Thesis (Ph.D.) -- McMaster University, 2001. / Includes bibliographical references (leaves 197-209). Also available via World Wide Web.

Fundação de Amparo a Pesquisa no Estado do Rio Grande do Sul / Introduction: Pediatric nursing practice is becoming increasingly complex, since the profile of Brazilian children is in the process of change, bringing the increase in the number of children with special health care needs. Nurses are professionals with an important knowledge about the best interests of children and families, advocating on behalf of their welfare and are thus inclined to experience moral distress. Aim: The aim of this study was to examine the experiences of moral distress of nurses who care for children with special healthcare needs. Methodology: interpretive phenomenology was selected as the study method. Nine nurses working at three different pediatric units of a teaching hospital were interview in November and December 2014. The data analysis process was held according to Patricia Benner's framework. The process consisted of transcription, coding, thematic analysis, and search for paradigm cases and exemplars. All the ethical aspects were preserved and the study was approved by the Research Ethics Committee of the institution under number 36618114.4.0000.5346. Results: Data analysis identified three themes. The themes arises from the relationships that nurses experienced in their daily lives and therefore their different moral experiences. Their moral experiences can be changed by their engagements. The nurses of this study are engaged in different levels according to their concerns throughout pediatrics nursing practice. Depending on the relationship they are living; with the health team, with other nurses, with the child's family, and the child; the participants can experience distress, anguish, frustration, satisfaction, responsibility. Conclusion: The findings identified that the engagement of nurses can be modified all the time during childcare situations and can instigate or inhibit their moral agency, according to their understanding of the nursing practice. / Introdução: A prática da enfermagem em pediatria vem se tornando cada vez mais complexa, uma vez que o perfil da infância brasileira encontra-se em processo de mudança, trazendo consigo o aumento do número de crianças com necessidades especiais de saúde. Os enfermeiros constituem-se em profissionais com importante conhecimento acerca dos melhores interesses da criança e da família, advogando em prol de seu bem estar, estando, dessa forma, inclinado a vivenciar o sofrimento moral. Objetivo: compreender como o sofrimento moral se apresenta no cotidiano de cuidado de enfermeiros que cuidam de crianças com necessidades especiais de saúde. Metodologia: Estudo fenomenológico interpretativo, realizado em três unidades de internação pediátrica e neonatal de um hospital de ensino. Participaram do estudo nove enfermeiros e a coleta dos dados foi realizada por meio de entrevista nos meses de novembro e dezembro de 2014. As entrevistas foram gravadas e transcritas. A análise deste estudo foi feita a partir da perspectiva Fenomenológica Interpretativa de Patrícia Benner. Na análise interpretativa ocorreu a busca por exemplares e casos paradigmáticos e na análise temática elencou-se os padrões de significado que possibilitaram a compreensão do fenômeno. Assim, três temas foram descritos referente às relações das enfermeiras que culminam no aparecimento de vivências morais. O estudo preservou os princípios éticos da pesquisa, conforme Resolução Nº 466, de 12 de dezembro de 2012 e foi aprovado pelo Comitê de Ética em Pesquisa da instituição, sob número 36618114.4.0000.5346. Resultados: As enfermeiras deste estudo mostraram-se engajadas em diversos níveis de intensidade diante das preocupações relacionados ao cuidado em pediatria. Dessa forma, na relação com a equipe de saúde, com os enfermeiros, com a família da criança, e com a criança, as participantes vivenciaram um cuidado que gera sofrimento, angústia, sentimento de frustração, satisfação, responsabilidade, entre outros. Conclusão: concluiu-se que o engajamento das enfermeiras modifica-se a todo o momento nas situações de cuidado à criança, podendo instigar a sua agência moral ou inibindoa, de acordo com as compreensões sobre a prática de enfermagem.

