M.Cur. / The purpose of this study is to compile a strategy for transformation management in a local authority. Traditionally local authorities rendered preventative and promotive services. The provinces were responsible for rendering of curative services. This service delivery was fragmented due to political policies and diversification. With the new political dispensation in South Africa, the White Paper for the transformation of health services in South Africa (1997), gives direction for the integration of health service delivery to achieve the following mission focussing on equity, acceptability, accessibility, affordability, availability and appropriateness. These policy/legislative changes therefore require a strategy for transformation management of primary health care services. This impacts on the current service delivery system. The type of service delivery has to be reconstructed, to accommodate free primary health care services for all South Africans, additional services like curative services, dental services and termination of pregnancy services. Human resource management will also undergo significant changes as the local authority is expected to take over the existing provincial staff allocated to clinics. This could result in labour unrest if not well managed. There are also financial constraints that will impact on this process of transformation. The scarcity or shortage of medicines, equipment and other supplies necessary for quality service delivery also impact on the transformation process. The changing environment is difficult to handle, especially as it involves human beings who react differently towards change. Some individuals adapt easily in a changing environment, others resist change. Many meetings have been held to discuss the transformation of health services. The outcomes of these meetings have clearly demonstrated that health personnel are experiencing problems which are a direct result of the transformation process. Therefore it is important for management in a local authority in the East Rand, to devise a transformation strategy in order to implement primary health care services effectively and efficiently. The transformation strategy requires careful planning and decision making, that will be beneficiary to all the role players involved. Management in a local authority will have to take a leading role in the transformation management of primary health care services. This situation can be either a "challenge" or a "dilemma".

No description available.

No description available.

The purpose of this study was to explore what keeps nurses in nursing by examining the impact of the relational experiences between the nurse and her or his patient in the context of the nursing situation. Heideggerian hermeneutic phenomenology grounded the study and was the method used to interpret the registered nurse participants' meaning of their everydayness. The nurses' first hand perspectives elicited implications for nursing practice. This qualitative research study examined what keeps nurses in nursing. The eight registered nurse participants provided rich descriptive data from which four relational themes emerged: Practicing from Inner Core Beliefs, Understanding the Other from Within, Making a Difference, and Nursing as an Evolving Process. The hermeneutical interpretative process guided the researcher to synthesize the themes into a constitutive pattern of meaning which the researcher named Intentional Compassion Energy. In intentional caring consciousness, the nurse intentionally knows the nursed as whole. Compassion energy is the intersubjective gift of compassion that gives nurses the opportunity to be with the nursed. Compassion energy is composed of compassionate presence, patterned nurturance and intentionally knowing the nursed and self as whole. Thus, intentional compassion energy is defined as the regeneration of nurses' capacity to foster interconnectedness when the nurse activates the intent to nurse. Intentional compassion energy was discovered in the meaning of the nurse participants being in their everydayness of practice. The participants described the intention to care compassionately as the grounding of their practice, striving to understand the other, to make a difference while living their nursing as an evolving process. Hermeneutic phenomenology provided the opening to discover what keeps nurses in nursing. / by Dorothy J. Dunn. / Thesis (Ph.D.)--Florida Atlantic University, 2009. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2009. Mode of access: World Wide Web.

by Chan Wai Han, Florence, Hui Wendy Wan Yee. / Thesis (M.B.A.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaf [44]).

The objective of this study is to evaluate the impact of the Diabetes Nurse Care Manager on an at-risk diabetic population using a Primary Group Visit Model in Outlying Medical Offices within the Kaiser-Permanente Health Care System upon the process and outcome of care in this population.

