M.Cur. (Professional Nursing) / Grievance procedures form an important instrument by means of which nursing staff can make their grievances known to management, thereby effecting a solution to the problem. Therefore, the way in which grievances are handled form an integral part of the staff duties of a nursing service manager. The effective handling of grievances directly influences the satisfaction of nursing staff, as well as the quality of nursing, and thus productivity. Effective handling of grievances depends on the nursing service manager's knowledge of and abiU ty to utilise grievance procedures. This implies that the nursing service manager should be willing and able to investigate all grievances that she becomes aware of, in a consistent manner. She can only fulfil this responsibility if there is an existing grievance procedure in the hospital, and if this procedure is known to all nursing staff. Utilisation of this procedure only is possible when all staff have access to it. This is ensured by training, which will equip them with knowledge and skills in the execution of grieval1ce procedures. The purpose of this study is to determine whether grievances are being handled effectively by nursing service managers in selected hospitals. A descriptive, exploratory study was done within this context by means of a historical analysis of available literature, including newspaper reports, as well as by case study analyses and interviews with nursing service managers in the selected hospitals. A self-training programme regarding the management of grievances will be developed. Analysis of the data indicates that nursing service managers in the selected hospitals do not handle grievance procedures effectively During interviews the nursing service managers indicated that grievance procedures do indeed exist at the hospitals in the Pretoria Witwatersrand area. However, a degree of uncertainty exist. about the difference between grievance procedures and disciplinary procedures.

D.Phil. / South African water resource management policies as well as the country's water law have been under review over the past three to four years. The Water Law Principles, which were established as part of this review process, indicate a commitment to sustainable development of water resources and the protection of an ecological "Reserve". Such policy goals highlight the limitations of conventional water quality management strategies which rely on stressor monitoring and associated regulation of pollution. The concept of an assimilative capacity is central to the conventional water quality management approach. Weaknesses inherent in basing water management on the concept of assimilative capacity are discussed. Response monitoring is proposed as a way of addressing some of the weaknesses. In fact, the inadequate use of biological indicators and techniques in monitoring and evaluating the quality of resources has been identified as a major factor responsible for the continuing decline in the health of natural resource systems. With advances in environmental monitoring over the last decade, it has become clear that biological techniques and protocols need to become part of monitoring in order to allow effective assessment and protection of aquatic resources. One way of incorporating response measures into resource assessment is through the use of toxicological assays. As an example, a toxicological assessment of the environmental risk associated with an organic pesticide (fenthion) is presented. Acute and chronic assays were conducted with a spectrum of test organisms. These toxicological response results provided an ability to predict the ecosystem response that can be expected from certain concentrations of fenthion in the environment. Theoretically, it would be possible to design a risk assessment experiment for every new anthropogenic substance. However, in terms of cost and time, it would not be practically feasible to execute such experiments. To overcome this problem, a method has been developed to derive water quality criteria for toxic substances using existing toxicological data. This provides water resource managers with a readily available set of values to guide them in decision-making. It is demonstrated how available acute and chronic toxicity data can be synthesised into acute and chronic water quality criteria for the protection of aquatic life. As these criteria are intended to extend protection to ecosystems country-wide, they are very conservative by design. Although a set of numeric water quality criteria provides an important tool to water quality managers, the limitations associated with the use of these criteria must be recognised. x Limitations relate either to the design of toxicity experiments or to the use of a chemical-specific approach alone in water resource management. In order to overcome these limitations, three broad supporting technologies are proposed, namely whole effluent toxicity (WET) testing, sitespecific adjustment of water quality criteria, and in-stream biological assessments. Whole effluent testing aims at evaluating the toxic effects of an effluent on organisms. In doing so, acute and chronic toxicity testing (and thus biological responses) becomes part of effluent regulation. An effluent control programme that incorporates toxicity-based standards and compliance criteria is proposed. One of several approaches that can be used for deriving site-specific water quality criteria is the calculation of a water-effect ratio. It is demonstrated that the water-effect ratio method could result in significant adjustments to the national water quality criteria. Although more development and local testing would be required, such site-specific criteria could be in the interest of both ecosystem protection and economic development. In-stream biological assessments introduces a type of response monitoring which provides insight into the overall integrity of aquatic ecosystems. A comprehensive biomonitoring programme is designed. To adhere to the objectives of this programme, specifications have been developed for the selection of sampling sites, the selection of biological and habitat indicators, and the management of the resulting data. This programme is referred to as the River Health Programme (RHP). The ultimate aim of any monitoring programme is to provide useful data. Such data must contribute to effective decision-making. To ensure that the RHP becomes truly operational as a management information system, a step-wise procedure is proposed for linking the collected data with management actions. It is demonstrated how following of this systematic and iterative procedure would facilitate ongoing learning and improvement of the individual steps (e.g. data collection and assessment, goal setting, selection and implementation of management actions) as well as the overall procedure. As a final step, the dynamics that influence the transition of any new technology from scientific development to operational application are explored. The RHP is used as a case study and theoretical models from the field of the management of technology are used to provide valuable insights. Four key components of the RHP design are analysed, namely the (a) guiding team, (b) concepts, tools and methods, (c) infra-structural innovations and (d) communication. These key components evolved over three broad life stages of the programme, which are called the design, growth and anchoring stages.

