Prior to 1994, the South African Health Department was characterised by a fragmented health care system, which was largely curative and hospital based, with services planned and managed without community involvement and participation. The government, through the establishment of a district health system, integrated the health services with the aim of overcoming the fragmentation, and providing integrated comprehensive health care services that are equitable, accessible, efficient and effective. The integration of health services in Gauteng, meant the devolution of primary health care services from the provincial health department to the local authority health department, because the local authority services are nearer and accountable to the community. The process of integration of health services also meant the closing down of provincial clinics and transferring of provincial authority nurses to the local authority clinics. The transfer process impacted negatively on staff morale and on the resources available for health care delivery to the communities. It is against this background that the researcher decided to investigate the integration process. The researcher then conducted focus group interviews with the local authority nurses, provincial authority nurses and the district management team as these nurses's immediate supervisors. The results revealed that the local and provincial authority nurses were integrated without proper consultation and as a result integration was rejected. The following themes emerged from the results as negative perceptions and obstacles towards integration: lack of consultation, disparities in conditions of service and resistance to change. Positive perceptions also emerged from the results as strategies to improve the integration, and these strategies were used to develop guidelines to operationalise the model. It is envisaged that the proposed model will serve as a theoretical framework for nurse managers from both spheres of government, local and provincial to improve the integration of nurses through proper consultation, and involvement of nurses in the process affecting them. It is further envisaged that the model will serve as guideline to introduce changes within the district health system with more understanding and acceptance by nurses affected. Health care managers will find the model useful to overcome disparities in conditions of service among nurses and, in turn this may boost the moral of nurses and lead to successful integration of provincial and local authority nurses. / Health Studies / D.Litt. et Phil (Health Studies)

Text in Afrikaans / 'n Opname is onder verpleegkundiges in diens van geselekteerde hospitale onderneem ten einde te bepaal watter ondersteuningstelsels tans in die hospitale vir verpleegkundiges beskikbaar is. Daar is ook bepaal hoe effektief hierdie ondersteuningstelsels benut word, en indien nie waarom nie en ten laaste of ondersteuningstelsels as 'n vereiste fasiliteit gesien word. Die leemtes betreffende ondersteuningstelsels in hierdie hospitale is ge·identifiseer, soos die gebrek van verpleegbestuur om outokratiese en burokratiese bestuurstyle met deelnemende bestuurstyle te vervang. Daar bestaan ook leemtes in ondersteuning by die beplanning van verpleegsorg, wat moontlik toegeskryf kan word aan verpleegbestuur se swak deelname en betrokkenheid by verpleegsorgbeplanning. Aanbevelings is geformuleer om hierdie leemtes aan te spreek. Tydens orientering behoort alle nuwe personeel ingelig te word oor die hospitaalbeleid, sodat doelstellings gesamentlik beplan kan word. Die funksie van bestuur en hulle bydrae tot personeelondersteuning behoort deel van die orienteringsprogram te vorm / A survey to establish which support systems are at present available to nurses, was undertaken in selected hospitals. It was determined how effective these support systems have been utilised, and if not, why not and whether the support systems were seen as an essential facility. The failure of nursing management to replace autocratic and burocratic management styles with participative management styles is a deficiency in the support systems of these hospitals. There is also a need for support in the planning of nursing care. This can possibly be due to the nurse manager's poor participation and involvement in the planning of nursing care. Recommendations were formulated to address these needs. During orientation all new personnel should be informed of hospital policy to enable them to plan collectively, to accomplish objectives. The functions of management and their contribution towards personnel ought to form part of the orientation programme / Agriculture and Environmental Sciences / M.A. (Verpleegkunde)