Abstract This diploma thesis, titled "Ensuring intimacy and dignity in patients on urgent reception, self-evident or a luxury?", highlights the issue of respecting human dignity and ensuring intimacy in treating patients on urgent admission. The above issues are currently lagging the prestige of modern healing and nursing practices. In intensive care and therefore in urgent arrivals, an inpatient health care system is being developed, where maintaining the dignity of a person and ensuring his intimacy is very complicated. At a slow pace, this issue moves to the forefront of the public's interests, both professional and lay, particularly from the point of view of patients who have some experience with healthcare. The aim of this diploma thesis was to map the provision of intimacy and respect for dignity in patients on emergency reception by treating staff. The theoretical part of this thesis describes areas such as dignity, intimacy, holism, the needs of the sick, as well as communication and burnout syndrome and the functioning of urgent income as such in a brief description. The practical part of the work was elaborated by the method of qualitative research using the techniques of semi-structured interview with patients who were treated for urgent income and with emergency care staff, combined with the secret observation of the work of the emergency care staff. Interviews and observation took place in April 2017, at the Emergency in Hospital. Permit for research was issued by the Deputy Minister for Nursing. The research group consisted of 10 nurses working on urgent admissions and 10 patients treated in this department. The research shows that nurses have a very good knowledge of dignified care and patient intimacy, but in terms of putting this knowledge into practice, this area is under the supervision of the department's staff to work on it and to deal with it more closely. In patients pointed out to insufficient awareness of the course of treatment, applied medications, and a lack of privacy in nursing. Almost the most discussed issue is communicating personal data and health problems in the emergency waiting room to a nurse, without any possibility of privacy. Some factors that interfere with dignified and intimate care relate to areas of rather structural and organizational adjustments to the department and will be proposed for further solutions.

PEREIRA, Maria Dayse. Ética da alteridade no cuidado de enfermagem em hospital de ensino no Ceará. 2009. 106 f. Dissertação (Mestrado em Políticas Públicas e Gestão da Educação Superior) – Universidade Federal do Ceará, Programa de Pós-Graduação em Políticas Públicas e Gestão da Educação Superior, Fortaleza-CE, 2009. / Submitted by moises gomes (celtinha_malvado@hotmail.com) on 2012-06-21T15:27:40Z No. of bitstreams: 1 2009_dis_MDPereira.pdf: 1453271 bytes, checksum: 8f1c8fd3aaa3b1ac3b2a790c6b761ded (MD5) / Approved for entry into archive by Maria Josineide Góis(josineide@ufc.br) on 2012-06-25T11:08:13Z (GMT) No. of bitstreams: 1 2009_dis_MDPereira.pdf: 1453271 bytes, checksum: 8f1c8fd3aaa3b1ac3b2a790c6b761ded (MD5) / Made available in DSpace on 2012-06-25T11:08:13Z (GMT). No. of bitstreams: 1 2009_dis_MDPereira.pdf: 1453271 bytes, checksum: 8f1c8fd3aaa3b1ac3b2a790c6b761ded (MD5) Previous issue date: 2009 / The practice of ethical Nursing care within health services, particularly in public hospitals of Education, comes as part of collective work in health, incorporating technical, managerial, educational, social and political. The ethical dimension of alterity of care in this work scene, assumes the configuration of an attitude of respect and welcome the other, and promotes a continous refletction and changing of attitude of nursing professionals. The aim of this study is to understand the design ethic of care in the daily experience of nursing in the University Public Hospital, with ethical discussion of radical alterity in Emmanuel Lévinas. Descriptive in nature, this study is based on the Hermeneutic-phenomenology, with a qualitative approach. The seizure of the empirical data was achieved with nine nurses of the hospital staff, using the