Thesis (PhD (Education))--University of Stellenbosch, 2006. / During the past twelve years of democracy health care services in South Africa have been influenced by political, social and economic change. As a result of the transformation of health care services and the change of political policy, the focus on primary health care increased. During the early stages of the transformation of health care services stakeholders realized that in order to provide an extensive health care service specialized training is required. Various educational institutions provided formal and informal programmes in order to meet the new challenges of the nursing profession. Although minimum requirements of the content and clinical practice have been established by the nursing council, the mode of presentation, costs, duration and type of qualification awarded to clinical nursing practitioners differed substantially. Uniformity in terms of programme content was lacking, neither were any scientifically founded attempts made to establish whether these programmes fulfilled the needs of the student in the rural community. Although a variety of training programmes exist the number of trained clinical nursing practitioners is still inadequate. In addition training is focused on the urban community. The objective of the research was to determine the opinion of the rural nurse on clinical nursing education, and to develop a training framework based on their input which would meet their needs. This research was conducted from an explanatory-descriptive paradigm. The case study was used as research design. A literature study on the development of primary health care both internationally and nationally was done. The literature study revealed the development of training programmes for clinical nurses. Chapter three of the literature study is dedicated to the theoretical aspects of the design of a student centered training framework for the adult student. A student centered training framework has created from data gathered via questionnaires completed by clinical nurses and semi-structured interviews with semi-qualified nurses. Semistructured interviews have also been conducted with the supervisors of nurses working in clinics and community health centres in the Northern Cape. The conclusion that respondents showed a positive attitude towards training in clinical nursing was encouraging. The majority of respondents indicated that they would welcome an additional qualification which will improve their knowledge and would result in better patient care. The respondents highlighted staff shortages, financial constraints and family responsibility as the main obstacles towards these qualifications. During the research it became clear that no formal training is currently available in Kimberley. This is as a result of the absence of mentors. Although the respondents have limited access to computers they indicated that they would prefer computer supported training in conjunction with physical contact sessions. The research indicated that no formal policy on the training of clinical nurses exists in the rural Northern Cape. In the absence of a training framework the research further contributed towards the development of a student centered training framework for clinical nurses in rural Northern Cape. The research succeeded in highlighting the necessity for formal policy on the training of clinical nurses in rural Northern Cape.

The purpose of this study was to explore and describe the perceptions of registered nurses with regard to facilitating the learning of student nurses during clinical placement. Focus group interviews with fifteen registered nurses were done, followed by participant observations in two clinical areas, to gain a clearer picture of obstacles, as well as the strategies employed during placement of student nurses in the clinical area. The :findings indicate that facilitation of the learning of student nurses during clinical placement is achieved by guidance, involvement, assisting and supervision of student nurses in the clinical area by nurses of all categories, and medical and paramedical personnel. Many obstacles were identified which obstruct the employment of strategies that are suitable for facilitation in the clinical area. Guidelines for the facilitation of learning of student nurses were recommended, to improve facilitation in the clinical area. / Health Studies / M.A. (Nursing Science)

The purpose of the study was to explore the perceptions of professional nurses on student mentorship. A qualitative, explorative, hermeneutic phenomenological research was conducted to determine the meaning of mentoring as perceived by professional nurses and to identify the successes and challenges encountered by professional nurses with regard to student mentorship during clinical practice. A face-to-face semi-structured interviews were done to collect data from operational managers (n=16) who were managing all unit activities, student mentoring included. Each interview lasted for ± 45 minutes. A hermeneutic data analysis (hermeneutic circle) was followed for data analysis. Four (4) themes and 15 sub-themes emerged from data collected from operational managers. The findings revealed that mentoring was perceived as a valuable phenomenon to apply in the preparation of student nurses for future professional role. In the process of mentoring, the caring attitude is revealed. Factors found to drive mentoring process successful was amongst other commitment, interest and partnership which guarantee the mutual efforts to the process. Though it is beneficial to mentor, mentee and the organisation as according to findings, challenges were also seen impacting on this process limiting its intentions / Health Studies / M.A. (Health Studies)

M.Cur. (Nursing Education) / Nursing education is a process requlrlng the cooperation of all the parties involved. The student nurse receives lectures on the theoretical aspects, at the college while the substance of the theory must be based on and interpreted in the clinical field. With the passage of time the student nurse finds expression, gains the necessary experience and thus becomes a member of the nursing profession. Internalization of the norms and values of the professional group takes place within the framework of the student nurse's behavioral patterns and self image. The student nurse enters the profession with fixed expectations regarding her participation and training. In general terms she is still regarded as young and immature and yet she is expected to assume responsibilities which few in the general public are ever required to take. The prerequisites for the successful! professional socialization and the acquisition of proficiency in the functions and tasks of nursing, are based on continuous and optimal accompaniment of the student nurse by her registered counterpart, who operates as an independent professional practitioner. Clinical accompaniment implies that the registered nurse shall be at the side of the student nurse to guide her every step of the way in order to support her in the learning process, or to refine skills she previously acquired.: A descriptive exploratory survey was undertaken by means of a questionnaire submitted to student nurses and registered nurses of hospitals affiliated with one college in the Transvaal. The aim of the study was "to establish whether, and to what extent, the training function of the ward sister is realized in practice. Analysis of the data showed the ward sister to be aware of her training function and her responsibility towards the student nurse as learner. It appears that the ward sister believes herself to be adequately involved with the basic care of patients and making a significant contribution to the training of student· nurses. However, the observations and the experience of the student nurse differ from this point of view. She is of the opinion that more can be done in the ward to help her achieve her training needs. The fact that in many cases she is primarily considered as a worker, comes as a great disappointment.

