Study project (Mnutr) -- University of Stellenbosch, 2005. / ENGLISH ABSTRACT: Quality nursing care is characterised by clinical decisions based on critical and analytical thinking. The assessment, planning and implementation information which is used as basis for decision making must be recorded in the patient's record/file. The questlon is rai_sed whetherthe patient's record does indeed reflect critical and analytical thinking. The focus on the midwife's practices during professional conduct hearings which relate to intrapartum service delivery, led to the specific choice of population, namely intrapartum services delivery in Levell hospitals in the Western Cape. A non-experimental study whereby qualitative and quantitative data were collected, was performed in six (6) Levell hospitals. Check lists were compiled to evaluate the structure and facilities in which midwifery practice is executed. The records of 128 patients were analysed to specifically investigate the nature and extent of critical and analytical decisionmaking by midwives, and the extent to which the midwife really applies reflective practices. The results showed that record-keeping is not done optimally; that the partogram, which - - ---- is a comprehensive evaluation of the progress of_lab_2~1isJ not used and that the records did not indicate that the midwife applies critical and analytical thinking and acts accordingly. Recommendationsare that the proposals for the improvement of intrapartum service delivery, as made by Odendal (2004: ii-iv) and the Department of Health (2000: 42), are to receive immediate attention. It appears as if protocols and guidelines for emergency action and general safe practices do exist, but are not enforced. Continued inservice training receive priority attention. Core words: critical analytical thinking; midwife's practice and practices; intrapartum care service delivery / AFRIKAANSE OPSOMMING: Gehalte verpleegsorg word deur kliniese besluite wat op kritiese en analitiese denke gegrond word gekenmerk. In die pasient se rekord moet die ramings-, beplannings- en implementeringsgegewens gerekordeer word wat gebruik is as basis vir besluitneming. Die vraag ontstaan egter of die pasient se rekord wei kritiese en analitiese denke weerspieel. Die fokus op die vroedvrou se praktyke in professionele gedragsake wat met intrapartumsorgdienslewering verband hou, het tot die spesifieke keuse van die populasie, naamlik intrapartumsorgdienste in vlak 1-hospitale in die Wes-Kaapaanleiding gegee. 'n Nie-eksperimentele studie waartydens kwalitatiewe en kwantitatiewe data ingesamel is, is in ses (6) vlak 1- hospitale uitgevoer. Kontrolelyste is opgestel om die struktuur en fasiliteite waarbinne vroedvroupraktyke plaasvind, te evalueer. Die rekords van 128 pasiente is ontleed om spesifiek ondersoek in te stel na die aard en omvang van kritiese en analitiese besluitneming deur die vroedvrou, en tot watter mate die vroedvrou wei weldeurdagte praktyke toepas. Die resultate toon dat rekordhouding nie optimaal gedoen word nie; dat die partogram wat 'n omvattende evaluering van die kraamverloop is, nie gebruik word nie, en dat daar uit die rekords nie 'n aanduiding gevind kan word dat vroedvroue wei krities en analities dink en optree nie. Aanbevelings is dat die voorstelle ter verbetering van intrapartumsorgdienslewering 5005 gemaak deur Odendal (2004: iii-v) en die Departement van Gesondheid (2000: 42), indringend aandag moet geniet. Dit wil voorkom asof protokolle en riglyne vir noodoptrede en algemene veilige praktykvoering wei bestaan, maar nie toegepas word nie. Voortgesette indiensopleiding moet as 'n prioritieit aangespreek word. Kernwoorde: kritiese analitiese denke; vroedvroupraktykvoering; vroedvroupraktyke, intrapartumsorgdienslewering.

