Magister Curationis - MCur / In South Africa, the Occupational Specific Dispensation (OSD) for professional nurses provides a structure for training and career progression in the Public Health Sector. It necessitates the urgency for professional nurses who are working in specialty units at hospitals, to study further in advanced post-graduate nursing sciences programmes, e.g. advanced psychiatric nursing. Professional nurses were not informed about the implications of the OSD for practice, prior to implementation. It was unclear how advanced psychiatric nurses were experiencing their practice in an OSD hospital setting. In this study, the experiences of advanced psychiatric nurses who were practising at an OSD psychiatric public hospital led to the description of guidelines for supporting these nurses during their practice in an OSD ward. A qualitative, exploratory, descriptive and contextual design was followed. The study population consisted of advanced psychiatric nurses (N = 50). Purposive sampling was conducted until data saturation was reached. Eight participants were included in the sample. In-depth unstructured individual interviews were conducted with each of these participants. Field notes were kept and voice recordings of all interview sessions were captured. The researcher conducted a pilot study with one participant in order to detect possible flaws that could occur during the data collection process. The data analysis where themes were identified was based on Tesch‟s method of qualitative analysis. A literature control supported the findings of this study. Subsequently, guidelines were described from the findings according to the method of Muller (2001:204-205). Trustworthiness was maintained by using the criteria of Guba‟s model; that is credibility, transferability, confirmability, and dependability. The ethical principles of the right to self-determination, withdrawal from the research study, privacy, autonomy and confidentiality, fair treatment, protection from discomfort and harm, and obtaining informed written consent was adhered to. Four themes emerged from the data that indicated: the under-utilisation of the full scope of advanced nursing skills, role conflict and overload, organisational structural barriers that delayed viii the implementation and practice of advanced nursing skills, and failure to conceptualise / clarify advanced nursing role that resulted in unrealistic and / or unmet expectations.

>Magister Scientiae - MSc / In South Africa, the Occupational Specific Dispensation (OSD) for professional nurses provides a structure for training and career progression in the Public Health Sector. It necessitates the urgency for professional nurses who are working in specialty units at hospitals, to study further in advanced post-graduate nursing sciences programmes, e.g. advanced psychiatric nursing. Professional nurses were not informed about the implications of the OSD for practice, prior to implementation. It was unclear how advanced psychiatric nurses were experiencing their practice in an OSD hospital setting. In this study, the experiences of advanced psychiatric nurses who were practising at an OSD psychiatric public hospital led to the description of guidelines for supporting these nurses during their practice in an OSD ward. A qualitative, exploratory, descriptive and contextual design was followed. The study population consisted of advanced psychiatric nurses (N = 50). Purposive sampling was conducted until data saturation was reached. Eight participants were included in the sample. In-depth unstructured individual interviews were conducted with each of these participants. Field notes were kept and voice recordings of all interview sessions were captured. The researcher conducted a pilot study with one participant in order to detect possible flaws that could occur during the data collection process. The data analysis where themes were identified was based on Tesch‟s method of qualitative analysis. A literature control supported the findings of this study. Subsequently, guidelines were described from the findings according to the method of Muller (2001:204-205). Trustworthiness was maintained by using the criteria of Guba‟s model; that is credibility, transferability, confirmability, and dependability. The ethical principles of the right to self-determination, withdrawal from the research study, privacy, autonomy and confidentiality, fair treatment, protection from discomfort and harm, and obtaining informed written consent was adhered to. Four themes emerged from the data that indicated: the under-utilisation of the full scope of advanced nursing skills, role conflict and overload, organisational structural barriers that delayed the implementation and practice of advanced nursing skills, and failure to conceptualise / clarify advanced nursing role that resulted in unrealistic and / or unmet expectations.

Recruitment and retention of professional nurses are crucial issues for hospital departments of nursing. Recognizing the necessity to bridge the gap that persists between nursing education and nursing services, hospitals have designed programs to assist new nurses make the transition to current nursing practice. By helping individuals make the transition to current nursing practice it is hoped that staff nurses will be retained.

Entry into professional nursing practice in the United States occurs at varied education levels including a diploma, an associate degree, and a baccalaureate degree. These multiple entry levels into practice create a situation where academic preparedness for nursing practice varies, which may influence the professional behavior of nurses and, consequently, patient care and outcomes. The purpose of this quantitative comparative study, guided by Miller's wheel of professionalism in nursing, was to determine if there is a difference in the professional behaviors of associate degree prepared registered nurses (RNs) compared to the professional behaviors of baccalaureate degree prepared RNs. The Behavior Inventory for Professionalism in nursing (BIPN) survey was emailed to RNs in Florida with a final sample size of 112 which yielded 56 in each group. Data were analyzed using the independent t-test. Results indicated a statistically significant difference in the means of total weighted scores of BIPN between the two groups of RNs in the state of Florida (p = 0.002; d = 0.58). These findings support studies that have addressed that the level of nursing education is an important factor of nursing professionalism. It would be worthwhile for the study to be replicated in other states. Such information can be used to support the rationale for a single-entry level into nursing practice at the baccalaureate degree level, which can lead to positive social change for the nursing profession.

