M.Cur. (Intensive General Nursing) / Tegnological and scientific progress inevitable. The nurse working in a present, had to obtain the knowledge and to work in her area of specialization. makes specialization specialized unit at skill that she needed It is expected of a general nurse, working in a postacute care unit, to co-ordinate, implement, interpret and evaluate the different and divergent aspects of terapeutic care prescribed by a specialist. The nurse as generalist needs the additio~al support of a Clinical Nurse Specialist with advanced knowledge and nursing skills. The Clinical Nurse Specialist must be able to assist the general nurse in giving effective and quality nursing care. A exploratory and descriptive survey was undertaken by means of a interview, questionnaires and a patient acuity classification system. Data was obtained from Senior Nursing Service Managers, Nursing Service Managers, Chief Professional Nurses, senior and junior registered nurses. The purpose of the study was to determine the desirability of and functions of a Clinical Nurse Specialist in a postacute care unit. Analysis of the data obtained indicated that there is a need for. a Clinical Nurse Specialist to assist with specialized nursing care and to assure continuity of care when a patient is moved from a critical care unit to a postacute care unit.

Thesis (NCur (Nursing Science))--University of Stellenbosch, 2008. / The current shortage of nurses has reached crisis proportions in South Africa and the effects of decreased numbers of health professionals are enormous. This results in far-reaching consequences for the health industry. An increased use of less-skilled personnel, in an attempt to meet the health care needs, impacts negatively on quality care. Personnel are often utilised outside their scope of practice, creating a high-risk therapeutic environment for the patients and health care workers alike. Consequently, the nursing managers and employers of nurses are currently faced with major challenges in ensuring that the nurses practise their profession within a safe and healthy environment, and within the legal and ethical framework of the nursing profession. For the purpose of this study the researcher decided to explore legal and ethical aspects influencing the clinical practice of the nurse. Specific objectives were set for the study. • Are nurses functioning outside their scope of practice? • Do nurses exercise their nursing right? • Do nurses function within ethical and legal guidelines? • Do caregivers function as nurses? • Do nurses still believe in the nursing philosophy? • Are nurses exploited in their area of work? • How much overtime do nurses work? These objectives were met through an in-depth explorative descriptive research design with a quantitative approach to explore legal and ethical aspects in the nursing practice. A stratified sample was drawn of all categories of nurses in selected private hospitals in the Western Cape Metropolitan area. Through the use of a questionnaire, data was collected personally by the researcher. Data analysis techniques that were used were based on descriptive and explorative procedures. Data was compressed in frequencies, percentages, means and standard deviations. The Chi-square test was applied. Findings include the following: • 53% of enrolled nursing assistants do not function under indirect supervision. • 40% of caregivers assist nurses with interventional nursing care. • Nurses still believe in the philosophy of the nursing profession. • The nurse’s rights are in contradiction with the patient’s rights (p = 0.08). • Nurses feel exploited in certain areas of work, depending on their qualifications. • Nurses do recommend the profession (p = 0.043). • Enrolled nursing assistants do not respect other religions (p = 0.04). • Nurses feel free to discuss the patient’s progress with the doctor depending on the nurses’ years of experience (p = 0.03). • 23% of nurses love to care for their patients. Recommendations were made based on the findings. • The patient approach should be respectful, not judgemental, accepting the patient’s right to self-autonomy. • Nurses should realise their autonomous role in addressing concerns. • A staff mix should be utilised that facilitates safe and professional nursing care. • Unfavourable or unsociable working conditions in some units such as the theatre should be addressed. • Managers should match the work load with a proper skills mix and competency. • Nursing practice should take place within the professional and statutory scope of practice of the nurse. • Nurses should keep up to date with knowledge through continuous professional development. • Caregivers should be regulated, installing the nursing philosophy and ethics into their practice.

Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: In South Africa, currently enrolled nurses make up the largest proportion of members of the nursing healthcare team. As in direct contact with patients it is essential that the practice environment supports patient and nursing outcomes. Studies confirm the complexity of the practice environment and the impact on both personnel and on the quality of nursing care provided. Job satisfaction is integrally linked to the quality and safety of care provided. The scarcity of registered professional nurses, particularly in the South African context, has resulted in enrolled nurses being widely used to continue to deliver acute care in quite complex situations. It is well documented that the use of suboptimal nursing personnel levels or substituting enrolled nurses for registered professional nurses is associated with an increase of adverse events such as infections, pressure ulcers and unanticipated death. The purpose of this study was to explore the experiences of enrolled nurses regarding quality nursing care in general nursing units in the private healthcare setting. The objectives being: - The exploration of the enrolled nurses understanding of the concept of quality care - The exploration of the enrolled nurses understanding of her value and contribution to quality care and - The exploration of the enrolled nurses experiences (positive and negative) of quality nursing care in private health care setting A descriptive qualitative methodology was applied. A purposive sample size of n=13 was drawn from the total population of N=387. An exploratory interview was completed. Lincoln and Guba’s criteria of credibility, transferability, dependability and confirmability were applied and ethical principles were met. Findings demonstrated that enrolled nurses experienced both positive and negative work experiences, some more negative than others. They had a very good understanding of quality care but had difficulty in reconciling the patient’s needs with what they were able to deliver, due to workload pressures and resource constraints: P6: “I miss the quality because that patient that needs just that back rub or just to hold his hand ...the thing is with quality nursing we don’t do quality nursing on the patient anymore.” Most participants experienced registered professional nurses absolving their clinical supervisory responsibility. This endangers the quality and duty of care of patients and is a legal liability. A recommendation is that registered professional nurses require professional development through utilising good role models. This exposure to positive learning experiences will enable their professional development and ethical behaviour. Registered professional nurses need to be taught the skills of how to be team players. / AFRIKAANSE OPSOMMING: Ingeskrewe verpleegsters maak huidiglik die grootste deel van die verplegingsspan se gesondheidsorg uit. As gevolg van die direkte kontak met pasiënte, is dit belangrik dat die omgewingspraktyk pasiënt- en verpleeguitkomste moet kan ondersteun. Navorsingsstudies bevestig die kompleksiteit van die omgewingspraktyk en die impak wat dit op beide personeel en op die kwaliteit van verpleging wat verskaf word, het. Werksbevrediging vorm ’n geïntegreerde skakel met die kwaliteit en veiligheid van sorg wat verskaf word. Die tekort aan geregistreerde professionele verpleegsters, veral binne die Suid-Afrikaanse konteks, het tot die gevolg dat ingeskrewe verpleegsters oral gebruik word om akute sorg in taamlik komplekse situasies te lewer.. Dit is goed gedokumenteer dat die gebruik van suboptimale verpleegpersoneelvlakke of die vervanging van geregistreerde professionele verpleegsters met ingeskrewe verpleegsters, geassosieer word met ’n toename in nadelige gevalle soos infeksies, druk-ulkusse en onverwagte dood. Die doel van hierdie studie is om die ervaringe van ingeskrewe verpleegsters ten opsigte van die kwaliteit van verpleegsorg binne algemene verpleegeenhede in die private gesondheidsorgomgewings te ondersoek. Die doelwitte is ’n ondersoek na die ingeskrewe verpleegsters se: - begrip van die konsep van kwaliteitsorg - begrip van hul waarde en bydrae tot kwaliteitsorg en - ervaringe (positief en negatief) van kwaliteit verpleegsorg binne private gesondheidsorgomgewings. ’n Beskrywende, kwalitatiewe metodologie is toegepas. ’n Doelgerigte steekproefgrootte van n = 13 is geneem uit die totale populasie van N = 387. ’n Voortoets is voltooi. Lincoln en Guba se kriteria van geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestigbaarheid is toegepas en etiese beginsels is nagekom. Bevindings het bewys dat ingeskrewe verpleegsters beide positiewe en negatiewe werkservaringe gehad het; sommige meer negatief as ander. Hulle het ’n baie goeie begrip van kwaliteitsorg, maar vind dit moeilik om aan die pasiënt se behoeftes, vanweë drukkende werkladings en beperkte bronne te voldoen. P6: “Ek mis die kwaliteit want al wat die pasiënt benodig is die vryf van die rug of net die vashou van sy hand…die probleem met kwaliteitsorg is dat ons nie meer kwaliteitsorg op die pasiënt doen nie.” Die meerderheid van die deelnemers verklaar dat die geregistreerde professionele verpleegkundiges hulle kliniese toesighoudende verantwoordelikheid afskeep. Die gedrag is bydraend tot swak kwaliteit pasient sorg en het direkte wetlik implikasies. Die aanbeveling is dat professionele ontwikkeling van geregistreedrde verpleegkundigies verbeter kan word deur gebruik te maak van goeie rol modelle. Die blootstelling aan positiewe leer ervarings en omgewing sal bydrae tot hulle professionele ontwikkeling en etiese gedragspatrone. Geregistreerde verpleegkundiges moet die vaardighede aanleer om as deel van ’n span te kan funksioneer.

