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Background: The nursing process is a widely accepted method and has been suggested as a scientific method to guide procedures and qualify nursing care. More recently, the process has been defined as a systematic and dynamic way to deliver nursing care. This process is performed through five interrelated steps, namely: assessment, diagnosis, planning, implementation and evaluation, with subsequent modifications used as feedback mechanisms that promote the resolution of the nursing diagnoses. The Lesotho Nursing Council (LNC) adopted the nursing process over a decade ago and the LNC mandated nurse training institutions and clinical settings to utilise this methodology. However, there is a reluctance to implement the nursing process despite its importance in nursing care (LNC, 2009:7). Purpose: The primary purpose of this research was to explore and describe the perceptions and experiences of nurses in implementing the nursing process in a district public hospital in Lesotho. On the grounds of these findings, the researcher ultimately makes recommendations for nursing education, nursing practice and nursing research. Methodology: To explore and describe the perceptions and experiences of nurses implementing the nursing process in a district public hospital in Lesotho, the researcher chose a qualitative, exploratory, descriptive and contextual research design. The researcher used voluntary purposive sampling to identify participants who complied with the set selection criteria. The sample comprised of professional nurses with varying years of working experience and qualifications. The data was collected by means of narratives and two focus group interviews; n=10 and n=6. The data was captured on a digital audio recorder and was transcribed verbatim. The researcher took field notes during each focus group. Both the researcher and independent co-coder analysed the narratives and transcribed data together, using narrative analysis and open coding (Creswell, 2009:185). Three main themes and nine subthemes emerged from the data collected from the narratives and focus groups. The researcher illustrated these themes through direct quotes by the participants. Each of these themes was discussed accompanied by relevant data obtained from literature, and reduced to conclusive statements, which serve as a basis for the derived recommendations to nursing education, nursing practice and nursing research. Trustworthiness was ensured in accordance with the principles of credibility, transferability, dependability and confirmability. Conclusions: The researcher reached a number of conclusions. The participants perceived several factors and experienced them as interfering with the efficient implementation of the nursing process. Operational difficulties experienced in the systematisation of nursing care in practice, are amongst others a lack of knowledge of the steps involved in the process, an excessive number of tasks assigned to the nursing team, the poor quality of professional education, insufficient reports on the physical examination related to the disease and difficulty to formulate the nursing diagnosis. The research report concluded with the researcher’s evaluation of the research and recommendations for nursing practice, nursing education and nursing research with the purpose of improving the implementation of the nursing process. / MCur, North-West University, Potchefstroom Campus, 2014

Background: The nursing process is a widely accepted method and has been suggested as a scientific method to guide procedures and qualify nursing care. More recently, the process has been defined as a systematic and dynamic way to deliver nursing care. This process is performed through five interrelated steps, namely: assessment, diagnosis, planning, implementation and evaluation, with subsequent modifications used as feedback mechanisms that promote the resolution of the nursing diagnoses. The Lesotho Nursing Council (LNC) adopted the nursing process over a decade ago and the LNC mandated nurse training institutions and clinical settings to utilise this methodology. However, there is a reluctance to implement the nursing process despite its importance in nursing care (LNC, 2009:7). Purpose: The primary purpose of this research was to explore and describe the perceptions and experiences of nurses in implementing the nursing process in a district public hospital in Lesotho. On the grounds of these findings, the researcher ultimately makes recommendations for nursing education, nursing practice and nursing research. Methodology: To explore and describe the perceptions and experiences of nurses implementing the nursing process in a district public hospital in Lesotho, the researcher chose a qualitative, exploratory, descriptive and contextual research design. The researcher used voluntary purposive sampling to identify participants who complied with the set selection criteria. The sample comprised of professional nurses with varying years of working experience and qualifications. The data was collected by means of narratives and two focus group interviews; n=10 and n=6. The data was captured on a digital audio recorder and was transcribed verbatim. The researcher took field notes during each focus group. Both the researcher and independent co-coder analysed the narratives and transcribed data together, using narrative analysis and open coding (Creswell, 2009:185). Three main themes and nine subthemes emerged from the data collected from the narratives and focus groups. The researcher illustrated these themes through direct quotes by the participants. Each of these themes was discussed accompanied by relevant data obtained from literature, and reduced to conclusive statements, which serve as a basis for the derived recommendations to nursing education, nursing practice and nursing research. Trustworthiness was ensured in accordance with the principles of credibility, transferability, dependability and confirmability. Conclusions: The researcher reached a number of conclusions. The participants perceived several factors and experienced them as interfering with the efficient implementation of the nursing process. Operational difficulties experienced in the systematisation of nursing care in practice, are amongst others a lack of knowledge of the steps involved in the process, an excessive number of tasks assigned to the nursing team, the poor quality of professional education, insufficient reports on the physical examination related to the disease and difficulty to formulate the nursing diagnosis. The research report concluded with the researcher’s evaluation of the research and recommendations for nursing practice, nursing education and nursing research with the purpose of improving the implementation of the nursing process. / MCur, North-West University, Potchefstroom Campus, 2014

