The purposes of this cross-sectional and internet mixed methods study were: (a) to explore the level of structural empowerment (SEP), psychological empowerment (PE), participation in decision making (PDM), their relationships, and their predictors among Taiwanese nurses, and (b) to explore the influence of contextual factors (culture and gender) on the nurses’ perception on their work environment and PDM based on the feminist perspective and Laschinger’s expanded empowerment model. This study included an Internet questionnaire survey (quantitative) and a Web-based online forum (qualitative). A convenient sample of 163 Taiwanese registered nurses (a) who are currently working full time in health care institutions for at least 3 months, (b) can read and write Chinese on the computer, and (c) have access to the Internet was recruited and completed the internet survey. Among them, 20 completed the online forum discussion topics. The findings of the internet survey indicated that participants had moderate level of SEP, high-moderate level of PE and low level of PDM. Personal characteristics, such as age, education, and work experience, did not significantly correlate to Taiwanese nurses’ empowerment. However, the work structures, such as workload, types of hospitals, and work units, were significantly related to Taiwanese nurses’ empowerment and PDM. PE was a mediator between SEP and PDM, which indicated that with increased access to workplace empowerment structures, nurses perceived better personal empowerment, which in turn increased nurses’ PDM. In the online forum, two themes were discovered: (a) foot-binding unto nursing and (b) not open up. The first theme indicated that certain stereotypes regarding gender roles in Taiwanese society were restraints to the growth of nursing. Due to the stereotypes, nurses were located in the lower social status and developed powerless behaviors. The second theme indicated that communication among nurses was not sufficient, which might stem from the influence of Confucianism, collectivism, and power distance. The findings in this study extend our understanding of the empowerment and PDM among Taiwanese nurses within the context of gender and culture. / text

The social phenomenon of stress and workplace burnout has spanned over five decades. Despite a plethora of literature that exists, there still remain problematic issues that neither scientific investigation or government legislation have been able to resolve. The literature examined throughout this research is extensive and does reflect this 50-year period. It demonstrates that studies into this phenomenon have attempted to define stress, identify causal factors of workplace stress, workplace burnout and environmental congruence; and discusses strategies (focused on both the individual and organizational levels) that have been implemented to effect beneficial outcomes for individuals affected by any one of these. As this thesis continues, the more recent literature gives a greater recognition to violence in the workplace and legislative enactments as preventative measures to reduce the heavy burden of costs, both physical and financial, to organizations. This extensive literature review indicates no answer to the problem has been identified to date and that this phenomenon remains, giving a clear indication that further scientific investigation is required to find a solution to what was described as the most serious health issue of the 20th century. Based on the literature examined this health issue has now gone well beyond the 20th century, giving relevance to the research study described in this thesis. The investigation is validated as vital and should be used as a basis for further research. This study undertook a collaborative social process, action research, empowering participants to identify and change stressful factors identified within their practice indicative to rural remote community mental health teams. A critical social theory arose out of the problems within the context of the research setting, based on the ideal that the significant issues for this group of individuals within this organization could be solved through the action research process. The group ‘existed’ within the issues indicative to this rural remote area, however these issues were outside their control. Through the implementation of the action research process courses of actions were undertaken that provided enlightenment in self-knowledge with dialogue heightening collective empowerment to effect change within their practice. The action research process, being a holistic process, facilitated this change in practice, developed and refined theory as it proceeded in a cyclic fashion within this local setting. It concerned actual not abstract practices in the social world in which these participants practice. This methodology facilitated examining the significant stressors identified by the Community Mental Health Support Team (CMHST) that caused distress, allowing them to implement changes in their practice. The forum provided an avenue that could reduce stressors significantly and prevent ongoing occupational stress that contributes to workplace burnout. It offered an opportunity to work with a group of participants in a nonhierarchical and non-exploitative manner and enabled members of this group to identify their roles as effective practitioners, empowering them to effect the changes they deemed as essential criteria to reduce the stress they were experiencing indicative to their remoteness. Critical reviewing throughout the data collection attempted to understand and redefine these significant issues. It aimed to acknowledge the way things were relative to how things could be improved from organizational, personal and wider community perspectives. Simple principles and guidelines of action research were followed potentiating acceptance as a rigorous research approach from a positivist perspective whilst retaining the attributes that characterise action research. There are solutions to the dilemma of the employee overcoming the debilitating effects of stress leading to workplace burnout. This includes the cooperation of managers, policy makers, academic researchers and government officials working collaboratively to reduce the impact of occupational stress. Through this collaborative process, changes can be effected to ensure the health of the nation improves and that relevant recognition is given to the fact that there is a significant threat to a healthy workforce. Examining the nursing profession from a social perspective provides alternatives to medicalising workplace injuries and illnesses. / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

