As the baby boomer generation move inexorably towards retirement and the requirement for health care services increases, the supply of nurses available to provide care at the patient bedside is forecast to fall significantly short of demand. This thesis has explored the perspectives of midlife nurses, asking what it would take to keep them in bedside practice until retirement. These nurses have provided insights which offer employers of valuable senior nurses, suggestions for maximising their potential. Through the use of questionnaires and focus groups nurses aged 45 years and over were asked what the employer can do to ensure that they are able to continue to work at the patient bedside until they reach the age of retirement. The results of this research demonstrate a workforce of nurses who are passionate and committed to their profession, but feeling disillusioned and disempowered. The nursing environment has changed over the span of their career and they find the increased workload, together with increasing professional demands, too hard to cope with. They feel they have no control over their workload, their shift patterns, or the expectations of their patients and colleagues. They want their experience to be recognized but they do not want to have to prove competency; they want to have a voice but they are unwilling to pursue postgraduate education to learn how to become visible and emancipated.

As the baby boomer generation move inexorably towards retirement and the requirement for health care services increases, the supply of nurses available to provide care at the patient bedside is forecast to fall significantly short of demand. This thesis has explored the perspectives of midlife nurses, asking what it would take to keep them in bedside practice until retirement. These nurses have provided insights which offer employers of valuable senior nurses, suggestions for maximising their potential. Through the use of questionnaires and focus groups nurses aged 45 years and over were asked what the employer can do to ensure that they are able to continue to work at the patient bedside until they reach the age of retirement. The results of this research demonstrate a workforce of nurses who are passionate and committed to their profession, but feeling disillusioned and disempowered. The nursing environment has changed over the span of their career and they find the increased workload, together with increasing professional demands, too hard to cope with. They feel they have no control over their workload, their shift patterns, or the expectations of their patients and colleagues. They want their experience to be recognized but they do not want to have to prove competency; they want to have a voice but they are unwilling to pursue postgraduate education to learn how to become visible and emancipated.

A qualitative, grounded theory study was undertaken to explore and describe how nurses conceptualise spiritual nursing care, and how they integrate spiritual nursing care in practice. An in-depth literature review through concept analysis on the phenomenon was conducted to assist the researcher with theoretical sensitivity and theoretical saturation. In-depth Individual interviews and focus group interviews were conducted to generate data. Interviews were audio-taped and transcribed by the researcher verbatim. Symbolic Interactionism was the philosophical base for the study. Data analysis was done through the use of the NUD*Ist computer soft ware programme version 4.0. The direct quotes of participants were coded and arranged into meaning units for analysis. A constant comparison method of data analysis was applied by following a process of open, axial and selective coding. Tech’s (1990:142-145) eight steps of analysis to analyse textual qualitative data was used until themes, categories and subcategories were identified and developed. Data analysis revealed that nurses had difficulty to differentiate spiritual nursing care from emotional, psychological or religious care. Nurses still felt inadequately prepared educationally on how to integrate spiritual nursing care in nursing practice. A Humane Care Model and practice guidelines were developed to guide nurses in clinical practice on how to provide such care. Recommendations proposed that the matter be taken up by nurse managers, educators and nurse clinicians to guide nurses in this regard. / Health Studies / D. Litt. et Phil. (Health Studies)

