Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Critical care nursing is the specialty within nursing that deals with an individual's response to life-threatening problems. These life threatening problems require continuous in-depth assessment and intense therapeutic measures and interventions. The level of nursing care is intense and the amount of documentation is enormous in the intensive care unit. Failure to document any aspects, may threaten the continuity of care and patient safety. Furthermore, it may result in negligence that may result in litigation. The purpose of this study was to retrospectively analyse nursing documentation in the intensive care units of an academic hospital in the Western Cape. The objectives set for this study were to determine whether the documentation of the: • assessment of the patients were adequate; • diagnoses were based on the assessment; • nursing care plans were based on the diagnoses; • nursing care plans were implemented and • nursing care plan shows evidence of continuous evaluation A retrospective exploratory- descriptive research design with a quantitative approach was applied to audit objectively the status of nursing documentation of patients who were admitted to the ICU’s of an academic hospital in the Western Cape in the first 48 hours of admission. Ethical approval was obtained from the University of Stellenbosch and consent from the Chief Executive Officer of the academic hospital to conduct the research in the hospital under study. The research population (N) was the documentation (files) of patients admitted in the ICU’s between 1 July 2008 and 31 December 2008. A stratified sample was drawn consisting of 151 files. The researcher collected the data personally utilising a pretested audit instrument. The reliability and validity was assured through experts in nursing science and intensive care nursing, a statistician and a research methodologist. A pilot study was conducted to pretest the instrument and the feasibility of the study. Modifications to the instrument were done based on suggestions from the experts and findings of the pilot study. Data analysis included statistical associations between variables using the Chi-square test on a 95% confidence level. Data is presented in the form of figures, tables and frequencies. The findings of the study show that the nursing documentation in the intensive unit is inadequate with the following total mean scores: • Assessment 62.6% • Nursing diagnosis 53.1% • Nursing care plans 37.1% • Implementation 72.6% • Evaluation 40.5%. In conclusion nursing documentation of patients admitted to an ICU is inadequate during the first 48 hours of admission. Poor documentation threatens the safety of patients and demands urgent improvement. Recommendations to improve the documentation include nursing practice supervision, quality improvement programmes, in-service training, evidence based practice and further research. / AFRIKAANSE OPSOMMING: Kritieke-sorg verpleging is die spesialiteit in verpleging wat betrekking het op die individu se reaksie.op lewensgevaarlike probleme.Hierdie lewensgevaarlike probleme benodig deurlopend deeglike beraming en intense terapeutiese benaderings en intervensies. In die intensiewesorg eenheid is die vlak van verpleegsorg baie intens en die dokumentasie hoeveelheid is enorm. Versuim om enige aspekte van sorg deeglik en akkuraat te dokumenteer, kan die deurlopendheid van sorg sowel as die veiligheid van die pasient bedreig. Verder kan dit tot regsstappe lei as gevolg van nalatigheid. Die doel van hierdie studie was om ‘n retrospektiewe analise van verpleeg dokumentasie in die intensiewe sorgeenhede van ‘n akademiese hospitaal in die Wes Kaap te doen. Die doelwitte van hierdie studie was om vas te stel of die dokumentasie van die: • beraming van die pasiênt voldoende gedoen is • verpleegdiagnose gebaseer is op die beraming • verpleegsorgplan gebaseer is op die diagnose • implementering van die verpleegsorgplan en • verpleegsorgplan bewyse toon. van deurlopende evaluasie ‘n Retrospektiewe eksploratiewe-beskrywende navorsingsontwerp met ‘n kwantitatiewe benadering is toegepas ten einde die status van verpleegdokumentasie van pasiente wat toegalaat is tot die intensiewesorg eenhede van ‘n akademiese hospitaal in die Wes Kaap in die eerste 48 uur na toelating te bepaal. Etiese goedkeuring is verkry van die Universiteit van Stellenbosch asook vanaf die Hoof Uitvoerende Beampte van die akademiese hospitaal om die navorsing daar uit te voer. Die navorsings populasie (N) was die dokumentasie (lêers) van die pasiente wat opgeneem is in die intensiewesorg eenheid tussen 1 Julie 2008 en 31 Desember 2008. ‘n Gestratifieerde steekproef is getrek bestaande uit 151 lêers. Die navorser het die data persoonlik kollekteer deur gebruik te maak van ‘n voortoets oudit instrument. Die betroubaarheid en geldigheid is verseker deur kundiges in verpleegkunde en intensiewesorg verpleging, asook ‘n statistikus en ‘n navorsingsmetodoloog. ‘n Loodstudie is gedoen om die instrument vooraf te toets en om die uitvoerbaarheid van die navorsing te bepaal. Veranderinge is aangebring op