technique of individual interview. The analysis revealed evidence of three areas: care, ethics and otherness of Nursing. Under such dimensions, the data analysis allowed us to identify the importance of ethics of alterity in nursing care, the search for the organization of the care and management, the training, the interdisciplinarity of the shares through the mobilization and articulation of knowledge, the ethical and responsible care, the attitude of understanding the importance of quality care, the commitment to the subjectivity of care, highlighted by the interviewees. However, these workers live, now, with the contradictions inherent in the process of their work, emphasizing the care model that persists in transit between the model and fully functional in form and curative hospital. The management model prints, even today, the characteristics of mechanistic and fragmented work, the multidisciplinary and its relationship with the hierarchy of care, rather than interdisciplinarity; the suffering occupational derivative inadequate working conditions; progressive deficit of the workforce and increased absenteeism, and change the current organizational structure to support the tension between the handle and manage. Because of this scenario, it can be concluded that the Nursing resist, so purposeful, to these challenges, with strong evidence on ethical alterity of care. This trend can express the reflection for the reinvention of the social practice of care, beyond the classical approach of partial care for the size of alterity ethics of care / A prática de cuidado ético de Enfermagem no âmbito dos serviços de saúde, especificamente nos hospitais públicos de ensino, se insere como parte do trabalho coletivo na área de saúde, incorporando aspectos técnico, gerencial, pedagógico, social e político. A dimensão ética da alteridade do cuidado, neste cenário laboral, assume a configuração de uma atitude de respeito e acolhimento do outro, ensejando a continua reflexão e mudança de atitude dos profissionais de Enfermagem. O objetivo deste estudo é compreender a concepção ética do cuidado na experiência cotidiana de Enfermagem no hospital público universitário, com discussão ética da alteridade radical em Emmanuel Lévinas. De caráter descritivo, este estudo se fundamenta na fenomenologia Hermenêutica, com abordagem qualitativa. A apreensão dos dados empíricos se concretizou junto a nove enfermeiros do quadro funcional do hospital, com a utilização da técnica de entrevista individual. A análise dos depoimentos evidenciou três eixos temáticos: cuidado, ética e alteridade de Enfermagem. Sob tais dimensões, os dados analisados permitiram identificar a importância da Ética da alteridade no cuidado de Enfermagem, a busca da organização do processo de cuidar e da gestão, o aperfeiçoamento profissional, a interdisciplinaridade das ações mediante a mobilização e articulação de saberes, o cuidado responsável e ético, a atitude de entender a importância da qualidade assistencial, o compromisso com a subjetividade do cuidado, ressaltados pelos entrevistados. Estes profissionais, todavia, convivem, atualmente, com as contradições inerentes ao seu processo de trabalho, acentuando o modelo assistencial que persiste em transitar entre o modelo funcional e integral, nos moldes curativista e hospitalocêntrico. O modelo a gestão imprime, ainda hoje, as características do trabalho mecanicista e fragmentado; a multidisciplinaridade e sua relação direta com a hierarquização do cuidado, em detrimento da interdisciplinaridade; o sofrimento ocupacional derivado das condições laborais inadequadas; deficit progressivo da força de trabalho e absenteísmo crescente; e mudança atual da estrutura organizacional, no que concorrem para a tensão entre o cuidar e gerenciar. Em decorrência deste cenário, é possível concluir que a Enfermagem resiste, de forma propositiva, a estes desafios, revelando acentuado indício ético em relação à alteridade do cuidado. Esta tendência poderá expressar a reflexão para a reinvenção da prática social do cuidar, transcendendo a clássica atitude do cuidado parcelar para a dimensão da alteridade do cuidado ético.