A formação pedagógica para a docência universitária no âmbito da pós-graduação stricto sensu enfrenta desafios. Os espaços para tal formação mostram-se reduzidos na universidade. A prioridade dada à formação para a pesquisa reforça a necessidade de valorizar a docência, bem como sua formação no âmbito da pós-graduação. Discute-se centralmente a importância dos conhecimentos específicos, articulados com os pedagógicos de modo que estes tragam subsídios para o professor atender mais plenamente às necessidades formativas. O estudo objetivou então, fazer uma reflexão sobre a percepção do pós-graduando acerca da formação docente, considerando os novos paradigmas que se instalam no campo da educação e da saúde. Trata-se de revisão sistemática da literatura, cujo objetivo foi levantar dados sobre o processo de formação docente na pós-graduação em Enfermagem considerando a importância de sintetizar e categorizar os estudos primários, realizados no Brasil no período de 2000 a 2012, sobre o assunto em apreço. A amostra foi constituída por dez estudos dos quais indentificou-se as situações-limites através da fala dos pós-graduandos com relação à formação pedagógica para a docência no ensino superior. Nota-se que os espaços destinados ao ensino na pós-graduação são incipientes para atender a demanda da formação docente. Contudo muitos pós-graduandos identificaram como espaços para a formação pedagógica, a existência de algumas disciplinas que fundamentam as questões relativas ao ensino e aprendizagem, além da reflexão sobre paradigmas que identificam posturas e características docentes, entre outros aspectos, bem como o Programa de aperfeiçoamento de ensino (PAE), como uma oportunidade relevante de aproximação com as questões mais amplas que dizem respeito ao processo do ensino superior e seus desafios no século XXI. / The pedagogical preparation for university teaching in the post-graduate programs faces challenges. Spaces for this development turned out to be very limited at university. The priority given to research training reinforces the need to enhance the professorship as part of their graduate program. It discusses the importance of expertise, articulated with the pedagogical knowledge so that it is beneficial for the teacher to more fully meet preparation needs. Then, the study aimed to reflect on the perception of the graduate student about teacher education, considering the new paradigms settled in education and health. This is a systematic review of the literature, whose goal was to collect data about the process of teacher education in graduate nursing, considering the importance of categorizing and synthesizing primary studies carried out in Brazil from 2000 to 2012, on the subject in appreciation. The sample consisted of ten studies which identified the limit situations through the speech of graduate students regarding pedagogical preparation for teaching in higher education. Note that the spaces for teaching in graduation are incipient to meet the demands of education. Yet, many graduate students identified as main spaces for exercising teaching knowledge, the existence of some courses concerning issues related to teaching and learning, and reflecting on paradigms that identify pedagogical postures and faculty characteristics, as well as Brazilian Improving Teaching Program, as a significant opportunity for rapprochement with the broader issues that concern the process of higher education and its challenges in XXI century.

Thesis (MTech (Human Resource Management))--Cape Peninsula University of Technology, 2015. / Occupational challenges exist in all working environments, and affect all levels of organisational personnel from top management to employee levels. State hospitals in South Africa place occupational demands mainly upon registered nurses who make up most of the hospital staff. The focus of the research investigation concentrated mainly on a population of three groups of registered nurses at a state hospital in Cape Town. They are staff nurses, professional nurses and enrolled nursing assistants. These nurses are experiencing a decline in morale, due to staff shortages, a lack of resources and a perceived lack of leadership. They experience various levels of stress, which affect their personal health and morale. The objective of the research was to analyse the impact on the state registered nurses of three main contributors of occupational challenges faced by these nurses, namely a lack of resources, staff shortages and a perceived lack of good leadership. The nurses are employed to provide quality care for patients in state hospitals.

