Dissertation submitted in fulfillment of the requirements for the Degree in Masters of Technology: Nursing, Durban University of Technology, 2011. / Background Working in the intensive care unit can be traumatic for nursing personnel. Critical care nurses are faced with repeated exposure to death and dying as they are involved in caring for patients who are actively dying or who have been told that they have a terminal illness and are faced with the possibility of impending death. Critical care nurses relate in different ways to the phenomena of death and dying within their nursing profession and their scope of practice. These nurses often have a difficult time coping with the stress that comes with caring for those who are dying or relating to loved ones of those that are dying. Aim of the study The aim of the study was to explore the critical care nurse’s experiences of death and dying. Methodology A qualitative, descriptive phenomenological approach was used to guide the study. Four nurses were recruited and rich descriptions of their experiences were gained through individual face-to-face interviews. One broad question was asked: ‘What are your experiences regarding death and dying of your patients in ICU?’ iii Results The findings of this study revealed that issues such as communication, multicultural diversity, education and coping mechanisms relating to caring for the critically ill and dying patient are essential in nursing education and practice. Critical care nurses need to have support networks in place, not only to assist in providing care, but also for their own emotional support / M

Introduction: It was previously established that mental health workers in Rwanda experience secondary traumatic stress when working with trauma survivors. The effects of secondary traumatic stress can be serious and permanent in mental health workers when working with traumatized clients. It interferes with mental health worker’s ability to do their work effectively. Aim: This study aimed to explore STS and to develop an intervention model to manage secondary traumatic stress in mental health workers in Kigali, Rwanda. Methodology: This study was carried out into five cycles using action research approach. In the first cycles of the study a quantitative design was used to explore secondary traumatic stress in mental health workers in Rwanda. For this cycle, the particular aim was to determine the extent of the secondary traumatic stress in mental health workers in Rwanda. A total of 180 participants were selected using convenience sampling to be part of the quantitative study. In the second cycle of the study a qualitative design was used to explore mental health workers’ experiences of secondary traumatic stress. For this cycle 30 unstructured interviews were conducted. The third cycle aimed at developing the model to manage secondary traumatic stress. Action research approach was used in this phase. Experts from mental health services involved in the study were asked to participate in the study based on their availability as research team members. The fourth cycle of the study consisted of implementing the model in one mental health service and the fifth cycle consisted evaluation of the implementation of the model after six weeks period. The main aim of this cycle was an observation of the model implantation. Results: A diagrammatical model to manage secondary traumatic stress was developed by mental health professionals. In the model development cycle of the study, it emerged that there are very strong concurrence between the findings from experts in mental health care system and literature in terms of what needs to be included in the intervention model to manage secondary traumatic stress in mental health workers in Rwanda. The key elements to include in the model were based on preventive, evaluative and curative strategies to manage secondary traumatic stress in mental health workers in Rwanda. During the evaluation of the implementation, it emerged that participant noticed a change in coping strategies when facing the stressful incident in the practice. Recommendations: include an emphasis on more psychological support for mental health professional in their workplace and for more concrete aids such as supervision, guidelines on stress management on workplace, education on secondary traumatic stress management and implementation of counseling service for mental health workers. Conclusion: The model developed in the present study outlined different ways to manage STS at the individual, social and organizational levels. There is a need to translate the interventions to manage STS into active ongoing coping activities to be conducted at the individual, group and organizational levels. Organizational responses, such as creating a supportive organizational culture that acknowledges the potential for secondary traumatic stress, may help mental health workers to deal with workplace related secondary traumatic stress. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

INTRODUCTION: Providing sufficient quality nurses in resource strapped countries is a human resource management challenge which nurse managers’ experience on a daily basis. THE PURPOSE of this study was to analyse and to determine the issues which affect the the human resources management of nurse managers in selected hospitals in the eThekwini District of the Province of KwaZulu-Natal, South Africa, and to formulate draft guidelines to assist nurse managers with human resource management. METHODOLOGY: A constructionist, reflexive ethnographic approach was used. The ethnographer spent two years in the field collecting data from informants, who were nurse managers, in four (4) selected district hospitals. Data was collected using unstructured informant interviews, non-participant observation and confirmatory document analysis. Data analysis led to eliciting codes from the data, searching for semantic relationships, performing componential analyses and discovering the themes for discussion within the final ethnographic report. A nominal group process was used to develop the draft guidelines. FINDINGS: The findings showed that the human resources management around sick nurses is a complex task. The themes of nurse managers’ experiences were a “burden” of maintaining confidentiality, as well as an emotional burden. Administratively, they experience the burden of absenteeism and the burden of policy compliance. The final theme is the burden of the deaths of HIV and Tuberculosis affected/infected nurses. CONCLUSION AND RECOMMENDATIONS: Organizations should create a non-judgmental work environment where non- disclosure by employees is respected in order to promote disclosure. They should have an awareness of the emotional effect on nurse managers and provide them with support. Emphasis needs to be placed on an HIV and AIDS policy and programme, incapacity leave workplace strategies and return to work policies. It is also recommended that contingency plans be provided when the death or prolonged absence of an employee impacts the staffing of the organization; consideration to be given to piloting and refining the draft guidelines; the management of employees on prolonged sick leave be included in the Nursing Administration Curricula taught to future nurse managers; and further research be conducted to assess employee reluctance to report needle stick injuries (sharps injuries) as well as the related phenomenon of stigmatization. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2014.