Made available in DSpace on 2015-07-22T20:49:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-04-28 / O Hospital Santa Casa de Montes Claros (MG) implementa mudanças em seus sistemas administrativos, e a Gestão por Processo passou a ser um instrumento de aperfeiçoamento contínuo, ajudando no planejamento, na liderança e no controle de tudo o que é feito, porém, de difícil utilização. Esta pesquisa buscou estudar as dificuldades vivenciadas pelos gerentes na utilização da ferramenta de Gestão por Processo, sendo possível analisar a percepção desses gestores e o grau de dificuldade nesta metodologia, identificando os principais aspectos do processo e analisando as estratégias utilizadas pelos profissionais da saúde, gestores da instituição, para a manutenção da qualidade. O cenário de estudo foi a Irmandade Nossa Senhora das Mercês – Hospital Santa Casa de Montes Claros, classificada como Hospital Geral, possuindo 320 leitos. Os sujeitos pesquisados foram os 24 Gerentes de Equipe tendo como instrumento de coleta de dados o questionário, previamente validado e testado. Ao finalizar todo o processo de análise, pôde-se concluir que a maioria dos gestores tem curso superior e parte deles já tem especialização. A maioria dos envolvidos teve o primeiro contato com esta metodologia na própria Santa Casa e já faz uso das ferramentas administrativas ao longo da trajetória profissional na instituição. Ao implantar esta metodologia, inicialmente, as principais dificuldades da utilização tratavam-se da falta de conhecimento teórico e prático dos gerentes, da cultura organizacional e da resistência às mudanças. Na atualidade, as principais dificuldades apontadas pelos gestores foram outras. O cenário atual aponta como o principal dificultador da utilização da metodologia Gestão por Processo o acúmulo de atividades do Gerente dentro da Santa Casa. Ao analisar a opinião dos pesquisados sobre o que seria realizado no gerenciamento de processos em uma unidade, a maioria compreendeu tratar-se de medição de indicadores, interação de processos e realização de análise crítica do mesmo. Outro ponto que necessitou ser destacado é o fato de o Hospital Santa Casa de Montes Claros oferecer informações sobre Gestão por Processo de forma muito satisfatória para os profissionais que trabalham no processo decisório. Esse envolvimento entre a instituição e os gestores fortaleceu a segurança e o senso crítico dos profissionais, avaliando os processos para que houvesse maior eficácia nos resultados previstos. Essa gestão é a eleita para trabalhar na Santa Casa, e o Gerente de Unidade é o profissional escolhido para realizar o levantamento e controle dessas informações. Assim, é necessário adequar suas atividades e minimizar as dificuldades encontradas utilização da metodologia de processos. Quanto aos benefícios com a implantação da metodologia Gestão por Processos no Hospital Santa Casa, a pesquisa apontou que a maioria acredita ser a constante busca da melhoria na qualidade dos serviços, na obtenção do título de Acreditação Hospitalar, no alinhamento de condutas e na padronização dos processos. Uma vez reconhecidas as implicações do sistema de qualidade pelos próprios profissionais, mais fácil será o caminho para a manutenção de todo o processo e a conquista da excelência no atendimento. Espera-se, portanto, que este estudo possa contribuir para que as equipes reflitam sobre o processo da qualidade, a responsabilidade social, as mudanças de hábitos e dos conceitos embutidos na metodologia de Gestão por Processo. / TEDE / BV UNIFESP: Teses e dissertações