Trata-se de uma pesquisa qualitativa cujo objeto é a percepção da enfermeira sobre a prática do aleitamento materno no contexto da feminilização da Aids. Tem por objetivos: analisar a percepção das enfermeiras de maternidade sobre a prática do aleitamento materno e a feminilização da Aids e discutir a prática da enfermeira em relação ao aleitamento materno a partir da feminilização da Aids. Os sujeitos do estudo foram nove enfermeiras de três maternidades municipais do Rio de Janeiro que possuem título de Hospitais Amigo da Criança. A coleta de dados foi realizada através de entrevistas semi-estruturadas. A técnica de análise do conteúdo foi baseada em Bardin. Emergiram três categorias: a) A percepção da enfermeira sobre sua prática quanto ao aleitamento materno; b) As percepções da enfermeira sobre a feminilização da Aids; c) A prática da enfermeira em relação ao aleitamento materno a partir da feminilização da Aids. Constatamos que a enfermeira percebe sua prática em relação ao aleitamento materno sob influência das Políticas Públicas voltadas para a promoção e proteção do mesmo, como a Iniciativa Hospital Amigo da Criança e o Alojamento Conjunto. Em relação à Aids, o advento da feminilização surpreende as enfermeiras que reagem com indignação, tristeza, medo e angústia. Estes sentimentos justificam-se, pois, para elas, pensar soropositividade em mulheres significa privá-las de exercer sua saúde reprodutiva e sexual plenamente, ou seja, os papéis esperados socialmente de uma mulher, como ser mãe e amamentar. A condição social e sexual da mulher (gênero) também emergiu dos depoimentos como determinantes para soropositividade. Ao perceberem sua prática às mulheres soropositivas nas maternidades, as enfermeiras apontam dificuldades geradas pela dicotomia (incentivo ao aleitamento materno e inibição da lactação) tanto para elas profissionais quanto para as mulheres que não podem amamentar. O processo de feminilização e os investimentos e recursos voltados para este acarretaram mudanças na prática da enfermeira, que refere mais segurança pessoal após disponibilização de teste rápido para HIV e cursos de capacitação para os profissionais. Além da prática voltada para as questões técnicas, apontam uma nova abordagem às mulheres soropositivas, como o objetivo de não expô-las às outras puérperas nas enfermarias de alojamento conjunto. Desta maneira, constatamos que as mudanças ocorridas nas práticas das enfermeiras estão relacionadas com o estabelecimento de políticas públicas voltadas para a amamentação e o HIV/Aids. Os valores pessoais ainda interferem na prática das enfermeiras, e a Aids ainda é vista como uma doença possuidora de estigmas tanto sociais quanto culturais. Reforçamos a necessidade de estratégias que possam diminuir a divergência das Políticas de Incentivo ao Aleitamento Materno e as de Prevenção à Transmissão Vertical, a fim de qualificar a prática de enfermagem às mulheres soropositivas. / This is a qualitative research whose object is the nurses perception about the practice of breastfeeding in the context of the feminization of Aids." The objectives: to analyze the maternity nurses perceptions on breastfeeding practices and the feminization of Aids and discuss the nurse's practice in relation to breastfeeding from the feminization of Aids. The subjects of the study were nine nurses from three maternity hospitals in Rio de Janeiro which possess the title Hospital Amigo da Criança. Data collection was conducted through semi-structured interviews. The technique of content analysis was based on Bardin. Three categories emerged: 1) The nurses perception about her/his practice regarding breastfeeding, 2) The nurses perceptions on the feminization of Aids, 3) The nursing practice in relation to breastfeeding from the feminization of Aids. We found out that nurses perceive their practice in relation to breastfeeding under the influence of public policies that aim its promotion and protection, as the Iniciativa Hospital Amigo da Criança and Alojamento Conjunto. Regarding Aids, the advent of the feminization surprised the nurses who react with anger, sadness, fear and anxiety. These feelings are justified, because to them, thinking soropositivity in women means to deprive them from exercising their full sexual and reproductive health, in other words, the socially expected roles of a woman as to become a mother and to breastfeed. The social and sexual condition of women (gender) also emerged from interviews as determinants for soropositivity. Realizing their practice to HIV positive women in maternity wards, the nurses pointed the difficulties created by the dichotomy (breastfeeding promotion and inhibition of lactation) for both them, professionally, and the women who cannot breastfeed. The process of feminization and the investment and resources toward it led to changes in nursing practice, which refered to more security with the availability of fast HIV testing and training courses for the professionals. Besides the practice focused on technical issues, the nurses pointed to a new approach to HIV positive women, as the intention of not exposing them to other mothers in rooming wards. Thus, we found out that the changes in the nurses practices are related to the establishment of public policies for breastfeeding and HIV / Aids. Personal values continue to influence the practice of nurses and Aids is still seen as a disease with both social and cultural stigmas. We emphasize the need for strategies that can reduce the divergence between the Policies Encouraging Breastfeeding and the ones for Prevention of Vertical Transmission in order to qualify the practice of nursing women living with HIV.

Este estudo busca desvelar o que é isto a prática da profissional enfermeira em hospitais públicos, segundo abordagem fenomenológica na tentativa de compreender as experiências vividas pelas enfermeiras no cotidiano de hospitais públicos. O processo de compreensão está fundamentado na fenomenologia social de Alfred Schütz, o que possibilitou desvelar a ação social da profissional enfermeira. O acesso às vivências das enfermeiras deu-se através de entrevista não diretiva diante da questão orientadora: Poderia me dizer como é o seu trabalho como enfermeira aqui no hospital? A análise das descrições permitiram a compreensão do típico da prática da enfermeira revelando revestir-se de grande complexidade. Os graus de complexidade são derivados da intensa relação face a face que acontece no ato de cuidar de outro na sua singularidade; das relações com as outras práticas de atenção a saúde; das limitações da formação técnica da enfermeira que se mostra insuficiente para dar conta dos fenômenos sociais presentes no mundo vivido no hospital; dos enfrentamentos cotidianos diante dos avanços científicos e tecnológicos que exigem reflexão profissional para incorporar-los no cuidado. A fenomenologia social de Alfred Schütz contribuiu para compreender a ação social das enfermeiras como grupo que se insere numa trama de relações sociais intersubjetivas derivadas da coexistência e convivência de uma temporalidade e um espaço comum de trabalho. / This study aimed to uncover the practice of nursing professionals in public hospitals, adopting a phenomenological approach, in an attempt to understand the experiences of nurses in the daily reality of public hospitals. The understanding process is based on the social phenomenology of Alfred Schütz, which allowed us to uncover the social action of nursing professionals. Access to nursing experiences was obtained through non-directive interviews, in view of the question: Could you tell me how your work is as a nurse here at the hospital? The analysis of their descriptions allowed for the understanding of what is typical about nursing practice, which revealed to be highly complex. The complexity levels derive from the intense face-to-face relation that occurs in caring for the singularity of others; from the relations with other health care practices; from limitations in technical nursing formation, which reveals to be insufficient for dealing with the social phenomena present in the hospital world; from the daily confrontations with scientific and technological advances, which require professional reflection to be incorporated into care. The social phenomenology of Alfred Schütz contributed to the understanding of nurses’ social actions as a group that is inserted in a web of intersubjective social relations, which derive from the coexistence and experience of a common time and work space.

