Philosophiae Doctor - PhD / Professional nurses constitute the highest number of health manpower all over the world. The nature of their work make them prone to physical and emotional trauma which sometimes affect the care they render. Therefore, nursing requires that professionals demonstrate acceptable levels of self-awareness and self-control which is congruent with the key principles of mindfulness contributing to a standard of nursing practices that do not always reach by providers as expected. Likewise, Nurse Managers are expected to utilise mindfulness principles in the planning, organising, staffing, directing and controlling activities of their units. Therefore, the aim of this study was to develop a mindfulness-based unit management training programme for professional nurses in Ondo State, Nigeria. The objectives of this study were to: (a) determine the level of individual mindfulness of professional nurses. (b) measure the extent to which individual mindfulness impacts professional nurses’ mindfulness. (c) determine the effect of professional nurses’ mindfulness on unit management performance of professional nurses. (d) design mindfulness-based unit management programme for professional nurses. (e) verify the developed mindfulness-based unit management training programme for professional nurses.

"Hearing is one of the body's five senses. But listening is an art." (Tyger, 2005 : para.1). While working in the haemodialysis unit in KwaZulu-Natal, I observed that patients preferred not to disclose their experiences of erectile dysfunction with the professional nurse practitioners but to the health care workers and to other patients in the unit. The nondisclosure served as a barrier to the patients receiving the assistance and support they required to be able to cope with erectile dysfunction. Added to this, there were no therapy groups or supportive groups available for the patients to allow them the platform to voice their experiences of erectile dysfunction and to provide them with strategies to cope with these experiences. The professional nurse practitioners lacked the knowledge and skills to assist the patients to cope with their experiences of erectile dysfunction. Therefore, there was a shortcoming in the provision of holistic nursing care to these patients, threatening their mental health specifically. The Theory for Health Promotion in Nursing (University of Johannesburg [UJ], 2009:4) states that a person is seen holistically in interaction with the environment in an integrated manner therefore the need for holistic nursing care. From the problem identified above I envisioned the need to conduct a study on the lived experiences of patients with erectile dysfunction from a holistic perspective that includes a mental health perspective. The overall aim of this study was to generate an in-depth understanding of the lived experiences of patients with erectile dysfunction who were on a haemodialysis programme in three units of a renal disease management organisation in KwaZulu-Natal. The aim was achieved by exploring and describing the patients’ lived experiences of erectile dysfunction. My understanding of the lived experiences of these patients formed the basis for proposing recommendations to facilitate the mental health of patients with erectile dysfunction in the context of this study with reference to nursing practice, education and research. The facilitation of mental health care to the patients in the haemodialysis units would require the provision of holistic nursing care to be implemented by the professional nurse practitioners with the assistance and support of the advanced psychiatric professional nurse practitioner. A phenomenological research design that was qualitative, explorative and contextual was followed to achieve the aim and objectives of the study. Purposive sampling was used for the sample selection based on the inclusion and exclusion criteria. The number of participants selected for this study was guided by data saturation. The total number of participants selected for this study was nine. The data collection methods utilised were phenomenological interviews, naïve sketches and field notes. In the phenomenological interview the participant was asked: “How is it for you to live with erectile dysfunction?” Thereafter the participants were requested to “Write a story on living with erectile dysfunction.” The field notes included observational, methodological, theoretical and personal notes. The phenomenological interviews were audiotaped and transcribed. An independent coder and I analysed the transcribed phenomenological interviews, written naïve sketches and field notes. I made use of Creswell’s method of data analysis (Creswell, 2007:156) in analysing the data. The measures taken to ensure trustworthiness in this study included credibility, dependability, confirmability, transferability and authenticity. The three primary ethical principles articulated by the Belmont Report (beneficence, respect for human dignity and justice) and the Declaration of Helsinki guided this study. There were two major themes with sub-themes that emanated from the collection of multiple data. The first major theme was that the participants’ lived experiences of erectile dysfunction reflected psychological, physical and social losses that seemingly negatively influenced their mental health. An alternative story of two of the participants’ acceptance of living with erectile dysfunction which positively influenced their mental health emerged as the second major theme. Therefore the essence of most of the participants’ experiences of erectile dysfunction was reflected by losses in the psychological, physical and social dimensions that seemingly negatively influenced their mental health. However, two participants had embraced the challenges of erectile dysfunction and managed to deal with the losses in the psychological and social dimensions. Based on the findings and the literature control recommendations were proposed for nursing practice, education and research. The recommendations were guided by the Theory for Health Promotion in Nursing from the University of Johannesburg (2009:1). These recommendations served as a frame of reference to enable the professional nurse practitioner to facilitate the mental health of patients who experience erectile dysfunction within the context of rendering holistic nursing care. The advanced psychiatric nurse practitioner has both developmental and consultative roles to implement in the haemodialysis unit. In implementing these roles, the professional nurse practitioner is assisted by the advanced psychiatric nurse practitioner to mobilise the internal and external resources to meet the patient’s needs on a holistic level. A psychiatric nursing qualification for professional nurse practitioners treating patients in the haemodialysis units is recommended to assist and support the patients to cope with their experiences of erectile dysfunction, thus facilitating their mental health. Copyright / Dissertation (MCur)--University of Pretoria, 2012. / Nursing Science / unrestricted