The nursing student who has undergone the four year diploma or degree training as a nurse also has to undergo compulsory community service as a requirement before she/he can be registered as a qualified professional nurse. While it has been compulsory for other health professionals such as doctors, dieticians or dentists to place students in compulsory community service, it has only been compulsory for nursing students since 2008. This means that the practice is relatively new in nursing and it is not clear how the newly qualified professional nurse experiences compulsory community service (CCS). The overall goal of this study is to determine the experiences of professional nurses placed at the state hospitals in Nelson Mandela Bay regarding compulsory community service clinical placement exposure and to use these descriptions to develop guidelines. The study followed a qualitative, exploratory, descriptive, contextual design. Literature was reviewed in order to identify research that was done previously regarding compulsory community service amongst health care professionals. The research population included professional nurses who underwent compulsory community service in the three state hospitals in the Nelson Mandela Bay. Purposive sampling was utilised to identify the participants. Semi-structured interviews were conducted to collect information and field notes were kept. The interviews were transcribed and Tech’s (1990) in Creswell, 2009:186) eight steps of data analysis were followed to create meaning from the data collected. An independent coder assisted with the coding process to ensure the trustworthiness of the findings. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness which consists of the following four constructs, namely credibility, transferability, dependability and conformability (Lincoln & Guba, 1999, as cited in Schurink, Fouche & de Vos, 2011:419- 421). Three themes and sub themes were identified. Literature control was done to compare the findings with existing research results. The researcher ensured that the study was conducted in an ethical manner by adhering to ethical principles such as beneficence, justice and fidelity. All the participants in the study felt that the clinical placement exposure was a worthwhile experience. The participants expressed a feeling of gratitude that they were afforded this opportunity of practicing under the guidance of experienced professional nurses. To them it was an opportunity to master whatever they were taught as student nurses so that by the time they practice as independent practitioners they would be confident and knowledgeable. The CCS nurses indicated that orientation and mentorship were not always of good quality and professional nurses were not always available as in some units professional nurses were not readily accessible. The CCS nurses were left alone and isolated with no one to consult. If proper orientation and mentorship had been in place the CCS nurses would have enjoyed the community service year more and they felt that they would have benefited more. Had there been a mentoring system in place it could have gone a long way to ascertain that the participants gained confidence and were able to perform tasks independently and confidently. The participants overwhelmingly indicated that unit management should have been included in their CCS year placement. During the CCS year the CCS nurses were not exposed to unit management. This was seen by CCS nurses as a missed opportunity. Had they been afforded the opportunity to practice unit management under the supervision of unit nursing managers, professional growth and development in unit management could have been facilitated. That they were not afforded that opportunity deprived them of a valuable skill as well as personal and professional growth. In conclusion guidelines for placement of CCS nurses in the Nelson Mandela State hospitals have been formulated for implementation. Recommendations were made to enhance nursing practice, nursing education and nursing research.

Indiana University-Purdue University Indianapolis (IUPUI) / Clinical nursing faculty members often work with students who underperform in the clinical area. Underperforming students are those who exhibit deficits in nursing knowledge, the application of nursing knowledge, psychomotor skills, motivation, and/or interpersonal skills. The outcomes of faculty work with underperforming students have implications for patient safety and the nursing workforce, yet little is known about how faculty work with underperforming students. The purpose of this project was to develop a theoretical framework that describes how clinical faculty work with underperforming students in the clinical area. Twenty-eight nursing faculty who had worked with underperforming nursing students during clinical rotations were interviewed and invited to tell stories about working with these students. Their narratives were analyzed using constant comparison analysis, and a theoretical framework was developed. The framework included three stages that unfolded as faculty worked with underperforming students over time. The first stage, Being Present, was the process by which faculty came to know students were underperforming. They did this by noticing red flags, taking extra time with students, working side-by-side with students, and connecting with students "where they were at." The second stage, Setting a New Course, was the process by which faculty attempted to provide remedial experiences to improve the performance of those students determined to be underperforming. The participants did this by beginning a new course of instruction for the students, bringing in new people to help the students, and creating new learning experiences for them. This process could result in students turning it [their performance] around, making it through [the clinical rotation], or not making it. The final stage, Being Objective, was the process by which participants made negative progression decisions. They did this by relying on objective indices, documenting problematic student behaviors, and obtaining validation for their decisions.