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 aim o f this study was to determine the key factors within the roles and functions of professional nurses working in different nursing units with the purpose for motivation for their compensation in accordance with their performance. A comparative, descriptive design was employed. Findings reveal that the professional nurse’s roles and functions in the different units show that there are some significant differences regarding certain activities while differences pertaining to other activities were not significant. However, there were factors which were subjected to a number o f limitations during the study. Apart from the significant differences, it thus appears as if the roles and functions required o f professional nurses working in the three disciplines do not vary much in content and intensity. From the findings o f this study, it therefore, does not appear as if paediatric professional nurses have a valid reason for expecting additional monetary rewards in view o f their roles and functions. / Health Studies / M.A. (Health Studies)

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 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)

D.Cur. / The impressive growth in the extent and range of psychiatric services provided by general hospitals in South Africa, creates stress among nurses employed in these settings which manifests its self in the negative attitudes displayed towards mentally ill people, refusal of dual diagnosis patients transferred from medical surgical units and poor intra-institutional relationships between nurses in medical-surgical units and those who are in the psychiatric unit. This has led to the research study aimed at describing a model for support to assist general hospital nurses mobilize appropriate resources in the process of nursing mentally ill people. The research methodology followed the research model in nursing proposed by Botes (1995). A theory generative, qualitative, explorative, descriptive and contextual design was followed. The research methods were dealt with in four steps of theory generation in the following manner: Step 1: Concept analysis: This step was dealt with in two phases which are concept identification and concept definition. During concept identification, a qualitative research strategy which is explorative, descriptive and contextual was used. This was attained through field research conducted in an urban general hospital. A sample of twelve professional was selected from a population of 800 professional nurses employed in a general hospital using a purposive sampling technique. This sample size was determined by saturation of data in themes. Both semi-structured individual phenomenological interviews and observations were used as methods of data collection. The field work was conducted without any preset theoretical framework of reference by using "bracketing" and "intuiting". Giorgi's (1986) method of descriptive data analysis was used. After data analysis, the results were reflected within the Nursing for the Whole Person Theory. Four themes emerged from the results of the study which were:1) the experience with the perception of the mentally ill people, 2) the experience with interpersonal communication patterns, 3) nurses' experience of violence and lastly, 4) the experience of inappropriate patient behaviours. It became clear that the experience of nursing mentally ill people was negative and affected the social, psychological and the physical dimensions of nurses. The results were validated through literature control. The major concept of model was identified as "facilitation of communication". The concept was analysed thoroughly by looking at the dictionary and subject usage. The defining attributes were identified and synthesised through a definition. The other related concepts were identified and classified using a survey list of Dickoff, James & Wiedenbach (1968:430). Step 2: Step 2 dealt with the creation of interrelationship statements between concepts identified in step 1, so that concepts were able to stand in relation to one another. Step 3: dealt with the description of the model using strategies proposed Chin & Kramer (1991). Step 4: dealt with the description of guidelines for model operationalization in practice, education and research. The evaluation of model operationalization will be carried out in future research. To ensure valid results, a model trustworthiness proposed by Guba (Lincoln & Guba, 1985) was used. The following criteria for trustworthiness was applied in all the steps of theory generation: truth value, applicability, consistency and neutrality.

M.Cur. (Nursing Education) / There is a shortage of nurses in the country and worldwide, and the problem is compounded by the resignation of nurse educators. These nurse educators leave with their expertise and skills, thus compromising the provision of quality teaching and learning. Despite the mandate by the Gauteng Department of Health to increase the student nurse intake by 25% each year, there are currently no retention strategies for nurse educators who may want to resign from a Johannesburg nursing college. It is thus imperative that a study to determine the factors leading to the resignation of nurse educators be conducted. The following research questions gave direction to the research study:  What are the factors that lead nurse educators to resign from a nursing college in Johannesburg?  What can be done to retain nurse educators at a nursing college in Johannesburg? The purpose of the study was to explore and describe the factors that led to the resignation of nurse educators at a Johannesburg nursing college and to describe strategies to retain them. A qualitative, exploratory, descriptive and contextual research design was used to provide an in-depth description of factors leading to nurse educators resigning from a Johannesburg nursing college. A purposive sampling method was used. When the sample was insufficient, snowball sampling was also used to identify other nurse educators who have resigned from the nursing college under study within the specified period between year 2000 to 2008. Fifteen (15) voluntarily agreed to take part in the study after they were invited. A pilot study was conducted with one (1) participant, who has resigned but was not involved in the actual research, and it assisted in determining the feasibility of the research question. Individual face-to-face semi-structured interviews were used to gather information from the nurse educators who resigned from the nursing college in question. The responses from the nurse educators were recorded on an audiotape recorder and field notes with the permission of the participants. An open coding, qualitative data analysis method was used. Trustworthiness was accomplished using the strategies as outlined by Lincoln & Guba (1985: 301–328). Ethical standards for nurse researchers were adhered to as outlined by DENOSA (in Brink et al., 2012: 48–51). The results of the data analysis that emerged were three (3) main categories, seven (7) subcategories and their related themes. The findings on factors leading to nurse educators resigning from a Johannesburg nursing college included factors related to management of the nursing college; emotional and attitudinal factors; and factors related to cultural diversity. Through conceptualisation, the themes identified from the research were supported or refuted by the relevant existing literature and interpreted by the researcher. Conclusions drawn from the conceptualization formed the basis for the description of strategies to retain nurse educators at a Johannesburg nursing college. The strategies identified through conceptualization were described in order to assist the nursing college under study to retain its nurse educators. It is recommended that the strategies be implemented in nursing education, management and research.