Nurses comprise the majority of health care service providers and function as an integral part of the services rendered by the health care system in South Africa. There are however, frequent expressions of concern about their working conditions and circumstances. The health care system in South Africa faces difficulties in terms of resources and service provision, with nurses themselves sometimes being criticised for rendering less than adequate services (Khoza, Du Toit & Roos, 2010). Healthcare sector strikes have also been a feature of recent times, influenced by poor salaries, deterioration of academic facilities, poor working conditions in the public sector and the unfortunate conditions facing patients at public health facilities (Dhai, Etheredge, Voster & Veriava, 2011). The nursing care-relationship, however, requires qualities of empathy, compassion, ethical practice and commitment and these demands and contradictions may lead to burnout, compassion fatigue and secondary trauma (Holdt, 2006). The study therefore explored the perceptions of nurses about their role, the quality of the health care services which they provide, their perceptions on nurse/patient relationships; and their perceptions of both problems and strengths or protective factors in their nursing role. Using a qualitative approach, the study included twenty nurses working in a large public hospital in Gauteng. Purposive sampling was used to select participants from various wards. Data was collected through semi-structured, face-to-face interviews, in order to enable participants to reflect on the meanings of their experiences and the perceptions they attach to these experiences. Thematic content analysis was used to analyze data. The main findings were that nurses perceive their occupational stress arising from shortage of staff and limited and inadequate equipment. This resulted in fatigue, and a high rate of absenteeism. Nurses in this hospital reported that they experience trauma due to the nature of their work with little visible and accessible formal debriefings, trauma counseling and Employee Wellness Programmes in place to assist them with stress management for traumatic experiences and other work related problems. Working conditions are perceived as unfavorable and unsafe, exposing them to health hazards, while simultaneously having to deal with frustrated patients and relatives.

<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>

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

<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>

A substantial amount of international research exists examining the impact of HIV/AIDS on health care workers. However, the impact of HIV/AIDS on nursing staff in South Africa has been relatively neglected. The primary objective of this study was to examine the impact of the AIDS pandemic on the subjective work experiences of peri-urban nurses in South Africa. The study explored the relationship between external changes in the nurses' working environment and their internal psychological responses for negotiating this change. A focus group of eight nurses was conducted, followed by indepth individual interviews with three group members. A grounded theory method was utilised to process and analyse the data. The research showed that nurses experience two forms of change. It was suggested that nurses respond to external changes in a manner designed to maximise their control and sense of meaning in an unpredictable environment. This accommodation involves the restoration of an internal psychological equilibrium through a process of balancing positive and negative experiences. The attainment of such an acceptable equilibrium may allow for diminished stress, increased satisfaction or fulfilment and the validation of personal and professional significance.

M.Cur. (Psychiatric Mental Health Nursing) / Injuries suffered by nursing personnel as a result of aggression by mental health care users are on the increase. The psychiatric nurses and assistant nurses working in a psychiatric institution may suffer physical trauma, which gets healed over time with proper treatment, but the emotional scars are not attended to, hence some of the psychiatric nurses and assistant nurses working in a psychiatric institution do not cope. The impact of this trend is enormous and it is reflected in the health care service. The main purpose of this research study is to explore and describe the experiences of psychiatric nurses and assistant nurses who have been exposed to aggression by mental health care users while working in a psychiatric institution, in order to formulate guidelines to promote the mental health of these psychiatric and assistant nurses to. A qualitative, exploratory, descriptive and contextual research design was utilised in this study. There were two phases to the research, whereby phase one included the description and exploration of experiences of nurses who have been exposed to aggression by mental health care users in a public psychiatric hospital in Gauteng. In phase two, guidelines were formulated to promote the mental health of the nurses in this context. A purposive sampling method was used, since it provides information-rich cases for in-depth study. One-on-one in-depth phenomenological interviews were utilised to gather data. Lincoln and Guba’s approach to trustworthiness was adopted, and I employed the services of an independent coder - an experienced psychiatric nursing specialist - to assist. Thereafter a consensus discussion was held. Ethical principles were adhered to throughout the study. The findings of the research were discussed in the light of literature relevant to this research study and similar studies will be used to verify the findings. Tesch’s method of data analysis was utilised in analysing the data of this research study. The findings revealed that participants experience significant emotional distress as a result of both verbal and physical aggression by mental health care users. Aggressive behaviour was recognised by the participants as being the outcome of interplay between numerous interactional and contextual factors. Participants may at times, experience conflict between their job mandate – to care for the mental health care users – and their need for personal safety. This often results in a sense of ambivalence towards those they care for, as well as towards their job. The participants were of the opinion that they should be offered counselling or debriefing services by management after exposure to aggressive incidents in order to recuperate from the anxiety-provoking situation they encountered. They also mentioned that they do not receive enough training in handling aggressive mental health care users, hence at times they feel demotivated. Guidelines to facilitate the mental health of nursing personnel who have been exposed to aggression by mental health care users, were formulated and recommendations were made to psychiatric nursing practice, psychiatric nursing education and psychiatric research. Evaluation of the study was done and the role of an advanced psychiatric nurse in mobilising resources to facilitate the mental health of psychiatric nurses and assistant nurses working in a psychiatric institution who have been exposed to aggression by mental health care users, was outlined.