The Doctor of Nursing Practice (DNP) Family Nurse Practitioner (FNP) curriculum was developed to incorporate learning outcomes and experiential opportunities for students to attain the core FNP knowledge for doctoral education. Historically, challenges related to developing clinical skills in blended/online programs has been problematic. The appeal of online FNP education has challenged educators to develop new ways to provide students opportunities to experience hands-on clinical skills within the subspecialties of the DNP, FNP role. With limited clinical sites, and now with more clinical access constraints imposed by the COVID-19 pandemic, it is imperative that new models of instruction provide students opportunities for skills training. The purpose of this project is to describe use of scaffolding methodology to design student skills learning activities using synchronous online and on-ground sessions during DNP intensives. Student and faculty input identified the types of practice skills and procedures needing improvement, such as suturing, electrocardiogram, etc. An intensive task force was organized to evaluate curricular elements; content was then mapped to analyze gaps. The first step included aligning advanced practice nursing skills sessions in each intensive with the related clinical courses offered within that semester. Then, students were organized into a skills rotation plan based on their date of admission and place within their program of study. Modifications required by COVID-19 on-ground restrictions necessitated re-thinking intensive skills sessions. Student satisfaction scores significantly improved after the intensive sessions were restructured. Faculty continue to seek feedback from the students to provide beneficial practice opportunities during the DNP intensives.

Background: The nursing workforce needs to be adequately prepared to deliver care to an increasingly diverse patient population in the United Kingdom (UK). The Nursing and Midwifery Council (NMC) expects newly qualified nurses (NQNs) to deliver culturally sensitive and respectful care. Aim: The study aimed to explore NQNs’ perceptions of culturally competent practice during the first 9 months post qualification. Methods: A qualitative longitudinal study was conducted with a volunteer sample of 14 NQNs recruited from 3 Higher Education Institutions in the north of England. Data was collected using directed reflections (at 2-3 and 5-6 months) and semi-structured interviews (at 8-9 months) and analysed using a phenomenological approach informed by symbolic interactionism. Results: Perceptions of culturally competent nursing practice were associated with core concepts such as individualised patient care, compassionate and respectful care, respecting individual differences, professionalism and patient trust. Specific behaviours were associated with verbal and non-verbal communication, care planning and diversity-specific adjustments. Discussion: Self-perceived competence and confidence in caring for, and interacting with, patients from diverse backgrounds developed and changed throughout the transition period with experience and interaction opportunities. An ability to reflect upon and learn from novel experiences, plus an enabling ward culture and environment which responded positively to nurses seeking advice and support was important. Conclusion: Educational preparation may have enabled NQNs’ opportunities to develop some but not necessarily all of the skills and behaviours required to demonstrate culturally competent practice. During transition, supported development and professional socialisation can assist in enhancing competence and confidence.

As new approaches to practice become available for school nurses, urban school districts must address the need to provide facilitators for the dissemination and adoption of new evidenced based practice models. With instructional capacity, curriculum challenges, and school climate at the center of the decision making of educational leaders, the needs of school health become neglected. As new innovations become available, school nurses working in urban school districts often rely on individual continuing education to access new ideas due to barriers that exist in urban schools with limited funding and resources. This dissertation research had two primary aims: (1) expand current research regarding specific barriers and facilitators to practice, and (2) to better understand the school nurses’ adoption of the Framework for the 21st Century School Practicing Nurse in an urban school district. This framework addresses the specific needs of the school nurse working in an evolving educational health setting. Using a descriptive and inferential quantitative design with a convenience sample of school nurses in the School District of Philadelphia (SDP), participants completed an online survey designed to examine awareness, agreement, and alignment with the framework, as well as barriers and facilitators of adoption. The results revealed differences in level of awareness of the framework across various demographic groups within the SDP. After presenting the framework to participants, school nurses agreed with the importance of fully aligning practice. Further, there were variations in level of importance regarding specific practice components of the framework. Participants identified facilitators and barriers that impacted their ability to fully align school nursing practice with the framework. / Urban Education