M.Cur. / In the basic vocational preparation of the student nurse, the field of clinical tuition takes on special significance due to the fact that the major part of the student nurse's professional preparation takes place within this field. The clinical practice offers a wide variety of learning opportunities and forms an indispensable bridge between the vast body of knowledge and the world of endeavour the student nurse has to master. There are, however, many traumatic experiences which deeply affect the student nurse in her involvement with the sick, with the result that she has need for an adult in whom she can confide. An adequate number of registered nurses with the necessary subject knowledge and professional skills should be available in the clinical practice in order to provide optimal accompaniment. The participation of the college tutor in clinical practice accompaniment once again manifested itself prominently following the affiliation of nursing colleges with universities. The National Health Council has formulated constitutional guidelines in terms of which accompaniment of student nurses by tutors has been made obligatory. According to the South African Nursing Council, accompaniment encompasses the conscious and purposeful guidance and support of the student nurse, by creating learning opportunities that make it possible for her to grow from passiveness to involvement to independent clinical practice. This process of accompaniment takes place in conjunction with the direct participation and physical presence of the tutor (SANC, 1988 : 4). Such active participation by the college tutor in the process of clinical practice guidance is not functioning optimally "at present. The purpose of the present study was to determine the extent of involvement by the college tutor in this process, and to establish certain guidelines for the implementation of effective participation. In order to obtain the necessary background for the study, a descriptive exploratory survey was undertaken by means of a questionnaire. Input was obtained from tutors, clinical training personnel and ward nurses. Analysis of the data indicated an urgent need for the active participation of the college tutor in the process of clinical practice guidance. . The planning, organisation, and implementation of nursing tuition at the college must be adapted to provide for the active participation of the tutor in this process. Clear guidelines with operational goals have been formulated with respect to the implementation of clinical practice guidance by the tutor.

M.Cur. (Nursing Education) / The competence of the newly qualified comprehensive diploma nurses has been a cause for concern to professional nurses in Swaziland. Once the diploma graduate nurses are deployed in the clinical health facilities, they tend not to display the expected competence when providing care to patients. This compromises the quality of care given to patients. The purpose of the study is to explore and describe the expectations of professional nurses regarding the competence of the newly qualified comprehensive diploma nurses in Swaziland rural clinical health facilities, in order to formulate strategies to improve their competence and subsequently improve nursing practice in general. A contextual, qualitative, exploratory, and descriptive research design was employed to explore the expectations of professional nurses regarding the competence of the newly qualified comprehensive diploma nurses in the Swaziland rural clinical facilities, thereby formulating strategies to improve practice. A purposive sampling method was used to select professional nurses in the rural clinical facilities of Swaziland who meet the inclusion criteria. The data was collected through focus group interviews. The focus group interviews were directed by the research questions. Data was analysed using the open coding qualitative method of data analysis as described by Tesch (in Creswell, 2007: 154 – 156). This method of data analysis was applied to reduce data from interview transcriptions into themes and categories. Trustworthiness was ensured by using the four criteria described by Lincoln and Guba’s model (1985), namely: credibility; transferability; dependability; and confirmability. Ethical considerations were in accordance with the Faculty of Health Science Committee for Academic Ethics (2005). The researcher obtained approval to conduct the study from the University Higher Degree and Ethics Committee, Scientific and Ethics Committee in Swaziland.

