Patient outcomes are influenced by the quality of care that the workforce renders. The registered nurse, as designated process-owner of the “Back to basics” quality improvement (QI) initiative, plays a vital role, being responsible for providing compassionate patient-centred care to alleviate suffering and restore health. The aim of the study was to gain an in-depth understanding of how nurses perceive their roles, responsibilities and challenges in delivering basic nursing care, linked to the organisational “Back to basics” QI initiative. A qualitative study with an explorative descriptive contextual design was utilised. Registered nurses with a direct patient care involvement in the general nursing discipline of a private hospital group participated in focus-group interviews. Data were analysed using Creswell’s data-analysis cycle. Findings were that patient care coordination involves an assessment-delegation-supervision triad. However, meeting stakeholder expectations, management and administrative responsibilities, remove the registered nurse from direct patient care. Time constraints affect physical bedside availability to model the exemplary knowledge, skills and attitudes underlying quality basic nursing care delivery. Reduced opportunities to model quality basic nursing care at the bedside affect patients’ care expectations, resulting in complaints related to basic nursing care omissions. Participants felt that they needed more clarification on the “Back to basics” QI initiative, and more in-service training. The many broad-ranging recommendations include in-service training that empowers registered nurses with the competencies to deal with role and task balance in the face of the diverse and complex demands of the modern healthcare arena. / Health Studies / M.A. (Health Studies)

Nursing documentation became an important part of work of a general nurse / a midwife. The nursing documentation differs in individual hospitals. The clinic management is responsible for the documentation contents in given hospital and general nurses / midwives at least participate in its development. The nursing documentation serves as the work aid for the nursing staff, being the material providing important information for other medical staff and institutions. The documentation objectively informs the medical team members about the health conditions of the given individual. Recently, significant stress started to be put on education activities of a nurse and its documenting. New examination methods or therapeutic procedures are being introduced into practice, which should help in treatment of clients. Regardless modern progress, the number of chronically ill clients increases ? for example diabetes mellitus, chronic renal insufficiency, asthma bronchiale etc. That is why nurses in the positions of educators play very important rules. The graduation thesis / diploma work aims at nursing documentation in practice. The aim of the graduation thesis / diploma work was to map the efficiency of nursing documentation and to find out what an importance attach the nurses to nursing documentation keeping. Another aim was to find out whether education plans make a part of nursing documentation. My last aim was to find out whether an education nurse is a member of the nursing team. For the research part of this work, a combination of qualitative and quantitative research solution was used. A semi-structured interview was used s the data collection technique for the qualitative part, while there were interviewed the chief nurses working in a hospital in Plzeň region. A questionnaire was used as the data collection technique for the quantitative part and it was designed for general nurses working in the faculty, regional and district hospitals in Plzeň region, in standard department, intensive care unit and in consequent care unit. The aims of the work were reached. Four hypotheses were set for the quantitative research. 1. Nurses perceive the efficiency of nursing documentation in case of being kept by an appointed nurse. 2. The shift nurses consider nursing documentation keeping to be rather a stress instead of an expression of professional activities of a nurse. 3. A part of standard equipment of nursing documentation is reserved for education activities. 4. The system of nursing care provision in the hospital departments does not allow application of education process, even though its keeping in nursing documentation is required. The first two hypotheses were confirmed, the third and fourth hypotheses were not confirmed. Five chief nurses expressed their interest in results of our research and investigations. They are interested in results obtained in their departments. We continue our co-operation as the output of the work is a draft of documentation for education of a client, the education standard and a seminar or course of education activities of a nurse.

M.Cur. / The intensive care nurse practising respiratory nursing care, is responsible for giving high quality nursing care. Due to the rising cost of health care more pressure is placed on the nurse to provide a high quality nursing care (Sanazaro, 1986:27) Bruwer (1986:220-245) states that there is a need for an orderly, methodical qua l Ity assurance approach on all nursing levels in South Africa, based on a South African model, as well as the development of nursing standards for public and private hospitals. Mechanical ventilation forms an important part of the nursing of the adult critically ill patient in the intensive care unit. To ensure that the patient benefits from mechanical ventilation and does not suffer from complications due to mechanical ventilation, standards must be developed to ensure the giving of a high quality of nursing care. Without these standards it is impossible to determine the quality of their nursing care given. The quality can furthermore,only be questioned and not be determined scientifically. Standards for providing high quality nursing care to mechanically ventilated patients do not exist in South Africa. The quality of the nursing care that these patients receive is therefore questioned.

