D.Cur. (Intensive General Nursing) / Critical care nursing is cost-effective quality nursing to the critical ill patient. This nursing is inftuenced by certain expectations as well as the professional-ethical authorisation. The aim ofthis study is to describe and explore the expectations and the professional-ethical authorisation of the functions of the critical care nurse to enable the formulation ofguidelines for the scope of practice for the critical care nurse within South African context. Phase I was to determine the expectations of the critical care nurse, the nursing service managers and the doctors with regard to the functions of the critical care nurse. A focus group interview was held with a group of experts in the field of critical care. The results were used to compile a questionnaire. This questionnaire was sent to the critical care nurses, the nursing service managers and the doctors in South Africa for completion. From these results the functions of the critical care nurse were determined. Phase 2 is to analyse the expectations (Phase 1) according to the professional-ethical authorisation of the critical care nurse. Firstly, literature was explored and described to determine the professional ethicalauthorisation regarding the accountability ofthe critical care nurse. Secondly, the functions were analysed according to the professional-ethical authorisation. The analysis showed that except for prescribing medication, altering medication dosages and drawing blood samples from the critical ill patient, the critical care nurse is practicing within her professional-ethical authorisation. Phase 3 was to formulate guidelines for the scope of practice for the critical care nurse within a South African context. Through usage of the data (Phase I and 2) the scope of practice was formulated. Guidelines were formulated for the practise, education and research regarding the limitations of the professional-ethical authorization and the implementation of the scope of practice for the critical care nurse.

Submitted in fulfillment of the requirements for the Degree in Master of Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Introduction Moral distress is a widely recorded phenomenon in the nursing profession. It can be described as a form of distress that occurs when one knows the ethically correct thing to do, but is prevented from acting on that perceived obligation. Moral distress impacts patients, nurses and the organization. If the nurse is unable to advocate for her or his patient and avoidance behaviour occurs, increased patient suffering result. Moral distress results in high staff turnover, decreased quality patient care and low patient satisfaction. Unrelieved moral distress jeopardizes nurse’s sense of self-worth and threatens their integrity. Aim of the study The aim of the study was to determine the impact of moral distress on the provision of nursing care amongst critical care nurses. Methodology A quantitative descriptive design was used to determine the intensity and frequency of moral distress amongst critical care nurses, to assess the impact of moral distress on the provision of nursing care to the patient as well as to evaluate the effectiveness of organisational strategies implemented to reduce moral distress. Critical care nurses from both private and public hospitals were selected to participate in the study. Data was collected by means of a survey using the moral distress scale which was revised to meet the objectives of the study. A non-probability purposive sampling technique was utilised to gather data from a sample size of 100 critical care nurses currently working in the critical care environment. Results The study indicates that the frequency and intensity of moral distress is related to specific clinical situations in the critical care environment. The study also specifies that moral distress continues to have a negative effect on the provision of nursing care. Critical care nurses feel that some strategies are effective whereas others are not at all effective. Impact of the research study This study reveals that there is a significant negative effect of moral distress on the provision of nursing care. Nurses experience challenges in the clinical environment that result in them experiencing moral distress. Nurses more attuned to the ethical dimensions of care may be more at risk for moral distress since these nurses see the moral dimensions of nursing being neglected. Nurses may find themselves distancing themselves from patient care, resulting in a perceived lack of care and concern for the patient. / M

M.Cur. (Nursing Science) / The primary objective of this study was to determine the emotional intelligence (EI) of, and make recommendations to facilitate an improvement in the EI of professional nurses commencing work in critical care units in private hospitals in Gauteng, South Africa. The quality of nursing care directly affects patient outcomes such as morbidity, mortality, adverse events as well as the total cost of care. This places the nurse central in good, comprehensive health care, especially in the critical care environment. Professional nurses starting in critical care consistently experience feelings of anxiety regarding their performance, related to the intensity of patient care, insufficient knowledge, extreme workload, role uncertainty, the feeling of being unsafe, making mistakes, having to work with new technology, as well as social acceptance in critical care with its unique working culture. Emotional labour is a big part of critical care, which leads us to explore emotional intelligence. Emotional intelligence (EI) is the ability to monitor one’s own and others’ feelings, to discriminate among them, and to use this information to guide one’s thinking and actions. It also refers to the ability to identify, express, understand and regulate emotions. Though emotional skills are learnt during childhood, it can also be developed and changed later in life with age, experience and good role models or mentors. Nurses with a higher EI have more positive attitudes, greater adaptability, improved relationships, and increased orientation towards positive values. The question that arose was: what is the emotional intelligence of professional nurses starting in critical care for the first time?...