grond van die voorstelle van die kundiges sowel as die bevindinge van die loodstudie. Data analise het ingesluit die statistiese assosiasies tussen veranderlikes deur gebruik te maak van die Chi-kwadraat toets tot ‘n 95% sekerheidsvlak. Data is aangebied in die vorm van figure, tabelle en frekwensies. Die bevindinge van die studie wys dat die verpleegdokumentasie in die intensiewesorg eenheid is onvoldoende met die volgende gemiddelde telling: • Beraming 62.6% • Verpleegdiagnose 53.1% • Verpleegsorgplanne 37.1% • Implementering 72.6% • Evaluering 40.5% Ten slotte, verpleegdokumentasie van pasiënte wat tot die intensiewesorg eenheid toegelaat is, is onvoldoende gedurende die eerste 48 uur van toelating. Swak dokumentasie bedreig die veiligheid van pasiënte en verg dringende verbetering. Aanbevelings om die dokumentasie te verbeter sluit in toesig oor verpleegpraktyke kwaliteit verbeteringsprogramme, indiensopleiding, bewysgebaseerde praktyke en verdere navorsing.

M.Cur. / The learning accompanists (nurse educator), in the didactic situation within the context of a nursing college, is midst a process of transformation. This transformation has a direct influence on the learning accompanists didactic role fulfilment. Didactic support systems enables the learning accompanist to fulfil her/his didactic role. These didactic support systems should be managed during the process of transformation, in such a way that it enables the learning accompanist to fulfil her/his didactic role. A new creative approach to the management of the didactic situation is necessary. The goal of this study is to describe guidelines for the management of didactic support systems, at a nursing college, to enable the learning accompanist to fulfil her/his didactic role. An inductive, qualitative, contextual, exploring, descriptive strategy is used to reach the goal of the study. The background and rationale of the study are described, the problem is stated as well as a central theoretical statement. The assumptions of the study are described within the framework of the nursing theory for the whole person. No explicit theoretical assumptions are made, so that the researcher is open to empirical findings and to prevent pre-conceived ideas. The methodological assumptions is based on the Botes research model. No explicit conceptual framework is used as point of departure. Because the participants are midst a process of transformation, their knowledge and experience are used as source of data, as they can express their needs and views the best. The goal of this study is reached by setting four objectives. Objective I is to explore and describe the learning accompanists need for didactic support systems, within the context of a nursing college. Objective II is to explore and describe the managements views with regard to the way they can give didactic support, within the context of a nursing college. Objective III is to describe a conceptual framework. Objective IV is derived from objective I, objective II and objective III. Objective IV is the description of guidelines for the management of didactic support systems at a nursing college. To attain objective I, exploring is done by means of interviews with learning accompanist's. One semi-structured question is: "What are your needs for didactic support systems in the college?" To attain objective II, exploring is done by means of individual interviews with role players. One central question is set: "How can you give didactic support to the learning accompanist?" The interviews are conducted by an independent moderator/interviewer and assistant. Data is recorded by means of audio tapes and field notes, whereafter transcription takes place. Data is coded by the researcher and an assistent coder. The data analysis is done through a systematic approach of text analysis, as described by Tesch (in Cresswell, 1995:155). Thereafter the empirical findings of objective I and objective II are described. The interpretations are grounded by statements from the empirical data. Statements (n = 57) are formulated from the empirical findings of objective I and objective II. From these statements (n = 57) a list of concepts are generated. These concepts are utilized to attain objective III, the describing of a conceptual framework. The survey list of Dickoff, James and Wiedenbach (1968) is utilized to describe the conceptual framework in a structured manner. Data collection is done through a literature search to correlate the empirical findings with the literature. During the description of the conceptual framework conclusion statements (n = 15) are made. These conclusion statements are utilized to attain objective IV. Objective IV is to describe guidelines for the management of didactic support systems at a nursing college. Through logical inferention 12 guidelines and possible operationalisation of each are described. The uniqueness of the study lies in the relevance within the current time frame context and that it expresses the needs of the learner accompanists and the views of the managers at a nursing college. An abundance of possibilities for further research are created.