Magister Curationis - MCur / Background: Mental illness has become more common than many other diseases such as heart disease, cancer or diabetes. Aggression or violence by patients towards psychiatric nurses is a global issue. These nurses, therefore, face the huge challenge of providing nursing care to aggressive psychiatric patients. Without the necessary knowledge and skills, the nurses are vulnerable to all kinds of injuries, given the time spent managing aggressive patients. Purpose and objectives: The purpose of the study was to determine the level of knowledge and skills that professional nurses possess to manage the aggression of psychiatric patients. The objective of the study was to ascertain whether the knowledge and skills of professional nurses were sufficient to manage aggressive psychiatric patients. Method: A quantitative approach and descriptive design was used to conduct this study at a Psychiatric Hospital in the Western Cape, South Africa. The target population consisted of 149 professional nurses employed at the Psychiatric Hospital. The sample for the study was all-inclusive i.e. all professional nurses employed at the hospital. Only 70 participants were available for the study. Structured questionnaires were distributed to the participants for data collection and the response rate was 77% (n=54). Data analysis was done with the aid of a statistician using a Statistical Package for Social Science, version 22, and nominal as well as ordinal data was analysed using descriptive analysis. The process and purpose of the study was explained to the participants, who gave their consent, prior to the distributing of the questionnaires. The researcher obtained permission from the necessary authorities before commencing with the study. Findings: The study found that nurses were more likely to be exposed to verbal aggression as opposed to sexual aggression. It also revealed that nurses with less years of experience had more knowledge than their counterparts who had more years of experience in same position. Furthermore, the study revealed that those who had training in aggression management reported that the training did not meet their needs. Overall, the findings revealed that nurses had a fair knowledge of managing aggressive psychiatric patients. The overall findings also revealed that professional nurses had the required skills to manage aggressive patients. Recommendations: There is a need for on-going in-service training and refresher courses in the management of aggression. There should also be a needs analysis before commencing with these training courses which should be made compulsory for all staff to attend. Further studies should be conducted on the different categories of nurses, and other disciplines within nursing, to ascertain their knowledge of the management of aggression. Qualitative studies should also be conducted on nurses‟ experience of aggression in different settings.