Thesis (MCUR)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: This study attempts to provide a historic background of the clinical nurse practitioner. Areas of potential conflict, malpractice, future research, service delivery, tuition and support are revealed. The current role and function and the work environment of the clinical nurse practitioner functioning on primary health care level in the Metropole Region of the Western Cape were examined as major themes. Triangulation is applied as methodology. Structured questionnaires were completed by 60 clinical nurse practitioners that completed their training during the period 1994 to 2002. Pre-compiled checklists were completed at 8 different primary health care institutions. Qualitative data were obtained by comments on the questionnaires, field notes, as well as structured and unstructured interviews conducted with clinical nurse practitioners. Needs identified include outcomes based theoretical and clinical methods of tuition, additional training in pharmacology and chronic care, transcultural nursing and the development of criteria for recognition of prior learning and experience. Disparities were identified on service level pertaining to the difference between service delivery and service needs, daily checking of emergency equipment and the establishing of partnerships on service level to improve service delivery. Utilisation, post-levels and remuneration need attention. The development of courses in pharmacology for the Western Cape is identified as a priority as well as in service training, the possibility of a year of internship and the expedite of the amalgamation of fragmented services. Clinical nurse practitioners in managerial positions need to become more involved in promotion, motivation, development, audit and marketing of the clinical nurse practitioner and the establishment of a forum for clinical nurse practitioners. / AFRIKAANSE OPSOMMING: Hierdie studie poog om ʼn historiese agtergrond te skets van die kliniese verpleegpraktisyn. Areas is blootgelê vir potensiële konflik en wanpraktyke, sowel as areas vir toekomstige navorsing, dienslewering, onderrig en ondersteuning. Twee hooftemas, naamlik die huidige rol en funksie, asook die werkomgewing van die kliniese verpleegpraktisyn in die Metropoolstreek van die Wes-Kaap, is ondersoek. Triangulasie is as navorsingsmetodiek aangewend. Gestruktureerde vraelyste is deur 60 kliniese verpleegpraktisyns wat hul kursus gedurende die tydperk 1994 tot 2002 voltooi het, ingevul. Voorafopgestelde kontrolelyste is by 8 verskillende primêre gesondheidsorginstansies aangewend. Kwalitatiewe data is verkry deur middel van kommentaar op die vraelyste, veldnotas, sowel as gestruktureerde en ongestruktureerde onderhoudsvoering met kliniese verpleegpraktisyns. Uitkomsgebaseerde teoretiese en kliniese wyses van onderrig, aanvullende farmakologie, chroniese sorg, transkulturele verpleging, taalvaardigheid, asook die ontwikkeling van kriteria vir akkreditasie vir voorafleer en ondervinding blyk onderrigbehoeftes te wees. Leemtes op diensvlak sluit die verskil tussen diensverskaffing en diensbehoeftes, daaglikse kontrolering van noodtoerusting en vennootskappe ter diensverbetering in. Aanwending, posbenamings en vergoeding benodig aandag. Die ontwikkeling van aanvullende farmakologiekursusse vir die Wes-Kaap is as prioriteit geïdentifiseer asook indiensopleiding, die moontlikheid van ʼn verpligte internskapjaar en die bespoediging van amalgamasie van gefragmenteerde dienste. Kliniese verpleegpraktisyns in bestuursposisies behoort meer betrokke te raak by die bevordering, motivering, ontwikkeling, oudit en bemarking van die kliniese verpleegpraktisyn asook by die daarstel van ʼn forum vir kliniese verpleegkundiges.

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.

The purpose of the study was to explore and describe the perceptions of the pupil nurses at their second year level towards clinical support at the private hospital in the Limpopo Province. Qualitative approach including exploratory, descriptive and contextual study design was followed. The target population for this study included pupil nurses at their second year level (n=20) following a two year programme leading to enrolment as a nurse from a private nursing education institution in the Limpopo Province. Data was collected utilizing written narratives, and focus group interviews. Field notes and audio tape were used to capture data. Data saturation was reached on twelve participants. Data were thematically analysed using Tesch’s method of open coding. The results revealed lack of clinical support. Lack of clinical support was attributed to inadequate educators for accompaniment, registered nurses’ uncaring attitude and not fulfilling their mentorship role, and pressure on pupil nurses to meet the high clinical demands. Pupil nurses were found not to be assuming full responsibilities over their practical learning. Therefore, it is mandatory as nurse educators, managers and researchers to take note of the gaps identified and intervene utilising recommendations provided to enhance clinical support. / Health Studies / M.A. (Nursing Science)

Background: The Continuing Professional Development (CPD) Framework established by the South African Nursing Council (SANC) states that organisations have a responsibility to create enabling environments in which the development of nurses can take place. Aim: The aim of this study is to assess the CPD of nurses at a public hospital in KwaZulu-Natal. Method: A quantitative descriptive design was followed. Convenience sampling yielded a sample of 166 nurses consisting of the registered nurse (63.2%) and enrolled nurse categories (36.8%). Data collection was done using a self-designed questionnaire. Statistical analysis was done using the Statistical Analysis System (SAS) Version 9.4 programme. Results: The findings revealed that CPD was ranked the least important area in terms of management priorities. Key barriers to development included staff shortages, lack of funding, poor resources and competing personal responsibilities. The study found that CPD had positive outcomes for nursing practice. / Health Studies / M.A. (Nursing Science)