Text in Afrikaans / In hierdie beskrywende, verkennende en kontekstuele studie is ondersoek gedoen na redes waarom opgeleide intensiewesorgverpleegkundiges uit die intensiewesorgomgewing bedank en buite die intensiewesorgomgewing werk in die noordelike gedeelte van Gauteng. Doelwitte vir die studie was om die faktore te bepaal wat bydra tot die bedanking uit die intensiewesorgeenheid, die identifisering van die nie-verpleegkundige beroepe wat tans beoefen word en die bepaling van die faktore wat bydra tot die beoefening van 'n nie-verpleegkundige beroep. Die data is ingesamel deur middel van 'n vraelys wat voltooi is deur opgeleide intensiewesorgverpleegkundiges wat bedank het uit die intensiewesorgomgewing. Die sneeubalsteekproeftegniek is gebruik. Die data-analise het getoon dat redes vir bedanking uit die intensiewesorgomgewing die volgende insluit: onvoldoende salarisse, te veel stres en emosionele uitputting, ongerieflike werkure, personeeltekort en onbevredigende werkomstandighede. Daar is bevind dat verpleeg-sessiewerk steeds deur die respondente gedoen word, al werk hulle huidig voltyds buite die intensiewesorgomgewing. / In this exploratory, descriptive and contextual study research has been done to establish the reasons why intensive care nursing personnel resign from the intensive care environment in the northern Gauteng region. The researcher aimed to establish the factors that contributed to the resignations from the intensive care environment, to identify the non-nursing careers currently being practised by former intensive care nursing staff and to establish the factors that influenced them to practice non-nursing careers. The data was collected through questionnaires completed by former intensive care nursing personnel. The snowball test sampling method has been used. Data analysis has shown the following to be inter alia the reasons for the resignations from the intensive care environment: insufficient income, exhaustion and emotional stress, inconvenient working hours, staff shortages and unsatisfactory working conditions. One finding is that respondents are still doing nursing session work although they are working full-time in nonnursing capacities. / Health Studies / M.A. (Verpleegkunde)

Text in Afrikaans / Die effek van die klient-verpleegkundige-verhoudings op kliente se keuse en volgehoue gebruik van kontraseptiewe metodes het tot op hede baie min aandag geniet. Die doel van hierdie studie was 'n ondersoek na die ongetroude klient se persepsie van die verpleegkundige se houding. Die steekproef het bestaan uit 99 kliente (tussen die ouderdomme van 15 en 50 jaar) wat die betrokke reproduktiewegesondheidsklinieke in die Kaapse Metropool besoek het. Die eerste 20 kliente wat die kliniek besoek het, is genader om 'n vraelys in te vul. Hierdie studie toon 'n algehele positiwiteit, naamlik 58,3% teenoor die houding van geregistreerde verpleegkundiges. Die meerderheid van die kliente (88,0%) het aangedui dat hulle weer die kliniek sal besoek wat dus die kliente se tevredenheid toon. / The effect of the client-registered nurse relationship on clients' choice and continuous use of contraceptive methods has until now received very little attention. The purpose of this study was to explore unmarried clients' perception of the attitude of the registered nurse. The sample existed of 99 clients (between the ages of 15 and 50 years) who visited the relevant reproductive health clinics in the Cape Metropole. The first 20 clients who visited the clinic were approached to complete a questionnaire. This study shows an overall positivity of 58,3% with regard to the attitude of registered nurses. Most of the clients (88,0%) indicated that they would visit the clinic again, which indicate their satisfaction. / Health Studies / M.A. (Nursing Science)

Aim: This study explores what type of information patients and nurses share with, or provide to, each other, and whether or not the information received was relevant and sufficient for their needs. Background: Information exchange, as part of shared decision-making, is advocated in policy and practice throughout the healthcare sector. Much of the literature on information exchange relates to one-to-one consultations with consultants or GPs. To date, no studies have explored information exchange between patients and nurses in ward settings. Nursing literature on patients’ information needs focuses on one-way information provision from nurses to patients, rather than on two-way information exchange between patients