Thesis (MPA)--Stellenbosch University, 2000. / Full text to be digitised and attached to bibliographic record. / ENGLISH ABSTRACT: Managing human resources is crucial to the efficient and effective delivery of quality health care. However, turnover of nurses constitutes a major factor in the shortages of staff which are being experienced by the nursing profession in the Republic of South Africa. Shortages of trained nurses with experience, particularly in public sector hospitals, have adverse effects on the provision of efficient and effective quality health care to the consumers of this service. The aim of the study was to provide an understanding of and insight into those inherent problems in the health sector that propel nurses to leave public sector institutions. The overall objective was to investigate and identify some of the factors which exercised an influence on the turnover of registered nurses in public sector hospitals, so as to be able to provide suggestions to hospital managers on the more effective management of human resources, in order to retain nursing personnel. Theresearch was based on a model of nursing turnover which regarded voluntary withdrawal as a process in which feelings of satisfaction with pay, on the one hand, and the opportunity of obtaining alternative jobs in the labour market, on the other, were proposed as the primary causative factors of turnover behaviour. In addition the propositions, made in literature reviewed, that age, tenure, kinship responsibility, general training, education, professionalism, marital status, lintent to stay', job satisfaction, routinization, job autonomy and responsibility, instrumental communication, promotional opportunity, integration, supervisory relationships, distributive justice, work-load, and local kin acted as predictors of turnover, were also investigated. The research was conducted with a sample of 123 nurses in one hospital, Groote Schuur, situated in the Western Cape Province of the Republic of South Africa. The sample included registered nurses, senior professional (registered) nurses, and chief professional (registered) nurses. The data was gathered from respondents by means of a selfadministered questionnaire. In addition, data was gathered by means of semi-structured, open-ended discussions with nursing management. The hypothesised interactions between variables influencing nursing turnover were explored by means of basic statistics, which made it possible to assess the effects of both independent and dependent variables. The results of data analysis provided some support for the proposition contained in the hypothesis. The determinants whose increase produced a greater degree of turnover were firstly, the many jobs available outside the hospital and secondly, professionalism. The determinants whose increase resulted in reductions in turnover were "intent to stay" (which the researcher views as a dimension of commitment), the existence of local kin (kinship responsibilities), participation in making job-related decisions (job autonomy), the receipt of sufficient work-related information (instrumental communication and good supervisory relationships), and tenure. The determinants whose decreaseresulted in increased turnover werepromotional opportunities, distributive justice, pay satisfaction, job satisfaction, integration, opportunity for self-development,age and tenure. Turnover of nurses has serious ramifications for employers, patients, and the nursing profession itself. Effective management of employee turnover is of critical importance to health care providers, employees, and patients. Better control of turnover can improve the quality of patient care, reduce labour costs, and improve employee morale. / AFRIKAANSE OPSOMMING: Die bestuur van menslike hulpbronne is die deurslaggewende omstandigheid ten einde die lewering van effektiewe en doeltreffende gesondheidsorg van gehalte. Nietemin, dra die omset van verpleegkundiges grotendeels by tot die personeeltekort wat tans deur die verpleegprofessie in Suid-Afrika ondervind word. Die tekort aan ervare, opgeleide verpleegkundiges, veral in die openbare sektor staatshospitale, het 'n nadelige uitwerking op die voorsiening van effektiewe en doeltreffende gesondheidsorg van gehalte aan die verbruikers van hierdie diens. Die doelwit van die studie was om 'n begrip te ontwikkel vir, en 'n insig te probeer kry in, daardie inherente probleme binne die gesondheidsektor wat verpleegkundiges dryf om die staatsinstellings te verlaat. Die oorkoepelende doel was die ondersoek en identifikasie van sommige faktore wat die omset van geregistreerde verpleegkundiges in staatshospitale beïnvloed. Die doel hiervan was om voorstelle aan hospitaal bestuurders te kan voorsien ten opsigte van die meer doeltreffende bestuur van menslike hulpbronne, in die strewe na behoud van verpleegpersoneel. Die navorsing is gebaseer op 'n model van verpleegomset wat vrywillige onttrekking as 'n proses beskou het waar gevoelens van salaristevredenheid, aan die een kant, en geleentheid tot alternatiewe betrekkings in die arbeidsmark, aan die ander, as die primêre veroorsakende faktore van omset-gedrag voorgestel is. Daarbenewens is die stellings vanuit die literatuurstudie dat die volgende dien as voorspellers van omset ook ondersoek: ouderdom, ampstermyn of dienstyd, verantwoordelikheid teenoor familie, algemene opleiding, opvoeding, professionalisme, huwelikstatus, 'voorneme om te bly', werksbevrediging, roetine, selfbestuur en verantwoordelikheid in die werksomgewing, bevorderlike kommunikasie, bevorderingsgeleenthede, integrasie, toesighoudende verhoudings, toedelende gereg, werkslading en plaaslike naasbestaandes. Die navorsing is uitgevoer met gebruik van 'n monster van 123 verpleegkundiges van een hospital, die Groote Schuur Hospital, geleë in die Wes-KaapProvinsie van die Republiek van Suid Afrika. Die monster het geregistreerde verpleegkundiges, senior geregistreerde verpleegkundiges en hoof geregistreerde verpleegkundiges ingesluit. Die data is verkry van respondente deur middel van 'n self-toegediende vraelys. Daarbenewens is data versamel deur half-gestruktureerde, niegeslote besprekings met van die verpleegbestuur. Die interaksie tussen veranderlikes ten opsigte van verpleegomset wat veronderstel is, is ondersoek deur middel van basiese statistiek, dus kon die uitwerking van afhanklike en onafhanklike veranderlikes bepaal word. Die uitslae van data-ontleding het wel ondersteuning verleen aan die voorstelling soos uiteengesit in die hipotese. Die determinante wie se toename 'n toename in die omsetkoers tot gevolg gehad het was, eerstens, meer werksgeleenthede buite die hospitaal en, tweedens, professionalisme. Die determinante wie se toename tot 'n vermindering in omset bygedra het was 'voorneme om te bly' (wat die navorser as binne die omvang van toewyding beskou), deelname aan werksverwante besluitneming (werks outonomie), die ontvangs van genoegsame werksverwante inligting (bevorderlike kommunikasie en goeie toesighoudende verhoudings), en ampsduur (dienstyd). Die determinante wat tot 'n vermindering in omset lei is bevorderingsgeleenthede, toedelende gereg, salaris bevrediging, geleenthede tot self-ontwikkeling, ouderdom en ampsduur. Die omset van verpleegkundiges het verreikende gevolge vir werkgewers, pasiënte en die verpleegsberoep self. Doeltreffende bestuur van werknemer-omsetis van kritiese belang vir gesondheidsorg voorsieners, werknemers en pasiënte. Die meer effektiewe beheer van omset kan die kwaliteit van pasiëntesorg verbeter, arbeidsonkoste verminder en die moraal van werknemers verbeter.