Within the current context of the healthcare environment, the charge nurse role has become very important for safety and positive outcomes. There is little known about the role from the perspective of the charge nurse. This qualitative descriptive exploratory study examined the experience of being a charge nurse in acute care practice, and describes how charge nurses live caring in their support of nurses and patients. Ray's (1989, 2006) theory of Bureaucratic Caring, Swanson's (2008) caring attributes and leadership, and Boykin and Schoenhofer's (2001) theory of Nursing as Caring provided the theoretical lenses through which study findings were viewed. Semi-structured interviews were conducted with 20 charge nurses in 4 acute care facilities. Eight themes emerged from an inductive analysis of the data describing the experience of being a charge nurse in acute care practice: Creating a Safety Net, Monitoring for Quality, Showing the Way, Completing the Puzzle, Managing the Flow, Mak ing a Difference, Putting Out Fires, and Keeping Patients Happy. Participants also were asked questions about how they provide support to staff nurses and patients. Themes that reflected how charge nurses live caring in their support of staff and patients were: Jumping in the Trenches, Nurturing Staff Growth, Offering Authentic Presence, and Looking after Nurses. Additionally, the researcher used methods of narrative inquiry to get the participants to share stories of how they lived caring in their support of nurses and patients. Recommendations included the need to elevate the visibility of the charge nurse role and its importance to the organization, and provide support for leadership development. Job descriptions and competencies for charge nurses must reflect the complexity of the environment. / Charge nurse participants did not dialogue explicitly about their functions in terms of communication and intraprofessional team building. Since charge nurses have an increasing involvement with mentoring novice nurses and new staff, they would benefit from developing coaching skills. Given the current environment, their responsibilities in these areas may need to be better articulated so that they can focus on increasing these abilities. / by Terry L. Eggenberger. / Signature page missing one signature and the date. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

A new role has been developed in nursing named the Clinical Nurse LeaderSM (CNL®). This new role positions the masters prepared nurse at the patient's bedside to oversee care coordination and serve as a resource for the clinical nursing team, and to bridge the gaps in health care delivery to better meet the needs of patients in all health care delivery settings. Since this is a new role, there is a paucity of research that has been conducted surrounding these nurses. A phenomenological investigation examined the lived experiences of CNLs® to gain understanding about the meaning of leadership at the point of care and to discover the unique expressions of living caring that CNLs® experience as they embark upon this new role in the acute care hospital setting. Ten CNL® participants were interviewed for this study. Their stories about patient situations and relationships with other disciplines were shared with rich description and emotion. Hermeneutic analysis of the text revealed six essential themes. Six essential themes emerged revealing the essence of leading at the bedside and living caring in the CNL® role: navigating safe passage, pride in making a difference, bringing the bedside point of view, knowing the patient as person, helping nurses to grow, and CNLs® needing to be known, understood and affirmed. Taken as a whole through a synthesis of the themes, the understanding of the meaning of leading to CNLs® includes keeping their patients safe, being proud of their accomplishments and the respect gained from others, as well as being a helper and advocate for other nurses. / This is accomplished through their privileged place at the bedside, where they come to know their patients as person and work hand in hand with nursing colleagues. When CNLs® are supported by management, and their roles are planned and understood, they are more fully able to optimally practice and live and grow in caring. / by Barbara C. Sorbello. / Thesis (Ph.D.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