Despite a number of research studies showing the correlation between higher nurse staffing levels and improved outcomes, RCN members continues to report lower nurse-to-patient ratios than what research results suggests (RCN, 2011:1). This reflected a general concern within the nursing profession. The operating room requires appropriate staffing which is critical to the safety of surgical patients and quality of patient care. The research study was motivated by the researcher’s own experiences while working in an OR in a private hospital where continuous discussions were held with management about the shortage of skilled staff; and where a shortage of OR nurses resulted in the use of Central Sterilizing Department (CSD) staff to do OR duties. The objective of the study was to explore and describe the perceptions of nurses regarding staffing in the operating rooms of a private hospital in the Nelson Mandela Bay Health District. The researcher used qualitative methods and designs to explore and described the perception of nurses regarding staffing in the operating room (OR) of a private hospital in the Nelson Mandela Bay Health District. The research population of the study included all the nurses working in the OR of a private hospital. The total number of 20 OR nurses was individually interviewed by means of semi-structured interviews. Three main themes emerged that includes nurses ‘perceptions with regard to the implications of inadequate staffing in the OR; nurses experiences towards top management with regard to staffing in the OR and recommendations from participants to improve staffing in the OR. Research findings concluded that nurses have a perception that shortage of OR nurses causes lack of communication, physical, emotional and psychological strain. They also perceived OR nurses to work under unrealistic conditions and to receive added responsibilities due to staff shortages, which affect the overall delivery of quality patient care. Comments included failure of management to attend to staff complaints and the perception of high staff turnover due to a lack of recognition and acknowledgement of overworked staff.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-12-01T11:13:40Z No. of bitstreams: 2 Tese - Leonora Rezende Pacheco - 2015.pdf: 3342602 bytes, checksum: bbdc9ce308653871ea3fd5c67a3fb72b (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-12-01T11:49:14Z (GMT) No. of bitstreams: 2 Tese - Leonora Rezende Pacheco - 2015.pdf: 3342602 bytes, checksum: bbdc9ce308653871ea3fd5c67a3fb72b (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-12-01T11:49:14Z (GMT). No. of bitstreams: 2 Tese - Leonora Rezende Pacheco - 2015.pdf: 3342602 bytes, checksum: bbdc9ce308653871ea3fd5c67a3fb72b (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-06-30 / The combating of violence against women must be done by the work that involves the health, legal, police and psychosocial areas in an intersectoral network, because it is a complex and multifactorial phenomenon. The nurse belongs to the health area and the care practice is essential in the confronting of violence.This study aims to: analyze the meanings of violence against women by professionals of Network of Violence Against Women Combat, Understand the operations of the Network of Violence Against Women Combat according to its professionals, analyze the nurse assistance in Network of Violence Against Women Combat by the professionals and nurses from the network. The theoretical categories for data analysis contemplated the concepts of violence against women, the practice of the nurse, the historic route of the nursing work in Brazil and the operationalization of Network of Violence Against Women Combat; passing by authors like: Lenore Walker, Hannah Arendt and Karl Marx. It is a Social Research in Strategic Mode on a qualitative form. The data were collected through semi-structured interview with 21 professionals from 15 institutions that composed the Network of Violence Against Women Combat of Palmas/TO, and by observation of the field. Data analysis was based on thematic content analysis, emerging three thematic categories: "Meanings of violence against women", treating about the meanings, concepts and forms of violence for the participants; "Understanding the Network of Violence Against Women Combat" describing the operation of the network, its barriers and solutions; "The meanings of nurse's practice assistance in the Network of Violence Against Women Combat", participants showed how nurses were performing their practice assistance in the fighting of violence against women. After analyzing the barriers in the functioning of Network of Violence Against