, a series of electronic exchanges achieved consensus on a range of topics varying from educational content to learning modalities and modern adult teaching techniques applicable to district hospital practice. This research presents information defining the circumstances, experiences and needs of medical practitioners working in district hospitals in the Western Cape province of South Africa. It reveals clear challenges to the capacity, attitudes, costs, isolation, political will, monitoring and organisation which will be crucial in the development of future human resource strategies.It, furthermore, defines the educational objectives, content and methods required to establish and maintain the ongoing professional competence of medical practitioners delivering district hospital services in the Western Cape. / AFRIKAANSE OPSOMMING: Distrikshospitale speel ‘n sentrale rol in die distriksgesondheidstelsel van die Wes- Kaap en ander provinsies in Suid-Afrika. Dit is ‘n dubbele rol wat beide primêre gesondheidsorgdienste ondersteun en optree as ‘n deurgang vir verwysing na hoër vlakke van sorg. Die meeste distrikshospitale is te vinde in plattelandse gebiede. Dit is hier waar die algemene geneeskundige praktisyn dienste lewer wat gewoonlik deur spesialiste in stedelike gebiede verrig word. Daar is ‘n gebrek aan bestaande navorsing en publikasies oor die omvang van praktyk van geneeshere in distrikshospitale in Suid- Afrika, sowel as onvoldoende inligting in verband met faktore wat die funksionering van hierdie praktisyns beïnvloed. Hierdie studie het twee hoofdoelwitte vervat. Die eerste doelwit was die bepaling van die professionele kennis en vaardighede van geneeshere werksaam in distrikshospitale in die Wes-Kaap, en die vergelyking daarvan met die behoetes van die diensplatform. Die tweede doelwit was om hierdie inligting te gebruik om aanbevelings te doen aangaande menslike hulpbronontwikkeling en toepaslike onderrig, opleiding en voortgesette professionele ontwikkeling vir hierdie geneeshere. Die studie is in drie fases uitgevoer om samehangende ontwikkeling van ondersoek, koördinasie en respons te verseker. Fase Een het bestaan uit ‘n omvattende opname van die professionele kennis en vaardighede van geneeshere werksaam in distrikshospitale in die Wes-Kaap deur die gebruik van distrikshospitaaldata, vraelyste vir geneeshere, en in-diepte onderhoude. Die resultate is gebruik om ‘n omvattende stel kennis en vaardigheidsareas te identifiseer. Fase Een het bewyse gelewer dat die rol en funksie van dokters in distrikshospitale uitsonderlik wyd is en wissel tussen die hantering van ongedifferensieërde probleme en die uitvoer van komplekse chirurgiese prosedures, sowel as ‘n belangrike rol in openbare gesondheid. Werksomstandighede en onderrigen opleiding is geïdentifiseer as die twee belangrikste invloede wat die uitvoer van hierdie praktisyns se pligte beïnvloed. Soortgelyk aan plattelandse praktyke in ander lande, het dit duidelik geword dat werksomstandighede ‘n groot invloed op houdings en funksionering het. Hierdie bevindings is saamgevoeg in ‘n konseptuele raamwerk om die negatiewe invloede toe te lig wat veroorsaak dat hierdie geneeshere die plattelandse diens verlaat. Ander faktore wat ‘n beduidende uitwerking op praktisyns se werksbevrediging gehad het, veral wat onderrig en opleiding betref, is saamgevat in ‘n tweede en omvattende raamwerk wat die positiewe en negatiewe invloede op effektiwiteit van dienslewering en werksverrigting uitspel. Fase Twee van die studie het bestaan uit die bevestiging van die bevindings van die basiese navorsingsinligting. Perspektiewe in die onderrig en opleiding vir plattelandse praktyk is ondersoek in oorleg met die tweede doelwit van die studie. Verskeie implikasies vir voorgraadse en nagraadse onderrig en opleiding en voortgesette professionele ontwikkelingsprogramme is uit ontblote tekortkomings geïdentifiseer. Die omskrywing en die behoud van professionele bevoegdheid is in Fase Drie ondersoek. Data verkry in Fase Een, en verfyn in Fase Twee, is gebruik in die ontwikkeling van ‘n reeks opvoedkundige vraagstukke. ‘n Groep deskundiges is daarna die taak gestel om konsensus te bereik oor ‘n spektrum van onderwerpe, insluitend toepaslike inhoud, metodes van leer en moderne volwasse onderrigtegnieke vir distrikshospitaal praktykvoering. Die Delphi tegniek met herhalende elektroniese rondtes is hiervoor gebruik. Hierdie navorsing lewer inligting wat die omstandighede, ondervindings en behoeftes van geneeshere werksaam in distrikshospitale in die Wes-Kaap provinsie van Suid- Afrika beskryf.Die navorsing onthul duidelike uitdagings vir die kapasiteit, houdings, koste, isolasie, politieke wilskrag, monitering en organisasie van strategieë vir die ontwikkeling van menslike hulpbronne. Dié navorsing definieër hierbenewens die opvoedkundige doelwitte, inhoude en metodes wat nodig is vir die vestiging en instandhouding van die professionele bevoegdheid van distrikshospitaalpraktisyns in die Wes-Kaap.

