D.Cur. (Professional Nursing Science) / It was very dear that dramatic transformation is needed in the new South Africa to accommodate the transformation demanded by the Reconstruction and Development Programme, the National Health System, and other political, economic, social, technological and staff management changes. It was also evident that transformational leadership was needed in nursing in general and in nursing management in particular. This is a qualitative, contextual, exploratory, descriptive and theory-generating study, with the overall aim of exploring and describing a model for transformational Ieadershlp by nursing unit managers to facilitate individual and nursing unit transformation. To accomplish this aim, specific objectives were formulated. Firstly, a conceptual framework and model were explored and described by means of analysis, synthesis, derivation and deductive reasoning. The model was described within the meta theoretical assumptions of the Nursing for the Whole Person Theory (ORU 1990; RAU 1992). The theoretical assumptions were derived from till' Nursing for the Whole Person Theory whereas the methodological assumptions were based on the Nursing Research model of Botes (1995). This Nursing Research model proposed functional reasoning approach. During the exploration and description of the model, connect identification and classification were handled according Lo the survey list of Dickoff, james and Wiedenbach (1968). Thereafter, an education programme was explored and described by deriving the theoretical content on transformational leadership from the conceptual framework and LIl(' model. TIll' principles of adult education (Knowles 1984, Gravett 1991) and the constructivistic learning theory (Klopper 1994 (a» were utilised for the didactical development of the education programme. This education programme was then implemented in a nursing service. Through purposive sampling, four nursing unils in the same nursing service were selected and the model implemented for a period of 12-14 weeks. The cases Ludy method was utilised.

M.Cur. / The nursing service manager is responsible and accountable for ensuring quality health care in a nursing service. The principle of liability requires a formal quality improvement programme in the nursing service according to which a specific level of quality nursing can be maintained. It is therefore clearly evident that a quality improvement programme, objectively maintain and evaluate the quality of a service. Opportunities for improvement are identified, and a mechanism is provided for taking remedial steps to bring about and maintain improvement, The abovementioned is of utmost importance and implies a constant commitment to health care service of a high quality. The overall objective of this study is to formulate and describe guidelines for a quality improvement programme for the nursing service of a referral hospital in the Gauteng Province. This study is an explorative, descriptive, qualitative and contextual research aiming to investigate the perceptions of quality in nursing/midwifery which will facilitate the exploration and description of a value clarification on quality, by the chief professional nurses, senior professional nurses, administrative personnel and patients within the nursing service of the referral hospital in the Gauteng Province. Focus group interviews, naive sketches and interviews as methods of data gathering was conducted. A simple random sampling method was used. A total number of three focus group interviews were conducted: one with seven chief professional nurses, one with fourteen senior professional nurses and one with twelve administrative personnel using tape recordings with the written consent of the participants. Naive sketches were obtained from the same groups. An expert psychiatric nurse, with a master's degree in the field and whose daily activities involved interviewing of the psychiatric nursing students and psychiatric patients, conducted the focus group interviews. The researcher conducted thirty individual patient interviews. Trustworthiness in this research was done according to Guba's model (!!! Krefting, 1991:214-222). Data analysis was done according to Tesch's (1990, in Creswell, 1994:155) protocol. An external coder with expertise in the field of coding in qualitative data was utilised to analyse and categorize the data. The researcher and the independent coder had consensus discussions for the formulation of the main categories and sub categories. Consensus discussions were also conducted with the study leader. The results were quantified based on the number of respondents whose perception on quality had reference to the same categories. The structured coding was based on the principles of quality: structure, process and outcome. A description of the conceptual framework was developed from the data analysis and a literature study. This framework with its content and criteria serves as scientific and theoretical basis of the quality improvement programme and are based on the values/value clarification on quality of the different roleplayers in the nursing service. Fifteen belief statements/values were described from the value clarification. The guidelines for the quality improvement programme of the nursing service in the referral hospital were described, based on the eight steps of the quality assurance model of Laing and Nish (Booyens, 1998: 576). A description of values is the first step and from these values on quality in the nursing service, the formulation of management standards was deduced in conjunction with the conceptual framework and the nursing/midwifery practice standards of the Nursing Department of RAU. Lastly the evaluation, limitations, recommendations and conclusion of the study were done.

Thesis (MCur)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: Nationally and internationally emphasis is placed on quality care in health services. The researcher identified a need to evaluate a component of primary health care service in the Northern province. A study based on the combination of qualitative and quantitative methods was conducted to formulate and evaluate structure, process and outcome standards for selected clinics in the Northern Province. The most important results are: • The standard relating to the structure was suboptimal. Physical and human resources are of critical importance to the rendering of quality patient care. However this did not comply with the pre-set standard norm of 80%. • Process standards focused on physical examination of patients taking into account the age of the client and the systems involved. Substandard care was found in all these aspects. • Outcome standards determined by the patient questionnaire also revealed negative findings. Recommendations include the development of a quality improvement model for the Northern Province Health Services, formulation of standards for all disciplines of health care, annual evaluation of patient care and the institution of a formal staff development programme. Key words: quality care, formulation of standards, structure, process, outcome / AFRIKAANSE OPSOMMING: Nasionaal en internasionaal word die belang van gehaltesorg in gesondheidsdienste beklemtoon. Die navorser het enbehoefte ge'identifiseer om en component van prirnerre gesondheidsorgdienste in die Noordelike provinsie te evalueer. en Kombinasie van kwalitatiewe en kwantitatiewe metodes is gebruik om struktuur-, proses en uitkomsstandaarde in geselekteerde klinieke in die Noordelike provinsie te formuleer en evalueer. Die belangrikste resultate was: • Die standard ten opsigte van die standard was suboptimal. Fisiese en menslike hulpbronne is van kritiese belang vir gesondheidsdienslewering. Die standaard hiervan het nie voldoen aan die voorafbepaalde norm van 80% wat gestel is nie. • Prosesstandaarde het op fisiese ondersoek van die pasiente gefokus met inagneming van die ouderdom van die klient en die simptome waarmee pasiente presenter. Sub-standaardsorg is ten opsigte van al hierdie aspekte gevind. • Uitkomsstandaarde is deur middel van en pasientevraelys gemeet en he took negatiewe bevindinge opgelewer. Aanbevelings sluit in die ontwikkeling van engehalteversekeringsmodel vir die Noordelike Provinsie se gesondheidsdienste, die formulering van standaarde vir aile dissiplines van gesondheidsorg, jaarlikse evaluering van pasientesorq en die instelling van enformele personeelontwikkelingsprogram. Kernwoorde: Gehaltesorg, formulering van standaarde, struktuur, proses, uitkomsstandaarde.