Women Combat and the aspects recommended by the literature and public political, a model/flowchart of network operating was proposed in a integrate and cross-sectoral way. The research concluded that for the implementation of networking is necessary to sensitize professionals and nurses about his role in the fighting of violence against women, making them recognize that the network service depends on the co-responsibility, initiative, communication and partnership of each of them. The network consists of institutions, and these by their professionals that should act effectively. Also offered subsidies for nurses practice, as well for other professionals from several sectors, in the establishment of coherent, solving and transforming actions for the prevention, detection and care of women in situations of violence. The training and inclusion of the issue of violence in the formation of professionals are very important. This research contributed to the Network of Violence Against Women Combat of Palmas, in the sensitize of professionals, recognition of partners and communication between them. / O enfrentamento da violência contra a mulher deve ser realizado por meio de trabalho que envolva as áreas da saúde, jurídica, policial e psicossocial, de maneira intersetorial em rede, por se tratar de um fenômeno complexo e multifatorial. O enfermeiro pertence à área da saúde e sua prática assistencial se faz essencial no enfrentamento da violência. Este estudo teve como objetivos: analisar os significados de violência contra a mulher atribuídos pelos profissionais da Rede de Enfrentamento da Violência Contra a Mulher, compreender a dinâmica da Rede de Enfrentamento da Violência Contra a Mulher sob a ótica de seus profissionais e analisar a prática assistencial do enfermeiro na Rede de Enfrentamento da Violência Contra a Mulher segundo profissionais e enfermeiros ligados à rede. As categorias teóricas para análise dos dados contemplam os conceitos de violência contra a mulher, a práxis do enfermeiro, o traçado histórico da atuação do enfermeiro no Brasil e a operacionalização da Rede de Enfrentamento da Violência Contra a Mulher; perpassando por autores como: Lenore Walker, Hannah Arendt e Karl Marx. Trata-se de uma Pesquisa Social na modalidade estratégica, de natureza qualitativa. Os dados foram coletados por meio de entrevista semiestruturada com 21 profissionais de 15 instituições que compunham a Rede de Enfrentamento da Violência Contra a Mulher de Palmas/TO, e pela observação do campo. A análise dos dados baseou-se na modalidade temática da análise de conteúdo, gerando três categorias temáticas: “Significados da violência contra a mulher”, abordando os significados, conceitos e formas de violência; “Compreendendo a Rede de Enfrentamento da Violência Contra a Mulher”, descrevendo o funcionamento da rede, seus entraves e soluções; “Significados da atuação do enfermeiro na Rede de Enfrentamento da Violência Contra a Mulher”, onde os participantes evidenciaram como os enfermeiros desempenhavam sua prática assistencial no enfrentamento da violência contra a mulher. Após análise dos entraves no funcionamento da Rede de Enfrentamento da Violência Contra a Mulher e os aspectos preconizados pela literatura e políticas públicas, um modelo/fluxograma de funcionamento da rede foi proposto de maneira integral e intersetorial. A pesquisa concluiu que para a implementação do trabalho em rede é preciso sensibilizar os profissionais e enfermeiros sobre sua atuação no enfrentamento da violência contra a mulher, fazendo-os reconhecer que a assistência em rede depende da co-responsabilidade, iniciativa, comunicação e parceria de cada um deles. A rede é constituída por instituições, e estas pelos seus profissionais que devem atuar de forma efetiva. Também ofereceu subsídios para a práxis do enfermeiro, bem como para a de outros profissionais dos demais setores, no estabelecimento de ações coerentes, resolutivas e transformadoras para a prevenção, detecção e atendimento das mulheres em situação de violência. A capacitação e inclusão do tema da violência na formação dos profissionais se mostraram importantes. Essa pesquisa contribuiu para a Rede de Enfrentamento da Violência Contra a Mulher de Palmas, na sensibilização dos profissionais, reconhecimento dos parceiros e na comunicação entre eles.

