Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The imbalance between job demands and available resources could cause burnout which may impact quality patient care. A scientific investigation was conducted to evaluate burnout amongst primary health care (PHC) nurses. The objectives for the study were to identify the prevalence of burnout amongst PHC nurses and to explore the contributing factors to burnout in PHC settings. The Job Demands-Resources (JD-R) model (Bakker and Demerouti, 2007:309) was used as a conceptual framework for the study. A non-experimental, descriptive cross-sectional design with a quantitative approach was applied. The population and sample consisted of professional nurses (PN) and clinical nurse practitioners (CNP) (n=72) in the Eden District of the Western Cape. A self-report questionnaire was used to collect the data in an uncontrolled, natural environment. Analysis of the results exposed high levels of burnout amongst PHC nurses. Nurses in PHC facilities all had an equal chance to develop burnout, regardless of their level of experience. The occurrence of burnout is equal in community health centres and in community clinics, although a trend was observed that subjects in community clinics may experience more emotional exhaustion. Work pressure, workload or an increase in job demands, lack of organisational support and management problems were rated as the main factors contributing to burnout. Recommendations were made to improve the working environments of PHC nurses in order to increase motivational levels, job satisfaction and to foster work engagement, as well as to reduce levels of burnout. Opportunities for further research are recommended. / AFRIKAANSE OPSOMMING: Die wanbalans tussen beroepseise en beskikbare hulpbronne kan uitbranding veroorsaak en gevolglik kwaliteit patiëntsorg beïnvloed. ‘n Wetenskaplike studie is gedoen om uitbranding onder primêre gesondheidsorg (PGS) verpleegkundiges te evalueer. Die doelstellings van die studie was om die voorkoms van uitbranding onder PGS-verpleegkundiges te identifiseer, en om die bydraende faktore wat aanleiding gee tot uitbranding in PGS-instellings, te ondersoek. Die Beroepseise-Hulpbronne model (Bakker and Demerouti, 2007:309) is as ‘n konsepsuele raamwerk vir die studie gebruik. 'n Nie-eksperimentele, beskrywende dwarssnit studie met 'n kwantitatiewe benadering, is toegepas. Die populasie en die steekproef het bestaan uit professionele verpleegkundiges en kliniese verpleeg praktisyns (n=72) in die Eden Distrik van die Wes-Kaap. ‘n Self-rapport vraelys was gebruik om data in ‘n ongekontroleerde, natuurlike omgewing te versamel. Die analisering van resultate het hoë vlakke van uitbranding onder verpleegkundiges in PGS-dienste ontbloot. Verpleegkundiges in PGS-fasiliteite het almal 'n gelyke kans om uitbranding te ontwikkel, ongeag die vlak van ondervinding. Die voorkoms van uitbranding is dieselfde in gemeenskaps-gesondheidsentrums en gemeenskapsklinieke, alhoewel daar ‘n neiging sigbaar was dat personeel in gemeenskapsklinieke meer emosionele uitputting ervaar. Werkdruk, werklas of toename in beroepseise, die gebrek aan organisatoriese ondersteuning en bestuursprobleme is aangewys as die hoof redes wat aanleiding gee tot uitbranding. Voorstelle is gemaak om die werksomgewing van PGS-verpleegkundiges te verbeter en om motiveringsvlakke en werkstevredenheid te herstel. Dit sal werksverbintenis versterk en die voorkoms van uitbranding beperk. Geleenthede vir verdere navorsing is aanbeveel.

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<p>A survey of the literature revealed that althougth a great deal of research has been carried out relating to stress and coping internationally, little has been written about nurses in South Africa. The aim of this study was to identify the possible causes and frequency of stress experienced by registered nurses working in a hospital, to identify the coping strategies used, to assess the relationship between stress and coping mechanisms of registered nurses, to compare stress and adopted coping strategies among registered nurses in the different units/wards, to identify the support systems that minimize stress and to address stress amongst nurses in South Africa.</p>

Job redesign could significantly impact the efficiency was obtained. This survey was comprised of nineteen scales with of the organization. The purpose of this descriptive, comparative study was to describe and compare job characteristics, general job satisfaction, and motivation potential of the job in order to diagnose the job profile of registered nurses, licensed practical nurses, and nursing assistants.The convenience sample consisted of all staff nurses, licensed practical nurses, and nursing assistants working at a 515 bed Department of Veterans Affairs Medical Center in the midwest who voluntarily agreed to complete the Job Diagnostic Survey. A response rate of 36.8% (n = 118) to measure the degree of job characteristics, motivating potential of the job, psychological states, growth need strength, general job satisfaction, and satisfaction context factors present in the current job.Mean scores were computed to measure each variable. All means for each job category were found to be over the midpoint (3.5). Growth need strength was significantly lower than the normative data for RN's and LPN's. Task identity and experienced responsibility for work outcomes were significantly lower than the norm for LPN's assigned to the acute medical area. Motivating potential was significantly lower for nursing assistants assigned to the acute medical and the long term psychiatric area.Adjusting staff assignments to encourage continuity and observation of patient outcomes, and providing direct feedback regarding performance to staff members from nurse managers were implications. Implications include combining tasks to provide a more identifiable job and enable the worker to visualize patient outcomes to a greater degree. Recommendations included further research utilizing the JDS, including comparison of various types of nurse jobs. Statistical analysis in future studies should include comparisons of these different groups. / School of Nursing