Problem: Because of the complex nature and autonomy of school nursing practice, multiple professional organizations recommend a Bachelor of Science in Nursing as the minimum level of education for entry into this specialty. Despite research demonstrating benefits to patients and nurses with this level of education, school nurses across the U.S. vary widely in their educational and experiential preparation for this critical role. Benner's Novice-to-Expert Framework emphasizes the importance of experience in nursing or in a specialty practice to developing the skill needed to provide expert nursing care. This study investigated what knowledge school nurses considered important to competent practice when responding to the National Board for Certification of School Nurses 2007 Role Delineation Survey and whether there are differences in how school nurses responded to these questions based on their educational and experiential backgrounds. Methods: This was a quantitative, non-experimental exploratory study involving secondary analysis of the survey data. Demographics were analyzed using descriptive statistics. Non-parametric statistical procedures (Fisher's Exact Test) were used to see if the 399 subjects' answers to 32 knowledge questions on the survey differed based on education level, years of general nursing experience, and years of school nursing experience. Results: Most subjects indicated that 27 of the 32 knowledge areas were moderately or extremely important for competent school nursing practice. Results of Fisher's Exact Test indicated differences on two items based on the education level of the respondents and differences on two items based on years of experience in school nursing, but no significant differences were found based on years of overall nursing experience. Communication skills in counseling had a significant difference based on both education level and years of school nursing experience; but it was impossible to tell which was more significant. Conclusions: This study contributes to the body of knowledge about school nursing and what this sample of school nurses perceived as important knowledge for competent practice. However, this analysis of differences in answers given to the survey knowledge questions does not settle the debate of whether there are differences in nurse perceptions based on education level or experience. / Ph. D.