and nurses. Methods: Interactions between patients and nurses were observed and audio-recorded using a remotely controlled audio-recording system. Semi-structured individual face-to-face interviews were then conducted to clarify and add to the observation data. A multiple case study design was used for this study: each case comprised one patient, the nurses caring for that patient, and the interactions between them. A pilot study was undertaken to inform the methods for recruitment and data collection for the main study. Results: The pilot study comprised five cases (patients n=5, nurses n=3). Changes to the recruitment strategy for the main study included surgical patients being invited to participate in the same way as medical patients. There were no difficulties with the data collection methods. The main study comprised nineteen cases (patients n=19, nurses n=22). Information exchange seemed unfamiliar to ward-based nurses. The findings show that information exchange may not be a one-off event but a complex series of interactions. Patients did not distinguish between clinical and non-clinical information in the same way as nurses. Primary reasons for patients’ hospital admission were not discussed and nurses did not share information about nursing interventions. The relevance for patients and nurses differed; patients generally wanted information for reducing anxiety and socialization; nurses wanted information for assessment and care planning. In terms of sufficiency, observation sessions highlighted that insufficient information was provided, often due to lost opportunities and paternalistic practice. However, the majority of patients and nurses perceived that they had exchanged sufficient information. Conclusion: This multiple case study provides insights into the type, relevance and sufficiency of information for patients and nurses in ward settings. In ward settings, information exchange as conceptualised by Charles et al. (1997 and 1999) may be difficult to achieve due to the complexity of patient/nurse interactions. Therefore, there are implications for policy makers as policies are not context specific. However, information exchange may be helpful for reducing patients’ anxieties. The concepts of shared decision-making and information exchange are not part of ward-based cultures and philosophies, which suggests implications for patient and nurse education. Research on information exchange between patients and nurses in other ward contexts may contribute to further understanding of information exchange in ward settings.

Aim The aim of this study was to describe ancillary health care workers’ perceptions of the Ancillary Health Care Learnership programme, and their current employment status within the health care sector. Methods A non-experimental cross sectional survey was used that incorporated complementary mixed method data collection (Balnaves & Caputi, 2001; Polit & Beck, 2010). Quantitative data collected during the first phase, a telephonic interview assisted self-report questionnaire was used to inform semi structured focus group interviews that took place during the second phase to obtain richer descriptions and explore response and results of the phase 1 cross sectional survey (Bell, 2005). A Convenience sample of ninety two (n=92) was achieved for the telephonic interview assisted self- report questionnaire, and was substantially lower that the number of potential participants (N=200). Purposive sampling was used to obtain fifteen (N=15) potential key informant participants, a final sample of nine (n=9) achieved for the focus group interviews. Results The research revealed that majority (69%) of participants had their expectations of the course met. Subjects such as agriculture and business plan were perceived as not valuable and participants recommended that these be removed from the course. Computer course information was seen as and needed addition in order to bridge the skills gap and improve the opportunities for employment.Despite particpants perceptions of the course being met, expectations regarding emplyment were not. Employment rates were low, specifically within the health care sector. Conclusion and Recommendations The Ancillary Health Care Programme has not assisted the graduates in gaining employment. The review of the Ancillary Health Care Programme and some of the unit standards is one of the recommended options that can be done to improve the employment opportunities. / Theses (M.N.)-University of KwaZulu-Natal, Durban, 2014.

