Maternal and perinatal mortality is one of the biggest challenges to public health, especially in developing countries. South Africa?s health care system is struggling to meet the “health for all” criteria against a backdrop of staff shortages (especially midwives) in an HIV/AIDS epidemic. These factors, together with the economic constraints of a developing country, places great demands on delivering cost–effective, safe, quality intrapartum care that exceeds expectations. The challenge for the manager is to organise the available resources to render the best quality of care cost effectively within the shortest period of time. Various reasons exist for the alarming shortage of nurses and midwives globally and also in South Africa. Unhealthy practice environments are the main cause of the problem as such environments have an impact on the job satisfaction of the midwives as well on patient satisfaction. In the turmoil of the health care system, patients are demanding greater quality of care and are insisting not only on excellent clinical skills, but also on empathetic and personalised care. This research was conducted to make a meaningful contribution to the body of knowledge, specifically knowledge related to quality intrapartum care through the development of a Quality Improvement Intervention Programme (QIIP?). The research was conducted in two phases including five objectives. The first objective gave a theoretical foundation of quality intrapartum care. The second objective included a situational analysis of the resources (personnel and equipment) and determine the quality improvement initiatives that could be implemented for intrapartum care. The third objective determined the practice environment in maternity units at Level 2 hospitals in the North West province that may influence quality intrapartum care. The fourth and last objective of Phase 1 determined the perceptions of management and midwives regarding the facilitating and impeding factors that influence the quality of intrapartum care. From the data that emerged from the first four objectives, specific themes kept repeating themselves, namely structure (what must be in place, e.g. infrastructure and human resources), process (what we do, e.g. life–long learning and implementation of policies) and outcome (the results, e.g. patient satisfaction and a positive practice environment). These collectively contribute to the quality of intrapartum care rendered. Phase 2 consisted of the development of a “Quality Improvement Intervention Programme (QIIP?)” for intrapartum care. In this phase the data from the first four objectives were used to develop the QIIP?. The QIIP? will be marketed as an accreditation tool for maternity units to measure themselves against the best in the world. Qualifying for QIIP? accreditation means improving the quality of intrapartum care resulting in satisfied patients, the establishment of a positive practice environment and a decrease in the Maternal Mortality Rate (MMR). / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2011.

Maternal and perinatal mortality is one of the biggest challenges to public health, especially in developing countries. South Africa?s health care system is struggling to meet the “health for all” criteria against a backdrop of staff shortages (especially midwives) in an HIV/AIDS epidemic. These factors, together with the economic constraints of a developing country, places great demands on delivering cost–effective, safe, quality intrapartum care that exceeds expectations. The challenge for the manager is to organise the available resources to render the best quality of care cost effectively within the shortest period of time. Various reasons exist for the alarming shortage of nurses and midwives globally and also in South Africa. Unhealthy practice environments are the main cause of the problem as such environments have an impact on the job satisfaction of the midwives as well on patient satisfaction. In the turmoil of the health care system, patients are demanding greater quality of care and are insisting not only on excellent clinical skills, but also on empathetic and personalised care. This research was conducted to make a meaningful contribution to the body of knowledge, specifically knowledge related to quality intrapartum care through the development of a Quality Improvement Intervention Programme (QIIP?). The research was conducted in two phases including five objectives. The first objective gave a theoretical foundation of quality intrapartum care. The second objective included a situational analysis of the resources (personnel and equipment) and determine the quality improvement initiatives that could be implemented for intrapartum care. The third objective determined the practice environment in maternity units at Level 2 hospitals in the North West province that may influence quality intrapartum care. The fourth and last objective of Phase 1 determined the perceptions of management and midwives regarding the facilitating and impeding factors that influence the quality of intrapartum care. From the data that emerged from the first four objectives, specific themes kept repeating themselves, namely structure (what must be in place, e.g. infrastructure and human resources), process (what we do, e.g. life–long learning and implementation of policies) and outcome (the results, e.g. patient satisfaction and a positive practice environment). These collectively contribute to the quality of intrapartum care rendered. Phase 2 consisted of the development of a “Quality Improvement Intervention Programme (QIIP?)” for intrapartum care. In this phase the data from the first four objectives were used to develop the QIIP?. The QIIP? will be marketed as an accreditation tool for maternity units to measure themselves against the best in the world. Qualifying for QIIP? accreditation means improving the quality of intrapartum care resulting in satisfied patients, the establishment of a positive practice environment and a decrease in the Maternal Mortality Rate (MMR). / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2011.

