Women's control over their fertility is vital for both their health and that of their children. Although family planning methods are available at most health facilities in the country, the service does not enable many Black South African women to control their fertility successfully. This inadequacy of the present service is demonstrated, by a high rate of teenage pregnancy and abortion. Based on anecdotal reports, one of the barriers to effective use of contraceptive methods seemed to be the competence and abilities of the providers. This qualitative study was done in clinics in a peri-urban township to explore the knowledge and problem-solving abilities of the nurses providing family planning services. The aim was to use the information so gained to improve family planning services in the area by preparing a set of guidelines for the management of specific clinical problems and making recommendations to service organisers. The study tape-recorded 18 actual nurse-patient interactions to get an idea of the clinical problems faced by the nurses. A consensus panel was used to derive a set of "ideal" answers to the clinical scenarios the nurses faced in the consultations and the nurses' and panels' responses were compared. A focus group discussion with the nurses was then conducted and their opinions and reasons for the differences explored. The results revealed a general malaise affecting the services in this area. There were significant differences in the nurses and panels' handling of the problems especially in the areas of counselling and advice. In addition, the nurses were found to be inappropriate providers of family planning as their scope of practice prevented them from examining patients. They were also unable to rule out pregnancy because there were no pregnancy test kits available in the clinics. The focus group discussions indicated that many of the nurses knew how to handle the problems and what advice to give. They claimed that work and time pressures prevented them from doing this. They also alleged that patients were the problem and never told the truth. Poor communication skills and attitudes towards patients were other barriers identified. Nurses spoke to their patients like children and were often rude. In addition, nurses counselled patients infrequently on the use of methods and the side effects to be expected. Patients were offered a choice of method rarely and health education when given, focused on morality and did not mention issues like safe sex and HIV/ AIDS. The manual of guidelines will only address the problem solving of the nurses. The study therefore concludes by making recommendations to the Directorate of Maternal, Child and Women' s Health to carefully evaluate the use of enrolled nurses as providers with full consideration given to the quality of care that can be provided by them. The resources available and the practices related to supervision and in-service training also need to be reviewed and prioritised. A recommendation is also made to the Provincial Human Resources Directorate to develop policies for improving staff attitudes towards service users and disciplinary procedures for staff who are rude to service users. Recommendations are also made to supervisors to review the present training course and introduce the problem-solving approach and respect for patient autonomy into it. The supervision is also recommended to be facilitative and on-site and the providers must be involved in the solving of problems. The emphasis of the service must change from patient turnover to effective contraceptive use to enable women in this area to have any meaningful control over their fertility.

This thesis explores triage code as a predictor of direct nursing care time, thus its potential usefulness in a model for calculating and allocating nurse requirements in emergency departments. A framework for nursing work is proposed. This framework is based on the works of O'Brien-Pallas, Irvine, Peereboom, and Murray (1997) and Houser (2003). It suggests that the structures of environmental complexity, nursing characteristics, patient nursing complexity, and patient medical condition and severity, impact on the processes of direct and indirect nursing care to affect patient outcomes. A prospective, non-experimental study was undertaken to examine the relationship between direct nursing care time and triage code. Six potential confounding variables were selected for this study: length of stay, age, ethnicity, sex, complaint type, and discharge category. Data were collected for 261 visits over a three day period in one New Zealand emergency department. Patient visits averaged 200 minutes. The mean direct nursing care time per visit was 49 minutes. On average, patients with more urgent triage codes, longer length of stay, or who were not discharged, received more direct nursing care. The model developed predicted 49% of variation in direct nursing care time (p < .05) related to triage code (16%), length of stay (31%) and disposition category (2%).Further exploration of the proposed framework has potential to develop a model allowing managers to identify nurse staffing required for optimal nursing care in emergency departments.