As intensive care of preterm infants and high-risk infants has evolved, the practice of close physical contact between parents and their infants has been curtailed, with the separation of mothers and their infants more the norm than the exception (Browne, 2004). However, in the past two decades, the physiologic and socio-emotional benefits of close physical contact between parents and their high-risk infants has been revisited, with the practice of Kangaroo Mother Care (skin-to-skin contact) dramatically increasing in neonatal care units worldwide (Browne, 2004). Although research on Kangaroo Mother Care’s effects is plentiful, literature reveals gaps in the research pertaining to the experiences of midwives and nurses in its practice (Chia, 2006 & De Hollanda, 2008). As the role of midwives/nurses has been identified as crucial for Kangaroo Mother Care practice, this gap was recognised, and impelled this research study to be conducted in order to further extend the practice of KMC for its benefits to infants and their families. Due to current staff shortages and poorly resourced neonatal facilities in our local hospitals, local data on midwives’ experiences of Kangaroo Mother Care was perceived to be a vital first step in exploring these experiences. The purpose of this qualitative study was to explore the lived experiences of midwives regarding the Kangaroo Mother Care initiative at a selected tertiary level hospital in the Ethekwini District. Interpretive phenomenology informed this study design, data collection and analysis. As Kangaroo Mother Care is a complex phenomenon, an interpretive paradigm allowed the researcher to access the meaning of participants’ experiences as opposed to explaining their predicted behaviour. Purposive sampling was used by the researcher to select the eight midwives working in the tertiary hospital in the Ethekwini District. The midwives were selected from the neonatal unit during August 2011. Data was collected through a single in-depth interview with each participant in the neonatal unit. The interviews were recorded and later transcribed verbatim to facilitate analysis. Colaizzi’s method of data analysis and representation was utilised. Eleven themes emerged from the analysis of the data. Themes were aligned to the research objectives and included the participants’ experiences of conceptualisations, experiences, hindering and facilitating factors of Kangaroo Mother Care. Conceptualisations were aggregated into two themes pertaining to a physiological concept of KMC and an emotive concept of KMC. The physiological concept regarded the catalytic action of KMC as a promotive agent in health through its effect in increasing average weight gain. Furthermore, KMC was seen as a protective agent in reducing cross-infection and hypothermia. These findings aligned with findings from authors in the literature review. An emotive concept of KMC was revealed by the participants’ input regarding the effect of the skin-to-skin contact in facilitating maternal-infant attachment through bonding. This study finding is supported by current literature. Lived experiences emerged regarding the theme of KMC in maternal instinct and capability, which findings encompassed increased maternal confidence and competence with which several authors concurred. Factors considered as hindering KMC included five themes which emerged as maternal concerns, increased work-load, lack of training, management support and resource scarcity. Contrary to these, facilitators of KMC included the need for motivation and education as well as the provision of a comfortable environment conducive to the practice of Kangaroo Mother Care. A number of recommendations for nursing practice, nursing education, communities and research based on the findings from the study were made available to relevant stakeholders. If implemented effectively, these recommendations may assist in the continued and increasing practice of KMC; resulting in its beneficial effects changing infants’ and families’ lives. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

Made available in DSpace on 2016-06-02T20:45:41Z (GMT). No. of bitstreams: 1 5323.pdf: 1239824 bytes, checksum: e10265e2651b624739cc1f4f8d63986e (MD5) Previous issue date: 2013-04-09 / This is a qualitative study aimed to evaluate the limits and possibilities for implementation of user embracement and risk assessment. In particular, from the perspective of local health managers of San Carlos, a town in the state of São Paulo. To collect the data, some semi-structured interviews were conducted with managers of the municipal health system: 61.53% graduated in nursing, 15.38% in medicine, 7.69% in dentistry; 7.69% in management and production engineering. The data were analyzed through thematic analysis. For this research, after collecting and analyzing data, six categories emerged from the analysis: (1) user embracement by organizing the service, (2) undesirable reality or constructed intentionally, (3) something intended but not accomplished, (4) A dream under construction, (5) learning to learn in daily service, (6) speaking the same language. From this definition, the study pointed out that there are different conceptions of user embracement , due to the approach assumed by each manager as suitable. There are also disparities in taking user embracement and under risk assessment as a procedure, possibly as a result of intricate political actions on health. To implement user embracement and risk assessment, it was possible to perceive the existence of limits and possibilities, with regards to organization of the service, local reality, care approaches, quality of assistance, permanent and continuing education as well as networking. / Trata-se de um estudo qualitativo cujo objetivo foi avaliar por onde perpassam os limites e possibilidades para implantação do acolhimento com avaliação de risco. Em específico, na perspectiva dos gestores municipais de saúde de São Carlos, uma cidade do interior do estado de São Paulo. Para coleta de dados, foram realizadas entrevistas semi-estruturadas com gestores do sistema municipal de saúde: 61,53% graduados em enfermagem; 15,38% medicina; 7,69% odontologia; 7,69% administração e 7,69% engenharia de produção. Os dados foram tratados através da análise temática. Para esta pesquisa, após coleta e análise dos dados, emergiram seis categorias de análise; (1) O acolhimento organizando o serviço; (2) Realidade não desejada ou construída intencionalmente; (3) Desejo algo e pratico outro; (4) Um sonho em construção; (5) Aprendendo a aprender no cotidiano do serviço; (6) Falar a mesma língua. A partir dessa delimitação, o estudo apontou que existem diferentes concepções sobre o acolhimento, em decorrência do modelo de atenção que cada gestor assume como sendo resolutivo. Também há disparidades em assumir o acolhimento com avaliação de risco como prática, possivelmente por questões políticas intrincadas nas ações em saúde. Para implementação do acolhimento com avaliação de risco, foi possível perceber a existência de limites e possibilidades, no que diz respeito à organização do serviço, realidade local, modelos de atenção, qualidade da assistência, educação permanente e continuada, trabalho em rede.