O enfermeiro tem sido cada vez mais requisitado para envolver-se nas decisões financeiras nas organizações de saúde. Sua participação no gerenciamento dos custos associado à assistência de enfermagem é importante para conhecer o quanto a enfermagem contribui para o faturamento de uma Unidade de Terapia Intensiva (UTI) e ao faturamento de um hospital e evidenciar, financeiramente, a relevância do trabalho desse profissional. No entanto, a literatura brasileira carece de estudos nesse aspecto. O objetivo deste estudo foi levantar o valor do faturamento gerado pelos procedimentos de enfermagem, mediante as prescrições médica e de enfermagem, identificar as atividades de enfermagem que são realizadas, mas não recebem pagamento pelas operadoras de saúde e estimar a perda monetária do hospital pela não taxação das atividades de enfermagem, em uma. Tratou-se de um estudo de caso exploratório, descritivo, com abordagem quantitativa. O estudo foi desenvolvido na UTI Cardiológica de um hospital geral filantrópico, com 319 leitos, na cidade de São Paulo. A amostra total calculada para 3 meses foi de 168 pacientes. O faturamento médio gerado pelas prescrições de enfermagem e médica foi de R$ 773,98, e R$ 333,06 corresponderam à prescrição de enfermagem e R$ 440,92, à prescrição médica. Em relação ao valor gerado pela prescrição de enfermagem (R$333,06), R$ 261,67 corresponderam ao pagamento de materiais de consumo e R$ 71,39, ao pagamento de taxas. Em relação ao valor gerado pela prescrição médica (R$ 440,92), R$ 322,51 corresponderam ao pagamento de materiais de consumo e R$ 118,41, ao pagamento de taxas. Os procedimentos da prescrição de enfermagem que mais contribuíram para o faturamento foram a troca de filtro bacteriano (R$ 10.342,80), a realização de punção venosa (R$ 8.062,99), o curativo de ferida operatória (R$ 5.315,26) e o curativo de traqueostomia (R$ 4.762,42). Os procedimentos provenientes da prescrição médica que mais geraram faturamento foram a realização de glicemia capilar (R$ 21.602,06), passagem de pressão arterial invasiva (R$ 14.220,56) e a passagem de sonda gástrica/enteral (R$ 20.239,00). A perda média estimada foi de R$ 480,65 por paciente da amostra. A estimativa média de perda para a amostra estudada foi de R$ 81.263,65. A projeção de perda média de faturamento, para o período dos 3 meses do estudo, para a amostra selecionada, foi de R$ 153.391,15. A extrapolação da estimativa de perda média para o período de um ano, para a amostra selecionada, foi de R$ 613.564,60. Do faturamento total da amostra selecionada, as atividades de enfermagem contribuíram com 1,7% do faturamento, e 0,65% corresponderam aos procedimentos executados mediante a prescrição de enfermagem e 1,05%, aos procedimentos provenientes da prescrição médica / Nurses have increasingly been asked to participate in financial decisions in healthcare organizations. Their participation in managing the costs of nursing care is important to know how nursing contributes to the turnover of an ICU and hospital billing, and, it shows, financially, the relevance of the work of these professionals. However, Brazilian literature lacks studies in this regard. The objective of this study was to raise the value of the revenue generated by nursing procedures by the medical and nursing requirements, to identify nursing activities that are performed but not paid by health insurance companies and to estimate the monetary loss of the hospital for not taxing nursing activities in an intensive care unit (ICU). It was an occurrence study, exploratory, descriptive in a quantitative approach. The study was conducted in the Cardiology ICU of a philantropic general hospital, with 319 beds in the city of Sao Paulo. The total sample calculated for three months was 168 patients. The sources of information were the medical and accounting records of selected patients. The average revenue generated by medical and nursing prescriptions was R$ 773,98 which R$ 333,06 corresponded to the nursing prescription and R$ 440,92, the medical one. In relation to the value generated by the nursing prescription (R$ 333,06), R$ 261,67 corresponded to the payment of consumables and R$ 71,39 to fees. For the value generated by the prescription (R$ 440,92), R $ 322,51 corresponded to the payment of consumables and R$ 118,41, the payment of fees. The procedures of nursing prescription which most contributed to revenue were the exchange of bacteria filter (R$ 10.342,80), performing venipuncture (R$ 8.062,99), the surgical wound dressing (R$ 5,315.26) and tracheostomy dressing (R$ 4.762,42). The procedures from prescription which most generated revenues were performing capillary blood glucose (R$ 21.602,06), passage of invasive blood pressure (R$ 14.220,56) and passage of nasogastric tube / enteral (R$ 20.239,00). The average loss was estimated at R$ 480,65 per patient sample. The average estimate of loss for the sample studied was R$ 81.263,65. The projected average loss of revenue for the period of three months of the study, for the sample selected, was R$ 153.391,15. The extrapolation of the estimated average loss for the period of one year, for the selected sample, was R$ 613.564,60. From the total revenue of the selected sample, nursing activities accounted for 1.7% of revenues, and 0.65% corresponded to the procedures performed by nursing prescription and 1.05% corresponded to the procedures from the doctors prescription