This thesis explores triage code as a predictor of direct nursing care time, thus its potential usefulness in a model for calculating and allocating nurse requirements in emergency departments. A framework for nursing work is proposed. This framework is based on the works of O'Brien-Pallas, Irvine, Peereboom, and Murray (1997) and Houser (2003). It suggests that the structures of environmental complexity, nursing characteristics, patient nursing complexity, and patient medical condition and severity, impact on the processes of direct and indirect nursing care to affect patient outcomes. A prospective, non-experimental study was undertaken to examine the relationship between direct nursing care time and triage code. Six potential confounding variables were selected for this study: length of stay, age, ethnicity, sex, complaint type, and discharge category. Data were collected for 261 visits over a three day period in one New Zealand emergency department. Patient visits averaged 200 minutes. The mean direct nursing care time per visit was 49 minutes. On average, patients with more urgent triage codes, longer length of stay, or who were not discharged, received more direct nursing care. The model developed predicted 49% of variation in direct nursing care time (p < .05) related to triage code (16%), length of stay (31%) and disposition category (2%).Further exploration of the proposed framework has potential to develop a model allowing managers to identify nurse staffing required for optimal nursing care in emergency departments.

Terminally ill patients and their families describe hospital care as nonsupportive to their needs during the final phase of life. Nurses generally are not comfortable with a supportive role when caring for the dying and tend to adhere to a curative role. The purpose of this descriptive, correlational study therefore was to describe the attitudes of general staff nurses working on medical-surgical units in hospitals towards the care of the dying and to ascertain the relationship between these attitudes and the education and experience of the nurses. An adaptation of the model for role episode, conflict, and ambiguity by Kahn, Wolfe, Quinn, Snoek and Rosenthal (1964) was the applied theoretical framework. The sample consisted of 197 randomly selected registered nurses employed full or part-time on general adult medical-surgical hospital units in British Columbia. The majority of the sample were married, Protestant females, between the ages of 26 and 45 years who were prepared at the diploma level in nursing. The mean length of time worked as a nurse was 8.5 years with a mean of 7.5 years on medical-surgical units. Attitudes towards the care of the dying were generally ambiguous, neither negative nor positive as measured by scores obtained on the ‘Questionnaire for Understanding the Dying Person and His Family’. Additionally, half the respondents did not believe that nurses should be the primary health care professionals equipped to deal with the emotional reactions of the dying yet three-quarters of the sample believed that patients turned to nurses to discuss such emotional issues. Data revealed that close to two-thirds of the respondents had received structured death and dying content in their basic nursing education yet less than half furthered their death and dying education since graduation. Overall death education for the sample was low. A small positive correlation (r=-0.26) was found between respondents' death education and their attitudes towards the care of the dying; no significant association was found between respondents' level of general nursing education and their attitudes. Although there was variability in the amount of professional and personal death experience, over half of the respondents experienced between one and three terminally ill patient deaths on their medical-surgical units per month. Additionally, the majority of respondents had experienced the death of an immediate family member. Overall death experience was low to moderate. A small, but significant positive correlation (r=0.24) was found between overall death experience and attitudes' towards the care of the dying; no significant association was found between general experience and attitude. Findings suggest that supportive nursing care is not being demonstrated with dying patients and their families. However, the influencing natures of death education and death experience on nurses' attitudes are positive, thereby providing the nursing profession with two possible ways of positively influencing nurses' attitudes to the care of the dying. / Applied Science, Faculty of / Nursing, School of / Graduate