M.Cur. / The study on the quality of nursing unit management was done in the four training hospitals approved for registered nurses' training in Namibia. There are no written standards on the quality of unit management in the hospitals. The objectives of the study were to formulate standards on quality nursing unit management and to evaluate compliance of clinical units with these standards A quantitative, contextual, descriptive and evaluative research design was followed. The study was done in two phases. In phase one, standards were formulated by means of a literature study by the researcher and validated through consensus discussion groups with nurse managers representing the different management levels and clinical disciplines. Purposive sampling was used and 25 participants rated the draft standards for relevance, representativeness, completeness and clarity. A rating instrument for this purpose was attached to the draft standards in the form of a questionnaire, and posted to participants, before the consensus discussion groups. Reliability and validity of the instrument and related items were ensured through the development of a conceptual framework and the consensus discussion groups. The pilot study indicated that a rating scale of 'Compliance', Partial Compliance, 'Non-Compliance' and 'Not Applicable' are more appropriated. Phase two represents the quality survey for the compliance with standards. The sample for the quality survey included 60 units from all four hospitals, representative of all clinical disciplines. Data was collected by means of interviews, observation and document analysis, using an evaluation instrument. Two surveyors, the researcher and a colleague, both lecturers from the Department of Nursing, University of Namibia, were involved in the data collection process. Double evaluations were done in 19 clinical units, representing 31,7% of the total clinical units (n=60), and the researcher alone evaluated 41 units, representing 68,3%. A high inter-rater reliability between the ratings of the surveyors was proven. The ethical principles of informed consent and anonymity have been adhered to throughout the study. Data was analysed through statistical analysis and are presented as descriptive statistics and comparative statistics. The findings revealed that, although unit nurse managers emphasise unit organisation, the quality of nursing unit management in the training hospitals in Namibia is poor. The findings also revealed that a need exists to empower nurse managers through in-service education on strategic planning as well as quality management in general. The recommendations from this study are to make written standards available, to empower nurse managers in quality management, to validate standards for quality nursing unit management nationally in the Namibian hospitals and for further research.

D.Cur. / The purpose of this study was to formulate clinical guidelines for critical nursing actions in a neonatal intensive care unit (NICU). Currently each NICU has their own set of policies and standards for various procedures relevant to NICUs. There is thus no standardisation of nursing methods between the increasing numbers of NICUs. Uniform standards are of significant importance with regards to the nurses working in the units on a freelance basis through nursing agencies. The nurses often work in more than one unit and are thus subjected to various methods of performing one task ...

M.Cur. / The nursing service manager is accountable for the managerial outputs of the nursing service, being quality nursing care, cost effectiveness and quality nursing staff management. These managerial responsibilities will influence the overall management efficiency of the health delivery system. There is a need for a more scientific basis of staffing in South African critical care units. Various methods are used to determine staffing needs, but the most accurate and acceptable method being used is the patient classification system. The success of a critical care patient classification system is based upon the accurate determination of the ideal nurse-patient ratio. Ideal nursepatient ratio depends on matching the competency of the critical care nurse to the severity of the critical care patient's illness. Internationally and nationally very few guidelines describe the competency requirements that the critical care nurse should have to function effectively in the critical care unit. To maintain a high standard of quality nursing care, the critical care nurse should be assigned to a critical care patient according to her competency level. The aim of this study was to describe a scientific patient classification system for critical care patients according to which workload and nursing requirements can be ascertained. Secondly, to describe guidelines for the competency requirements of a registered critical care nurse assigned to nurse the different categories of critical care patients categorised by the patient classification system as prescribed. The aim of the study is justified by means of an exploratory, descriptive, contextual research design. A critical care patient classification system has been developed and validated by a group of critical care nursing experts using a structured two phase research method. The statistical validity of each item of the critical care patient classification system was determined by means of a content validity index. All the items of the critical care patient classification system were rated as valid and therefore the critical care patient classification system as a whole has been accepted as valid. The reliability of the critical care patient classification system was tested by means of a pilot study in two selected research units. It was determined that the inter-rater reliability was within the 95 per cent confidence interval, that the system could discriminate between different critical care patients and nurse-patient ratios were effectively determined by the system. Critical care nurse competency requirements were identified by critical care nursing experts by means of a focus group interview. The results obtained from the focus group interview were verified by a literature control and peer group review. Guidelines for the competency requirements of the critical care nurse were compiled. The critical care patient classification system developed will equip the critical care manager with a scientific instrument to assign personnel to critical care units. The critical care patient classification system will furthermore assist the critical care unit manager in the daily utilisation of valuable human resources, in that critical care nurses with the appropriate level of expertise can be assigned to each patient, thus facilitating quality critical care nursing.

