Workplace violence is an international problem and has negative consequences for individuals, organizations and communities. For individuals, the effect includes symptoms of fear, stress, irritability, feelings of isolation, insecurity, and low selfesteem. Healthcare organizations incur increased cost due to litigation due to poor quality of care, high staff turnovers and absenteeism, and their brands are negatively affected. Community members, who are the recipients of care, are placed in danger and are indirectly the victims of such workplace violence, which in turn affects their trust in private healthcare organizations or professions to provide the quality health care that they expect and deserve. Workplace violence takes many forms such as incivility, horizontal violence and bullying to name but a few. The perpetrators of such violence are doctors, nurses, patients and relatives. Workplace violence takes place in South Africa however, paucity in research was found by the researcher. The aim of the study was to explore and describe the experiences of professional nurses regarding workplace violence in a private healthcare facility in order to develop guidelines to address workplace violence in such a facility. A qualitative, explorative, contextual and descriptive study was conducted, using the Critical Social Theory as the paradigm. Data were gathered from professional nurses that have experienced workplace violence utilizing narratives. Fourteen narrative interviews were done until data was saturated. The data was transcribed verbatim and Tesch’s method of thematic synthesis was used to analyse the data. The three themes that emerged from the data were: Professional nurses acknowledge the existence of workplace violence where they work, Participants described the effect of workplace violence on themselves, others and the work environment, and Participants discussed their views regarding management of violence in the workplace. A thick description of the data with a literature control was provided. Thereafter inferences were made regarding the main themes of the guidelines and these focussed on: Preventing and addressing workplace violence by Nursing Service Managers; Preventing and addressing workplace violence by Nurse Unit Managers and Empowering professional nurses to address workplace violence. To ensure rigour and trustworthiness of the study, the researcher used Lincoln and Guba’s criteria namely: credibility, dependability, conformability and transferability. To protect the right and dignity of the participants and to safeguard the integrity of the study the researcher complied with the following ethical principles: beneficence, non- maleficence, autonomy, justice, veracity, privacy, and confidentiality. The limitations of this study were that data was collected from only one category of nurses and only one private healthcare facility was used. Recommendations from this study include implementation of the guidelines to establish their effectiveness. The findings of this study can be used to empower professional nurses to deal with workplace violence and to prevent the short and long term effects of workplace violence on the individual, the organization and the community. Nursing education institutions can also incorporate workplace violence into their curriculum to increase the awareness of students regarding this phenomenon.

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 World Health Organisation (WHO) declared tuberculosis (TB) a global emergency, and this infectious disease remains a health threat by being the leading cause of death amongst adults (Naidoo, Dick & Cooper, 2008:55). In 2005, South Africa was ranked seventh in the world for having the highest TB rate and the lowest TB success rate in the world. As a professional nurse involved in the tuberculosis programme at a clinic in the Nelson Mandela Bay Municipality at local government level for approximately three years, the researcher observed that the morale of professional nurses who provide TB services appeared to be low. They also appeared to be frustrated because they feel that they are not winning the battle with regard to the TB epidemic in their communities irrespective of their efforts to try and curb the spread of the disease. The extent of the workload per person also appeared to add to the low morale and frustration of the professional nurses rendering TB health services because they feel that they are unable to manage everything. The objectives of the study were therefore to explore and describe how professional nurses experienced the management of health services being rendered to TB patients in Sub district B of the Nelson Mandela Bay Municipality (NMBM) in order to make recommendations that could be used by the district manager to address the research findings. The research study was based on a qualitative, explorative, descriptive and contextual research design. The research population consisted of all professional nurses who worked in the TB services of Sub district B. Non-probability, purposive sampling was used to select the participants for the study. Seven in-depth and three follow-up interviews were conducted before data saturation was achieved. The data gathered during the interview process by the researcher were transcribed and coded by an independent coder using Tech’s model for data analysis. Ethical considerations were adhered to throughout the research study. The aspect of trustworthiness according to Guba’s model was implemented in the research study and included credibility, applicability, consistency and neutrality. iii One theme, two sub themes and categories were identified relating to the diverse experiences expressed by the participants relating to the management of health services being rendered to TB patients. The experiences expressed by the professional nurses included both negative and positive experiences. The negative experiences expressed by the participants were for example, a lack of resources as hampering adequate service delivery, a concern regarding the number of staff contracting TB due to a lack of infection control measures, a difference in conditions of service between the two local authorities and the DOTS supporters as being a threat to patient confidentiality. The positive experiences expressed by the participants included experiences relating to job satisfaction in rendering TB health services, the DOTS supporters as being supportive to the staff, the TB meetings serving as an appropriate platform for problem solving and the audits conducted by managers as being remedial. The study concludes with recommendations made with regard to the areas of nursing practice, education and research.