Abstract The purpose of this study was to develop a descriptive model of envy in nursing practice and nurse education environments. The context of nursing and the concept of envy were described in the first phase of the study. The aim of the second and third phases was to describe envy and its conceptual meaning in the nursing practice and educational communities. Data were collected by a questionnaire presented to 78 (N = 120) employees in one central hospital in 1994 and to 94 (N = 110) student nurses in one polytechnic of health and welfare in 1996 in Finland. The data were analysed using cross-tabulations and factor analysis. The construct validities of the questionnaires were good, but their construct reliabilities were only acceptable and partly even poor. The aim of the fourth phase of the study was to describe different opinions of envy. Data were collected from 64 (N = 100) student nurses in 1998. The aim of the fifth phase of the study was to describe envy and its conceptual meaning in nursing practice and nurse education environments. The material was collected by interviewing four lecturers from two polytechnics of health and welfare in 1998. A phenomenographic approach was used to analyse these materials. In the sixth phase of the study, the concept of envy, the positions of employees/students/lecturers and the relations between them, the managers and the other community members, the objects of envy and the methods of coping with envy and were shown. According to the model of envy, the position of an individual was defined by his/her experience of him/herself and his/her role in the community. The role was related to his/her tasks, individual actions and socioemotional factors. Envy was considered to pertain to the relations between individuals and groups, managers and objects of envy, such as professional knowledge, individual abilities and the individual's position of the community. The informants coped by themselves, co-operated in their tasks and worked with a task orientation. They shared a subjective feeling of busyness. The connections between the concepts were not tested. The concepts were assumed to be related to each other. The model of envy is hence hypothetical. This study produced new knowledge of envy in nursing practice and nurse education environments. The results can be used in nurse management and to improve curricula and collaboration. The methodological solutions can be used in other kinds of nursing research. / Tiivistelmä Tässä tutkimuksessa tarkoituksena oli kehittää malli kateudesta, joka kuvaa terveysalan käytännössä ja koulutuksessa ilmenevää kateutta. Tutkimuksen ensimmäisen vaiheen tehtävänä oli kuvata terveysalan kontekstia ja kateuden käsitettä. Toisen ja kolmannen vaiheen tehtävänä oli kuvata terveysalan käytännössä ja koulutuksessa ilmenevään kateuteen liittyviä tunnuspiirteitä. Aineistot kerättiin 1994 yhdessä keskussairaalassa työskennelleiltä 78 henkilöltä (N = 120) ja 94:ltä (N = 110) sosiaali- ja terveysalan opiskelijalta yhdessä ammattikorkeakoulussa kyselylomakkeella 1996. Aineistot analysoitiin käyttäen ristiintaulukointia ja faktorianalyysia. Kyselylomakkeiden rakennevaliditeetti oli hyvä. Sisäinen johdonmukaisuus oli hyvä ja osin kyseenalainen. Tutkimuksen neljännen vaiheen tehtävänä oli kuvata kateuteen liittyviä erilaisia käsityksiä. Aineisto kerättiin 64:ltä (N = 100) terveysalan opiskelijalta 1998. Tutkimuksen viidennen vaiheen (1998) tehtävänä oli kuvata terveysalan käytännössä ja koulutuksessa ilmenevään kateuteen liittyviä käsitteitä. Siksi haastateltiin neljä terveysalan opettajaa, jotka toimivat kahdessa eri sosiaali- ja terveysalan ammattikorkeakoulussa. Aineistot analysoitiin käyttäen fenomenografista lähestymistapaa. Kuudennessa vaiheessa kuvattiin terveysalalla ilmenevä kateuden käsite, työntekijän/opiskelijan/opettajan asema, suhde samassa yhteisössä toimijaan, johtajuuteen ja toiseen yhteisöön, kateuden kohteet ja kateudesta selviytymisen keinot sekä niihin liittyvät käsitteet, joiden avulla kehitettiin malli kateudesta. Kehitetyn kateuden mallin mukaan ihmisen asemaa kuvaa käsitys itsestä ja omasta roolista yhteisössä. Käsitykseen itsestä liittyy ammatillinen tyytyväisyys tai tyytymättömyys. Rooli on tehtäväkeskeinen, yksilöllinen ja sosioemotionaalinen. Kateus liittyy ihmisten keskinäisiin ja eri ryhmien välisiin suhteisiin sekä johtajuuteen ja kateuden kohteisiin (ammatilliseen osaamiseen, henkilökohtaisiin taitoihin ja ominaisuuksiin sekä asemaan yhteisössä). Terveysalan käytännössä ja koulutuksessa toimivat selviytyvät yksin, tekevät tehtävän mukaista yhteistyötä ja työskentelevät tehtäväkeskeisesti. Toimijoita yhdistää kiireen kokemus. Mallissa ei testattu muodostettujen käsitteiden välisiä suhteita, mutta oletetaan, että käsitteet liittyvät toisiinsa. Tuotettu malli kateudesta on hypoteettinen. Tutkimus tuottaa uutta tietoa terveysalan käytännössä ja koulutuksessa ilmenevästä kateudesta. Tuloksia voidaan käyttää terveysalan johtamisessa ja kehitettäessä opetusmenetelmiä ja yhteistoiminnallisuutta. Tutkimuksen menetelmällisiä ratkaisuja voidaan soveltaa myös muissa hoitotieteellisissä tutkimuksissa.