Background: Since the 1980s, Saudi Arabia’s socio economic transformation has led to vast social development. As a result there has been increased adoption of behaviours such as smoking and sedentary life styles, which pose a risk to health. It is anticipated that cancer incidence will double over the next two decades and it is thus vital that high quality of care is provided to meet the growing health care demands. Moreover, it is important that patients are satisfied with their care provision. This thesis begins with a narrative synthesis of the existing literature about patient satisfaction in the Saudi context and beyond. An evaluation of the key concepts for understanding patient satisfaction illuminated the lack of evidence about the assessment of patient satisfaction including specific key domains of the structure and process of care. This evaluation also indicated the need to further investigate the Saudi patient perspectives in oncology hospital setting. The aim of my study was to examine the extent to which clinical effectiveness impacts upon patient satisfaction in oncology ward settings in the Kingdom of Saudi Arabia (KSA). Methods: A sequential explanatory mixed methods design was employed. The Donabedian quality framework (1980) and Patient experience model (Reimann and Strech 2010) were used to assess patient satisfaction with quality of care provided. A quantitative phase was followed by a qualitative phase. In the first phase, the European Organisation for Research and Treatment of Cancer (EORTC) IN-PATSAT32 validated questionnaire was used to collect data from 100 adult oncology inpatients at a Cancer Centre in Riyadh. The second qualitative phase involved semi-structured telephone and face to face interviews with 22 adult oncology inpatients who previously answered the questionnaire. Synthesis occurred at the intersection of quantitative Phase 1 and qualitative Phase 2 data. The qualitative Phase 2 thus further explored the satisfaction scores of quantitative Phase1 to deepen the understanding of patient satisfaction in oncology ward settings in KSA. Findings: The main findings were that patient satisfaction levels are influenced by the clinical effectiveness of doctors and nurses, accessibility to health care and socio-demographic factors. Specifically, the interpersonal aspects of care were deemed core to patient experiences in oncology ward settings in KSA. It emerged that doctor-patient relationships, nurse shortages and language barriers are particular areas where changes could be made to improve care, thereby enhancing patient satisfaction. These findings contribute important new insights into the interpersonal aspects of care in the light of the underlying social and cultural contextual factors that influence patient satisfaction in the KSA. Conclusion: This study has provided new evidence supporting the need for stronger interpersonal relations and a more patient-centred approach in the oncology health system in KSA. In particular, the influential role of cultural issues in influencing patient satisfaction in oncology ward settings was apparent. Evidence provided by this research will make a substantial contribution to policy makers and hospital management teams in the KSA wanting to improve patient satisfaction in oncology wards and in other health care settings.

OBJECTIVES: Legislation and health policy enabling nurses and pharmacists to prescribe a comprehensive range of medicines has been in place in the UK since 2006. Our objective was to evaluate the clinical appropriateness of prescribing by these professionals. METHODS: A modified version of the Medication Appropriateness Index (MAI) was used by 10 medical, seven pharmacist and three nurse independent raters to evaluate a sample of 100 audio-recorded consultations in which a medicine was prescribed by a nurse or pharmacist. Raters were current prescribers with recognized experience in prescribing. Consultations were recorded in nine clinical practice settings in England. RESULTS: Raters' analysis indicated that, in the majority of instances, nurses and pharmacists were prescribing clinically appropriately on all of the ten MAI criteria (indication, effectiveness, dosage, directions, practicality, drug-drug interaction, drug-disease interaction, duplication, duration, cost). Highest mean 'inappropriate' ratings were given for correct directions (nurses 12%; pharmacists 11%) and the cost of the drug prescribed (nurses 16% pharmacists 22%). Analysis of raters' qualitative comments identified two main themes: positive views on the overall safety and effectiveness of prescribing episodes; and potential for improvement in nurses' and pharmacists' history-taking, assessment and diagnosis skills. CONCLUSIONS: Nurses and pharmacists are generally making clinically appropriate prescribing decisions. Decisions about the cost of drugs prescribed and assessment and diagnostic skills are areas for quality improvement.