M.Cur. / Following the democratic elections that took place in 1994, South Africa is undergoing transformation. This transformation was initiated by the external and internal driving forces, of which, the political forces are the most significant. This political transformation led to the promulgation of the Constitution of the country, which impacted on the transformation of the health system, to ensure accessibility and equity. The promulgation of the Constitution was followed by many legislative and policy changes, such as a new Higher Education Act. The South African transition from apartheid to democracy, necessitated that all the existing policies, institutions and practices should be transformed and revised, according to the demands of the new era. With the new political dispensation of the country, many regional, national and local policies have changed. These changes have had an inevitable impact on higher education, which in turn impacts on nursing education. The change in the higher education system required the restructuring and rationalisation of nursing colleges in all the provinces. The need for the transformation of nursing colleges is unavoidable because of the development of the new legislation to readdress the imbalances of the past. Following the new political dispensation, it was however necessary to transform these nursing colleges through rationalisation/integration. The focus of this study is on the transformation of nursing colleges in Gauteng, which poses many challenges to the directors in terms of the management of transformation. The transformation process impacts directly on the directors of nursing colleges. This study is based on the transformation management of selected nursing colleges in Gauteng. The study is conducted in two phases. Phase one explores and describes the experiences and perceptions of directors regarding the transformation of nursing colleges in Gauteng. Phase two describes the formulation of transformation management standards which consists of two phases of standards formulation, namely, the development phase and the quantifying phase.

M.A. / Changes in South Africa's political, socio-political and economical environments are putting pressure on local organisations to move towards a non-racial, democratic and fully representative internal organisation environment. In an attempt to accelerate the process, companies are embarking on programmes such as affirmative action and black empowerment for the employment and development of previously disadvantaged groups in order to assimilate them into the organisational culture. At present, however, the results of these efforts still leave a lot to be desired and the management of diversity in South Africa is viewed with interest as well as scepticism. The link between the success of diversity management and a supportive organisational culture has been made in the literature on the subject, but not explored extensively in terms of the elements contributing to the culture, especially language and the processes involved in sharing meaning. It has been proven that a well-planned strategic approach to diversity management should have communication as its pivotal point, making language and meaning the next logical field of study. The literature overview thus systematically explored the ways in which the process of sharing meaning can perpetuate the status quo or act as a change agent in the process of transforming an organisational culture to be receptive and supportive of diversity.

M.Cur. (Psychiatric Nursing Science) / Please refer to full text to view abstract

M.Cur. / The study on the quality of nursing unit management was done in the four training hospitals approved for registered nurses' training in Namibia. There are no written standards on the quality of unit management in the hospitals. The objectives of the study were to formulate standards on quality nursing unit management and to evaluate compliance of clinical units with these standards A quantitative, contextual, descriptive and evaluative research design was followed. The study was done in two phases. In phase one, standards were formulated by means of a literature study by the researcher and validated through consensus discussion groups with nurse managers representing the different management levels and clinical disciplines. Purposive sampling was used and 25 participants rated the draft standards for relevance, representativeness, completeness and clarity. A rating instrument for this purpose was attached to the draft standards in the form of a questionnaire, and posted to participants, before the consensus discussion groups. Reliability and validity of the instrument and related items were ensured through the development of a conceptual framework and the consensus discussion groups. The pilot study indicated that a rating scale of 'Compliance', Partial Compliance, 'Non-Compliance' and 'Not Applicable' are more appropriated. Phase two represents the quality survey for the compliance with standards. The sample for the quality survey included 60 units from all four hospitals, representative of all clinical disciplines. Data was collected by means of interviews, observation and document analysis, using an evaluation instrument. Two surveyors, the researcher and a colleague, both lecturers from the Department of Nursing, University of Namibia, were involved in the data collection process. Double evaluations were done in 19 clinical units, representing 31,7% of the total clinical units (n=60), and the researcher alone evaluated 41 units, representing 68,3%. A high inter-rater reliability between the ratings of the surveyors was proven. The ethical principles of informed consent and anonymity have been adhered to throughout the study. Data was analysed through statistical analysis and are presented as descriptive statistics and comparative statistics. The findings revealed that, although unit nurse managers emphasise unit organisation, the quality of nursing unit management in the training hospitals in Namibia is poor. The findings also revealed that a need exists to empower nurse managers through in-service education on strategic planning as well as quality management in general. The recommendations from this study are to make written standards available, to empower nurse managers in quality management, to validate standards for quality nursing unit management nationally in the Namibian hospitals and for further research.