Introdução: As teorias do filósofo Rudolf Steiner, no início do século XX, aplicadas em várias áreas das ciências humanas, biológicas e exatas, trouxeram ao mundo ocidental uma nova cosmovisão do Ser Humano, a Antroposofia, que não trata apenas de antropologia, mas de uma ciência do Cosmo, tendo por centro e ponto de apoio, o homem. O cuidar antroposófico está embasado em teorias de enfermagem, como de Martha Rogers, que abordam o aspecto holístico do ser humano. O interesse de enfermeiros pela Antroposofia começou, no Brasil, na década de 1970, buscando fazer dela o fundamento para as formas complementares de terapia em enfermagem. A crescente influência da enfermagem antroposófica no desenvolvimento das ações integrais à saúde motivou este estudo. Objetivos: caracterizar enfermeiros que realizam atividades na enfermagem antroposófica; conhecer e compreender o significado e a vivência profissional de enfermeiros antroposóficos no Brasil; analisar atos normativos éticos e legais para a sua prática; desvelar o que os enfermeiros vislumbram para o futuro da enfermagem antroposófica; e, identificar dificuldades para o seu exercício. Metodologia: Estudo de natureza descritiva, exploratória, qualitativa e prospectiva com base nos conteúdos de entrevistas de nove enfermeiras. Referencial teórico: a fenomenologia social, de Alfred Schütz, fundamentou as categorias sobre os motivos porque e motivos para que. Resultados e discussão: Entre os motivos porque, quatro categorias condensam o interesse de enfermeiros pela antroposofia: 1) busca de novas perspectivas profissionais: algo diferente que oferecesse mais satisfação profissional; assistência de enfermagem espiritual; insatisfação com o paradigma alopático. 2) encontro com a antroposofia através da Filosofia, Medicina, Pedagogia e Enfermagem; 3) Metamorfoses decorrentes dos novos conhecimentos adquiridos: mudanças pessoais e profissionais na perspectiva do cuidar antroposófico; diferenças vivenciadas nos tratamentos alopático e antroposófico; vivências e relatos de experiências; 4) dilemas éticos e legais. As quatro categorias relacionadas aos motivos para que foram: 1) perspectivas para a enfermagem antroposófica no Brasil; 2) necessidade de incluir antroposofia na formação do enfermeiro generalista; 3) necessidade de cursos de especialização e pesquisa; 4) anseio de superação de dificuldades na prática antroposófica pelas enfermeiras. Considerações finais: este estudo demonstrou que a enfermagem antroposófica amplia o cuidar, aguça o olhar e ajuda o profissional a se tornar mais consciente na percepção do outro, a cuidar respeitando a individualidade do paciente, a direcionar a ação a todo e qualquer ser humano. Observa-se que pacientes graves, crônicos e oncológicos se beneficiam mais, talvez porque o olhar do enfermeiro antroposófico é mais holístico e individualizado. A Enfermagem Antroposófica atua também em situações do nascimento e da morte. Após o fechamento da Clínica Tobias, na década de 1990, profissionais ficaram sem referência, mas enfermeiros continuaram cultivando e praticando seus conhecimentos individualmente, embora almejassem criar uma organização formal, como associação, para discutirem problemas comuns e unirem forças; ter a Sistematização da Assistência de Enfermagem Antroposófica implantada em seus locais de trabalho; possibilitar que conceitos básicos de enfermagem antroposófica fossem inseridos nos programas dos cursos de graduação, e criados cursos de especialização / Background: The philosopher Rudolf Steiner theories, in the beginning of the XX Century, applied to various areas of the human, biological and exact sciences, have brought to the occidental world a new Cosmo vision of the human being, the Anthroposophy which is not only just anthropology, but a Cosmo science, having man as the center and supporting point. The Anthroposophical care is based on nursing theories, such as by Martha Rogers which has approached the holistic aspect of the human being. Nurses interest on Anthroposophy has started in Brazil, in the 1970s trying to make it the foundation for complementary therapies in nursing. The growing influence of Anthroposophical nursing for development of integral actions for health has motivated this study. Objectives: to characterize nurses who carry out anthropological nursing activities; to know and understand the meaning and professional experiences of anthropological nurses in Brazil; to analyze legal and ethical enactments for practicing it; to disclose what nurses see in relation to the future of the anthropological nursing; and to identify difficulties for its practice. Methodology: it is a descriptive, exploratory, qualitative and prospective study, based on contents of interviews given by nine nurses. Theoretical reference: the Alfred Schütz social phenomenology has founded the construction of the main categories on reasons why and reasons for what for. Results and discussion: Among reasons why, four categories have identified the nurses interest on anthroposophy: 1) search for new professional perspectives: something different that would offer better professional satisfaction, search for a nursing spiritual care; dissatisfaction with allopathic paradigm: 2) meeting Anthroposophy through philosophy, medicine, pedagogy and nursing. 