M.Cur. / The overall purpose of this study is to describe empowerment strategies for the nurse unit manager to create a climate conducive to clinical learning at the nursing college in the North-West Province. In view of the South African Nursing Council report (1990), it clearly indicates that the nurse unit managers do not apply their theoretical knowledge to clinical practice, and that the student learning in the clinical nursing units are not up to the expected standard, hence the quality of clinical nursing education is questionable. The current education system in South Africa focuses on the provision of quality assurance in order to be in line with international standards. In accordance with the South African Qualifications Authority, the Constitution, South African Nursing Council, Batho-Pele principles, National Plan for Higher Education and outcomes-based education, there is a need to create a climate that is conducive to learning in the nursing units in order to develop the students' abilities regarding analytical, critical, evaluative and creative thinking. The nurse unit manager is experiencing problems with regard to clinical nursing education and the nursing students are also complaining that the clinical learning areas are not conducive to their learning. Therefore, the products that are produced by such an environment lack knowledge, skills, values and attitudes inherent in the nursing profession. Hence this study strives to describe empowerment strategies for the nurse unit manager to create a climate conducive to learning, based on their expert knowledge and experiences. The research questions arising from this problem are: What are the expectations and perceptions of the nursing students about the role of the nurse unit manager in creating a climate conducive to learning at the nursing college in the North-West Province? How can the nurse unit manager be empowered to create a climate conducive to clinical learning? The objectives are: Phase One: Stage one: To explore and describe the expectations of the nursing students regarding the role of the nurse unit manager in creating a climate conducive to learning. Stage two: To explore and describe the expectations and perceptions of the nurse unit manager regarding their role in creating a climate conducive to learning. Phase Two: To describe a conceptual framework. Phase Three: To describe empowerment strategies for the nurse unit manager to create a climate conducive to learning. The research design in this study was qualitative, descriptive, explorative and contextual in nature. In stage one of phase one, descriptive naïve sketches were used as a method of data gathering (Giorgi in Ornery, 1983:52) whereby 22 nursing students from the nursing college were selected for the research study. The following open-ended questions were written on the chalkboard, namely: "What are your expectations about the role of the nurse unit manager in creating the clinical nursing units as a climate conducive to learning?" The data was analysed according to Tesch's descriptive method (in Creswell, 1994:155). An independent coder who was purposively selected was used in the categorisation of data. The researcher held meetings with the independent coder for consensus discussions reached independently. Trustworthiness was ensured as described by Lincoln and Guba's (1985:290-326) model of trustworthiness. In order to ensure the credibility of the study, five nursing students who participated in the study were selected to participate in individual interviews to validate the categories and subcategories. In stage two of phase one, focus group interviews were conducted as a method of data gathering whereby 13 nurse unit managers from the clinical learning areas where the nursing students are placed for their clinical learning experiences were selected by the quota sampling technique. The interview was conducted by a nurse educator with a Master's degree, who is also a psychiatric nurse with expertise and experience in interviewing skills. A tape recorder was utilised with the nurse unit manager's permission to collect data. A follow-up interview with five nurse unit managers was conducted to validate the data gathered during the focus group interview. The following open-ended questions was used to obtain data from the nurse unit manager: "What are your perceptions regarding your role in creating an environment conducive to clinical learning?" "How can you be empowered as part of your role, to create clinical nursing units as climates conducive for clinical teaching and learning for nursing students?" Data was analysed according to Tesch's descriptive method (in Creswell, 1994:155). An independent coder was purposively selected in the categorisation ( iv ) of data. Categories were defined and arranged in table form for both participants in order to arrive at final categories. Trustworthiness was ensured as described by Lincoln and Guba's (1985:290-326) model of trustworthiness. Findings were conceptualised and conclusive statements made through logical deductive, inductive reasoning and inferences. A conceptual framework was developed within Muller's (1998) management process and the legal and professional frameworks. The integrated empowering process was adapted from Muller's management process, Vogt & Murrel's (1990) & Hokanson-Hawks' (1999) empowerment methods. This process comprises planning, organising (providing and structuring), directing (education, leading, mentoring and supporting), and control (actualising). Empowerment strategies for the nurse unit manager were described to create a climate conducive to learning, based on the results of phase one and phase two. Evaluation of the study was done, limitations, recommendations and conclusions were described with regard to nursing education, practice and nursing research.