The complex environment of an intensive care unit is associated with a considerable amount of stress. Intensive care nurses are confronted daily with increasing work demands, emanating from the growing numbers of critically-ill patients; the introduction of highly sophisticated technologies in the intensive care environment; increasing competition between health care institutions; increased work loads; and limited career opportunities caused by, among other things, budget cuts by the government (Janssen, De Jonge & Bakker, 1999:1360). Research has shown that such stressors can result in mental, physical and behavioural stress reactions among nurses (Demerouti, Bakker, Nachreiner and Schaufeli, 2000:454). The objective of this study is to explore and describe registered nurses’ perceptions of factors causing stress in intensive care environments of state hospitals. The main purpose of the study is to develop guidelines for a stress management programme, to assist registered nurses to cope with the stressors in an intensive care environment. The research design is placed within a quantitative, explorative and descriptive contextual framework. Validity and reliability in testing and evaluating the research questionnaire are discussed, as well as the ethical and legal considerations relating to this research study. Findings of the research study will be utilized to assist the researcher in developing guidelines for a stress management programme to assist registered nurses in coping with stress in an intensive care environment

Critical care nursing is a vital and significant part of health care provision to critically ill patients. It is a specialty area of nursing that requires registered nurses who are highly motivated, knowledgeable and skilled to provide optimal care to critically ill patients. These patients are nursed in a complex environment consisting of specialised equipment (such as ventilators, defibrillators, intravenous pumps, and cardiac monitors) that is not found in any other field of nursing. Collegial support and an adequate registered nurse: patient ratio is vital in critical care units in order to provide optimal quality care to critically ill patients. However, an understaffed work environment, the demands of critical care nursing and other work-related problems, such as conflict with physicians, inadequate remuneration packages and an increased workload can cause serious distress and dissatisfaction amongst registered nurses in this specific environment (Carayon & Gürses, 2005:287). The objectives of this study therefore are to explore and describe the experiences of registered nurses of their work environment in a critical care unit and to make recommendations that will assist registered nurses working in a critical care unit. A qualitative, explorative, descriptive and contextual research design will be utilised. Data will be collected by means of semi-structured interviews and analysed according to the framework provided by Tesch (in Cresswell, 2003:192). Purposive sampling will be used to select a sample of registered nurses working in a critical care environment. Guba’s model (in Krefting, 1991) will be utilised to verify data and to ensure trustworthiness of the study. Ethical considerations will be adhered to throughout the study. Once data has been analysed, recommendations will be made that will assist registered nurses working in a critical care unit.

A critical care unit is a dynamic and highly technological environment. Professional nurses who have been working in the critical care unit for a period of time are passionate about the environment in which they work. They find their on duty time challenging and stimulating. The critical care environment is slowly changing. Due to the fact that there are fewer professional nurses with an additional qualification in critical care available to work in the critical care units. The utilisation of an increasing number of agency nurses leads to an increase in sub-standard nursing care as well as dissatisfied doctors and patients. The shortage of critical care staff has resulted in the need to find an alternative human resources framework and still provide cost effective, safe quality patient care. This leads to the design and implementation of a team nursing care framework for critical care. The research objectives for this study were: - To explore and describe the experiences of professional nurses with regard to a team nursing care framework in private critical care units. - Develop guidelines to optimize the team nursing care framework in critical care units in a private hospital group. The research is based on a qualitative, explorative, descriptive and contextual research design. The study is based on a phenomenological approach to inquiry. Eleven in-depth semi structured face-to-face phenomenological interviews were utilized as the main means of collecting data. A purposive, criterion based, sampling method was used. Specific inclusion criteria were met and consent was obtained from the participants and from the management of the private clinic where the research was conducted. Two central themes were identified:- Theme One: The professional nurses experienced the team nursing care framework in the critical care unit as a burden. Six sub-themes were identified. - Theme Two: Professional nurses made recommendations for improvement of the team nursing care framework in the critical care unit. By describing the lived experiences of the professional nurses in the critical care units, based on research interviews, the researcher painted a clear picture of the team nursing care framework in the critical care unit. Guidelines were developed based on the identified themes. The broad guidelines are aimed at ensuring that the nurses are competent to care for critical care patients prior to them commencing work in the critical care unit. The researcher concludes this study by making recommendations for Nursing practice, education and research.