Nurses experience stress, fear and anger while they are trying to reconcile their ideals/ goals about health care with its inadequacies and abuses (Jameton, 1984:5), while at the same time trying to stay true to their convictions (Lindh et al., 2010:552). Moral distress is experienced when nurses cannot adhere to these goals (Corley, 2002:637). Conflicting moral principles, stress-provoking and contradicting demands weaken the nurse’s sense of control, power and autonomy (Lützen et al., 2010:213). The current descriptions of moral distress inadequately define the concept, and this might lead to the inconsistent use of the term moral distress. Therefore, conceptual clarity is needed. Current available instruments measure antecedents and situations causing moral distress. Therefore, an instrument measuring the attributes of moral distress is urgently needed. Such an instrument might be used in a variety of clinical departments because it is not based on department-specific situations but on the attributes of moral distress. Moral distress has a great impact on the nurse, patient care and the organization. This research used Benson and Clark’s (1982) method of instrument development as a theoretical framework. It is the aim of this study to develop and validate an instrument to measure moral distress in the clinical health care context of the professional nurse. In order to attain this aim the following objectives were set: To conduct an integrative literature review to identify antecedents, consequences, attributes and empirical indicators of moral distress; to conduct interviews to explore professional nurses’ experience of moral distress; to develop an instrument to measure moral distress in professional nurses; to validate the instrument. A qualitative and quantitative research design with explorative, descriptive and contextual strategies was used. The research process was divided into phases. During Phase One, an integrative literature review was conducted and the population included all available national and international data on moral distress in nurses/ nursing and sampling included all-inclusive sampling. Data analysis was performed through descriptive synthesis.Phase Onealso included semi-structured interviews and the population included professional nurses working in hospitals and clinics in the North-West Province. The sampling method applied was purposive sampling. Tesch’s method was used as data analysis method. During Phase Two, a content validation was conducted and the population included experts in the field of moral distress and instrument validation, and purposive sampling was applied. Data collection was done through the instrument that was developedand data analysis was the content validity index. Phase Twoalso included a qualitative evaluation which was conducted and the population consisted of professional nurses working in hospitals and clinics in the North-West Province and purposive sampling was applied. Data was collected through the developed instrument and a focus group session. Data analysis was conducted through aconsensus discussion. During Phase Three, a pilot study was conducted and the population was professional nurses working ina hospital with different departments and clinics in the Free State Province. All-inclusive sampling was applied and the instrument that was developed was used as data collection. Data analysis included: Descriptive statistics, factor analysis (exploratory, confirmatory and Bartlett’s test of spherity), Cronbach’s alpha coefficient, correlations and ANOVA. According to the results from the face-, content-, exploratory and confirmatory, discriminant- as well as divergent validity, the instrument has been shown to be valid. The Cronbach’s alpha for the Moral Distress Instrument was deemed reliable. Finally, the research was evaluated and limitations were identified. Recommendations for nursing education, -practice, research and policy were formulated. / PhD (Nursing), North-West University, Potchefstroom Campus, 2014

Nurses experience stress, fear and anger while they are trying to reconcile their ideals/ goals about health care with its inadequacies and abuses (Jameton, 1984:5), while at the same time trying to stay true to their convictions (Lindh et al., 2010:552). Moral distress is experienced when nurses cannot adhere to these goals (Corley, 2002:637). Conflicting moral principles, stress-provoking and contradicting demands weaken the nurse’s sense of control, power and autonomy (Lützen et al., 2010:213). The current descriptions of moral distress inadequately define the concept, and this might lead to the inconsistent use of the term moral distress. Therefore, conceptual clarity is needed. Current available instruments measure antecedents and situations causing moral distress. Therefore, an instrument measuring the attributes of moral distress is urgently needed. Such an instrument might be used in a variety of clinical departments because it is not based on department-specific situations but on the attributes of moral distress. Moral distress has a great impact on the nurse, patient care and the organization. This research used Benson and Clark’s (1982) method of instrument development as a theoretical framework. It is the aim of this study to develop and validate an instrument to measure moral distress in the clinical health care context of the professional nurse. In order to attain this aim the following objectives were set: To conduct an integrative literature review to identify antecedents, consequences, attributes and empirical indicators of moral distress; to conduct interviews to explore professional nurses’ experience of moral distress; to develop an instrument to measure moral distress in professional nurses; to validate the instrument. A qualitative and quantitative research design with explorative, descriptive and contextual strategies was used. The research process was divided into phases. During Phase One, an integrative literature review was conducted and the population included all available national and international data on moral distress in nurses/ nursing and sampling included all-inclusive sampling. Data analysis was performed through descriptive synthesis.Phase Onealso included semi-structured interviews and the population included professional nurses working in hospitals and clinics in the North-West Province. The sampling method applied was purposive sampling. Tesch’s method was used as data analysis method. During Phase Two, a content validation was conducted and the population included experts in the field of moral distress and instrument validation, and purposive sampling was applied. Data collection was done through the instrument that was developedand data analysis was the content validity index. Phase Twoalso included a qualitative evaluation which was conducted and the population consisted of professional nurses working in hospitals and clinics in the North-West Province and purposive sampling was applied. Data was collected through the developed instrument and a focus group session. Data analysis was conducted through aconsensus discussion. During Phase Three, a pilot study was conducted and the population was professional nurses working ina hospital with different departments and clinics in the Free State Province. All-inclusive sampling was applied and the instrument that was developed was used as data collection. Data analysis included: Descriptive statistics, factor analysis (exploratory, confirmatory and Bartlett’s test of spherity), Cronbach’s alpha coefficient, correlations and ANOVA. According to the results from the face-, content-, exploratory and confirmatory, discriminant- as well as divergent validity, the instrument has been shown to be valid. The Cronbach’s alpha for the Moral Distress Instrument was deemed reliable. Finally, the research was evaluated and limitations were identified. Recommendations for nursing education, -practice, research and policy were formulated. / PhD (Nursing), North-West University, Potchefstroom Campus, 2014