The experience of verbal bullying at school may cause a female adolescent much distress. This distress can result in the adolescent experiencing life as traumatic and may influence her sense of well being negatively. Verbal bullying usually takes the form of name-calling, put-downs and insults. This can be very traumatic for adolescents and can lower their self-esteem, which may eventually lead to mental illness. The parents of adolescent learners often have the misconception that bullying is a normal part of a teenager’s life and are unaware of the distress it may cause the adolescent. The victimized adolescent should, therefore, be provided with support in order to avert the occurrence of mental illness. The goals of this study were to: • Explore and describe the experiences of adolescent girls regarding verbal bullying in secondary school settings. • Develop guidelines to assist mental health nursing specialists in helping adolescent girls to cope with bullying in secondary schools. The researcher used a qualitative, explorative, descriptive and contextual design with a phenomenological approach. The research population consisted of female learners in a secondary school setting. Purposive sampling was used in this study to identify participants. Data was collected by means of naïve sketches, one-to-one-interviews and field notes based on observations. Data was analyzed using Tesch’s method (in Creswell, 1994:190) of descriptive analysis. The identified themes were compared to available literature. The data collected from this study was used to develop guidelines to aid mental health nursing specialists to help adolescents to cope with verbal bullying.

M.Cur. (Psychiatric Nursing) / In view of statistics available there is a definite need for a primary mental health service for children in the Republic of South Africa. Very little literature is available on the functions of the child psychiatric nurse, in this regard. This study was done to determine the functions of the child psychiatric nurse in the deliverance of a primary mental health care service for children. It was done by using the opinions of practicing child psychiatrists and child psychiatric nurses in South Africa.

D.Cur. / With the current expanding privatisation of health services in South Africa, the establishing of quality assurance mechanisms is not only essential but is becoming a prerequisite for further privatisation. Privatisation of health care services, together with economical problems, are causing the role fulfilment and accountability structure of the nurse administrator to become much more complex and greater demands are continually made. A profile of the nurse administrator in private hospitals in South Africa, was compiled by means of an explorative descriptive study. This was done to ascertain their preparedness for the formalisation of quality assurance in nursing. The conclusion which was ultimately reached conceded that the nurse administrator in South African private hospitals, is not adequately prepared for her managerial responsibilities. She is, however, according to the registered qualifications, adequately qualified;.. to exercise effective quality control and assurance in the various nursing disciplines. Consequently national nursing service standards for private hospitals were formulated. These standards were validated bya representative group of national experts. The validation process consisted of a two-stage research technique. The statistical validity was calculated by means of a content validity index for each standard. Fourteen (N=275) of these standards (5%) were rejected by the whole group and 25 (9%) require reformulation. The respondents from the private sector rejected three more standards. Standards form the basis of the quality assurance process. These standards should equip the nurse administrator with valuable guidelines to promote a high standard of nursing service management in private hospitals. It is recommended that these standards should serve as optimum standards for nurse administrators in private hospitals.

