Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: In South Africa, currently enrolled nurses make up the largest proportion of members of the nursing healthcare team. As in direct contact with patients it is essential that the practice environment supports patient and nursing outcomes. Studies confirm the complexity of the practice environment and the impact on both personnel and on the quality of nursing care provided. Job satisfaction is integrally linked to the quality and safety of care provided. The scarcity of registered professional nurses, particularly in the South African context, has resulted in enrolled nurses being widely used to continue to deliver acute care in quite complex situations. It is well documented that the use of suboptimal nursing personnel levels or substituting enrolled nurses for registered professional nurses is associated with an increase of adverse events such as infections, pressure ulcers and unanticipated death. The purpose of this study was to explore the experiences of enrolled nurses regarding quality nursing care in general nursing units in the private healthcare setting. The objectives being: - The exploration of the enrolled nurses understanding of the concept of quality care - The exploration of the enrolled nurses understanding of her value and contribution to quality care and - The exploration of the enrolled nurses experiences (positive and negative) of quality nursing care in private health care setting A descriptive qualitative methodology was applied. A purposive sample size of n=13 was drawn from the total population of N=387. An exploratory interview was completed. Lincoln and Guba’s criteria of credibility, transferability, dependability and confirmability were applied and ethical principles were met. Findings demonstrated that enrolled nurses experienced both positive and negative work experiences, some more negative than others. They had a very good understanding of quality care but had difficulty in reconciling the patient’s needs with what they were able to deliver, due to workload pressures and resource constraints: P6: “I miss the quality because that patient that needs just that back rub or just to hold his hand ...the thing is with quality nursing we don’t do quality nursing on the patient anymore.” Most participants experienced registered professional nurses absolving their clinical supervisory responsibility. This endangers the quality and duty of care of patients and is a legal liability. A recommendation is that registered professional nurses require professional development through utilising good role models. This exposure to positive learning experiences will enable their professional development and ethical behaviour. Registered professional nurses need to be taught the skills of how to be team players. / AFRIKAANSE OPSOMMING: Ingeskrewe verpleegsters maak huidiglik die grootste deel van die verplegingsspan se gesondheidsorg uit. As gevolg van die direkte kontak met pasiënte, is dit belangrik dat die omgewingspraktyk pasiënt- en verpleeguitkomste moet kan ondersteun. Navorsingsstudies bevestig die kompleksiteit van die omgewingspraktyk en die impak wat dit op beide personeel en op die kwaliteit van verpleging wat verskaf word, het. Werksbevrediging vorm ’n geïntegreerde skakel met die kwaliteit en veiligheid van sorg wat verskaf word. Die tekort aan geregistreerde professionele verpleegsters, veral binne die Suid-Afrikaanse konteks, het tot die gevolg dat ingeskrewe verpleegsters oral gebruik word om akute sorg in taamlik komplekse situasies te lewer.. Dit is goed gedokumenteer dat die gebruik van suboptimale verpleegpersoneelvlakke of die vervanging van geregistreerde professionele verpleegsters met ingeskrewe verpleegsters, geassosieer word met ’n toename in nadelige gevalle soos infeksies, druk-ulkusse en onverwagte dood. Die doel van hierdie studie is om die ervaringe van ingeskrewe verpleegsters ten opsigte van die kwaliteit van verpleegsorg binne algemene verpleegeenhede in die private gesondheidsorgomgewings te ondersoek. Die doelwitte is ’n ondersoek na die ingeskrewe verpleegsters se: - begrip van die konsep van kwaliteitsorg - begrip van hul waarde en bydrae tot kwaliteitsorg en - ervaringe (positief en negatief) van kwaliteit verpleegsorg binne private gesondheidsorgomgewings. ’n Beskrywende, kwalitatiewe metodologie is toegepas. ’n Doelgerigte steekproefgrootte van n = 13 is geneem uit die totale populasie van N = 387. ’n Voortoets is voltooi. Lincoln en Guba se kriteria van geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestigbaarheid is toegepas en etiese beginsels is nagekom. Bevindings het bewys dat ingeskrewe verpleegsters beide positiewe en negatiewe werkservaringe gehad het; sommige meer negatief as ander. Hulle het ’n baie goeie begrip van kwaliteitsorg, maar vind dit moeilik om aan die pasiënt se behoeftes, vanweë drukkende werkladings en beperkte bronne te voldoen. P6: “Ek mis die kwaliteit want al wat die pasiënt benodig is die vryf van die rug of net die vashou van sy hand…die probleem met kwaliteitsorg is dat ons nie meer kwaliteitsorg op die pasiënt doen nie.” Die meerderheid van die deelnemers verklaar dat die geregistreerde professionele verpleegkundiges hulle kliniese toesighoudende verantwoordelikheid afskeep. Die gedrag is bydraend tot swak kwaliteit pasient sorg en het direkte wetlik implikasies. Die aanbeveling is dat professionele ontwikkeling van geregistreedrde verpleegkundigies verbeter kan word deur gebruik te maak van goeie rol modelle. Die blootstelling aan positiewe leer ervarings en omgewing sal bydrae tot hulle professionele ontwikkeling en etiese gedragspatrone. Geregistreerde verpleegkundiges moet die vaardighede aanleer om as deel van ’n span te kan funksioneer.