Thesis (MCur)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: Against the background of the approach to make the follow up care to oncology patients more accessible and with the emphasis on quality care, it was indicated that this service needs to be evaluated. A study based on a combination of qualitative and quantitative methods (also called triangulation) was conducted to formulate structure, process and outcome standards for a comprehensive follow up care for the oncology patients and to evaluate this service according these standards. The most important results are: • The quality of care relating to the structure standards was optimal regarding the organization of the patient's visits, follow up treatment and referrals. A suboptimal standard was found regarding the general management system. • In the process standards focusing on the physical and psychosocial needs of the patient, a suboptimal standard was found regarding all aspects. Nursing practice leading to subobtimal care of patients is a major cause for concern. • With the outcome standards reflecting in patient satisfaction, positive as well as negative opinions and perceptions were found. Recommendations include: • Upgrading of management systems • Empowerment of the nurses with knowledge and scientific competencies • Attention to the opinions and perceptions of the patients to completely involve the patient in the service and treatment process. Keywords: Oncology follow up service I formulation of structure, process and outcome standards. / AFRIKAANSE OPSOMMING: Teen die agtergrond van die benadering om opvolgdienste meer toegangklik te maak vir onkologiese pasiënte, met die beklemtoning van gehaltesorg, is dit aangedui dat hierdie diens geëvalueer moes word. 'n Studie gebaseer op 'n kombinasie van kwalitatiewe en kwantitatiewe metodes (genoem triangulasie) is uitgevoer om struktuur, proses en uitkomsstandaarde vir 'n omvattende opvolgdiens aan onkologiepasiënte te formuleer en die diens aan die hand daarvan te evalueer. Die belangrikste resultate is: • Die gehalte van sorg wat verband hou met die struktuurstandaarde was net optimaal ten opsigte van die organisasie van die pasiënt se besoeke, opvolgbehandeling en verwysings. 'n Suboptimale standaard is gevind ten opsigte van die algemene bestuurstelsel. • In die prosesstandaarde wat fokus op die fisiese en psigososiale behoeftes van die pasiënt, is 'n suboptimale standaard in alle aspekte gevind. Verpleegpraktyk wat lei tot suboptimale sorg van pasiënte is 'n groot bron van kommer. • Met die uitkomsstandaarde wat reflekteer in pasiënttevredenheid is positiewe maar ook negatiewe opinies en persepsies gevind. Aanbevelings sluit in: • Verbetering van bestuurstelsels • Bemagtiging van die verpleegkundige met kennis en wetenskaplike vaardighede • Aandag aan pasiënte se opinies en persepsies ten einde die pasiënt ten volle te betrek by die hele diens en behandelingsproses. Sleutelwoorde : Onkologiese opvolgdiens / formulering van struktuurproses en uitkomsstandaarde.

The healthcare strike action that rocked South Africa in 2007 and 2010 highlighted the trend of professional nurses towards exercising their rights as employees to embark on strike actions, often also in solidarity with other categories of employees. This study aimed to highlight the problem brought about by the lack of proactive strategies to maintain a balance between human and professional rights and responsibilities of nurses within the legal framework of South Africa. The theoretical grounding of the study included both organisational change models and transformational leadership models. A descriptive and analytic design was followed, using both qualitative and quantitative non-probability sampling approaches to meet the research objectives of determining factors for nurses‘ involvement in strikes and their impact. Eighty professional nurses were included as the total sample of the study with 53 that did not participate in strike action and 27 that participated in strike action. A sample of eleven nurse managers was also included in the study to determine their views on strikes by nurses and their understanding of the changing work environment. To determine the overall impact of the nurses‘ strike, 40 healthcare consumers were included. The sample was selected from four provinces: Eastern Cape, KwaZulu-Natal; Western Cape and Gauteng. The study was limited to professional nurses, nurse managers within the public-health sector and healthcare consumers using public-health facilities. The findings and the relevant literature referred to in this study indicate that though there are different reasons for strike action in the public-health sector by area or by country, remuneration is undoubtedly the most mentioned reason. Important to note is that salary per se is not the most critical actor but it is a tangible measure of the value that the employer places on people. In the absence of other incentives in the nursing environment, it becomes the focal point. However, addressing salary issues alone will not prevent strike action in the public-health sector / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study is to explore and describe the nature and extent of school health nurses’ roles and responsibilities in the prevention of drug abuse by learners in schools. The study was conducted at two high schools in Eldorado Park Extension 4 (Region G), in Johannesburg West. A mixed-methods (triangulated) research approach was opted for, in terms of which structured focus group interviews, self-administered questionnaires, and participant observations optimised and complemented the data collection process. The non-probability simple random sampling technique was utilised to select 35 research participants consisting of 9 (nine) educators, 1 (one) school health nurse and 25 community healthcare workers. The 1 (one) school health nurse and the 25 community-based healthcare workers were involved in the study by means of structured self-administered questionnaires, while the nine (9) educators (who were not part of the 26) only participated in the study’s two focus group interview sessions. Among others, the study’s findings indicate that the distribution of professionally trained and registered school health nurses is not yet proportionally commensurate to addressing the problem of drug and substance abuse in schools. There has been a need to augment the shortage of school health nurses with community-based school health workers. / Health Studies / M.A. (Nursing Science)