Thesis (DPhil (Psychology))—University of Stellenbosch, 2010. / ENGLISH ABSTRACT: This dissertation examines how nurses in primary health care in South Africa make use of guidelines. Primary level health care is reliant primarily on nurses, who are under-resourced and often overwhelmed by the complex needs of their clients in the context of the TB and HIV/AIDS epidemic. Despite various continuing education strategies to promote current and evidence-based practice, there are many barriers to providing optimal care. Clinical practice guidelines using best evidence are an important tool for updating health professionals in current practice, particularly at primary care level, where busy practitioners often do not have time or sufficient access to the best evidence. Despite this, we know little of the practitioners’ experiences of guideline use. This study describes experiences of nurses in implementing clinical practice guidelines in the delivery of health care in selected primary level contexts in the Free State Province. The primary research question for this study was “What are the experiences of nurses in using guidelines in primary health care facilities?” A qualitative research approach, drawing on a psychoanalytic framework, was adopted. Three linked studies were conducted, utilising secondary data analysis of transcripts collected during the PALSA (Practical approach to Lung Health in South Africa) RCT study (sub-study 1), document description and review of guidelines used in primary care settings (sub-study 2), observation of nurses in practice and during patient consultations, and focus group discussions with nurses in primary health care facilities (sub-study 3). After the introduction of new format guidelines with onsite training and access to good support and updates, nurses reported feeling more confident, as the guidelines were explicit and gave them clear direction as to when a patient would need referral to the medical practitioner. When the guidelines were followed, and the patient responded positively to an intervention, this gave nurses a sense of credibility and validated their role as primary level health care providers. Guidelines available in the primary care clinics covered a wide variety of clinical conditions, were inconsistent, often outdated and even contradictory. A detailed comparison of two selected guidelines, the South African TB control guidelines and the PALSA PLUS guidelines, both in everyday use in the Free State province, shows that the preferences expressed by the nurses in sub-study 1 are evident in the layout, colour, and user-friendliness of the PALSA PLUS guideline. Nurses in the Free State province do use guidelines, but not consistently. Nurses make clinical judgments and decisions based on experience, alternative knowledges and intuitive responses, in consultation with colleagues and through the use of guidelines. Very few guidelines were used regularly, and each nurse had her preferences for a limited number of guidelines which she found useful. There is a clear need for integrated approaches to the information needs and support of nurses and nurse practitioners at primary care level. Guidelines play a role in promoting learning, changing professional practice and strengthening health care delivery by nurse practitioners at primary level. They can also be thought of as a strategy the health care system uses to defend against the possibility of its health professionals not meeting its expectations of providing quality care. Guidelines may contain anxiety and improve the quality of care, or compromise practice through the imposition of controls. The use of guidelines in primary care settings facilitates decision making, may contain practitioner anxiety and improve the quality of care, yet guidelines pose challenges to creative discernment of the patient’s symptoms in relation to his/her personal circumstances and may impact on the personalised holistic care approach which characterises the essence of nursing. Today’s primary care nurse and nurse practitioner needs to be a competent clinician, compassionate carer, and confident co-ordinator – the overlapping roles of caring, diagnosing and treating and managing. The challenge for the nurse in primary care is to combine her traditional caring and co-ordination role into a role which encompasses curing, caring and co-ordination, a new, yet critically important identity for the 21st century nurse. / AFRIKAANSE OPSOMMING: Die proefskrif ondersoek hoe verpleegsters in primêre gesondheidsorg in Suid-Afrika van riglyne gebruik maak. Primêre vlak gesondheidsorg steun hoofsaaklik op verpleegsters, alhoewel hulle verswelg word deur die komplekse behoeftes van hul kliënte in die konteks van die TB en HIV/AIDS epidemie. Ten spyte van verskeie volgehoue onderrigstrategieë om die huidige en bewese basiese te bevorder, is daar verskeie struikelblokke om optimale versorging te voorsien. Kliniese praktyk riglyne voorsien die beste bewyse en is 'n belangrike hulpmiddel om praktiserende professionele gesondheidswerkers, veral op die vlak van primêre gesondheidsorg, op hoogte van sake te hou. Besige programme en onvoldoende toegang tot hierdie riglyne weerhou dikwels die gesondheidswerkers van bestaande inligting. Dit is egter onbekend wat gesondheidswerkers se ondervinding en gebruik van riglyne is. Die studie beskryf versorgers se ervaring van die implementering van kliniese praktyk riglyne vir gesondheidsorg in primêre vlak kontekste in die Vrystaatprovinsie. 'n Kwalitatiewe navorsingsbenadering wat steun op 'n psigoanalitiese raamwerk, is gebruik. Drie verbandhoudende studies is gedoen wat sekondêre data analise transkripsies gebruik het wat verkry is gedurende die PALSA (Practical Approach to Lung Health in South Africa): RCT (Willekeurig Gekontroleerde Toets) studie (sub-studie 1), beskrywing van dokumentasie en oorsig van riglyne wat in primêre vlak ontwikkeling gebruik is (sub-studie 2), en observasie van verpleegsters in die praktyk en gedurende konsultasies met pasiënte, en fokusgroep besprekings met verpleegsters in primêre vlak gesondheidsorg fasiliteite (sub-studie 3). Na die bekendstelling van 'n nuwe formaat riglyne vir indiensopleiding en toegang tot goeie ondersteuning, het die verpleegsters meer selfversekerd gevoel omdat die riglyne duideliker was en aan hulle 'n beter aanduiding gegee het wanneer 'n pasiënt verwysing na 'n mediese praktisyn benodig het. Wanneer die riglyne gevolg is en die pasiënt positief op behandeling gereageer het, het dit aan hulle 'n gevoel van agting en deug vir hulle rol in primêre vlak gesondheidsorg gegee het. Beskikbare riglyne in primêre sorg klinieke dek 'n wye verskeidenheid kliniese kondisies, is onsamehangend, dikwels verouderd en selfs soms weersprekend. 'n Gedetailleerde vergelyking is tussen twee geselekteerde riglyne gedoen: die Suid-Afrikaanse TB kontrole riglyne en die PALSA PLUS riglyne. Beide word daagliks in die Vrystaatprovinsie gebruik. Die verpleegsters in sub-studie 1 het a.g.v. die uitleg, kleur en gebruikersvriendelikheid die PALSA PLUS riglyne verkies. Verpleegsters in die Vrystaat gebruik wel riglyne maar nie op 'n gereelde grondslag nie. Hulle maak eerder kliniese keuses en besluite gebaseer op ondervinding, alternatiewe kennis en intuïtiewe gevoel, in konsultasie met kollegas en na bestudering van die riglyne. Baie min riglyne is gereeld gebruik, en elke verpleegster het haar voorkeure vir 'n beperkte aantal riglyne wat sy bruikbaar vind. Daar is 'n duidelike behoefte aan 'n geïntegreerde benadering tot die informasiebehoeftes en ondersteuning aan verpleegsters en praktisyns op primêre sorg vlak. Riglyne speel 'n belangrike rol in die bevordering van onderrig, verandering van professionele praktyke en die versterking van gesondheidsorg wat deur verpleegsters in primêre vlak gesondheidsorg gelewer kan word. Dit kan ook gesien word as 'n strategie wat die gesondheidsorgsisteem kan gebruik om te verseker dat gesondheidswerkers kwaliteit diens lewer. Riglyne kan moontlik angstigheid beperk en verhoogde versorgingskwaliteit bring, of dit kan gesondheidsorg benadeel deur die afdwing van kontrolemaatreëls. Die gebruik van riglyne in primêre sorg fasiliteer besluitneming, en mag dalk angstigheid by die praktisyn beperk, wat dan die kwaliteit van versorging kan verhoog. Riglyne bied uitdagings aan die kreatiewe oordeelsvermoë om die pasiënt se simptome te sien binne die konteks van sy/haar omstandighede en mag 'n impak hê op persoonlike holistiese versorging wat die aard en kern van verpleging is. Die huidige primêre sorg verplegingspraktisyn moet 'n bekwame klinikus, ontfermende versorger en betroubare koördineerder wees – met oorvleuelende rolle van versorging, diagnosering en behandeling, en bestuur. Die uitdaging vir die verpleegster in primêre sorg is om die tradisionele versorging en koördinering te kombineer tot 'n omvattende rol van genesing, versorging en koördinasie; 'n nuwe, maar krities-belangrike identiteit vir die 21ste-eeuse versorger.