Este trabalho foi desenvolvido com os objetivos de analisar o Gerenciamento da Qualidade implantado em um serviço de enfermagem hospitalar e conhecer a opinião do enfermeiro a respeito desse Gerenciamento no serviço em que trabalha. Por tratarse de um estudo de caráter exploratório e descritivo optamos por utilizar, como instrumento de coleta de dados, um formulário para entrevista elaborado pela autora com base em Deming (1990) e Antunes (1997). A partir dos resultados obtidos, juntamente com a revisão da literatura, acreditamos que os objetivos inicialmente propostos foram alcançados. Como principais resultados do estudo podemos citar que 17 (100%) dos enfermeiros entrevistados: afirmam que conhecem a filosofia da Qualidade Total aplicada ao serviço de enfermagem em que trabalham e acreditam que a implantação da filosofia trouxe melhoria para a sua prática. Além disso, quatro (24%) dentre estes, únicos presentes no hospital desde a adoção da nova filosofia, percebem aumento na satisfação do cliente em relação aos cuidados prestados; acreditam que houve melhoria no relacionamento interpessoal da equipe de enfermagem; e acham que o desempenho profissional do pessoal de enfermagem aumentou após a implantação. Dentre os 14 princípios de Deming (1990), o mais bem pontuado pelos enfermeiros foi o sétimo, que diz respeito a adotar e instituir a liderança (82% de atribuições à pontuação máxima). Por outro lado, o princípio menos pontuado foi o terceiro: cesse a dependência da inspeção em massa (18% de atribuições à pontuação máxima). Pretendemos que os enfermeiros, principalmente os que exercem cargo de gerência, considerem a filosofia da Qualidade Total como viável e aceitem o desafio de romper as barreiras da tradição, passando do discurso para a prática. / This research aimed to analyze the management of quality implemented in a hospital nursing care to learn the opinion of nurses regarding the management of the service they perform. Because the study exploratory and descriptive characteristics, the data collection was performed through an interview using a form elaborated by the author based in Deming (1990) and Antunes (1997). We believe the initial objectives were reached based on the literature review and results obtained. Among the main the results we can point that 17 (100%) of the interviewed nurses affirm to know the philosophy of Total Quality applied to the nursing service in which they work and believe the implementation of the philosophy improved their practice. Beside that, four (24%) among all, the only ones present at hospital since the adoption of the new philosophy, perceive the client?s increased satisfaction regarding the care delivered; believe the interpersonal relationship of the nursing team improved; and believe the professional performance of the nursing team improved after the implementation of the philosophy. Among the 14 principles of the Deming (1990), the higher scored one was the seventh, which concerns to the adoption and institution of leadership (82% of the attributions). On the other hand, the least scored principle was the third: cease the dependency of mass inspection (18% of the attributions). We pretend that nurses, specially those who exert management positions, consider the philosophy of Total Quality as viable and accept the challenge of breaking the barriers of tradition, going from discourse to the practice.