D.Cur. / The purpose of this study was to evaluate the quality of professional conduct by the nursing practitioner in clinical nursing care as reflected in post laparotomy and respiratory disorders in selected public hospitals in the Northern (Limpopo) Province, and to develop a programme to improve the quality of professional conduct by the nursing practitioner in public hospitals. Professional conduct in this study refers to the level of compliance with the SANC/Muller (1999) practice standards as refined by the researcher. The following dimensions are addressed in relation to post laparotomy patients and patients with respiratory disorders: knowledge, skills/competencies, scientifically-based care, recording, teamwork/networking, health promotion, therapeutic environment and accountability. The hypothesis for this study was that the quality of professional conduct by the nursing practitioner in clinical nursing care as reflected in post laparotomy and respiratory disorders is inadequate and non-compliant with the standards and criteria in selected public hospitals in the Northern (Limpopo) Province. The following research questions were addressed: a) What is the quality of professional conduct by the nursing practitioner in clinical nursing as reflected in practice setting of post laparotomy and respiratory disorders in selected public hospitals in the Northern (Limpopo) Province? b) What professional conduct programme should be developed to improve compliance with the standards and criteria? A quantitative evaluative descriptive and contextual survey was conducted consisting of: 1. Refinement of standards by the researcher 2. Baseline survey to evaluate the quality of professional conduct by the nursing practitioner in clinical nursing care as reflected in post laparotomy and respiratory disorders; 3. The development of a professional conduct programme as a remedial action strategy. The data collection method utilised strategies such as the use of trained evaluators, direct and indirect observations, individual and group interviews, and documentation analysis. Population and samples were selected from public hospitals that offer clinical nursing care to both post laparotomy patients and patients with respiratory disorders. The units that offered clinical nursing care to the same patients and the nursing practitioners who provide clinical nursing care to these patients were selected. A three point rating scale consisting of compliance (C) = 1, partial compliance (PC) = 0.5 and non-compliance (NC) = 0.0 was used to collect data. Statistical analysis system was used by the statistician to analyse the data. Individual items were analysed and percentages calculated. Then mean (M) and standard deviation (SD) on individual standard were determined. The results revealed that for practice standard one the nursing practitioner showed partial compliance (M = 0.375; SD = 0.197); practice standard two, the nursing practitioner showed partial compliance (M = 0.355; SD = 0.267) slightly lower than standard one; practice standard three the nursing practitioner showed non-compliance (M = 0.319; SD = 1.211); practice standard four, the nursing practitioner showed partial compliance (M = 0.552; SD = 0.180); practice standard five, the nursing practitioner showed partial compliance (M = 0.397; SD = 0.220); practice standard six, the nursing practitioner showed non-compliance (M = 0.238; SD .= 0.257), the lowest of all the standards; practice standard seven, the nursing practitioner showed partial compliance (M = 0.396; SD = 0.237); and practice standard eight, the nursing practitioner demonstrated partial compliance (M = 0.530; SD 0.267). The first research question was what is the level of compliance by the nursing practitioner with the standards and criteria in clinical nursing care in public hospitals in the Northern Province? The overall results for the eight standards showed partial compliance (M = 0.380; SD = 0.175). The second research question was what professional conduct programme should be developed to improve compliance with the standards and criteria. The professional conduct programme was developed based on the SANC/Muller practice standards as the theoretical foundation. Further analysis was done on contributory factors. There was a relationship between the recording format (78.9% inadequate) and compliance with practice standard three; scientifically-based recording on patient records rated low at all the selected hospitals (M = 0.319; SD = 0.211). There was also an association between supervision/support (85% inadequate) and practice standard six, indicating non-compliance (M = 0.238; SD = 0.257) and practice standard seven (M = 0.396; SD = 0.237). A relationship between availability of stock and supplies (69.4% inadequate) and practice standard one and two, was observed (M = 0.375; SD = 0.197) and (M = 0.355; SD = 0.269) respectively. There was, however, no relationship between staffing and the practice standards;