This study explored and described the impact of the rights and obligations of nurses on the delivery of quality patient care in a clinical setting. Quantitative research approach was utilised. Data was collected using a self-administered questionnaire. The research results revealed that respondents who participated in this study were aware of their rights and obligations, the effects and impact of factors influencing such rights and obligations on patient care. It was established that “patient abandonment” observed when nurses embark on a strike as their constitutionally enshrined right is not due to a lack of insight about their rights and obligations, but on how such rights and obligations are implemented. The researcher recommends that further research be undertaken to explore the causes of nurses embarking on strike actions despite their high level of knowledge concerning the impact of such actions on patient care in a clinical setting / Health Studies / M.A. (Health Studies)

Dissertation submitted in fulfillment of the requirements for the Degree in Masters of Technology: Nursing, Durban University of Technology, 2011. / Background Working in the intensive care unit can be traumatic for nursing personnel. Critical care nurses are faced with repeated exposure to death and dying as they are involved in caring for patients who are actively dying or who have been told that they have a terminal illness and are faced with the possibility of impending death. Critical care nurses relate in different ways to the phenomena of death and dying within their nursing profession and their scope of practice. These nurses often have a difficult time coping with the stress that comes with caring for those who are dying or relating to loved ones of those that are dying. Aim of the study The aim of the study was to explore the critical care nurse’s experiences of death and dying. Methodology A qualitative, descriptive phenomenological approach was used to guide the study. Four nurses were recruited and rich descriptions of their experiences were gained through individual face-to-face interviews. One broad question was asked: ‘What are your experiences regarding death and dying of your patients in ICU?’ iii Results The findings of this study revealed that issues such as communication, multicultural diversity, education and coping mechanisms relating to caring for the critically ill and dying patient are essential in nursing education and practice. Critical care nurses need to have support networks in place, not only to assist in providing care, but also for their own emotional support / M

This study explored and described the impact of the rights and obligations of nurses on the delivery of quality patient care in a clinical setting. Quantitative research approach was utilised. Data was collected using a self-administered questionnaire. The research results revealed that respondents who participated in this study were aware of their rights and obligations, the effects and impact of factors influencing such rights and obligations on patient care. It was established that “patient abandonment” observed when nurses embark on a strike as their constitutionally enshrined right is not due to a lack of insight about their rights and obligations, but on how such rights and obligations are implemented. The researcher recommends that further research be undertaken to explore the causes of nurses embarking on strike actions despite their high level of knowledge concerning the impact of such actions on patient care in a clinical setting / Health Studies / M.A. (Health Studies)

M.Cur.(Medical & Surgical Nursing: Critical Care General) / The majority of Africans use traditional medicine, but do not divulge this information to the nurses and doctors when admitted to critical care units. For this reason, patients develop complications, and these makes it difficult for nurses and medical doctors in critical care units to assess and to provide comprehensive quality care, as they treat only the visible clinical manifestations. The purpose of this study was to explore and describe the factors leading to non- divulgence by patients who used traditional medicines in critical care units of a Westrand mine hospital, in order to describe strategies to facilitate divulgence. The researcher used a qualitative, exploratory, descriptive and contextual research design. The population was composed of the patients who were envisaged to have used traditional medicines in the critical care unit of a Westrand mine hospital. Twelve participants were purposively selected from the critical care unit register because these patients displayed the symptoms of having used traditional medicine. Semi-structured individual interviews were conducted. Ethical principles were adhered to. Trustworthiness was ensured by using namely; credibility, transferability, dependability and confirmability. A qualitative open coding method of data analysis was used according to Tesch’s protocol. The following theme and subthemes emerged from the data analysis: Fear and anxiety as the main theme. Subthemes were 1. Fear to divulge secrets. 2. Fear of negative attitudes from nurses and 3. Fear to lose rights, norms and values. It is recommended that the strategies described be used in clinical practice, nursing education and for further research regarding divulgence of the use of traditional medicine to the nurses and doctors, in order to provide a comprehensive assessment and treatment of the patients in critical care units.