INTRODUCTION AND AIM: The current shortage of nurses is a concern shared by the healthcare industry globally. Whilst the reasons for these shortages are varied and complex, a key factor among them seem to involve an unhealthy work environment. The demanding nature of the critical care environment presents a challenge to many nursing professionals and it carries the risk of a high turn over rate due to the stress and intensity of the critical care environment. The critical care nurse is responsible for caring for the most ill patients in hospitals and the acute shortage of critical care nurses contributes to the intensity and pressures of this environment. Little evidence exists of research conducted to explore and describe the practice environment of the critical care nurse in South Africa. The main aim of this research study was to construct a theory for positive practice environments in critical care units in South Africa, grounded in the views and perceptions of critical care nurses working in the private hospital context. In recognition of the fact that a positive practice environment is considered to be the foundation for the successful recruitment and retention of nurses, it was clear that issues related to staff shortages will not be resolved unless the unhealthy work environment of nurses is adequately addressed. RESEARCH DESIGN AND METHOD: A constructivist grounded theory design was selected to address the inquiry at hand. The study was divided into two phases and pragmatic plurality allowed the use of both quantitative and qualitative data collection methods to explore, describe and contextualise the data in order to achieve the overall aim of the study. In phase one, a checklist developed by the researcher was used to describe the demographic profile of the critical care units (n=31) that participated in the study. The perceptions of critical care nurses (n=298) regarding their current practice environment was explored and decribed by using a valid and reliable instrument, the Practice Environment Scale of the Nursing Work Index (PES-NWI). In phase two, the elements of a positive practice environment were explored and described by means of intensive interviews with critical care nurses (n=6) working in the critical care environment. Concepts related to the phenomenon under investigation were identified by means of an inductive analysis of the data through a coding process and memo-writing. One core conceptual category and six related categories emerged out of the data. In the final phase of the theoretical sampling of the literature, a set of conclusions relevant to the phenomenon under study was constructed. The conclusions deduced from the empirical findings in both phases of the research process were integrated with those derived from the literature review to provide the foundation from which the theory was constructed. FINDINGS: The findings from the first phase of the research process provided information about the context in which the participants operate and assisted in discovering concepts considered relevant to the phenomenon under investigation. A grounded theory depicting the core conceptual category of "being in controi" and its relation to the other six categories was constructed from the data in order to explain a positive practice environment for critical care units in the private healthcare sector in South Africa. / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2010.

INTRODUCTION AND AIM: The current shortage of nurses is a concern shared by the healthcare industry globally. Whilst the reasons for these shortages are varied and complex, a key factor among them seem to involve an unhealthy work environment. The demanding nature of the critical care environment presents a challenge to many nursing professionals and it carries the risk of a high turn over rate due to the stress and intensity of the critical care environment. The critical care nurse is responsible for caring for the most ill patients in hospitals and the acute shortage of critical care nurses contributes to the intensity and pressures of this environment. Little evidence exists of research conducted to explore and describe the practice environment of the critical care nurse in South Africa. The main aim of this research study was to construct a theory for positive practice environments in critical care units in South Africa, grounded in the views and perceptions of critical care nurses working in the private hospital context. In recognition of the fact that a positive practice environment is considered to be the foundation for the successful recruitment and retention of nurses, it was clear that issues related to staff shortages will not be resolved unless the unhealthy work environment of nurses is adequately addressed. RESEARCH DESIGN AND METHOD: A constructivist grounded theory design was selected to address the inquiry at hand. The study was divided into two phases and pragmatic plurality allowed the use of both quantitative and qualitative data collection methods to explore, describe and contextualise the data in order to achieve the overall aim of the study. In phase one, a checklist developed by the researcher was used to describe the demographic profile of the critical care units (n=31) that participated in the study. The perceptions of critical care nurses (n=298) regarding their current practice environment was explored and decribed by using a valid and reliable instrument, the Practice Environment Scale of the Nursing Work Index (PES-NWI). In phase two, the elements of a positive practice environment were explored and described by means of intensive interviews with critical care nurses (n=6) working in the critical care environment. Concepts related to the phenomenon under investigation were identified by means of an inductive analysis of the data through a coding process and memo-writing. One core conceptual category and six related categories emerged out of the data. In the final phase of the theoretical sampling of the literature, a set of conclusions relevant to the phenomenon under study was constructed. The conclusions deduced from the empirical findings in both phases of the research process were integrated with those derived from the literature review to provide the foundation from which the theory was constructed. FINDINGS: The findings from the first phase of the research process provided information about the context in which the participants operate and assisted in discovering concepts considered relevant to the phenomenon under investigation. A grounded theory depicting the core conceptual category of "being in controi" and its relation to the other six categories was constructed from the data in order to explain a positive practice environment for critical care units in the private healthcare sector in South Africa. / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2010.

