Ongoing instability in the nursing workforce is raising questions globally about the issue of nurse turnover. It is against this background that this research examines the impact of learning, advancement and quality of work-life on turnover intentions among nurses in selected hospitals from Eastern Cape. Little research has been conducted to investigate the impact of the above mentioned subjects on turnover intentions among nurses in the South African health sector. Research questions as well as hypotheses were formulated as the means to gain data on the subject. The research employed a quantitative design with a sample size of 160 nurses and 159 were returned. The data analysis consisted of both descriptive and inferential statistics. The main findings of the study showed a positive relationship among job satisfaction, work-life rewards, learning and advancement opportunities and job satisfaction. However, there were negative relationships between job satisfaction and turnover intentions; work-life rewards and turnover intentions; and also among learning, career advancement and turnover intentions. Finally, suggestions were made to the top management in the Health sector to come up with strategies and mechanisms that improve nurses’ quality of work-life and offering them training and advancement opportunities through organisational change programs.

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 reports the effects of a 4-week online mindfulness meditation practice in a sample of undergraduate and graduate nursing students. Self-reported levels of mindfulness, depression, stress, and anxiety were measured pre- and post-intervention. A randomized pretest posttest control group design was implemented, and members of the National Student Nurses Association were invited via email to participate. A total of 145 participants completed the study.During the study the active control group received audio modules reporting nursing news and the experimental group received audio meditation modules. Meditation modules were created and recorded by the researchers. Participants in both groups were asked to utilize the audio modules at least three times a week. All participants completed the 21-item Depression, Anxiety, and Stress Scale and the 39-item Five Facet Mindfulness Questionnaire online before and after the intervention. Results revealed a statistically significant interaction between group and time of test for all four outcome variables. Simple main effects analyses showed a reduction in symptoms of depression, stress, and anxiety, as well as a significant increase in reported feelings of mindfulness in the experimental group. Findings of the study support the need to better recognize mental health challenges in nursing students and to consider the use of meditation practice in nursing programs to improve psychological outcomes.

Nurses have been on the front line of the COVID-19 pandemic and experienced direct impacts over the last few years. Many encountered additional stressors of isolation from loved ones and the challenges of parenting school-age children. Additionally, due to the recent and significant departure of nurses from bedside nursing, there has been greater need for remaining nurses to precept new staff coming into the hospital. Some nurses assumed a preceptor role in addition to their direct care responsibilities. It has been reported that combined home and work-life burdens put nurses at higher risk of burnout, resulting in poor health outcomes and increased depression, anxiety, and stress. Mindfulness meditation is an evidenced-based tool to help acknowledge surroundings and to help to lower or decrease perceived stress. A randomized controlled design with a two-group pretest-posttest was used to evaluate the impact of a mindfulness smartphone application on the perceived levels of burnout, stress, anxiety, depression, and mindfulness of nurses. After taking a pretest, participants were randomized to either a waitlist control group or an intervention smartphone group. The waitlist group did not have any intervention during the 30 -day study period. The intervention group was asked to complete sessions via a smartphone mindfulness app for 30 days. The instruments used in this study were the Maslach Burnout Inventory (MBI), Depression, Anxiety, and Stress Scale 21 questions (DASS-21), Mindfulness Attention Awareness Scale (MAAS), and the Mobile Device Proficiency Questionnaire 16 questions (MDPQ-16). This dissertation includes three reports based on the same dataset. The first report analyzed the effects of a smartphone mindfulness application on burnout in nurse preceptors. Results of the study indicated that a smartphone application can reduce burnout in the subscales of Personal Accomplishment and Depersonalization but not in Emotional Exhaustion. The second report examined the impact of a smartphone mindfulness application on scores of depression, anxiety, and stress of nurses. The study results indicated a significant improvement in the smartphone application group compared to the waitlist group for the variables of depression and stress. The third report evaluated the impact of the smartphone mindfulness application on the mindfulness levels of participants and the relationship between their technology proficiency to their interaction with the application. The smartphone group's mindfulness scores increased significantly compared to the waitlist group. However, mobile proficiency was not significantly related to the participants’ use of the mindfulness application. The findings of this study indicate that the use of a smartphone application can effectively increase mindfulness when used by nurses at the bedside. The smartphone mindfulness app also showed potential benefits in reducing self-perceived levels of several aspects of burnout, depression, and stress in nurses. Hospitals could choose to embed mindfulness principles into the hospital environment's culture or provide staff opportunities to practice mindfulness through a smartphone application during the day. Such mindfulness may decrease the consequences of burnout, which include increased nurse turnover, decreased quality of care, and high costs of recruiting and training new nurses. Further research is needed to study the long-term impact of using the smartphone application and the time required daily to show results

This cross-sectional survey examined the relationship between social interest, as postulated by Alfred Adler, and job satisfaction among full-time employed registered nurses to determine whether social interest was related to work attitude and whether job satisfaction was related to age, level of education, experience, and type of position in nursing.