M.Cur. / There is little information about the outcomes and safety of home births, although more and more women are starting to lean towards natural and active births. A home birth provides a more relaxed environment with familiar attendants and less medical intervention. No separation exists between mother and baby as well as other family members. Freedom of movement is promoted and the woman can eat and drink as she pleases. Unnecessary routine preparation for labour doesn't exist and privacy is respected. The purpose of this research was to explore and describe the outcomes of home births in Pretoria, attended by private midwifes, and to provide guidelines in relation with home births.

M.Cur. / The intra-aortic balloon pump is a volume displacement device that is used to provide partial support to the left ventricle. The IABP is an effective and general used circulatory support device. The nursing of a patient on IABP therapy requires demonstration of specific clinical competence by the critical care nurse. Clinical competence is defined as the ability of the critical care nurse to integrate his/her knowledge, skills and values and to demonstrate it during nursing of a patient on IABP with the aim to promote the patient's health. The aim of this research had been to evaluate the clinical competence of the critical care nurse during the nursing of a patient on IABP, and to make recommendations according to that regarding education, the practice and research. The relationship between the components of clinical competence namely knowledge, skills and values that were set as aim, were also established. A quantitative, contextual, descriptive, correlational research design had been used in the study to compile a self-developed evaluation instrument that had been used to evaluate the clinical competence of the critical care nurse. The evaluation instrument consisted of a questionnaire that evaluated the knowledge of the critical care nurse, a check list that evaluated the skills of the critical care nurse and a semantic differential scale that evaluated the values of the critical care nurse during the nursing of a patient on IABP therapy. After the data was analyzed, it appeared that critical care nurses don't possess the necessary knowledge and skills to nurse patients on IABP, and as such are not clinically competent to nurse patients on IABP. iii Recommendations were made regarding education, the practice and research in order to improve the clinical competence of critical care nurses during the nursing of a patient on IABP therapy

M.A. / The purpose of the study was to ascertain whether patients suffering from irritable bowel syndrome (IBS) differed from non- IBS clients in terms of their defense mechanisms. Although irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders encountered by primary care physicians and gastroenterologists, it is one of the least well understood. Part of the reason for this is the lack of real consensus of opinion regarding the nature of the complaint (Read, 1985). Today it is widely agreed that irritable bowel syndrome is a psychosomatic disorder, that is, a disorder of physiological functioning and anatomical structure, which are determined for most part by psychological factors (Lachman, 1972; Moser, 1986). Evidence linking psychological variables to gastrointestinal disorders is surprisingly sparse, and all too often confusing and contradicting. Such conflicting results probably reflect the many methodological weaknesses common to all areas of study (Bennett, .1989). Although evaluation of the impact of psychological interventions on both symptomatic and psychological relief has been pursued, its findings provide tangential support for the importance of psychological disorders. Nevertheless, these studies have shown a consistency of positive results not found in the etiological research (Read, 1985). Using a variety of techniques, most with the therapeutic goal of stress reduction, psychological therapy has been shown to produce. symptomatic relief, increase periods of remission, and to reduce the impact of stress resulting from severe symptomatic flare ups in IBS (Bennett, 1989). In .addition, most IBS patients may not identify their gut symptoms in psychological terms. Therefore, they inappropriately and repeatedly subject themselves to unnecessary, expensive and harmful medical procedures in search of an organic cause. Further research into the psychological factors of IBS, including the defense mechanisms underlying it may lead to a reduction in type of anxiety (Folkman, Lazarus, Gruen & DeLongis, 1986). The ways in which people cope with intense emotions may have a significant effect on their psychological and physical health. StresS factors and the suppression of emotions, for example through defense mechanisms, are thought to be especially relevant in the etiology and exacerbation of psychosomatic illness (Ogden & Von Sturmer, 1984). The role that defense mechanisms play in the development of IBS forms the cornerstone of the present research.

D.Litt et Phil. (Clinical Psychology) / Please refer to full text to view abstract