3) Metamorphosis as a result of new knowledge: personal and professional changes within Anthroposophical care perspective; difficulties faced during treatments allopathic and Anthroposophical ones; reporting experiences lived by Anthroposophical nurses; 4) ethical and legal dilemmas. The four categories found within reasons for what for were: 1) perspectives for Anthroposophical nursing in Brazil; 2) need for inclusion of anthroposophy in nursing education programs at undergraduate level; 3) need of a specialization and research; 4) wish to overcome difficulties in the Anthroposophical practice by nurses. Final considerations: this study has showed that Anthroposophical nursing amplifies caring, sharpen the look and help professional to become more assertive to perceiving others, to care with more respect the patients individuality; and to guide actions toward any human being. It is observed that chronic, oncology or grave patients are better benefited, perhaps because the Anthroposophical nurses look is more holistic and individualized. Anthroposophical nursing is also active on birth and death situations. After closing down of the Tobias Clinic in the 1990s many professionals turned off reference, but nurses individually continued to cultivating and practicing their knowledge, even wishing to create a formal organization as an association to discuss common problems and unite forces; having Anthroposophical nursing care systematization implemented at their working places; making possible that basic concepts of Anthroposophical nursing be inserted at the undergraduate programs and specialty courses be created

O sofrimento moral é descrito na literatura como o sentimento resultante do impedimento à uma ação considerada moralmente apropriada, devido, sobretudo, a obstáculos institucionais, como a falta de recursos e a carga de trabalho. As consequências envolvem sintomas físicos, como mal estar, choro e desordens do sono e sintomas psicológicos, como frustração, impotência e culpa, além de implicações organizacionais, principalmente relacionadas com afastamentos e abandono do emprego. Considerando que o contexto de trabalho pode influenciar na vivência de situações moralmente problemáticas, o objetivo do estudo foi analisar o fenômeno do sofrimento moral em enfermeiros no Brasil e em Portugal. Trata-se de uma pesquisa metodológica para desenvolvimento, busca de evidências de validade e refinamento de um instrumento de pesquisa. A investigação partiu da análise de 38 estudos da literatura para construção de uma escala para identificação de fatores de risco para sofrimento moral. A busca por evidências de validade incluiu uma análise de juízes, para validação de conteúdo, e uma análise fatorial exploratória, para validação de constructo, com uma amostra de 268 enfermeiros brasileiros e 278 enfermeiros portugueses. O resultado foi uma escala com evidência de validade para ambos os países, com Alpha de Cronbach de 0,913 e 0,790, teste de Kaiser-Meyer Olkin de 0,869 e 0,914 e índice de Bartlett significativo (p <0,001) para Brasil e Portugal, respectivamente. Cerca de 59,8% da variância é explicada por 30 itens, divididos em sete fatores, na versão brasileira, e cerca de 53,9% da variância é explicada por 20 itens, divididos em 4 fatores, na versão portuguesa. A vivência de fatores de risco para sofrimento moral foi considerada moderada no Brasil e baixa em Portugal. As variáveis que mostraram associação significativa com maiores médias totais de risco nos dois países foram o tipo de serviço, as horas de trabalho, estar em sofrimento moral e ter a intenção de deixar o emprego atual. Pesquisas no âmbito do sofrimento moral podem, entre outros aspectos, auxiliar na identificação dos desafios e das dificuldades que mais preocupam os enfermeiros em seu contexto de trabalho. No intuito de contribuir no desenvolvimento de estratégias de enfrentamento e melhorar a retenção e a satisfação profissional, pesquisas acerca do sofrimento moral podem refletir positivamente na qualidade dos cuidados. / Moral distress is described as the feeling resulting from the impediment to an action considered morally appropriate, mainly due to institutional obstacles such as the lack of resources and the high workload. Main consequences are physical symptoms, such as malaise, crying and sleep disorders and psychological symptoms, such as frustration, impotence and guilt, as well as organizational implications, mainly related to withdrawal and abandonment of employment. Considering that the work context may influence the experience of