Due to the fragmented structure of the health organisation in South Africa, there is often difficulty in assuring good co-ordination between in-patient and domiciliary health facilities. This results in the discharge of patients from hospital with poor prospects for the continuity of health care in the community. At Groote Schuur Hospital, approximately 44% of the hospital beds in the white section of the Hospital are occupied by patients in the age group of sixty-five years and over. This group of patients must be regarded as particularly vulnerable with regard to the transition of the care in a hospital to their own home for some of the following reasons: - * The nature of the disease - The chronic and recurrent nature of the degenerative diseases of old age often results in varying degrees of disability. in the aged patient. Many geriatric patients suffer from several unrelated clinical conditions, and thus there is a need to coordinate the many health services required. * Social circumstances - The aged population frequently live alone or with a frail relative, often in poor economic circumstances. * Re-admission rate - The geriatric re-admission rate following discharge is high. As the first principle of geriatric care is to restore independence, and to help patients live away from the hospital environment, the provision of extended care facilities for vulnerable patients is of utmost importance. A structured interview was used to assess the need for extended care facilities of 172 white patients over the age of 60 years who were discharged from Groote Schuur Hospital during March to May of 1981. An attempt was made to evaluate how effectively these needs were being met in the community following discharge. It was found that 34% of the patients interviewed were not getting the nursing care and support in the community which they needed to facilitate rehabilitation. The most vulnerable patients as regards aftercare were: - * The aged * The chronically ill * Patients who live alone or without social support * Patients whose illness leads to temporary or permanent disability * Patients hospitalised for prolonged periods. It was found that the patients interviewed were given insufficient preparation, while still in hospital, for the problems they would be faced with on discharge. No systematic policy exists to ensure that health care staff give adequate information to the patient on discharge from hospital. The ward sister was found to play a vital role in making the preparations for a patient's transfer from hospital to home. A questionnaire was designed to assess the Groote Schuur ward sisters' attitudes towards the importance of discharge planning. An analysis of the ward sisters' response indicated that great variation existed in the attitudes towards the importance of this task. An investigation into the existing community services for geriatric patients was undertaken. An attempt was made to assess the limitations and gaps which exist in the provision of services for the aged. Finally, the role of the recently established Department of Community Liaison at Groote Schuur Hospital was investigated. It was evident that the Community Liaison nurse had proved to be an invaluable member of the health team of a large, specialist hospital such as Groote Schuur. The activities of the Community Liaison nurse led to improved continuity of care for patients needing extended care facilities in the community.

Introduction: Working in the hospital accident and emergency unit is perceived to be very stressful. However, minimal or no organizational support measures are made available to enable the nurses working in these hospital units to cope effectively with stressful incidents. The purpose of the study was to develop strategies to enhance the support systems of nurses in the accident and emergency unit. Method: The study used a qualitative approach to explore the experiences of and describe the coping strategies used by nurses working in the accident and emergency units of regional urban hospitals at KwaZulu-Natal, in South Africa. Fourteen participants were interviewed in the accident and emergency units of four (4) hospitals. Data were collected through in-depth individual interviews. The data were analysed manually following the steps explained by Creswell (2009:186). Findings: The interviews led to the description of the nurses’ experiences in the accident and emergency units. Four themes emerged from the findings of the interviews, and included working under pressure and stressful conditions, the need for safety and security, limited resources and psychological and emotional problems. Among the problems discussed within the themes, there was anger that was directed by the patients and their relatives to the nurses; absenteeism that contributed to an increase in work pressure; emotional disturbance; lack of physical security; and lack of continuous support from the hospital management. Conclusion: Five strategies were developed to generate a support systems for the nurses whose hospital units formed part of the study and were as follows: develop or strengthen an existing employee assistant program (EAP) specifically for counselling and support of the nurses within the unit; address staff absenteeism through the provision of extra staff through overtime or agency work; enforce attendance of monthly debriefing sessions; strengthen the security system through increasing and evenly distributing the security staff; and give attention to all the problems and provide a quick response. The strategies developed are trusted to remain as a point of reference whenever a need arises. / Health Studies / D. Litt. et Phil. (Health Studies)

MCur / Department of Advanced Nursing Science