The purpose of this study was to determine the extent to which Neonatal Intensive Care Unit (NICU) nurses participate in ethical decision making, and to describe the role NICU nurses have in the ethical decision making process.This study replicated a 1991 study conducted by Elizondo. According to Lowe, 1991, replication research is the repeating of a study for the purposes of validating the findings of the original investigation. The traditional theory of utilitarianism provides the theoretical framework for this study, a goal-based approach to ethical decison making that focuses on consequences of actions. Findings provide information about satisfaction and conflicts related to nurse participation in ethical deecision making in the NICU.The Nurse Participation in Ethical Decision Making (NPEDM) questionnaire (Elizondo, 1991) was used for data collection. Of fifty NICU nurses, seventeen (34%) of the sample completed the questionnaire. Confidentiality was maintained. Results showed that all respondents were able to identify methods that are used for participation in ethical decision making. Informal conversations with physicians was identified as the primary method of participation. Forty-one percent of respondents were satisfied with the nurse's role in ethical decision making. Forty-seven percent were only somewhat satisfied.An indication of satisfaction demonstrated by 100% of the study sample was that nurses' ideas are respected by other health care professionals.Findings indicated that a significant positive relationship exists between role satisfaction and study variables. Eighty-eight percent of respondents stated that conflicts related to participation were experienced. Overwhelmingly, respondents felt that the primary source of conflicts were with physicians. These findings are consistent with results reported in the original study.When asked what factors impact on how decisions are made, 40% of respondents indicated that ethical decisions are often impacted by generalized decisions based on viability of the neonate as determined by the gestational age, and "quality of life."Seventy-six percent of respondents believed nurses should be more involved in the ethical decision making. Conferences with physicians and parents was identified by 69% of the study sample. This study found that the older the nurse, the more satisfied with role in the ethical decison making process. Length of employment also contributed positively to satisfaction in ethical decision making. The more educated the nurse, the more satisfied with role in the ethical decision making process. Nurses were less satisfied if conflicts were experienced or identified.Findings suggest that collaborative relationships exist between nurses and other health team members and that nurses feel some sense of fulfillment with their role in the ethical decision making process. It was concluded that many issues were unsolved and need to be discussed. / School of Nursing

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

The literature is replete with studies and information about registered nurse burnout, compassion fatigue, and turnover rates. Registered nurses enhance and bring benefits to the health care system, but stressful health care environments may contribute to their self-neglect and may adversely affect their decision to remain working at the bedside. Retention of registered nurses is necessary for the delivery of patient care. An investigation of self-compassion among registered nurses in the clinical workplace may help to understand how registered nurses deal with the pressures of the health care setting. In addition, there is a need for research to clarify what self-compassion looks like among nurses and how it may foster caring for themselves, nurse retention, and the delivery of quality patient care. This qualitative study used a phenomenological method designed to illuminate registered nurses’ experiences of self-compassion in clinical practice. Also, findings from this study will contribute to the body of knowledge of self-compassion in the context of registered nurses. Van Manen’s phenomenological research method of the six activities were used to guide the study. Nine registered nurses were interviewed about their experiences of being kind and compassionate toward oneself in the clinical work setting. Transcripts of the study participants’ interviews were analyzed and four essential themes emerged that shed light on these nurses’ experiences of self-compassion: (1) Transforming Time Famine; (2) Authentic Communication and Presence, (3) Collegial Cohesion, and (4) Evolution Toward an Ideal Registered Nurse. Most of the participants in this study shared stressful situations in the clinical workplace along with encouraging learning points through their stories of being kind to themselves in the workplace while caring for others.

The purpose of this thesis was to examine the relationship between locus of control and the intensive care nurse's perception of job-related situations. It was hypothesized that intensive care nurses who evidenced an external locus of control would classify job-related situations as more stressful, more threatening, and less challenging than intensive care nurses who evidenced an internal locus of control. The instruments consisted of (1) a demographic questionnaire, (2) an instrument developed by this investigator to measure the degree of perceived stressful, threatening, and challenging aspects of certain job-related situations, and (3) Rotter's Internal-External Locus of Control Scale. The questionnaires were distributed to nurses working in intensive and coronary care units in one medium sized city in Indiana. An N of 75 was obtained.The hypotheses that external intensive care nurses would classify job-related situations as more stressful and more threatening were supported (F = 9.26, p<0.01, and F = 6.08, p<0.01 respectively). The hypothesis that internal nurses would classify more job-related situations as challenging was not supported by the data (F = 0.01, p = 0,91).Ball State UniversityMuncie, IN 47306

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Public Health / Master / Master of Public Health