Recognising the enormous challenges in South Africa confronting the nursing of the mentally ill, the project was conducted in a public hospital in Gauteng. The purpose of the research was to describe professional nurses' perception of nursing mentally ill people in a general hospital setting and was carried out amongst a sample size of 124 professional nursing staff using a self-administered tool. The study looked at four different types of perceptions guided by categories of conceptual framework proposed by Mavundla (2000:1569-1570), namely perception of self, perception of patients, perception of environment and perceived feelings. The study found that the majority of professional nurses have a predominantly positive self- perception of nursing mentally ill people in a general hospital, although a significant number have a negative perception of patients, the nursing environment and perceived feelings. Lack of knowledge, skill and experience affect the nursing care of mentally ill people in the general hospital. / Health Studies / M.A. (Health Studies)

Health Studies / M. A. (Health Studies)

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.

Text in English / This study explores and describes the perceptions of student nurses regarding professional nurses as role models in the clinical learning environment. An exploratory-descriptive qualitative approach was followed. The population for this study was the final year students in the programme: Bridging course for enrolled nurses leading to registration as a general nurse. Nonprobability, quota sampling was done. The study was conducted at two Gauteng campuses of a private nursing education institution. Two “World Café” conversations were conducted where after data saturation was achieved. The three major themes that emerged were professionalism of the professional nurse, the need for student support and the teaching and learning environment. From the students’ feedback it was evident that professional nurses should be aware of the important role they play in the professional and personal development of students. Professional nurses as role models should portray the professional behaviours and attitudes required by the profession. Students have a vision of how they expect to be when they qualify as professional nurses. Recommendations from this study relate to the three themes identified and clearly indicate that students have a realistic expectation of and a need for visible role models in the clinical learning environment. / Health Studies / M.A. (Health Studies)

The purpose of the study was to investigate the perceived lack of empowerment of registered nurses in the Mpumalanga Province. To determine the reasons for the perceived lack of empowerment and the effect thereof on professional conduct after which empowerment guidelines would be developed which managers can apply in order to enhance the empowerment of registered nurses in their service, and in turn cultivate confident nurse leaders. The main study objectives were to describe what empowerment entails, and its effect on professional conduct in the workplace; explore the level of empowerment among nurse managers and registered nurses; ascertain the effect of perceived powerlessness on the professional conduct and behaviour of nurse managers and registered nurses; establish the reasons for the perceived lack of empowerment among nurse managers and registered nurses; determine if there is a difference in the way in which nurse managers and registered nurses perceive the existing empowerment in their public hospitals and to develop empowerment guidelines for nurse managers and registered nurses. Kanter’s Theory of Structural Empowerment formed the basis of the study and guided the structure of the report. This theory contains three components, each with several dimensions resulting in 14 factors to be tested. A quantitative research approach, with an exploratory and descriptive design was used. Using a researcher-developed questionnaire as the data collection instrument. The site population consisted of one randomly selected district containing eight public hospitals in the Mpumalanga Province. All nurse managers and registered nurses in these hospitals were invited to participate in the study. The researcher delivered the questionnaires to the respondents of the eight hospitals that met the inclusion criteria. Two hundred and sixty seven (267) completed questionnaires were collected upon completion resulting in a response rate of 30.2%. Descriptive and inferential statistics were used to analyse the data. Generally, the results indicated that the majority of the respondents felt empowered with the dimensions contained under the structural empowerment, psychological empowerment and positive work behaviours and attitudes components of Kanter’s Theory. However the respondents noted that they had limited resources. According to the results those nurse managers and registered nurses who felt empowered, scored strongly in the areas of structural and psychological empowerment. The empowerment guidelines were developed for dimensions which were found to be non-empowering to assist nurse managers and registered nurses in creating workplace environments that could enhance the empowerment of registered nurses in their hospitals. / Health Studies / D. Litt. et Phil. (Health Studies)

A quantitative, descriptive, explorative design was applied to study the problems that hindered the Primary Health Care (PHC) nurses in rendering quality health care in the health facilities in Limpopo province South Africa. The sample consisted of 53 PHC nurses who completed a pre-tested questionnaire which covered various aspects related to the provision of quality PHC services. The data were analysed by computer using SPSS version 15 soft ware. The findings revealed that most of the problems could be attributed to financial constraints, poor budgeting, and shortage of staff to manage large number of patients, lack of enough support from other professional staff, unreliable referral systems and communication networks. PHC nurses work under difficult conditions and often have to improvise to care for patients, but unless more funds are allocated to rural health care facilities and these problems are addressed, more nurses will work under difficult circumstances. / Health Studies / M.A. (Health Studies)