The study comprises an investigation of the quality of the clinical teaching environment of undergraduate students in the accredited Primary health care ( PHC) facilities used by a provincial nursing college in Limpopo. The researcher, who is employed full time in one of the accredited PHC facilities to which undergraduate students are admitted for clinical practice, became aware of the tension between the undergraduate students and professional nurses working in the PHC facility during the performance of clinical practice. Undergraduate students accused the professional nurses of neither supervising them properly during the execution of their clinical practice, nor assessing them on the prescribed practical outcomes. On the other hand, the professional nurses working in the PHC facility complained that undergraduate students were placed at the PHC facilities in large numbers with no clinical accompanist accompanying them. The research objectives were to determine the quality of clinical practice in the PHC clinical learning environment as rated by undergraduate students allocated by a provincial nursing college located working in a PHC facility in a district of Limpopo Province, and to formulate recommendations for the professional nurses in PHC districtmanagement to incorporate supervision for undergraduate students in order to enhance clinical teaching for undergraduate students in Primary health care facilities. The researcher used a quantitative, descriptive, explorative and contextual design. An all-inclusive sampling method was used to select research participants. Participants were undergraduate students of a provincial nursing college in Limpopo. Informed consent was obtained. Ethical approval was obtained from the relevant authorities. Data was collected by using an internationally validated Clinical Learning Environment Supervision and Nurse Teacher Instrument (Saariskoki & Leino-Kilpi, 2008:259-267).. Data analysis was done by using descriptive statistics and revealed that the clinical practice environment was not conducive to enhancing practical skills development in the real practical PHC practice. Evaluation of study, limitations and recommendations for education, research, practice and policy were discussed. / MCur, North-West University, Potchefstroom Campus, 2014

The study comprises an investigation of the quality of the clinical teaching environment of undergraduate students in the accredited Primary health care ( PHC) facilities used by a provincial nursing college in Limpopo. The researcher, who is employed full time in one of the accredited PHC facilities to which undergraduate students are admitted for clinical practice, became aware of the tension between the undergraduate students and professional nurses working in the PHC facility during the performance of clinical practice. Undergraduate students accused the professional nurses of neither supervising them properly during the execution of their clinical practice, nor assessing them on the prescribed practical outcomes. On the other hand, the professional nurses working in the PHC facility complained that undergraduate students were placed at the PHC facilities in large numbers with no clinical accompanist accompanying them. The research objectives were to determine the quality of clinical practice in the PHC clinical learning environment as rated by undergraduate students allocated by a provincial nursing college located working in a PHC facility in a district of Limpopo Province, and to formulate recommendations for the professional nurses in PHC districtmanagement to incorporate supervision for undergraduate students in order to enhance clinical teaching for undergraduate students in Primary health care facilities. The researcher used a quantitative, descriptive, explorative and contextual design. An all-inclusive sampling method was used to select research participants. Participants were undergraduate students of a provincial nursing college in Limpopo. Informed consent was obtained. Ethical approval was obtained from the relevant authorities. Data was collected by using an internationally validated Clinical Learning Environment Supervision and Nurse Teacher Instrument (Saariskoki & Leino-Kilpi, 2008:259-267).. Data analysis was done by using descriptive statistics and revealed that the clinical practice environment was not conducive to enhancing practical skills development in the real practical PHC practice. Evaluation of study, limitations and recommendations for education, research, practice and policy were discussed. / MCur, North-West University, Potchefstroom Campus, 2014