The focus of this study was to investigate work-family conflict, social support and gender ideologies of professional/registered nurses in the South African context, specifically within the Cacadu District (Eastern Cape). The study had four aims: (a) to investigate the construct validity of the measuring instrument, (b) to investigate the relationship between social support provided by family and family interference with work (FIW), (c) to ascertain the influence of shift work on perceived work-family conflict, and lastly, (d) to determine whether there is a difference between the number of children in households and nurses’ perceptions of work-family conflict. A quantitative research design was used in the study. The sample (N = 106) was taken from five district hospitals in the Cacadu District, Eastern Cape. The measuring instrument consisted of three scales, namely the Multi-dimensional Work-Family Conflict Scale (Carlson, Kacmar, & Williams, 2000), the Social Support Questionnaire (Sarason, Sarason, Shearin, & Pierce, 1987), and an adapted Gender Ideology Scale (Tsai, 2008). The results indicated that the construct validity of the Multi-dimensional Work-Family Conflict scale was satisfactory. However, analysis of the Social Support Questionnaire and Gender Ideology scales both suggested that these scales have not been validated for use with diverse samples outside the contexts in which they were developed. The results also indicated that there is a relationship between social support provided by families and behaviour-based family interference with work. Additionally, there appeared to be a difference between the shifts worked by nurses and their perceived work-family conflict, except for strain-based work interference with family. And lastly, the only significant difference between the number of children in the household and work-family conflict was reported for strain-based work interference with family. The implications of the results for future research suggest the importance of developing and validating work-family conflict, social support and gender ideology scales that are dependent on the context of the research. In so doing, the constructs of the scale are made meaningful. Additionally, the findings provide preliminary evidence of tailoring work-family initiatives that address the needs of the nursing profession and the context of healthcare institutions

The complex environment of an intensive care unit is associated with a considerable amount of stress. Intensive care nurses are confronted daily with increasing work demands, emanating from the growing numbers of critically-ill patients; the introduction of highly sophisticated technologies in the intensive care environment; increasing competition between health care institutions; increased work loads; and limited career opportunities caused by, among other things, budget cuts by the government (Janssen, De Jonge & Bakker, 1999:1360). Research has shown that such stressors can result in mental, physical and behavioural stress reactions among nurses (Demerouti, Bakker, Nachreiner and Schaufeli, 2000:454). The objective of this study is to explore and describe registered nurses’ perceptions of factors causing stress in intensive care environments of state hospitals. The main purpose of the study is to develop guidelines for a stress management programme, to assist registered nurses to cope with the stressors in an intensive care environment. The research design is placed within a quantitative, explorative and descriptive contextual framework. Validity and reliability in testing and evaluating the research questionnaire are discussed, as well as the ethical and legal considerations relating to this research study. Findings of the research study will be utilized to assist the researcher in developing guidelines for a stress management programme to assist registered nurses in coping with stress in an intensive care environment

Critical care nursing is a vital and significant part of health care provision to critically ill patients. It is a specialty area of nursing that requires registered nurses who are highly motivated, knowledgeable and skilled to provide optimal care to critically ill patients. These patients are nursed in a complex environment consisting of specialised equipment (such as ventilators, defibrillators, intravenous pumps, and cardiac monitors) that is not found in any other field of nursing. Collegial support and an adequate registered nurse: patient ratio is vital in critical care units in order to provide optimal quality care to critically ill patients. However, an understaffed work environment, the demands of critical care nursing and other work-related problems, such as conflict with physicians, inadequate remuneration packages and an increased workload can cause serious distress and dissatisfaction amongst registered nurses in this specific environment (Carayon & Gürses, 2005:287). The objectives of this study therefore are to explore and describe the experiences of registered nurses of their work environment in a critical care unit and to make recommendations that will assist registered nurses working in a critical care unit. A qualitative, explorative, descriptive and contextual research design will be utilised. Data will be collected by means of semi-structured interviews and analysed according to the framework provided by Tesch (in Cresswell, 2003:192). Purposive sampling will be used to select a sample of registered nurses working in a critical care environment. Guba’s model (in Krefting, 1991) will be utilised to verify data and to ensure trustworthiness of the study. Ethical considerations will be adhered to throughout the study. Once data has been analysed, recommendations will be made that will assist registered nurses working in a critical care unit.

The literature has indicated that nurses perceive more occupational stressors than do other professional groups. HIV is a new stressor which has impacted on society, in particular on people caring for HIV/AIDS patients. The availability of antiretroviral treatment (ART) which is accessible at wellness clinics has improved the quality of life of people with HIV and greatly prolonged the lives of many infected people. Wellness clinics are out-patient clinics where HIV positive patients receive their ART. This study has explored and described the occupational stressors perceived by nurses working in wellness clinics in Nelson Mandela Bay. The study was conducted using a qualitative research approach. Convenience sampling was used consisting of voluntary registered female nurses. The data were collected by means of semi-structured interviews. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using Tech’s method. The nurses who participated in this study reported their perceptions of occupational stressors in wellness clinics where they worked. The occupational stressors perceived by the nurses included the working environment, interpersonal relationships and the organizational structure. However, they also reported that they experienced satisfaction from their jobs despite the perceived stressors.