M.Cur. / The establishment of the South African National Defence Force (SANDF) in 1994 was coupled with problems for all the members that were integrated into the new defence force. The perception exists that members of the former non-statutory forces are receiving preferential treatment to the members of the old South African Defence Force. These perceptions create a spirit of negativity amongst members of the former statutory forces. On the other hand members of the former non-statutory forces are frustrated because they feel that top management in the SANDF is resistant to change. The South African Medical Health Service (SAMHS) is an integral part of the SANDF, and therefore the changes that took place in the last five years have had a direct effect on the members of the service, inter alia, the nursing staff It seems as though nursing service managers in the South African Military Health Service are suffering from a lack of motivation. At the moment they are also unable to motivate their subordinates. The following research questions were posed: What are the perceptions of the nursing service managers in the SAMHS with regard to their own level of motivation? What problems do the nursing service managers in the SAMHS encounter with regard to the motivation of their subordinates? Which factors motivate nursing service managers in their work setup (SAMHS and SANDF)? Which factors demotivate nursing service managers in their work setup (SAMHS and SANDF)? Which strategy must be developed to enhance the motivation of the nursing service managers in the SAMHS?

M.Cur. / It is explicit that the change in the South African government since 1994 accompanied by the transformation of nursing services with its new policies and practices is inevitable, and poses challenges for the nursing service managers in Gauteng hospitals. The transformation of nursing services can be a difficult process creating a period of fear, uncertainty, stress and role ambiguity for the nursing service managers. The transformation has been so extensive that the nursing service manager's role responsibilities have changed to such an extent that they are now required to manage grossly reduced levels of resources, multicultural societies with different values, beliefs and attitudes and increased numbers of patients, resulting in overcrowded hospitals. The transformation of nursing services demands the demonstration of appropriate nursing service management. The abilities of the nursing service managers are critical to the effectiveness of the future. Most nursing service managers are unprepared for their new roles and the present concern is for the quality of the management of the transformation process. No written standards for transformation management in a nursing service are available in Gauteng public hospitals. Consequently, nursing service managers find themselves making major decisions about nursing service transformation with little information about the effectiveness of alternative approaches. The experiences and perceptions of the nursing service managers regarding transformation of nursing services in selected Gauteng hospitals are also not known. Understanding the nursing service managers' experiences and perceptions will provide a basis for the formulation of standards for transformation management in a nursing service.