morally problematic situations, the objective of these study was to analyze the phenomenon of moral distress among nurses in Brazil and in Portugal. It is a methodological research for development, searching for evidence of validity and refinement of a research instrument. The research started with the analysis of 38 studies for the construction of a scale to identify risk factors for moral distress. The search for evidence of validity included an analysis of judges, for content validation, and an exploratory factorial analysis, for construct validation, with a sample of 268 Brazilian nurses and 278 Portuguese nurses. The result was a scale with evidence of validity, Cronbachs Alpha of 0,913 and 0,790, Kaiser-Meyer Olkin test of 0,869 and 0,914 and a significant Bartlett (p <0,001). About 59,8% of the variance was explained by 30 items, divided into seven factors in the Brazilian version, and about 53,9% of the variance was explained by 20 items, divided into four factors in the Portuguese version. The experience of risk factors for moral distress was considered moderate in Brazil and low in Portugal. The variables that showed a significant association with the highest risk for moral distress in both countries were the type of work context, the hours of work, being in moral distress and having the intention to leave the current job. Research in the field of moral distress can, among other things, help in identifying the challenges and difficulties that most concern nurses in their work context. In order to contribute to the development of coping strategies and to improve professional retention and satisfaction, researches about moral distress may positively reflect on the quality of care.

M.Cur. / Modern technology has brought on the possibility to sustain life for an indefinit3e period, but does not give answers to the questions arising from such situations. In view of shrinking resources available for tertiary care, and the growing awareness of justice, indefinite continuation of life-support therapy has been subjected to scrutiny. Traditionally the treating physician made all decisions regarding therapy. In Western culture the public are more aware of their right to self-determination and participation in decision making with the autonomy to do so. The nurse's role also changed from "handmaiden" to an independent practitioner who takes part in decision making regarding her patient. Decisions regarding life-support therapy is sensitive and becomes more complicated the more people become involved. The following question can then be asked: What are all the factors in decision making concerning life-support therapy? The aim of this study is to identify the factors in decision making concerning life support, as the first step in defining the parameters in decision making. The design chosen to identify these factors is a qualitative, exploratory, contextual, phenomenological case-study design. one case study was done on a patient where the continuation of life support was questioned. All persons involved with the patient were included in the case study. Interviews were conducted, observations and field notes were made and patient records were explored to identify factors in decision making. A narrative was written to present this information. As these constituted the micro-level, a literature study was done to identify factors on the macro- and meso-levels. The results of the analysis are presented as a list of factors in decision making concerning life-support therapy.

Bakgrund: Moralisk stress är ett begrepp som först kom att definieras av Jameton (1984) och anses uppstå när sjuksköterskor inte kan handla i enlighet med det de anser vara det rätta på grund av organisatoriska eller institutionella barriärer. Den legitimerade sjuksköterskan ansvarar för ett stort kunskaps- och arbetsområde som ska präglas av ett etiskt förhållningssätt och en personcentrerad vård. En inre konflikt uppstår när sjuksköterskan hindras att arbeta utifrån de rådande värdena, vilket ger upphov till känslor av moralisk stress. En större kunskap och förståelse inom problemområdet är nödvändig för att åstadkomma framtida förbättringar. Syfte: Syftet var att belysa moralisk stress hos sjuksköterskan. Metod: För att uppnå syftet har en litteraturöversikt genomförts. Sökningar efter relevanta artiklar i enlighet med den engelska översättningen av moralisk stress utfördes. Artiklar med kvalitativa och kvantitativa ansatser har använts. Resultat: Ur analysen urskildes tre olika huvudkategorier: bakomliggande orsaker till moralisk stress, konsekvenser av moralisk stress och strategier för hantering av moralisk stress. Diskussion: I resultatdiskussionen diskuteras moralisk stress hos sjuksköterskor utifrån Jean Watsons teori om mänsklig omsorg samt andra relevanta artiklar. Uppkomsten av moralisk stress hos sjuksköterskor diskuteras ur olika perspektiv. Skillnader i miljö och ledningens betydande roll