Magister Curationis - MCur / The frequent readmission of patients in psychiatric hospitals is caused by the relapse in their different psychiatric conditions. With a shortage of professional nurses, lack of resources, and an ever-increasing workload, the frequent readmission of psychiatric patients further worsens the situation.

The healthcare workforce throughout the world is experiencing a shortage of healthcare workers and various strategies, processes and programs exist today of which nursing manager’s use to not only recruit nursing staff, but to retain these scarce resources. This research aims specifically to examine how career anchors and job compatibility influences the levels of job satisfaction of professional nurses. This study measured career anchors and job satisfaction to determine whether those whose job type and career anchor matched reported higher satisfaction than those whose job type and career anchor did not match. Results suggested that significant differences exist between functional nurses and managerial nurses. Specifically, the nursing group placed importance on lifestyle and service/dedication to a cause, while the managerial group places importance on functional competence and lifestyle. Finally, results indicated that job type and career anchor compatibility on their own might not be adequate predictors of job satisfaction. / Dissertation (MBA)--University of Pretoria, 2012. / Gordon Institute of Business Science (GIBS) / unrestricted

Magister Curationis / Undiagnosed and untreated medical illnesses are more predominant in patients with mental illnesses, compared to the general population. Concerns have risen about the observed lack of regular screening for Metabolic Syndrome potentially increasing the prevalence rate of the disease especially in young adolescents on anti-psychotics. Recognizing the recurrent co-morbidity between mental and physical health conditions, specific commendations addressing the physical conditions causing the increased morbidity and mortality of people with severe mental illness are needed. In some instances, treatment recommendations for the general population may need to be modified for people with SMI.

Quantitative, descriptive research was conducted to determine which factors contribute to absenteeism among nurses. A structured self-administered questionnaire was administered to the entire population of nurses who worked at a district hospital in the Limpopo Province. Statistical data analysis, involving factor analysis, frequencies and Chi-squares was performed. The findings revealed that various factors related to the characteristics of the nurse, characteristics of the manager, characteristics of the work and characteristics of the organisation contribute to absenteeism. Professional nurses and sub-professional nurses, as well as nurses younger than 40 and nurses who are 40 years and older, appeared to disagree on the extent to which various factors contribute to absenteeism in the workplace. This study was aimed at assisting organisations and managers in reducing absenteeism in the workplace, and by doing so, improving the quality of care. / Health Studies / MA (HEALTH STUDIES)