The study explored moral and ethical dilemmas experienced by Black nurses in a local community clinic. In particular, it examined the influences of the concept of self or personhood in nurses' ethical and moral decision-making. Influences of culture and family on morality were also investigated. Using the interview methodology developed by Gilligan (1982), nurses were asked to tell stories involving moral dilemmas in their work. Interviews were analysed using the voicecentred relational method. This method involves reading the interview narratives a number of times, each reading focusing on a particular aspect of a respondent's narrative. Results show that nurses often find themselves caught between two opposing moral and ethical viewpoints in their practices. On the one hand are hospital procedures, which are informed by universalist approaches to the person and the moral. From these are derived ethical principles emphasizing individual autonomy and choice. On the other hand, the majority of patients subscribe to a communal view . ofpersonhood. From this perspective, to be moral entails knowing one's position and responsibilities within family and community. Dilemmas arose from nurses' identification with patients' moral perspectives while realizing that this could lead to "unethical" conduct, (given , their training and current codes of ethics). It is recommended that moral and ethical deiiberations should dialogue with alternative, marginalised, viewpoints, in order to be culturally responsive. It is further recommended that ethics be conceptualised as a practical-moral engagement, rather than a detached application of knowledge. / Thesis (M.Soc.Sc.)-University of Natal, Pietermaritzburg, 2000.

Thesis (MA (Psychology))--University of Stellenbosch, 2007. / Much research has focused on the social and psychological dimensions of nursing; yet we have not identified the thoughts and feelings of health care professionals as a priority in trying to understand a variety of nursing phenomena. There is a need to explore how nurses understand their social and psychological worlds, specifically with regards to the phenomena of violence, abuse and neglect within health care. Therefore, this study has attempted to answer the following research question: How do nurses understand and talk about the occurrence of violence towards patients? The research question demanded the use of qualitative methods to collect and analyse data. In-depth interviews, consisting of open-ended questions were conducted. 11 female participants were enlisted from a tertiary hospital labour ward in Cape Town by means of convenience sampling. Data were transcribed and analysed using a combination of methods. In addition to more traditional methods, I have also included autoethnography in this thesis.

Globally, the nursing profession is faced with a decline in school-leavers’ interest in nursing as a career. The decline in school leavers entering the nursing profession poses a threat to the future of nursing because, globally, the average age of nurses in many countries exceeds 40 years (International Council of Nurses, 2008). The role of marketing in attracting school leavers to careers of choice is well documented; however, there is a lack of documented marketing attempts by Nursing Education Institutions to market nursing as a career at secondary schools in the Nelson Mandela Bay Municipality. The purpose of the study was to determine the views that grade nine learners have regarding the marketing of nursing as a career to attract school-leavers to the profession. The researcher also explored and described how grade nine learners are being informed or wish to be informed of nursing as a career. Based on the findings of the study, broad guidelines were developed for nurse educators at Nursing Education Institutions so as to facilitate the marketing of nursing as a career for school leavers. To achieve the purpose of this study, a quantitative, explorative, descriptive and contextual study design was used. The study was conducted at selected senior secondary schools in the Nelson Mandela Bay Municipality. The research population in this study comprised of all grade nine learners at secondary schools in the Nelson Mandela Bay Municipality. A simple random sampling method was used to select participants. A structured self-administered questionnaire was used as the data collection tool. The data collected were analysed with the help of the statistician, using descriptive and inferential statistics. The study findings revealed that grade nine learners in the Nelson Mandela Bay Municipality had a positive response to choosing nursing as a career and that schools situated in the lower socio-economic areas had the highest percentage of grade nine learners indicating an interest in nursing as a career. The study concludes with recommendations for nursing practice, education and research. Ethical principles have been maintained throughout the study.