1 online resource (vii, 138 leaves : ill.) / Following an awareness of an increased turn over of staff in the eating disorder unit as compared with other specialised units, in a psychiatric hospital in Johannesburg, South Africa, Tara Hospital, the researcher was motivated to investigate the issue. An exploratory, descriptive based research was chosen to explore and gain information about the topic and its implications. A qualitative research approach was used to gain insight into the perceptions and needs of the team working on the unit. The case study method was used. A pilot study was undertaken to test the validity of the interview schedules. The sampling category was a non- probability one. Individuals were selected from the population of staff working on the unit. Participants were selected from two groups, those who were presently working on the unit and those who had previously worked on the unit and now working in other units. Interview procedure involved personal semi-structured interviews conducted by the researcher and analysed qualitatively and a structured interview questionnaire analysed quantitatively. The researchers assumption that many staff members move from working in an eating disorders unit was confirmed and is due to the following: Staff turnover is due to constant exposure to occupational stress and burnout. Feelings of helplessness, a sense of being unappreciated and excessive exposure to conflict from the patients. In addition, staff experience minimum rewards leading to lowered job satisfaction due to the patients slow recovery rates and a poor prognosis of the illness. Staff also experience a change in their eating patterns and an increased awareness around food and food issues. Recommendations to the staff include: * Psycho-education on eating disorders. * Implementation of strategies to provide supportive care for all staff members. * Education on stress management and strategies to prevent staff burnout and lowered job satisfaction. * A multidisciplinary teamwork approach by the staff, when working in the unit. / Social Work / M. A. (Social Science in Mental Health)

Abortion is a highly controversial subject that has again come into the spotlight in South Africa due to the legalisation of abortion on demand in 1996. The results of various studies conducted since the Choice on Termination of Pregnancy Act 92 of 1996 was implemented, have indicated that abortion providers have met with a great deal of negativism and ostracism. This study focused on the implications of abortion work on nurses' social relationships with family, friends, colleagues and their communities. Recent literature was reviewed on the subject. The researcher however, found little information on this specific aspect of abortion. The study was conducted with abortion nurses from two government designated hospitals in the East London area responsible for abortion services. Thus, results cannot be generalised. This is a qualitative study that aimed at obtaining firsthand information regarding the personal experiences of abortion nurses. A non-probability sampling technique was used viz. criterion sampling. The Interview Guide Approach was used whereby in-depth, semi-structured interviewed were conducted with the guidance of a set of questions in the form of an Interview Schedule. The ten respondents were asked to share their recommendations as to possible measures that could address the challenges mentioned during their interviews. The researcher came to the conclusion that nurses' social relationships and lives are definitely impacted by abortion work. This impact is largely negative as the majority of respondents experience labelling, stigmatization and ostracism from family, friends, and their colleagues. Abortion nurses also experience a lack of social support, ambivalent feelings with regard to abortion, and a range of negative emotions ranging from stress and depression to frustration and anger. A number of repeat abortions are being done and there seems to be a general lack of contraception. The need exists for nurses to go to Value Clarification Workshops and also to get support in terms of compulsory, continuous, counselling. Separate wards should be set up for abortions whilst sex education should be included in school curriculums at both primary and secondary schools. Family planning and facts about the abortion process should also be included in these sex education programmes. Overall. the need exists for family planning initiatives to promote contraception and deter women from using abortion as a means of contraception. As this study reveals, conducting abortions has come at a great cost for the majority of nurses who lack social support and bear the brunt of anti-abortion sentiment expressed by significant others in their lives. The latter being the people who would normally be the one's they would turn to for help, counsel, support and assistance

A non-experimental, explorative, descriptive, quantitative study was undertaken. The purpose was to explore and describe the views of preceptors and preceptees regarding the fulfillment of the role of the preceptor in selected clinical nursing practice settings in the Botswana context. The study included 72 preceptors and 200 nursing students/preceptees who voluntarily agreed to participate in the study. A questionnaire was used to collect data. Data was analysed by using descriptive and inferential statistics. The findings of this study indicated that there were numerous constraints that interfered with the preceptor role in accompaniment of the preceptee. These constraints included the lack of desirable characteristics and time to plan learning opportunities, inadequate use of teaching strategies and inadequate knowledge on preceptee evaluation. Recommendations were stated for improvements in the future role of the preceptor in clinical practice settings Limitations of this study were also highlighted. / Health Studies / M.A.(Health studies)