Thesis (MCur)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: The critical care nurse works in an environment where patient need often shifts the parameters within which she or he practices. It is expected of a skilled critical care nurse to be able to make independent decisions and take action regarding patient care based on her or his knowledge and skills without discounting the parameters of her or his scope of practice. Practice experience has indicated that the critical care nurse is often uncertain about whether her or his clinical activities are protected by the regulations provided by the Nursing Council. This is more specifically true in the private hospital industry where medical advice or assistance is not always easily available. This situation led to the following research question: Do the available professional and legal guidelines provide an appropriate foundation to guide the practice of the registered critical care nurse in the private hospital sector critical care environment? A non-experimental descriptive study with a qualitative orientation was conducted in 19 private hospitals in the Western Cape. Through nonprobability, random sampling, 71 registered critical care nurses were included in the study. A questionnaire was designed and validated to collect the data. Quantitative data was analysed through Excel® while qualitative data was analysed thematically. It was found that the legal and professional guidelines in place at present do provide a foundation for the clinical activities of critical care nursing in the private hospital sector. It is suggested that it is rather the critical care nurses’ interpretation of the Scope of Practice (No.R.2598 of 30/11/1984 as amended) that limits their practice as opposed to the wording of the regulations. It is recommended that critical care nurses must determine nursing care parameters based on patient need, using the regulations as a foundation for critical, analytical and reflective practice rather than as a set of rules to be followed. Key words: Scope of practice, critical care practice, ICU nursing care, private hospital nursing practice. / AFRIKAANSE OPSOMMING: Die kritiekesorgverpleegkundige werk in ‘n omgewing waar pasiëntebehoeftes gereeld die parameters waarin sy of hy praktiseer, verskuif. Dit word van ’n bekwame kritiekesorgverpleegkundige verwag dat sy of hy onafhanklike besluite en aksies met betrekking tot pasiëntesorg, gebaseer op haar of sy kennis en vaardighede, sal neem sonder om die parameters van haar of sy bestek van praktyk te oorskry. Praktykondervinding het getoon dat die kritiekesorgverpleegkundige dikwels onseker is oor watter van haar of sy optredes deur die Regulasies, soos deur die Raad op Verpleging gespesifiseer word, beskerm word. Dit is nog meer spesifiek van toepassing in die privaathospitaal-industrie waar geneeskundige advies en bystand nie altyd maklik beskikbaar is nie. Die situasie het tot die volgende navorsingsvraag aanleiding gegee: Voorsien die beskikbare professionele en wetlike riglyne ’n geskikte grondslag om die praktyk van ’n geregistreerde kritiekesorgverpleegkundige in die privaatsektor- kritiekesorgomgewing te rig? ’n Nie-eksperimentele, beskrywende studie met ’n kwalitatiewe oriëntasie is in 19 hospitale in die Wes-Kaap onderneem. Deur nie-waarskynlikheids-, toevallige steekproefneming is 71 geregistreerde kritiekesorgverpleegkundiges in die studie ingesluit. ’n Vraelys is ontwerp en gevalideer om inligting in te samel. Kwantitatiewe data is deur middel van Excel ontleed terwyl kwalitatiewe data tematies ontleed is. Daar is gevind dat die wetlike en professionele riglyne wat tans beskikbaar is, ‘n grondslag bied vir die kliniese aktiwiteite van kritiekesorgverpleegkundiges in die privaathospitaal.. Dit word voorgestel dat dit die kritiekesorgverpleegkundige se interpretasie van die Bestek van Praktyk (No.R.2598 of 30/11/1984 soos aangepas) is wat hulle praktyk beperk, eerder as die bewoording van die regulasie self.