Aim. The overall aims of this study were to develop a Chinese version Heart Manual and to examine its effectiveness in enhancing the health-related quality of life (HRQL) and psychological status of Chinese patients recovering from AMI. / Conclusion. The findings of this study provide evidence of areas, including the development of a culturally relevant needs-based Heart Manual, and the consideration of a home-based rehabilitation strategy, that could contribute to the development and improvement of cardiac rehabilitation in China. The study provides a unique tool to help Chinese nurses to meet the cardiac rehabilitative care needs of AMI patients. The study can also generate a much-needed impetus and indicate the direction for the development of cardiac rehabilitation nursing, especially home-based self-managed rehabilitative care in China. / Methods. In the first place, qualitative research was conducted to generate data regarding the experiences and needs of Chinese patients and their spouses immediately after their discharge from hospital following a first heart attack, and the views and beliefs of Chinese health professionals' concerning cardiac rehabilitative care in the hospitals of China. The information gained from the couples and health professionals was used to develop a Chinese version Heart Manual that is tailored to patient needs and adapted to the local culture. / Patients in the experimental group demonstrated better progress across a 6-month period than the control group, in terms of: significantly greater improvements in seven of eight domains of generic HRQL (p = 0.031-0.002) as assessed by the Chinese Mandarin version of Short Form 36-item healthy survey (CM:SF-36) and in five of seven dimensions of disease-specific HRQL (p = 0.008-0.000) as measured by the Chinese Mandarin version of Myocardial Infarction Dimensional Assessment Scale (CM-MIDAS); a significantly greater reduction in anxiety (p = 0.046) as assessed by the Chinese version of Hospital Anxiety and Depression Scale (C-HADS); a significantly greater reduction in the serum lipids of triglyceride (p = 0.04), total cholesterol (p = 0.01) and low-density lipoprotein (p = 0.01); a significantly better control of diastolic blood pressure (p = 0.02); and significantly fewer unplanned cardiac-related medical consultations (p = 0.035). However, the effects of the rehabilitation programme on depression, smoking cessation, serum lipids of high-density lipoprotein, systolic blood pressure, body mass index and blood glucose, as well as unplanned cardiac-related hospital readmissions and emergency room visits were not confirmed in this study. / Results. The Chinese version Heart Manual contains three sections. The first section consists of six weekly topics to educate the patient on coronary heart disease. The second section answers commonly asked questions about medication, Percutaneous Coronary Intervention (PCI), sexual life after a heart attack, and anxiety and depression after a heart attack. The third section presents information on the normal values for blood pressure, blood glucose and serum lipids, as well as on the saturated and unsaturated fats to be found in daily foods. A panel of experts and the potential users were invited to evaluate the validity of the contents in terms of the accuracy, appropriateness and applicability of the Manual. All of the content was considered to be accurate and appropriate by the expert panel, and the potential users found it was easy to understand and to follow. / Then, a randomized control group study with repeated measures was used to examine the effectiveness of a six-week home-based cardiac rehabilitation programme using the Chinese version Heart Manual. A total of 160 participants were recruited, and randomly assigned to either the experimental or the control group. Participants in the experimental group received the Chinese version Heart Manual at their discharge, and both groups received the usual care from the hospital. A telephone follow-up to both groups was made 3 weeks after hospital discharge. The outcomes measured included health-related quality of life, psychological status, smoking status, cardiac physiological risk parameters and unplanned health service use. Data collection was conducted at the baseline, at 6 weeks when the programme ended, and at 3 months and 6 months after hospital discharge. Inferential statistics, such as the multivariate repeated measures ANOVA, the Chi-square test, the Mann-Whitney U test and the Friedman test, were used to compare the differences of outcome variables between the experimental and the control group across the 6 months of the study period. / Wang, Wenru. / "November 2007." / Advisers: Sheila Twinn; Sek Ying Chair. / Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4671. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 297-337). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-31T23:24:12Z No. of bitstreams: 1 AlbertinaSilva_dissert.pdf: 1488903 bytes, checksum: 9add0f502a27d505b85c7f76253035a6 (MD5) / Made available in DSpace on 2018-10-31T23:24:12Z (GMT). No. of bitstreams: 1 AlbertinaSilva_dissert.pdf: 1488903 bytes, checksum: 9add0f502a27d505b85c7f76253035a6 (MD5) Previous issue date: 2018-06-11 / The engagement is a mental state of affective-cognitive achievement-positive motivational work-related, involving persistent sense of accomplishment, motivational and social in nature. Nurses with good levels of engagement will be more productive and can achieve greater resolution in the service to users of health services. Objective: To evaluate levels of engagement in nurses of primary health care units of municipality of São José do Rio Preto, São Paulo. Method: Cross-sectional study among nurses in primary health care units. Data collection were used two instruments: one prepared by the researchers, containing socio-demographic variables; and the