The aim of the study was to investigate motivation, job satisfaction and attitudes of nurses in the public health services of Botswana. The objective was to discover how nurses felt about a wide range of variables in their work environment and ultimately to distil them into what they conceived as the mainstay motivators, job satisfiers and positive attitudes. The non pariel (unrivalled, unique) role of the government in creating both the hardware and the software of national health services was acknowledged and recognised with a particular reference to the primacy it placed on developing the human resources in the form of nurses, in order to realize the goals of administering the public health services efficiently and effectively. It was noted that nurses were the change agents and the axis in promoting quality standards of healthcare but in partnership with the government, which must be seen to be responsive and proactive in discharging its fiduciary responsibilities, in respect of both the content and the context of nurses’ occupational ambience. For the purposes of constructing a database from which both the government and the nurses can draw, the most salient thematic details of the theories of motivation, job satisfaction and attitudes were studied and examined and were used as a scaffolding for the empirical survey of nurses. Nine hundred questionnaires were distributed to both registered and enrolled nurses with a minimum of two years work experience in the public health sector and 702 of these were returned constituting a return rate of 78%. The findings indicated that a majority of nurses enjoyed job satisfaction in certain areas of their work namely autonomy, participating in decision-making, choice of type of nursing, change of wards or departments or work units, interpersonal relationships amongst nurses themselves and between nurses and their supervisors. Nurses also perceived the hospital as an environment in which they could continually learn and they were moreover satisfied with the nursing job or the work itself. The other end of the spectrum revealed an overwhelming majority of 92.2% of nurses who were dissatisfied with the level of pay and 88.5% who were not happy with the fringe benefits including the provision of accommodation. Working conditions were viewed as generally disliked by 67.3% of the nurses. Low pay, workload, lack of viii recognition for outstanding performance and or delayed promotional chances were singled out as being particularly disliked by 67.2%, 64.9%, 42.6% and 44.4% of the nurses respectively. Interviews held with 31 nurses yielded similar results. The research further showed that the most important motivators to nurses were dominated by competitive salary which was mentioned by 80.9% of the respondents, attractive or sufficient working conditions which were stated by 71.2% of the nurses, opportunity for continuous education which was rated by 63.8% of the nursing candidates, reduced workload which was claimed by 59.3% of the nursing cadres, opportunity for the recognition of outstanding performance and opportunity for promotion which were scored by 54.1% and 53.4% of the nurse respectively. Job satisfiers were also represented by competitive salary which received 76.1% of the nurses’ votes. Risk allowance occupied the second position with 69.1% and competitive working conditions were awarded a third ranking by 68.2% of the nurses. Those nurses who derived job satisfaction from the fact of each nursing shift being manned by an adequate number of nurses accounted for 63.1% of the sample. Competitive fringe benefits attracted 60.1% of the nurses. Opportunity to attend workshops and the need for high morale in nursing team-work were chosen as job satisfiers by 53.7% and 49.6% of the nurses respectively. In the section on recommendations the government was exhorted to invoke corrective or remedial measures in view of the detailed exegesis of the satisfactions and dissatisfactions in the nurses’ work environment and the ensuing problematique (doubtful, questionable) of raising the standards of health care in the public health services. Living up to these sanguine expectations should be the cherished longterm vision of the government if it is to meet and quench the soaring aspirations of its modernizing society for quality health care delivery and the escalating needs of the nurses. / Public Administration and Management / D.P.A.

The research has worked towards the general aim of generating a synthesis of burnout in the nursing profession, and also towards coming to a synthesis of burnout in nursing from the perspective of the salutogenic paradigm. Existing knowledge from the literature has been consolidated and integrated, and 'new knowledge' of the phenomenological experience of the causes and symptoms of burnout and how nurses stay healthy, were presented. Firstly was discovered that burnout, over time is caused by various factors that are individual and personal and therefore not easily discovered by other than the phenomenological method, where the life world of each individual is described. Secondly, the study ofthe strengths that nurses exhibit in order to manage the tension and stress in their lives and not to succumb to illness, proved to be a sound and descriptive paradigm with great utilisation possibilities. Three answers to the salutogenic question, namely sense of coherence, hardiness and learned resourcefulness were presented in great detail. Thirdly, it was stated that the individual nurses and the nursing practice in general be made aware of: (1) the existence of burnout, (2) the contributing factors to burnout, (3) the various manifestations ofburnout at work and in the organisation, and (4) the coping strategies available to counter this problem in a positive and salutogenic manner. The phenomenological results of this research revealed a number of issues that have implications for both the prevention and treatment of burnout in nurses. The results especially established how nurses can operationalise their inherent salutogenic qualities. Specific salutogenic coping strategies emerged via the respondents. The research took a broad view of personality in health research. It studied the psychological processes underlying the observed connections between psychological variables and health outcomes. In order to study the operationalisation of these processes, a phenomenological, person-based approach was followed. They study focussed on health phenomena and the individual nurse was retained as the unit of analysis. This approach represented a movement away from a fragmented science, infatuated with technology and linked to a singular epistemology, towards a focus on the process and dynamics of personal experience. / Psychology / D. Litt. et Phil. (Psychology)