avseende sjuksköterskors känslor av moralisk stress diskuteras vidare. Konsekvenser av moralisk stress hos sjuksköterskor diskuteras med betoning på patientsäkerhet och bemötandet av patienter. Medvetenheten kring moralisk stress hos sjuksköterskor behöver bli större. Ett fokus på moralisk stress hos sjuksköterskor kan med fördel lyftas redan under sjuksköterskeutbildningen. / Background: Moral stress is a term that was first defined by Jameton (1984) and is considered to occur when individuals are unable to act in accordance with what they consider to be right due to organizational or institutional barriers. The registered nurse is responsible for a large area of knowledge and work that needs to be characterized by an ethical approach and person-centered care. An internal conflict occurs when the nurse is prevented from working on the basis of these values, which causes feelings of moral stress. A greater knowledge and understanding of the problem area is necessary to achieve future improvements. Aim: The aim was to illustrate moral stress among the nurse. Method: To achieve this goal, a literature review has been conducted. Searches for relevant articles in accordance with the English translation of moral stress were performed. The databases Cinahl, PsycINFO and PubMed were used. Articles with qualitative and quantitative approaches have been used. Results: The analysis revealed three different main categories: underlying causes for moral stress, consequences of moral stress and strategies for managing moral stress. Discussion: In the result, moral stress is discussed among nurses based on Jean Watson's theory of human care and other relevant articles. The appearance of moral stress in nurses is discussed from different perspectives. Differences in the environment and management's significant role regarding nurses' feelings of moral stress are discussed further. The consequences of moral stress in nurses are discussed with emphasis on patient safety and the encounter of patients. Awareness about moral stress in nurses needs to be greater. A focus on moral stress in nurses should be emphasized during nursing education.

Patient safety is a primary concern of members of the surgical team. Professional nurses working in the operating room play a vital role in the safety of the patients from the moment the patient enters the operating room to the discharge of the patient to the unit. Quality nursing care is of the utmost importance and therefore it is the responsibility of a professional nurse to ensure patient safety during the peri-operative period. Team work and good communication in the operating room are essential in order to ensure patient safety. Nursing care practices related to patient safety should be a key aspect to consider in rendering care to the surgical patient and professional nurses should perform their duties to the best of their ability despite lack of resources and shortage of staff. The main purpose of the study was to explore and describe nursing care practice related to patient safety in the operating room at hospitals in the Nelson Mandela Metropolitan area. Once this was established recommendations on how to enhance nursing care practice related to patient safety in the operating room were made. This study is based on a quantitative, explorative, descriptive and contextual design. Convenient sampling was used in this study. Data were collected by means of a self-administered questionnaire. Descriptive and inferential statistics were used to analyse the data. Ethical considerations were adhered to and the findings of the research will be disseminated appropriately. Recommendations based on the findings that emerge from the data, as well as the literature review, will be offered to enhance nursing care practice related to patient safety in the operating room.

The dissertation examines the ethics of staff in perioperative care. The aim was to analyze the errors that occur during surgery, to determine the participants in perioperative care who commit these mistakes, and to analyze the reasons why these errors occur. The theoretical part deals with the concept of security from different perspectives of patient safety in surgery, and the international guidelines that direct it. The situation in the Czech Republic in terms of care for patient safety in surgery is also described. One chapter deals with the autor's internship in operating rooms in Sweden. Using the results of observations, the empirical part of the dissertation analyzes the actual behaviour of staff in perioperative care during surgery against the binding documents that ensure safe perioperative care. It also sets out the reasons that lead to non-compliance of health and safety regulations in perioperative theatres. In conclusion, I suggest steps that would help to improve the situation. Key words Perioperative care, safety, security, pacient pafety, medical ethics, nursing ethics