Todos os países, independente do modelo de assistência à saúde adotado, têm compartilhado de um problema comum, os custos explosivos frente a recursos ou orçamentos limitados. Assim, custos crescentes e elevados dos serviços de saúde têm afetado todos os prestadores de serviços, sejam públicos ou privados. Na atual realidade financeira da saúde os hospitais terão que adotar um sistema para se ter um melhor controle dos processos de trabalho e informações precisas que possibilitem avaliar os resultados financeiros do hospital. As enfermeiras administradoras estão cada vez mais sendo envolvidas em decisões financeiras, no planejamento orçamentário de suas instituições, tendo que gerir recursos (humanos, materiais e financeiros) muitas vezes escassos. Diante destas considerações, constata-se a importância da enfermeira enquanto geradora de receita por ações prescritas ao paciente e como gestora das atividades realizadas na sua unidade, demandadas por outro profissional, principalmente em um hospital privado, onde as maiores fontes pagadoras são os convênios. Assim os objetivos desse estudo foram: calcular o faturamento gerado pelos procedimentos de enfermagem em uma unidade de terapia intensiva e calcular a porcentagem do faturamento gerado pela enfermagem em relação ao faturamento total da UTI. Tratou-se de uma pesquisa exploratória, descritiva, documental, com abordagem quantitativa. Foi realizado em uma UTI geral, de um hospital geral, privado, de grande porte, com 407 leitos, na cidade de São Paulo. A amostra foi de 159 pacientes. As fontes para obtenção dos dados foram as prescrições de enfermagem, as prescrições médicas, a fatura do paciente, o guia para apontamento em planilhas e procedimentos da qualidade. Foram elaborados dois instrumentos para coleta de dados. Concluiu-se que os procedimentos da prescrição de enfermagem, que mais contribuíram, foram: verificar débito cardíaco, instalar VAMP, colocar trackcare, trocar filtro umidificador, verificar pressão capilar pulmonar e fazer curativos e os procedimentos de enfermagem, da prescrição médica, que mais contribuíram foram: dieta enteral, dieta parenteral (NPP) e diálise. Em média, o faturamento recebido de cada paciente foi de R$8.918,30; o faturamento dos procedimentos de enfermagem, oriundos da prescrição de enfermagem foi de R$1.230,33 e os da prescrição médica foi de R$508,57. Em média o faturamento da prescrição de enfermagem foi de 11,3%, ou seja, o faturamento da prescrição de enfermagem foi maior que o da prescrição médica; sendo 5,4% com mão-de-obra e 5,9% foram com materiais e em média, 3,8% do faturamento obtido de cada paciente, foi da prescrição médica; desses, 1,4% foi com mão-de-obra e 2,4% foi com materiais. Obteve-se, então, que os procedimentos de enfermagem foram responsáveis por 15,1% do faturamento total da UTI. A abordagem do tema representou um grande desafio pela falta de literatura específica a respeito, além de ser uma realidade, praticamente, nova para a enfermeira que, hoje, é considerada gestora de sua unidade de negócio. / Every country, no matter the health assistance model adopted, has been sharing a common problem: high costs facing limited resources and budgets. Thus, growing and high costs of health services have been affecting all public or private service providers. In the current financial health reality, hospitals will have to adopt a system to get a better control of work processes and precise information to make possible to evaluate the Hospital’s financial results. Nurse managers are even more involved in financial decisions, and budget institution planning and have to manager human, material and financial resources which sometimes are rare. Facing those considerations, the importance of the nurses is proven as income generator by actions prescribed to patients and as managers of activities held at their units, demanded by another professional, mainly at a private hospital, where major payer sources are medical health care. Thus, this study objects were: calculating incoming generated by nursing procedures at a intensive care unit and calculating percentage of incoming generated by nursing facing the total IUC incoming. It was an exploratory, descriptive, documental and quantitative approach research. It was held at a general ICU at a general private big hospital with 407 beds in the city of São Paulo. 159 patients were enrolled for the sample. Data sources were nursing prescriptions, medical prescriptions, patient’s invoice, permit to note in spreadsheet and quality procedures. Two data collection instruments were elaborated. We concluded nursing prescription procedures that contributed most were: verifying heart debt, installing VAMP, placing trackcare, changing humidifier filters, verifying pulmonary capillary pressure and plastering and nursing medical prescription procedures that contributed most were: enteral diet, parenteral diet (NPP) and dialysis. As an average, incoming received from each patient was R$8.918,30; nursing procedure incoming, from nursing prescription was R$1.230,33 and those from medical prescription was R$508,57. Nursing prescription incoming was 11,3%, that means, nursing prescription incoming was higher than the medical prescription one; nursing prescription turnover was higher than medical prescription turnover; it was 5,4% with workforce and 5,9% with materials, and 3,8% of each patient turnover was from medical prescription; of these, 1,4% was with workforce and 2,4% with materials. We concluded that nursing procedures were responsible for 15,1% of total ICU incoming. This approach represented a great challenge due to the lack of specific literature, and it is an almost new reality for nurses considered managers of their business unit today.