The dissertation discusses theis sues of psycho-socio-spiritual care of midwives for a woman after perinatal loss and is mainly focused on interventions that help building an attitude towards perinatal loss (farewell rituals with a baby, collection of mementos) and their influence on grieving process of women after perinatal loss. The objective of the empirical part of the study was to thoroughly describe the experiences of Czech women with parting with a child after perinatal death and investigate the impact of this experience on the grieving process after the perinatal loss. Thesub-objective of the thesis was to validate the Czech version of the Perinatal Grief Scale. We used a mixed methods research design to fulfill the dissertation's objectives. The analyses of qualitative and quantitative data were performed separately and integrated during the interpretation of research findings. The study sample comprised of total 102 women who experienced perinatal loss. The detailed description of experience of Czech women with interventions related to parting with the deceased child was dominated by the decision making process of women about farewell rituals (seeing and holding the baby, receive mementos of it). The key factors that influenced the decision making process were classified as internal (the need of the woman to get to know her child, doubt and fear of contact) and external (emotional support, information provided and a relationship with the midwife/ attending doctor) during our research. The research proved a significant influence of the independent decision of the woman about the contact with her deceased child on the intensity of grief. Grief of women who decided on their own and were confident about their decision was statistically less severe than grief of women whose decision was made by the medical personnel instead. We were checking the intensity of grief of women after perinatal loss using the newly validated Perinatal Grief Scale instrument that can be used as a single factor scale in the Czech Republic. Reliability of the research instrument was established using Cronbach alpha coefficient (? = 0.9545) and indicated high reliability. The outcomes of the mixed research point towards necessary changes in the psycho-social care of midwives for women after perinatal loss.

O preparo e a administração de medicamento permanecem sendo um ponto crítico na prestação de uma assistência de qualidade para os indivíduos. Este estudo teve como objetivo analisar o efeito da intervenção educativa com profissionais de enfermagem acerca da segurança do paciente na administração de medicamentos injetáveis em um Hospital Público de Porto Alegre. A presente pesquisa teve uma abordagem prospectiva, com delineamento quase-experimental, antes e depois, para detectar e avaliar os não erros e erros durante o preparo e a administração de medicamentos.Os sujeitos foram auxiliares e técnicos de enfermagem, que atuavam na unidade de tratamento intensivo adulto com 59 leitos e em três unidades de internação (clínicas e cirúrgica). O estudo foi desenvolvido em quatro fases: observação não participante das áreas físicas de preparo de medicamento (I), observação não participante do processo de preparo e administração (II), grupos focais com parte dos sujeitos (III), e nova observação não participante (IV). Foram totalizadas 776 observações não participantes nas duas etapas (sendo 427 na II e 349 na fase IV). Cada observação foi correspondente ao preparo e administração de um medicamento injetável por trabalhador, durante o seu turno de trabalho. Realizaram-se no mínimo cinco observações de preparo de medicamentos por sujeito, com 74 sujeitos na etapa II e 61 auxiliares ou técnicos de enfermagem participantes na etapa IV. Na etapa III, a metade dos sujeitos foi convidada a participar dos grupos focais, no entanto, apenas 25 compareceram, formando o grupo intervenção e na IV etapa, os sujeitos da etapa II foram novamente convidados. Dos sujeitos, 81,1% foram do sexo feminino e 67,5% trabalhava apenas nessa instituição. A principal via de administração dos medicamentos injetáveis foi à intravenosa (63,7%, fase II e 58% fase IV). A pesquisa demonstrou consolidação dos pontos positivos da administração dos medicamentos, que foram evidenciados nas duas fases, onde três dos “nove certos” (paciente, medicamento e via certa) mantiveram 100% de execuções corretas pelos sujeitos pesquisados. Como também 