The nursing student who has undergone the four year diploma or degree training as a nurse also has to undergo compulsory community service as a requirement before she/he can be registered as a qualified professional nurse. While it has been compulsory for other health professionals such as doctors, dieticians or dentists to place students in compulsory community service, it has only been compulsory for nursing students since 2008. This means that the practice is relatively new in nursing and it is not clear how the newly qualified professional nurse experiences compulsory community service (CCS). The overall goal of this study is to determine the experiences of professional nurses placed at the state hospitals in Nelson Mandela Bay regarding compulsory community service clinical placement exposure and to use these descriptions to develop guidelines. The study followed a qualitative, exploratory, descriptive, contextual design. Literature was reviewed in order to identify research that was done previously regarding compulsory community service amongst health care professionals. The research population included professional nurses who underwent compulsory community service in the three state hospitals in the Nelson Mandela Bay. Purposive sampling was utilised to identify the participants. Semi-structured interviews were conducted to collect information and field notes were kept. The interviews were transcribed and Tech’s (1990) in Creswell, 2009:186) eight steps of data analysis were followed to create meaning from the data collected. An independent coder assisted with the coding process to ensure the trustworthiness of the findings. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness which consists of the following four constructs, namely credibility, transferability, dependability and conformability (Lincoln & Guba, 1999, as cited in Schurink, Fouche & de Vos, 2011:419- 421). Three themes and sub themes were identified. Literature control was done to compare the findings with existing research results. The researcher ensured that the study was conducted in an ethical manner by adhering to ethical principles such as beneficence, justice and fidelity. All the participants in the study felt that the clinical placement exposure was a worthwhile experience. The participants expressed a feeling of gratitude that they were afforded this opportunity of practicing under the guidance of experienced professional nurses. To them it was an opportunity to master whatever they were taught as student nurses so that by the time they practice as independent practitioners they would be confident and knowledgeable. The CCS nurses indicated that orientation and mentorship were not always of good quality and professional nurses were not always available as in some units professional nurses were not readily accessible. The CCS nurses were left alone and isolated with no one to consult. If proper orientation and mentorship had been in place the CCS nurses would have enjoyed the community service year more and they felt that they would have benefited more. Had there been a mentoring system in place it could have gone a long way to ascertain that the participants gained confidence and were able to perform tasks independently and confidently. The participants overwhelmingly indicated that unit management should have been included in their CCS year placement. During the CCS year the CCS nurses were not exposed to unit management. This was seen by CCS nurses as a missed opportunity. Had they been afforded the opportunity to practice unit management under the supervision of unit nursing managers, professional growth and development in unit management could have been facilitated. That they were not afforded that opportunity deprived them of a valuable skill as well as personal and professional growth. In conclusion guidelines for placement of CCS nurses in the Nelson Mandela State hospitals have been formulated for implementation. Recommendations were made to enhance nursing practice, nursing education and nursing research.

Submitted in fulfillment of requirements for the Degree of Master of Technology: Nursing, Durban University of Technology, Durban, South Africa, 2015. / Introducion Mental health nurses face challenging positions in practice. They are required to support and care for people hospitalised for treatment of mental illnesses on their recovery journeys but are also expected to manage ward administrative tasks, admit patients, attend meetings, dispense medication and communicate with patients (Gunasekara, Pentland, Rodgers and Patterson 2014: 101; Fourie, Mc Donald, Connor and Bartlett 2005: 135). It has been suggested that mental health nurses spend more time managing the ward environment and staff matters resulting in little time to develop and maintain therapeutic patient relationships (Fourie et al. 2005: 135). Problem Statement Research conducted in other countries identified the roles of the psychiatric nurse and mental health care nurses as attending to patients’ basic needs, assistance with self-care activities, monitoring and administering medication, ensuring safe environments in the health care setting and health education (Rungapadiachy, Madill and Gough 2004; Bowers 2005; Seed, Torkelson and Alnatour 2010). Although there is evidence of studies in psychiatric and mental health nursing locally, little is known about the roles of registered nurses and psychiatric nurses at in-patient facilities. OBJECTIVES • To explore which mental health problems are most commonly seen amongst psychiatric patients at these facilities. • To investigate the challenges faced by psychiatric nurses when caring for psychiatric patients. • To investigate what specialized knowledge and skills are required when nursing such patients. • To investigate whether their education and training prepared them adequately to deal with psychiatric patients and suggest guidelines to strengthen nursing education. METHODOLOGY The study utilized a quantitative non-experimental descriptive design to survey registered nurses and psychiatric nurses at in-patient psychiatric facilities in KwaZulu-Natal. A census was utilized in this study as the entire population was sampled. Data were collected using survey questionnaires. Phase two of the study, qualitative content analysis of Psychiatric nursing curricula strengthened the survey findings. FINDINGS Findings of this study showed that 98.4% of respondents believe psychiatric nursing care is an important aspect of holistic nursing practice. Respondents agree that challenges are commonly encountered in psychiatric nursing practice and that they are prepared to deal with these patients. However the aspects most frequently identified as needing greater attention in the Psychiatric nursing curricula were The Mental Health Care Act no 17 of 2002 and practical management of aggression, violence and de-escalation / M