A prática do gerenciamento de enfermagem necessita romper barreiras da influência do método funcional e direcionar-se às práticas contemporâneas do gerenciamento do cuidado de enfermagem, pautado pela ideia da gerência participativa, tendo como centralidade o usuário, criando espaços coletivos, envolvendo todos os agentes do processo de trabalho, com a articulação da gerência ao cuidado de enfermagem, na perspectiva de que, a partir dele, emergem elementos para a organização do trabalho de enfermagem. Entretanto, essa concepção de gerenciamento ainda é pouco difundida e sua prática não está consolidada. Esta pesquisa teve como objetivo caracterizar, segundo a ótica de enfermeiros que atuam na enfermagem brasileira na área de gerência, o gerenciamento de enfermagem hospitalar centrado no usuário, bem como descrever sua concepção, identificar as prioridades e sistematizar tendências futuras. Metodologicamente, foi realizado estudo exploratório quantitativo, de mensuração de opinião, utilizando a técnica Delphi, com participação de enfermeiros experts em gerenciamento de enfermagem hospitalar, atuantes em hospitais e em docência, em três rodadas de opiniões para estabelecimento de consenso sobre o assunto. Os dados foram apresentados segundo estatística descritiva e analisados a partir do referencial teórico sobre o tema. O projeto foi aprovado pelo Comitê de Ética em Pesquisa. Os resultados evidenciaram que o cenário atual no qual, o gerenciamento de enfermagem está imerso, é influenciado pelo método funcional, sendo explícita a necessidade de mudança de paradigma, sem, contudo, desconsiderar seus aspectos positivos, sendo o gerenciamento do cuidado de enfermagem tendência potencial, por ter o usuário como foco das ações e por considerar a lógica das instituições, dos profissionais e usuário. Na atualidade, já é possível identificar o enfoque do gerenciamento do cuidado, porém, sem a concretização na prática que se encontra distanciada dos princípios que a norteiam. Identificou-se que há lacuna entre o panorama atual e a perspectiva futura, na qual aspectos que ainda não fazem parte da realidade atual têm perspectiva de concretização. A concepção versou sobre a articulação da gerência no cuidado de enfermagem, sendo que, na ocorrência da cisão entre essas dimensões, são geradas deficiências na assistência. Estabeleceu-se consenso quanto à necessidade de priorizar o cuidado como núcleo do processo de trabalho e as ações gerenciais, tendo como finalidade a assistência. Para a implementação do gerenciamento de enfermagem com foco no usuário, evidenciou-se a necessidade de desenvolver competências pautadas no trabalho coletivo. Este estudo possibilitou identificar conhecimentos referentes ao gerenciamento de enfermagem, na perspectiva da atualidade e do futuro. Entende-se que o gerenciamento de enfermagem, com foco no usuário, articula gerência e assistência, sofre influência e influencia as especificidades das diferentes clínicas. Identificar e discutir os pontos fracos e fortes, os fatores facilitadores e dificultadores, bem como as características essenciais para a prática do gerenciamento, favorece a reflexão sobre a estruturação dos processos e o direcionamento das ações para que, de fato, as mudanças necessárias comecem a ocorrer. Trata-se de alternativa contemporânea e inovadora para modificar moldes de gerenciamento ainda praticados que não têm obtido êxito ao contemplar a integralidade da assistência ao usuário. / The nursing management practice needs to break barriers of the influence of the functional method and direct itself to the contemporary practices of nursing care management, guided by the idea of participative management, focused on users, creating collective spaces, involving all stakeholders of the work process, jointly with nursing care managers, in the perspective that elements for the organization of nursing work emerge from it. However, this conception of management is still not widespread and its practice is not consolidated. This study aimed to characterize, according to the viewpoint of nurses working in management of Brazilian nursing, the management of user-centered hospital nursing, and to describe its design, identify the priorities and systematize future trends. It is an exploratory and quantitative study, with measurement of opinion, using the Delphi technique, and with the participation of nurses expert in hospital nursing management, who works in hospitals and in teaching, in three rounds of opinions to establish consensus on the subject. Data were presented according to descriptive statistics and analyzed from the theoretical framework on the subject. The project was approved by the Research Ethics Board. Results showed that the current scenario, in which nursing management is inserted, is influenced by the functional method, and there is explicit need for a paradigm shift, without, however, ignoring its positive aspects. Nursing care management is a potential trend, as it focuses its actions on users and considers the logic of the institutions, professionals and users. Currently, it is possible to identify the focus of care management, however, this is not found in practice, which is detached from its guiding principles. Gaps were identified between the current situation and future perspective, in which