Thesis (MBA)--Stellenbosch University, 2012. / An exploratory, cross-sectional, qualitative survey was conducted to describe the market of lower income mothers who had recently given birth to a child in a state hospital in the Western Cape (WC) region of South Africa. These mothers were viewed by the researcher as potential consumers of low cost maternity plans which would provide for maternity care in Active Birthing Units (ABUs) in the private healthcare sector in South Africa. The motivation behind the research stems from various sources. The currently inequitable healthcare system in South Africa, which has been described as a two tier system in the recent Policy Paper on National Health Insurance (Republic of South Africa, 2011: 4-5), is one such source. Reports of poor maternity care in the South African public healthcare system (Vogel, 2011: E1097-E1098), is another source of motivation behind the research report. It was apparent to the researcher that given the low quality of maternity care in state hospitals, a potential market of healthcare consumers – who would be willing to pay a small premium for what they considered to be a more acceptable level of maternity care in the private healthcare sector – could exist. This view was supported by research conducted by Joan Costa and Jaume Garcia (2003: 587-599) in which the “quality gap” was confirmed as a driving force behind the demand for private health care. This focus on the lower socioeconomic groups as a market for private sector goods and services was found to be well described by Prahalad (2005). The researcher conducted interviews amongst mothers who had delivered a child in a public hospital in the previous two years. A convenience sample of 100 mothers was selected in a shopping mall in the Western Cape (WC). The researcher administered a structured questionnaire during a face-to-face interview with each of the 100 respondents. The respondents were rewarded with a shopping voucher to the value of 50 ZAR, which was both a prerequisite specified by the management of the shopping mall and consistent with rewards offered in similar studies (Francis, Battle-Fisher, Liverpool, Hipple, Mosavel, Soogun, & Nokuthula, 2011). Data collected from the questionnaire included both data on willingness to pay (WTP), as well as demographic data, which provided interesting insights into a relatively under-researched market segment. A statistical analysis of the data collected revealed that 31 respondents (31%) reported a positive WTP for private maternity care. A statistically significant relationship was revealed between respondents’ WTP and the birth experience the respondents had had during their most recent pregnancy, whereby mothers who had described their most recent birth experience as “poor” were significantly more likely to exhibit a positive WTP for private maternity care (p=0.00006). Significant relationships between respondents' WTP for private maternity care and their age and household size were also discovered, whereby younger mothers were more likely to be willing to pay than older mothers (p=0.02) and mothers from smaller households were also significantly more likely to be willing to pay than mothers from larger households (p=0.02). Amongst a sub group of 32 respondents deemed to have potential monthly savings, those with a higher monthly household income were more likely to exhibit positive WTP (p=0.02753) than were those with higher levels of monthly expenditure (p=0.04093). The researcher acknowledged that the limitations of the research included the fact that respondents were selected non-randomly, as a small isolated sample, which made the extrapolation of the results to the larger population of South African mothers impossible. The research did, however, serve to describe the demographic characteristics of a new and relatively under researched target market of mothers from the lower socioeconomic segment of the WC. Data gleaned from this survey will serve to inform further research into this target market, so as to complete a more comprehensive feasibility analysis for the establishment of low cost maternity care packages and ABUs in South Africa.