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Control over nursing practice (CONP) is a participatory process through which nurses have input and engage in decision making about the context of practice and unit operations related to nursing practice. CONP has been associated with a number of positive outcomes related to nurse satisfaction, nurse status, effectiveness of patient care, and quality of patient outcomes. However, no comprehensive model has been created nor comprehensive analysis been conducted related to approaches for increasing CONP. This study tested a hypothesized model of antecedents to CONP developed from a review of the literature in nursing, psychology, and organizational management using a complexity theory perspective.The study used a nonexperimental, comparative design. The sample for data analysis consisted of 28 nurse managers and 583 staff nurses from 32 units in 10 hospitals. Existing instruments were used in a paper and pencil format to collect demographic and perceptual data on CONP and the hypothesized antecedent variables. Data were aggregated to provide an analysis of organizational and unit level contextual and variable effects related to CONP.Contextual regression indicated a greater influence of unit-level variables than organizational-level variables on nurses' perceptions of CONP. Regression analyses and revised model testing demonstrated that nurse manager supportiveness, implementation of a formal structure for CONP, and information flow consisting of open and accurate communication were positively related to CONP. Hierarchy of authority was negatively related to CONP. The relationship between CONP and job codification and autonomy varied based upon the measurement of the dependent variable. Manager's perception that participative decision making enhances organizational effectiveness; manager's perception that participative decision making does not reduce their power; nurses' experience, expertise, and educational preparation; and nurses' desire for control did not significantly relate to CONP as hypothesized.This study contributes to nursing research and clarifies strategies for improving the work environment for nurses by delineating antecedents to CONP in the acute care hospital setting. These data will be useful to nurses, nurse managers, and hospital administrators who want to improve patient safety, reduce patient mortality, increase nurse satisfaction, and increase nurse retention.

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

Unintended consequences of electronic health records represent undesired effects on individuals or systems, which may contradict initial goals and impact patient care. The purpose of this study was to determine the extent to which a new quantitative measure called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire (CG-UCE-Q) was valid and reliable. Then, it was used to describe acute care nurses' experience with unintended consequences of electronic health records and relate them to the professional practice environment. Acceptable content validity was achieved for two rounds of surveys with nursing informatics experts (n = 5). Then, acute care nurses (n = 144) were recruited locally and nationally to complete the survey and describe the frequency with which they encounter unintended consequences in daily work. Principal component analysis with oblique rotation was applied to evaluate construct validity. Correlational analysis with measures of the professional practice environment and workarounds was used to evaluate convergent validity. Test-retest reliability was measured in the local sample (N = 68). Explanation for 63% of the variance across six subscales (patient safety, system design, workload issues, workarounds, technology barriers, and sociotechnical impact) supported construct validity. Relationships were significant between subscales for electronic health record-related threats to patient safety and low autonomy/leadership (P < .01), poor communication about patients (P < .01), and low control over practice (P < .01). The most frequent sources of unintended consequences were increased workload, interruptions that shifted tasks from the computer, altered workflow, and the need to duplicate data entry. Convergent validity of the CG-UCE-Q was moderately supported with both the context and processes of workarounds with strong relationships identified for when nurses perceived a block and altered process to work around it to subscales in the CG-UCE-Q for electronic health record system design (P < .01) and technological barriers (P < .01).

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

Thesis ( Ph.D. ( Nursing)) -- University of Limpopo, 2016 / The purpose of this study was to develop an evidence-based model for enhancing optimal midwifery practice environment in maternity units of public hospitals, Limpopo Province. A mixed method sequential explanatory design was adopted. The study was conducted in four phases, namely: quantitative, qualitative, model development and validation of the model. Self-developed 4-point Likert scale questionnaires consisting of 81 item questions for learner midwives and 89 item questions for midwifery practitioners were administered. The questionnaires were pre-tested prior to being administered to the respondents of the main study. The sample size of midwifery practioners was 174 and that of the learner midwives was 163. Data collected from respondents were analyzed quantitatively using descriptive and inferential statistics. Tables, pie and bar graphs were drawn to present the results. The results from the quantitative phase were utilized to formulate the interview guides that were used to explore the experiences of midwifery practitioners, experiences of learner midwives and perceptions of puerperal mothers. Phenomenological semi-structured individual interviews were conducted for midwifery practitioners (n=20), 3 Focus group discussions of learner midwives (n=18) and 3 focus group discussions of puerperal mothers (n=18) were held until data reached saturation. Data were analyzed qualitatively using Tesch’s open-coding method. Themes and sub-themes were coded manually. Results that emerged from the corroboration, comparison and integration of quantitative and qualitative results revealed the existence a sub-optimal midwifery practice environment, sub-optimal midwifery experiential learning environment and provision of sub-optimal midwifery interventions in the public hospitals of Limpopo province. Development of an evidence-based model emanated from the findings of numeric quantitative data and qualitative narratives. The evidence-based information from the existing situation as seen from the world of participants brought about a gap of optimal midwifery practice environment. The ideal situation was designed in a way of addressing the gaps identified. Experts were given the validation tool to assess whether the model was clear, simple, understood and that it can be utilized by any discipline in future.

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This dissertation is a multi-disciplinary study, which integrates a software engineering approach with instructional factors in the decision-making, analysis, design and development processes of instructional software. Software engineering models, tools and representations are used in the process of software construction. With reference to the fundamental characteristics of the software product, several disciplines and factors, from both instructional and computing perspectives are considered, and the most appropriate approach/es selected. Software engineering, instructional design and instructional theory are considered as pillars of courseware engineering. The object-oriented design paradigm and a prototyping life-cycle model are found to be most suitable for development of computer-aided instruction. The conceptual study is illustrated by prototype development of a component-based multi-activity practice environment in theoretical Computer Science. It offers perusal or practice, in various instructional modes, according to the user's preferred learning style or need. / Computing / M. Sc. (Information Systems)