aspects that are not yet part of the current reality have a prospect of accomplishment. The design addressed the joint management in nursing care, and, in the case of splitting between these dimensions, deficiencies in care occur. Consensus was established regarding the need to prioritize care as the core of the work process and management actions, aiming at care. For the implementation of nursing management focused on users, there is need to develop skills based in collective work. This study identified knowledge related to nursing management, in the perspective of present and future. It is understood that nursing management, focused on users, articulates management and care, is influenced and influences the specificities of the different areas. Identifying and discussing the strengths, weaknesses, facilitating factors and difficulties, as well as the essential characteristics of the management practice, encourages reflection on the structuring of processes and guides actions so that, in fact, the needed changes start to happen. It is a contemporary and innovative alternative to modify management molds still practiced and that have not been successful in providing comprehensive care to users.

Thesis (M.Cur.) -- University of Limpopo, 2014 / The purpose of the study was to develop protocol for professional nurses regarding NIMART management that is based on data and specific challenges that are faced in the Ehlanzeni district by professional nurses. A quantitative, descriptive and cross-sectional research design was used for this study. The population consisted of all professional nurses who are NIMART trained, managing and initiating patients on ARV’s at primary health care clinics. Systematic random sampling method was used to select 135 respondents. Data was collected through the self-developed questionnaire. The questionnaire was pre tested. Reliability was ensured through self-administered questionnaire and with the guide of literature review. The questionnaire was also pre tested by conducting a pilot study. Validity was ensured through undertaking extensive literature review, giving operational definitions of concepts, questionnaires were given to supervisors, questions constructed according to the objectives of the study and congruence was ensured between research questions, objectives, findings and recommendations. Data analysis was done through descriptive studies, using SPSS statistics 21.0 programme of data analysis with the assistance of the statistician. The findings indicate that challenges faced by professional nurses regarding nurse initiated and management of antiretroviral therapy are be lack of professional nurses, fear of infecting themselves while treating HIV positive patients, patients do not come on their return dates, encountering problems when they trace defaulters and shortage of retroviral drugs. The study recommends that staff shortage should be addressed, medicine supply should be monitored, a competent HIV trained doctor should be appointed and dedicated outreach team should be appointed. Keywords: NIM-ART, HIV/AIDS, Professional nurse

Thesis (M.CUR.) -- University of Limpopo, 2014 / The purpose of the study was to develop protocol for professional nurses regarding NIMART management that is based on data and specific challenges that are faced in the Ehlanzeni district by professional nurses. A quantitative, descriptive and cross-sectional research design was used for this study. The population consisted of all professional nurses who are NIMART trained, managing and initiating patients on ARV’s at primary health care clinics. Systematic random sampling method was used to select 135 respondents. Data was collected through the self-developed questionnaire. The questionnaire was pre tested. Reliability was ensured through self-administered questionnaire and with the guide of literature review. The questionnaire was also pre tested by conducting a pilot study. Validity was ensured through undertaking extensive literature review, giving operational definitions of concepts, questionnaires were given to supervisors, questions constructed according to the objectives of the study and congruence was ensured between research questions, objectives, findings and recommendations. Data analysis was done through descriptive studies, using SPSS statistics 21.0 programme of data analysis with the assistance of the statistician. The findings indicate that challenges faced by professional nurses regarding nurse initiated and management of antiretroviral therapy are be lack of professional nurses, fear of infecting themselves while treating HIV positive patients, patients do not come on their return dates, encountering problems when they trace defaulters and shortage of retroviral drugs. The study recommends that staff shortage should be addressed, medicine supply should be monitored, a competent HIV trained doctor should be appointed and dedicated outreach team should be appointed. Keywords: NIM-ART, HIV/AIDS, Professional nurse