Conflict exists in all health care settings across the world. In a profession such as nursing, where there is constant interaction among staff, conflict is a common and often unavoidable challenge. Conflict represents a state where two parties have differing views on issues considered important to each of them. There are various forms of conflict such as intrapersonal, interpersonal, inter-group and/or inter-organisational conflict. While not all conflict can be managed or requires the need to be managed, learning how to manage it, may reduce the chances of it recurring or producing negative consequences. The inappropriate management of conflict has been reported to contribute to decreased productivity, poor morale and financial loss in and for healthcare organisations. The goal of this study was to make recommendations regarding how to optimise conflict management by Nurse Unit Managers (NUMs). A qualitative, explorative, descriptive and contextual research study was conducted to explore and describe the ability of NUMs to manage conflict in the nursing units of the Nelson Mandela Bay public hospitals. NUMs working in the three (3) public hospitals of the Nelson Mandela Bay Municipality situated in the Eastern Cape Province of South Africa were interviewed using unstructured individual interviews to collect meaningful data on how the NUMs would manage conflict based on a conflict scenario presented to them. Data was directly collected from the participants. The researcher developed a conflict scenario and the model answer in consultation with experts in both nursing management and human resource management. This was done to relate the responses and themes from the data collected with what literature suggest as the appropriate management of conflict. Tesch’s method of thematic synthesis was utilised to analyse this data. Recommendations were developed for nursing practice, nursing education and nursing research. Data was collected from eleven NUMs with each of the participating hospitals represented in the interviews. Unstructured interviews were conducted. The unstructured interview consisted of one central question and probing questions. This was done for all the interviews until data saturation was reached. The data collected was then transcribed and coded yielding the themes and sub-themes for this study. The model answer was then used to gauge the responses of the participants in comparison to what literature suggests regarding effective conflict resolution and management. The three themes that emerged from the data were Nurse Unit Managers managed the conflict in an appropriate manner, Nurse Unit Managers avoided the conflict and Nurse Unit managers did not apply the accepted process to manage the conflict. Thereafter the ability of NUMs to manage conflict in a nursing unit was described based on the findings. The researcher ensured trustworthiness by using Guba and Lincoln’s criteria, namely credibility, dependability, conformability, transferability. The participants’ rights and dignity were protected and the integrity of the study safeguarded by complying with the following ethical principles: autonomy, beneficence and non-maleficence, justice, privacy and confidentiality as well as authenticity. The limitations of the study were that only NUMs from the general hospitals in the public sector participated in the study and therefore the ability of NUMs in other types of hospitals and the private sector are not known. Other levels of nursing management were not included in the study. The findings in this study could be integrated into the orientation, training and preparation of nurse managers by health care organisations and educational institutions as well as Human Resource Management practices.

A qualitative, non-experimental, explorative and descriptive research design based on the phenomenological philosophical tradition by Heidegger to broaden hermeneutics was conducted. The study was conducted at Umkhanyakude District to investigate the perspectives of eligible nursing students relating to the provision of spiritual care to patients. A purposive sample of 9 participants was recruited and consent form obtained. An unstructured interview guide, with a grand tour question, was used to conduct face to face individual interviews. The Thematic analysis and interpretative phenomenological method of analysis were employed until three themes, six categories and eleven subcategories emerged from the data. Data analysis revealed that nurses had difficulty to differentiate spiritual care from religious care. Commonly cited methods of providing spiritual care were prayer, reading sacred text and singing spiritual songs. Nurses still felt inadequately prepared educationally on how to provide spiritual care in nursing practice. Most of the participants provided spiritual care out of their own interest and not as part of their professional responsibility. Recommendations proposed that the matter be taken up by nurse managers to conduct related in-service education and mentoring programs and nurse educators to guide curriculum planning which evidently include spiritual care. / Health Studies / M.A. (Health Studies)