99,7% das doses dos medicamentos foram administradas corretamente na quarta fase do estudo. Destacamos que a pesquisa apresentou um dado preocupante, no sentido de constatar que durante o processo de preparo e administração do medicamento ocorreram no mínimo dois erros potenciais de medicação (um no preparo e outro na administração), evidenciando a complexidade desse cuidado assistencial, tendo em vista as 32 etapas a serem realizadas para a segurança do paciente. Assim concluímos que o erro de medicação é a consequência, e não a causa dos problemas assistenciais, e que a abordagem de prevenção do erro foi sempre reativa. Contudo, o erro no preparo e administração de medicamentos injetáveis é decorrente de um conjunto de fatores que envolvem desde a área física inadequada, a falta de supervisão e controle, até o desconhecimento e em consequência a imprudência durante a execução das atividades. Dessa forma, a intervenção educativa por meio de grupos focais com os profissionais de enfermagem acerca de medidas de segurança ao paciente na administração de medicamentos auxiliou a reflexão dos sujeitos sobre as administrações medicamentosas injetáveis com segurança. / The preparation and administration of medicines remains a critical issue in providing quality care to individuals. This study aims to analyze the effect of educational intervention with nursing professionals regarding patient safety in the administration of injectable drugs in a public hospital in Porto Alegre, Brazil. This research adopted a mixed, forward-looking approach, with a quasi-experimental design, in order to detect and evaluate errors and non-errors during preparation and administration of medications. Subjects were nursing auxiliaries and technicians who worked in the adult intensive care unit with 59 beds and three inpatient units (clinical and surgical). The study was developed in four phases: non-participant observation of the physical areas of medication preparation (I), non-participant observation of the preparation and administration process (II), focus groups with part of the subject (III), and new non-participant observation (IV). There have been 776 non-participant observations in total for both phases (being 427 in phase II and 349 in phase IV). Each observation was corresponding to the preparation and administration of an injectable drug per staff professional during their shift. At least five observations of medication preparation were carried out per subject, with 74 subjects in phase II and 61 auxiliary or technical nurses participating in phase IV. In phase III, half of the subjects were invited to participate in focus groups. However, only 25 attended them, forming the intervention group and, in phase IV, subjects from phase II were invited again. From the subjects, 81.1% were women and 67.5% worked only in that institution. The main route of administration of injectable drugs was intravenous (63.7% on phase II and 58% on phase IV). Research has demonstrated consolidation of the positive points of medication administration that were highlighted in the two phases, where three out of the nine rights (right patient, drug and via) kept 100% correct executions by researched subjects. Besides that, 99.7% of medication doses were properly administered in the fourth study phase. It is worth highlighting that the research presented worrying data, in the sense of verifying that the process of medication preparation and administration shows at least two medication potential error (one in preparation and in another administration), demonstrating the complexity of assistance care, in view of the 32 steps to be taken to patient safety. Therefore, we conclude that the medication error is a consequence, not the cause of healthcare problems, and the error prevention approach has always been reactive. However, the error in the preparation and administration of injectable drugs is due to a set of factors ranging from inadequate physical area to lack of supervision and control, knowledge and caution, and concern the implementation of activities. Thus educational intervention through focus groups with nursing professionals concerning patient safety measures in medication administration has helped in the reflection of the subjects regarding safe administration of injectable drug. / La preparación y la administración de fármacos sigue siendo un tema crítico en la prestación de una atención de calidad para las