Aim The purpose of the study was to formally identify trauma care delivery problems at the study institution, implement a solution in the form of trauma case management (TCM), and measure the effect of TCM on staff satisfaction, clinical coding accuracy and patient outcomes, using practice-specific outcome variables such as in-hospital complication rates, length of stay, resource use and allied health service intervention rates. This research also aimed to make a unique contribution to the international trauma literature by addressing the lack of any evidence specifically measuring the impact of trauma case management intervention. Methods St George Hospital is a 600 bed urban Teaching Hospital of the University of NSW. It is a designated Trauma Centre, seeing around 200 severely injured patients and around 2500 injury admissions per year. A series of focus groups and a staff satisfaction survey identified perceived problems associated with trauma care, and a trauma case management program was implemented. A preliminary study was conducted with positive results and funding was obtained to provide TCM seven days a week to all trauma patient admissions. A larger clinical trial was conducted and data from 754 patients were collected over fourteen months after TCM was introduced at the study hospital. These data were compared with 777 matched patients from the previous 14 months as a control group. An audit was conducted on trauma patient clinical coding using the daily progress record kept by the trauma case manager. The data were analysed with SPSS. The statistical tests used were Mann-Whitney U, chi-squared (2) logistic regression and generalised linear models. Results Focus groups and the staff satisfaction survey identified communication and coordination as the main problems associated with trauma care delivery. Following the initial implementation of the program, staff support for TCM was overwhelming. TCM greatly improved the rate of and time to Allied Health intervention (p&lt0.0001). Results demonstrated a decrease in the occurrence of deep vein thrombosis (p&lt0.038), coagulopathy (p=0.041) and respiratory failure. A reduced hospital length of stay (LOS), particularly in the paediatric (p&lt0.05) and 45 - 64 years age group was noted. There were 6621 fewer pathology tests performed (p&lt0.0001) and the total number of bed days was 483 days less than predicted from the control group. Many hospital clinical coding errors and omissions were highlighted by the TCM record comparison. The use of TCM records resulted in Twenty eight percent of recoded records having their Australian national diagnostic related group (AN-DRG) changed, which resulted in the identification over $39,000 in unidentified funding. Conclusion TCM improves staff satisfaction, communication and clinical coding accuracy. The introduction of TCM improved the efficiency and effectiveness of trauma patient care in our institution. This initiative demonstrates that TCM results in improvements to quality of care, trauma patient morbidity, financial performance and resource use. This research makes an important and original contribution to the international trauma literature by providing the results of a clinical trial formally measuring the impact of trauma nursing case management intervention.

The purpose of the study was to describe the relationship between motivation, job satisfaction, characteristics of nursing care delivery systems, and intent to leave, and to consider the applicability and usefulness of the Job Characteristics Model (JCM) of work motivation to the work of nursing in four McGill University teaching hospitals. / The population consisted of over four hundred nurses who work in medical surgical units of four McGill University teaching hospitals. A total of one hundred and fifty-nine useable questionnaires were collected for a response rate of 40%. / Respondents were full and part time nurses with an average age of 36 years and eight years of nursing experience. More than 90% of the nurses reported primary nursing/total patient care to be the model in use. However, the variations in the attributes of delivery systems within that one model attest to the variations that exist within models. Feedback, communication, support for autonomy and time on patient care contributed to the development of the internal psychological states. / The proposals of the Job Characteristics Model were generally supported by the data. The psychological states, referred to by Hackman and Oldham as the causal core of the model, mediated between the core job characteristics and the outcomes. The factors of autonomy, significance and meaningfulness of the work of nursing played an important role in nurses' perceptions of their jobs. / Work environment and work content were more strongly related to an intent to leave than external or individual factors. General satisfaction increased and intent to leave decreased as the patient environment became less complex. / There were no differences in the study findings according to education, but job satisfaction was higher for nurses with more than ten years of experience and for those who were 50 years of age or older. / Findings supported the utility of the JCM as a model of work motivation and satisfaction for nurses. The addition of specific attributes of support for autonomy, exchange of information, and inclusion of environmental complexity contributed to a fuller understanding of the factors in nursing related to motivation and satisfaction, and led to the development of a revised model of job characteristics for nursing.