Thesis (MCur) -- University of Stellenbosch, 2005. / ENGLISH ABSTRACT: A non-experimental descriptive study was conducted in four prisons in the Western Cape. The research focussed on the standard of care within primary health care settings in the purposively selected prisons. No official written standards existed to measure the quality of care. After an in-depth literature study, structure, process and outcome standards were formulated and validated. The main findings of the study indicated that: • Standards in these three dimensions of care did not meet the pre-set level of performance as determined by the researcher; • The clients were generally satisfied with the hygiene in the clinics; • Aspects of concern were the lack of explanation offered to the clients before and after consultations and nursing care interventions. The researcher recommends the implementation of a comprehensive quality care model for the health care of the prisoners with adequate human and nonhuman resources Core words: Qualtiy care, Correctional services health care, Nursing care in prisons. / AFRIKAANSE OPSOMMING: "n Nie-eksperimentele beskrywende studie is in vier gevangenisse in die Wes- Kaap uitgevoer. Die navorsing het gefokus op die gehalte van sorg binne primere gesondheidsorgomgewings in die doelbewuste geselekteerde omgewings. Geen amptelike geskrewe standaarde om die gehalte van sorg te meet, het bestaan nie. Na 'n in-diepte literatuurstudie is struktuur-, proses- en uitkomsstandaarde geformuleer en gevalideer. Die belangrikste bevindings van die studie het aangedui dat: • Standaarde in hierdie drie dimensies van sorg het nie aan die voorafbepaalde vlak van sorg voldoen het nie soos deur die navorser bepaal is; • Die kliente was oor die algemeen tevrede met die higiene in die klinieke; • Kommerwekkende aspekte het ingesluit die gebrek aan voldoende verduidelikings aan kliente voor en na konsultasies en verpleegintervensies. Die navorser bevel aan dat In omvattende gehalteversekeringsmodel vir die gesondheidsorg van gevangenes ingestel word met voldoende beskikbare mensen ander hulpbronne. Kernwoorde: Gehaltesorg, Korrektiewe dienste gesondheidsorg, Verpleegsorg in gevangenisse.

The purpose of this hermeneutic phenomenological study was to understand the essence of the lived experience of women after having an abnormal prenatal ultrasound. One hundred years ago, health disciplines had limited therapies for prenatal and neonatal disorders. During this period, the eugenics movement influenced leaders to involuntarily sterilize individuals who were sought to be "unfit" to prevent disorders in offspring. ... One of these contemporary reproductive genetic technologies is the use of ultrasound and serum bio-medical markers for detection of congenital, chromosome, and genetic disorders. When ultrasounds reveal abnormal findings, the perceived perfect pregnancy vanishes and gives way to feelings of shock, disbelief, fear, guilt, loss, and threats to self and their unborn baby. Twelve women who had an abnormal ultrasound were interviewed within the context of their cultural values and beliefs. The method of van Manen's hermeneutic phenomenology illuminated the meaning for these women in their life worlds. ... They endured this experience through their own coping mechanisms, but often felt uncertainty and emotional turmoil until the birth. The women also sought comfort through their cultural values, beliefs, and traditions. In coping with the risks found on this abnormal ultrasound, women often selected silence or blocking perceived threats. With these coping methods, they were alone in their suffering. ... Health providers, in not recognizing these women's misunderstandings and emotional fears, abandoned them in their psychosocial and cultural needs. The significance reveals that nurses and health providers need to infuse human caring ways of being, knowing, and doing within advanced technological environments. / by Jeanne Chatham Gottlieb. / Thesis (Ph.D.)--Florida Atlantic University, 2013. / Includes bibliography. / Mode of access: World Wide Web. / System requirements: Adobe Reader.