personas. Este estudio tuvo como objetivo analizar el efecto de la intervención educativa con los profesionales de enfermería con relación a la seguridad del paciente en la administración de medicamentos inyectables en un hospital público de Porto Alegre. Esta investigación tuvo un enfoque prospectivo, casi-experimental, del tipo antes y después, para detectar y evaluar los no errores y errores durante la preparación y administración de medicamentos. Los sujetos fueron auxiliares de enfermería y técnicos que trabajaban en la unidad de cuidados intensivos de adultos con 59 camas y tres unidades (clínicos y quirúrgicos). El estudio se realizó en cuatro fases: observación no participante de las áreas físicas de la preparación de la medicina (I), la observación no participante del proceso de preparación y administración (II), grupos de enfoque, como parte de los sujetos (III), y nueva observación no participante (IV). Fueron totalizaron 776 observaciones no participantes en dos etapas (con 427 en Segunda y 349 en fase IV). Cada observación era relevante para la preparación y administración de un producto inyectable por trabajador durante su turno. Había por lo menos cinco de preparación de medicamentos de observaciones por tema, con 74 sujetos en estadio II y 61 asistentes o técnicos de enfermería que participan en el paso IV. En la etapa III, la mitad de los sujetos fueron invitados a participar en grupos de enfoque, sin embargo, sólo 25 asistieron, formando el grupo de intervención y el estadio IV, las materias de la fase II se les preguntó de nuevo. De los sujetos, el 81,1% eran mujeres y el 67,5% trabajaba sólo en esa institución. La principal vía de administración de los medicamentos inyectables era intravenosa (63,7% en estadio II y el 58% en estadio IV). La investigación demostró la consolidación de los puntos positivos de la administración de los medicamentos, que se evidencia en dos fases, donde tres de los “nueve correctos (paciente, medicación y via correcta)” tuvieron 100% de realizaciones correctas entre los encuestados. Así como 99,7% de las dosis de medicación se administra correctamente en la cuarta fase del estudio. Hacemos hincapié en que la investigación presentó un dato preocupante, al ver que el proceso de preparación y administración de la droga tiene al menos dos errores potenciales de medicación (uno en preparación y en otro administración), que muestra la complejidad del cuidado asistencial, considerando los 32 pasos para realizarlo para garantizar la seguridad del paciente. Así llegamos a la conclusión de que el error de medicación es la consecuencia, no la causa de los problemas de bienestar y el enfoque de la prevención del error siempre ha sido reactiva. Sin embargo, el error en la preparación y administración de medicamentos inyectables se debe a una serie de factores que intervienen desde inadecuada área física, la falta de supervisión y control, a la desinformación y en consecuencia imprudencia na ejecución de las actividades. Por lo tanto la intervención educativa a través de grupos focales con profesionales de enfermería sobre las medidas de seguridad a la administración de la medicación al paciente ayudó a la reflexión de los sujetos en la inyección de las administraciones de medicamentos de forma segura.

The purpose of this study was to describe the perceptions/views of student nurses, nurse educators and unit supervisors on accompaniment of student nurses in clinical settings of the Northern Province of the RSA A quantitative descriptive cross-sectional survey was used in this study to describe the perceptions/views of student nurses, nurse educators and unit supervisors on apcompaniment of student nurses in clinical settings. Data was collected during February and March 200 I when student nurses, nurse educators and unit supervisors in the Northern Province completed questionnaires. The study revealed positive and negative perceptions regarding accompaniment of student nurses in clinical settings, including that: • accompaniment in the clinical settings enhanced student nurses' clinical learning experiences • the presence of nurse educators in the clinical settings improved student nurses' accompaniment • facilitators played an important role in the accompaniment of student nurses • accompaniment enhances correlation of theory and practice / Health Studies / MA (Advanced Nursing Sciences)

Health Studies / D. Litt. et phil. (Advanced Nursing Sciences)