The purpose of the study was to explore and describe the lived experiences of neophyte professional nurses working in ICU during their first year post graduation with the aim to discover strategies to support the nurse in critical care unit. An explorative, descriptive, interpretative qualitative design was conducted to uncover the nurse’s experiences. A purposive sampling was used which is based on belief that the researcher’s knowledge about the population can be used to hand pick sample elements. Data was collected through in-depth unstructured interviews and written narratives. Collaizi’s method of data analysis was used. The study findings revealed that neophyte professional nurses experienced difficulties and challenges in adjusting to the unit because of lack of mentors emanating from the shortage of staff. Nurses experienced mixed feelings regarding the relationship with colleagues in terms of support received. / Health Studies / M.A. (Health Studies)

Professional nurses comprise the largest number of health care professionals in South Africa. High turnover rates contribute to shortages of nurses in South Africa, aggravated by the emigration of nurses, inadequate recruitment of student nurses, and the expected retirement of many baby boomer nurses by 2016. This study addressed factors influencing the retention of professional nurses in the Gauteng Province of South Africa. In phase 1, postal questionnaires were completed by 101 registered nurses while semi-structured interviews were conducted with 21 nurse managers in phase 2. Personal, organisational and managerial factors influenced the retention potential of the professional nurses. In terms of Maslow' Hierarchy of Needs Theory, most factors influencing nurses' retention operated on the lowest (physiological) level and concerned remuneration. Safety needs were compromised by the lack of equipment and supplies, the shortage of nurses and unsafe working places. Esteem needs included respect from doctors, managers and colleagues as well as recognition for outstanding performance. In terms of Vogt et al's Theory of Nurse Retention Theory, the constrictions caused by inadequate remuneration and safety aspects should be addressed. Lewin's Force-Field Analysis Theory recommends that the factors that influence nurses' retention negatively should be unfrozen, changed and refrozen, including communication. Based on these results guidelines were compiled for enhancing the retention rates of professional nurses (Annexure G). / Health Studies / D.Litt. et Phil. (Health Studies)

Limited research has investigated the stress-related experiences of South African nursing students. Moreover, there is a scarcity of empirical studies that have reported on the development and evaluation of psycho-educational stress-management programmes that focus on both pathogenic, as well as positive and meaning-related factors among nursing students. The aim of this investigation was to study compassion fatigue, burnout, compassion satisfaction and meaning in life among a sample of nursing students with the aim of developing, and then empirically evaluating, a psycho-educational stress-management programme. The psycho-educational stress-management programme was articulated from a logotherapy-based perspective. A research design, consisting of three interdependent phases, was used to pursue the aim of the study. The aim of phase 1 was to describe the (1) prevalence of, and (2) correlations between, the deleterious and positive and meaningful effects of caring and among a sample of 80 nursing students (Mage = 22.40 years, SD = 11.1, female = 91.25%). The results indicated that participants may benefit from a logotherapy-based psycho-educational stress-management programme. The purpose of phase 2 of the study was to develop a logotherapy-based psycho-educational stress-management programme for nursing students. The goal of the logotherapy-based psycho-educational stress-management programme was to assist participants to develop the skills, knowledge and abilities that may be required to address deleterious challenges, and enhance positive and meaning-related opportunities. In phase 3 the logotherapy-based psycho-educational stress-management programme was presented to a sample of 42 first year nursing students (Mage = 20.21, SD = 1.57, female = 79.31%). A convergent parallel mixed methods research design was used to evaluate the efficacy of the logotherapy-based psycho-educational stress-management programme. Quantitative results indicated (1) a reduction in compassion fatigue and burnout, and (2) an increase in compassion satisfaction and meaning in life, scores over the course of the programme. Qualitative analysis supported the quantitative results. It was subsequently concluded that the logotherapy-based psycho-educational stress-management programme was effective in assisting participants to address the deleterious , as well embrace the positive and meaning-related effects of caring. However, ongoing support may be required to fully assist nursing students to address stressful challenges. / Psychology / D. Litt. et Phil. (Psychology)