M.Cur. / Managed healthcare was introduced in South Africa largely in order to control the rampant increase of medical costs, more especially in the private healthcare industry. Managed healthcare is a system of healthcare delivery, which ensures that cost effective quality care is provided to patients without jeopardising the health of the patient. Positive working relationships are necessary among the role players in the provision of cost effective quality care within the managed healthcare context. Role players experience problems in the delivery of healthcare, affecting their working relationships, which in turn affects the quality of care provided to patients. Because managed healthcare is a new concept in South Africa, little is known about the problems. As a result, there are no guidelines for the formulation of a strategy to enhance positive working relationships among the role players within the context of managed healthcare. Understanding the problems experienced by the role players will provide guidelines to the researcher to formulate a strategy to enhance positive working relationships, hence the reseacher sought to explore and describe these problems in the study. The purpose of the study is to formulate a strategy to enhance positive working relationships among the role players within the managed healthcare context in Gauteng. The specific objective is to explore and describe the problems experienced by the role players, as well as the possible solutions within the managed healthcare context in Gauteng. The relevant research questions are: * What are the problems experienced by the role players within the managed healthcare context in Gauteng, and what are the recommended solutions to counteract these problems? * What strategy can be formulated to enhance positive working relationships among the role players within the managed healthcare context in Gauteng? A qualitative, exploratory, descriptive and contextual design was followed to answer the research questions. Focus group interviews and a workshop were conducted to collect data and a content analysis was conducted as described by Tesch (1990). The results were analysed in two phases: the problems experienced and the suggested solutions to counteract these problems. A strategy to enhance positive working realtionships was suggested. The strategy, which is based on role player empowerment, staff development, staff recruitment and selection, use of advanced information technology and standardisation of methods across managed healthcare industry, was derived from a synthesis of solutions suggested by the participants. Guba and Lincoln's (1983:290) principles of trustworthiness were employed by the researcher and the ethical standards as set by DENOSA (1998) were adhered to by the researcher to facilitate the quality of the study. It was recommended that the strategy be implemented and evaluated for its effectiveness by evaluating the quality of working relationships among the role players and that ethical standards be formulated in managed healthcare.

This study was aimed at investigating the attitudes of nurse managers towards quality improvement programmes in the East London Hospital Complex. The research design comprised a qualitative, exploratory and descriptive approach. A purposive sample of 10 nurse managers participated in the study. The data were collected through interviews, using a semi-structured interview guide. Interviews were recorded using audiotape. Data were analysed manually and by using the computer software Atlas ti. Positive and negative themes were identified and ethical consideration was ensured by means of privacy, confidentiality and anonymity. The findings revealed that nurse managers in the East London Hospital Complex had overall positive attitudes towards quality improvement programmes. A few negative attitudes and their contributory factors were also identified. The limitations of the study and recommendations based on the findings of the study are presented