Submitted in fulfillment of requirements for the Degree of Master of Technology: Nursing, Durban University of Technology, Durban, South Africa, 2015. / Introducion Mental health nurses face challenging positions in practice. They are required to support and care for people hospitalised for treatment of mental illnesses on their recovery journeys but are also expected to manage ward administrative tasks, admit patients, attend meetings, dispense medication and communicate with patients (Gunasekara, Pentland, Rodgers and Patterson 2014: 101; Fourie, Mc Donald, Connor and Bartlett 2005: 135). It has been suggested that mental health nurses spend more time managing the ward environment and staff matters resulting in little time to develop and maintain therapeutic patient relationships (Fourie et al. 2005: 135). Problem Statement Research conducted in other countries identified the roles of the psychiatric nurse and mental health care nurses as attending to patients’ basic needs, assistance with self-care activities, monitoring and administering medication, ensuring safe environments in the health care setting and health education (Rungapadiachy, Madill and Gough 2004; Bowers 2005; Seed, Torkelson and Alnatour 2010). Although there is evidence of studies in psychiatric and mental health nursing locally, little is known about the roles of registered nurses and psychiatric nurses at in-patient facilities. OBJECTIVES • To explore which mental health problems are most commonly seen amongst psychiatric patients at these facilities. • To investigate the challenges faced by psychiatric nurses when caring for psychiatric patients. • To investigate what specialized knowledge and skills are required when nursing such patients. • To investigate whether their education and training prepared them adequately to deal with psychiatric patients and suggest guidelines to strengthen nursing education. METHODOLOGY The study utilized a quantitative non-experimental descriptive design to survey registered nurses and psychiatric nurses at in-patient psychiatric facilities in KwaZulu-Natal. A census was utilized in this study as the entire population was sampled. Data were collected using survey questionnaires. Phase two of the study, qualitative content analysis of Psychiatric nursing curricula strengthened the survey findings. FINDINGS Findings of this study showed that 98.4% of respondents believe psychiatric nursing care is an important aspect of holistic nursing practice. Respondents agree that challenges are commonly encountered in psychiatric nursing practice and that they are prepared to deal with these patients. However the aspects most frequently identified as needing greater attention in the Psychiatric nursing curricula were The Mental Health Care Act no 17 of 2002 and practical management of aggression, violence and de-escalation / M

Introduction: Working in the hospital accident and emergency unit is perceived to be very stressful. However, minimal or no organizational support measures are made available to enable the nurses working in these hospital units to cope effectively with stressful incidents. The purpose of the study was to develop strategies to enhance the support systems of nurses in the accident and emergency unit. Method: The study used a qualitative approach to explore the experiences of and describe the coping strategies used by nurses working in the accident and emergency units of regional urban hospitals at KwaZulu-Natal, in South Africa. Fourteen participants were interviewed in the accident and emergency units of four (4) hospitals. Data were collected through in-depth individual interviews. The data were analysed manually following the steps explained by Creswell (2009:186). Findings: The interviews led to the description of the nurses’ experiences in the accident and emergency units. Four themes emerged from the findings of the interviews, and included working under pressure and stressful conditions, the need for safety and security, limited resources and psychological and emotional problems. Among the problems discussed within the themes, there was anger that was directed by the patients and their relatives to the nurses; absenteeism that contributed to an increase in work pressure; emotional disturbance; lack of physical security; and lack of continuous support from the hospital management. Conclusion: Five strategies were developed to generate a support systems for the nurses whose hospital units formed part of the study and were as follows: develop or strengthen an existing employee assistant program (EAP) specifically for counselling and support of the nurses within the unit; address staff absenteeism through the provision of extra staff through overtime or agency work; enforce attendance of monthly debriefing sessions; strengthen the security system through increasing and evenly distributing the security staff; and give attention to all the problems and provide a quick response. The strategies developed are trusted to remain as a point of reference whenever a need arises. / Health Studies / D. Litt. et Phil. (Health Studies)

Die Queen Victoria Gedenkhospitaal van Stellenbosch, wat sedert 1904 die Stellenbosse gemeenskap bedien het, het as gevolg van 'n groeien~e inwonergetal geleidelik 'n gebrek aan ruimte ondervind. Daarom is daar gedurende die 1930's pogings aangewend vir die oprigting van 'n groter hospitaal. Hierdie pogings is uiteindelik met sukses bekroon en in 1944 het die Stellenbosch Hospitaal sy deure geopen. Spoedig na die opening van die hospitaal is verskeie probleme, soos byvoorbeeld 'n tekort aan beddens en 'n behoefte aan meer moderne mediese toerusting, ondervind. Die Hospitaalraad het deur voortdurende verto~ tot die Kaapse Provinsiale Administrasie en met die finansi~le steun van die Stellenbosse gemeenskap daarin geslaag om belangrike moderne algemene en mediese toerusting aan te koop. Die Stellenbosch Hospitaal, in samewerking met die Cloetesville Gemeenskaps Gesondheidsentrum, wat onder die beheer van die hospitaal staan, se belangrikste doelwit was, en is, om die beste moontlike diens aan die gemeenskap te lewer. Daarom het die Hospitaalraad met verloop van tyd 'n omvattende gemeenskaps gesondheidsprogram ontwikkel. Sedert die dae van die Queen Victoria Gedenkhospitaal het die Stellenbosse gemeenskap 'n aktiewe rol in die lewering van noodsaaklike hospitaaldienste gespee!. As gevolg van die betrokkenheid en die finansi~le bydraes van die gemeenskap kon die Hospitaalraad noodsaaklike uitbreidings, soos 'n kraamsaal en 'n verpleegsterstehuis finansier. Omdat die gemeenskap besef het dat dit nie net die staat se verantwoordelikheid was om gesondheidsdienste te lewer nie, is die Aksie Stellenbosch Hospitaal, die gemeenskapsarm van die hospitaal, in 1988 gestig. Hierdie Aksie Stellenbosch Hospitaal speel dus in 'n tydperk waar staatsfondse beperk is, 'n belangrike rol om die Stellenbosch Hospitaal doeltreffend te laat funksioneer en om steeds hoe standaarde met betrekking tot gesondheidsorg te handhaaf.