Utrech Work Engagement Scale (UWES), composed of seventeen self-assessment items with three dimensions (force, dedication and absorption) and overall score. The calculation of scores of the dimensions of UWES proposed statistical model was used in Preliminary Manual UWES. Comparison of socio-demographic variables with the scores of the UWES occurred by the F test in analysis of variance (ANOVA), with a significance level of 95%. Results: 75 nurses participated, being 26 (34.7%) managers of units. There were female prevalence (94.7%), age between 29 and 39 years (52.0%), carry title of specialist (81.3%), married (57.3%), gazetted (68.0%), working 40 hours per week (98.7%), income six to 10 minimum wages (49.4%), acting on primary health care between three and 10 years (42.7%) satisfied with profession (92.0%), never thought of quitting profession (57.3%). The average scores of UWES ranged from 4.6 to 4.8 and engagement levels were high in all dimensions. Nurses who exercised the function of managers showed a very high level of Dedication (5.0; ± 1.4); professionals with 40 years or more showed very high levels in all dimensions [Dedication: 5.2 (± 0.9); Absorption: 5.0 (± 0.8); Force: 5.3 (± 0.8) and overall Score: 5.1 (± 0.8)]; professionals with over ten years of experience in the primary health care showed very high levels in all dimensions [Dedication: 5.0 (± 1.5); Absorption: 5.0 (± 1.5); Force: 5.0 (± 1.4) and overall Score: 5.0 (± 1.4)]. Conclusion: The study showed prevalence of female nurses, with less than 40 years old, married, with graduate course and satisfied with the work. Have formal link between three and 10 years of experience in the primary health care. The professionals showed high levels of engagement, which demonstrates that are excited and proud of activities engaged, energy and mood, concentration and effort, and persistence in adversity situations in environment laboral. The managers presented high involvement in carrying out its activities. The results show that primary health care system of municipality encourages engagement and ability to work of nurses, enhances the performance of team and promotes quality of care and effectiveness of assistance. / O engagement é um estado mental de realização afetivo-cognitivo-motivacional positivo relacionado ao trabalho, que implica sentimento de realização persistente, de natureza motivacional e social. Enfermeiros com bons níveis de engagement serão mais produtivos e poderão atingir maior resolutividade no atendimento aos usuários dos serviços de saúde. Objetivo: Avaliar os níveis de engagement em enfermeiros de unidades da atenção primária à saúde do município de São José do Rio Preto, São Paulo. Método: Estudo transversal entre enfermeiros de unidades da atenção primária à saúde. Para a coleta de dados foram utilizados dois instrumentos: um elaborado pelos pesquisadores, contendo variáveis sociodemográficas; e a Utrech Work Engagement Scale (UWES), composta por dezessete itens de autoavaliação com três dimensões (vigor, dedicação e absorção) e um escore geral. Para o cálculo dos escores das dimensões da UWES utilizouse modelo estatístico proposto no Manual Preliminar UWES. A comparação das variáveis sociodemográficas com os escores da UWES ocorreu pelo teste F na análise de variância (ANOVA), com nível de significância de 95%. Resultados: Participaram 75 enfermeiros, sendo 26 (34,7%) gerentes das unidades. Houve prevalência do sexo feminino (94,7%), idade entre 29 e 39 anos (52,0%), portadores do título de especialista (81,3%), casados (57,3%), concursados (68,0%), carga horária de trabalho de 40 horas semanais (98,7%), renda de seis a 10 salários mínimos (49,4%), atuando na Atenção Primária à Saúde entre três e 10 anos (42,7%), satisfeitos com a profissão (92,0%), nunca pensaram em desistir da profissão (57,3%). Os escores médios da UWES variaram de 4,6 a 4,8 e os níveis de engagement foram classificados como altos em todas as dimensões. Enfermeiros que exerciam a função de gerentes apresentaram nível muito alto de Dedicação (5,0;±1,4); profissionais com 40 anos ou mais apresentaram níveis muito altos em todas as dimensões [Dedicação: 5,2 (±0,9); Absorção: 5,0 (±0,8); Vigor: 5,3 (±0,8) e Escore geral: 5,1 (±0,8)]; profissionais com mais de dez anos de atuação na Atenção Primária à Saúde apresentaram níveis muito altos em todas as dimensões [Dedicação: 5,0 (±1,5); Absorção: 5,0 (±1,5); Vigor: 5,0 (±1,4) e Escore geral: 5,0 (±1,4)]. Conclusão: O estudo mostrou prevalência de enfermeiras, com menos de 40 anos, casadas, com curso de pós-graduação e satisfeitas com o trabalho. Possuem vínculo formal e entre três e 10 anos de atuação na Atenção Primária à Saúde. As profissionais apresentaram níveis altos de engagement, o que demonstra que são entusiasmadas e orgulhosas das atividades que exercem, apresentam energia e disposição, concentração e capacidade de esforço, e persistência frente às adversidades do ambiente laboral. As gerentes apresentaram alto envolvimento na realização de suas atividades. Os resultados evidenciam que o sistema de Atenção Primária à Saúde do município estimula o engagement e a capacidade de atuação dos enfermeiros, potencializa o desempenho da equipe e favorece a qualidade do atendimento e a eficácia da assistência prestada.