Simulation in nursing education involves an instructor observing students performing a specific task using an anatomical model, standardized patients, or high-fidelity simulation using a simulator. This education method allows creation of realistic clinical scenarios to allow nurses to perform tasks in a safe learning environment. However, accurate performance in the simulation lab must be replicated in the clinical environment to impact patient outcomes. Chapter 2 is a systematic literature review resulting in 21 articles addressing dependent variables, conceptual frameworks, study designs and outcomes measured in new nurses. Knowledge, simulation satisfaction, confidence, and clinical performance were common simulation outcomes studied. Only 7 research articles reported using a theoretical framework. Even though most of the studies used self-reported measures to demonstrate improvement in the studied variables after simulation, none of the studies used objective observation in the actual clinical setting after simulation. Assessing performance in the actual clinical environment after simulation is an opportunity to link simulation education to patient outcomes. Researchers should explore if learned skills in simulation are transferred to the real clinical setting resulting in safe and competent care. This gap in the literature was the impetus for the study described in Chapter 3. Chapter 3 focuses on a quasi-experimental study on new nurses hired at an oncology institution to determine if skills learned in the simulation lab transferred to the clinical setting. The study’s aim addressed if a difference exists in clinical observation scores between the intervention group (involved in simulation) and control group (not involved in simulation) when performing a central line dressing change. Fifty-six participants were consented with 19 nurses completing all data collection points. No significant differences were identified between groups. Chapter 4 is a narrative account applying the concept of resilience to the doctoral dissertation experience during a pandemic. Using Richardson’s Resiliency Model, the challenges of performing research on staff development during a pandemic are presented. The presence of a stressor (pandemic) and the resulting stages of disruption and reintegration are described resulting in resilient reintegration during the doctoral research process. Simulation is an educational methodology in academia and staff development. However, outcomes such as confidence, knowledge and simulation satisfaction are over-studied and there is a need for studies to focus on if skills performed during simulation are replicated accurately in the clinical setting. In addition, simulations should be designed to ensure they are addressing the identified construct (e.g. clinical judgement). In addition, the logistics involved in observing practice at the point of care is challenging due to unpredictable factors such as staffing, patient acuity, and operational decisions that may impact study design present unique challenges. Keywords: Simulation, new nurses, resilience

South Africa has been brain drained of nurses and doctors and the Eastern Cape as a Province within South Africa is not an exception. Its rural nature has caused many nurses and doctors loose interest of serving in its facilities. This study sought to describe factors that can influence retention especially of nurses in the rural health facilities of the Eastern Cape Province and develop recommendations for nurse managers on how to retain nurses in rural areas. The major inferences drawn from this study is that nurses are dissatisfied with lack of promotional opportunities, lack of professional support, facing drastic responsibilities but with less income, tremendous workloads, emotional demands and unrealistic salary package. The researcher believes that the nurse managers have a crucial role to play in ensuring nurse retention and the recommendations drawn from this study can contribute in improving the work environment. / Health Studies / M.A. (Health Studies)

The aim of this study is to explore and describe the coping skills of registered nurses in a changed working environment. The research is conducted in the City Health clinics. The objectives of the study are:  to identify strategies which nurses use to cope with the changes in the health care services;  to explore appropriate support systems that will enhance the coping skills of registered nurses in clinics in the City Health Department; and  to deduce guidelines on how to support staff from the literature study and the results of the research. The research problem is the following: nurses in primary health care facilities do not adequately cope with major changes in health care delivery. A qualitative approach for the research was chosen. Personal interviews and focus group discussions were used to identify the coping skills of registered nurses. Data analysis was done manually. Transcriptions of recordings of the individual interviews and group discussions were done. Themes were organized and categorized into meaningful links and relationships. The findings indicate that the following factors improve the coping skills of registered nurses:  team-work and support;  to voice your opinion when necessary and good communication between staff;  regular breaks during working hours;  inherent factors for example strong spiritual and emotional strength that assist registered nurses to cope;  family support;  the provision of quality care is rewarding;  the assistance and support from the church (congregation);  the effective re-organisation of health services;  continuous support programs for staff; and  continuous education to develop skills of registered nurses. / Advanced Nursing -- Psychological aspects / M.A.

Human resources are the most important assets of any health system. In recent years it has been increasingly recognised that improving the performance of health personnel should be at the core of any sustainable solution to health system performance. However, it is widely acknowledged that health systems are not producing the desired output of health interventions due to factors such as insufficient skilled and experienced health personnel, demotivated health personnel, lack of management skills, poor working conditions and environment, and inadequate remuneration. This study explores the factors that affect performance of nurses in Namibia with the aim of providing a management framework for improving the performance of professional nurses. The study followed a quantitative research approach using an explorative descriptive design. A survey method using questionnaires was applied. The reaction to the study was positive as a response rate of 75.8% was obtained. Data analysis included identifying and comparing existence or absence of factors using the SSPS package. The target population included all professional nurses in Oshana, Otjozondjupa and Khomas regions. Baseline results revealed various factors which affect performance. The study revealed that hospitals currently have deficiencies in human resource management aspects such as recognition of employees who perform well, working conditions, implementation of performance appraisal systems, feedback on performance outcomes and management skills. These aspects are strongly associated with level of performance of health personnel. Based on the results, a management framework was proposed. The framework consists of activities for enhancing the nursing profession; strengthening knowledge and expertise, including management skills; improving performance; and generating knowledge through research. / Health Studies / D. Litt. et Phil.(Health Studies)

The purpose of this study was to examine the relationship between perceived availability of opportunities for promotion, training, career progression, existing management style and voluntary staff turnover intention among the nurses working in Mengo Hospital. A quantitative, descriptive correlational design was used. Data collection was done using structured questionnaires. Full time staff nurses (N= 235) were surveyed. The findings revealed that all the four variables were significantly and negatively correlated to the intention to leave and predicted 16.8 percent of the variance in intention to leave scores. Management style was the strongest predictor of intent to leave (14.5%). Nurses perceiving their managers as participatory had lower intention to leave. To retain qualified personnel, hospital administrators should focus on participative management style and career development programs that address the needs of the staff and the hospital / Public Health / M.A. (Public Health)