Magister Curationis - MCur / In our constantly changing healthcare system and with large numbers of staff shortages in hospitals, newly qualified professional nurses are expected to be competent and work unsupervised in leadership capacities soon after they have completed their nursing programs. The study was aimed at determining the perceptions of professional nurses of newly qualified professional nurses' competency as well as factors that influence competency. A quantitative approach using a descriptive survey design was employed, using 34 experienced professional nurses working in selected private hospitals in the Western Cape. Data was collected by means of a peer evaluation questionnaire, namely the Competency Inventory for Registered nurses. Data was analyzed, using IBM SPSS 19 with the assistance of a statistician. The results of the 55-item Competency Inventory for Registered Nurses indicate that newly qualified nurses were perceived as highly competent in clinical care, leadership, interpersonal relation, legal/ethical and professional development. Newly qualified nurses were perceived as low in competency in teaching/coaching, critical thinking and research aptitude. All the factors identified using literature, were perceived as having an influence on competency. Recommendations were made to the institutions to assist newly qualified nurses in competence development.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: There is no formal succession plan for paediatric professional nurses (PNs) in academic, tertiary hospitals in the Western Cape. A lack of a succession plan could have major implications for the sustainability of effective and efficient health care services (Department of Health, DoH, 2010:1). Therefore, a systematic scientific investigation is required to determine the opinions of PNs regarding the characteristics or criteria for a succession plan in a paediatric organization. The aim of this study was to determine the opinions of paediatric PNs regarding succession or career planning in academic, tertiary hospitals in the Western Cape. A quantitative approach with an exploratory, descriptive, non-experimental design was applied by means of a questionnaire survey which consisted of closed and openended questions. Reliability and validity were assured by means of a pilot study and consultation with nursing experts and a statistician. Cronbach’s alpha test was used to test for internal consistency between the responses to the 3-point Likert scale and dichotomous questions on the characteristics of an ideal succession plan. The data was collected by means of a self-administered, structured questionnaire to elicit opinions regarding the characteristics of an ideal succession plan that includes a career plan. Ethical approval was obtained from the Health Research Ethics Committee of the University of Stellenbosch. Permission for access to the hospitals was obtained from the hospital and nursing managers. Informed written consent was obtained from the participants. The questionnaires were distributed personally by the researcher at two hospitals and via the assistant manager in nursing at one hospital. Data was analysed by the statistician and descriptive statistics were presented by means of frequency distribution tables and histograms. Furthermore, the existence of relationships between variables was compared by means of a t-test or when assumptions of the t-test were not fulfilled an appropriate non-parametric test was considered. The results were evidence of the need for the development of a succession plan based on Benner’s Novice to Expert Model for paediatric PNs in academic, tertiary hospitals in the Western Cape. In addition, participants’ opinions on the value of a succession plan, including a career plan showed multiple benefits that will outweigh its challenges once developed and implemented. Recommendations are based on the scientific evidence that show the urgent need for the development and implementation of a formal five level skill-based clinical training programme that includes a 360-degree feedback system for paediatric PNs by means of an integrated, collaborative approach. The development and implementation of a formal succession plan will strengthen and enhance the retention of the various levels of competent, proficient and expert paediatric PNs. In addition, a formal succession plan will attract and motivate the novice and advance beginners to progress to competent, proficient and expert levels. / AFRIKAANSE OPSOMMING: Daar is geen formele opvolgplan vir pediatriese professionele verpleegpersoneel in akademiese tersiêre hospitale in die Wes-Kaap nie. ’n Gebrek aan ’n opvolgplan kan ernstige gevolge vir die volhoubaarheid van effektiewe en doeltreffende gesondheidssorgdienste inhou (DoH, 2010:1). Dus, is ’n sistematiese wetenskaplike ondersoek nodig om die opinies van professionele verpleegpersoneel te bepaal, ten opsigte van die eienskappe of kriteria vir ’n opvolgplan in ’n pediatriese organisasie. Die doel van hierdie studie was om die opinies van pediatriese professionele verpleegpersoneel te bepaal ten opsigte van ’n opvolg- of beroepsplan in akademiese, tersiêre hospitale in die Wes-Kaap. ’n Kwantitatiewe benadering met ’n ondersoekende, beskrywende, nie-eksperimentele ontwerp is toegepas deur gebruik te maak van ’n vraelysopname wat bestaan het uit geslote en ope-vrae. Betroubaarheid en geldigheid is verseker deur gebruik te maak van ’n loodsondersoek en raadpleging van verpleegkundiges en ’n statistikus. Cronbach se alpha-toets is gebruik om te toets vir interne konsekwentheid tussen die response tot die 3-punt Likertskaal en tweeledige vrae oor die kenmerke van ’n ideale opvolgplan. Die data is gekollekteer deur gebruik te maak van ’n selfgeadministreerde, gestruktureerde vraelys om opinies te onthul ten opsigte van die kenmerke van ’n ideale opvolgplan, wat ’n beroepsplan insluit. Etiese goedkeuring is verkry van die Gesondheidsnavorsing se Etiese Komitee van die Universiteit van Stellenbosch. Toestemming vir toegang tot die hospitale is verkry van die hospitaal en verpleegbestuurders. Ingeligte skriftelike toestemming is van die deelnemers verkry. Die vraelyste is persoonlik versprei deur die navorser by twee hospitale en via die assistentbestuurder wat by een van die hospitale verpleeg. Data is geanaliseer deur die statistikus en beskrywende statistiek is aangebied by wyse van frekwensie verspreidingstabelle en histogramme. Voorts, is die bestaan van verwantskappe tussen veranderlikes vergelyk, deur gebruik te maak van ’n ttoets of waar veronderstellings van die t-toets nie bereik is nie, is ’n gepaste nieparametriese toets oorweeg. Die resultate is bewys van die behoefte vir die ontwikkeling van ’n opvolgplan wat gebaseer is op Benner se Novice to Expert Model vir pediatriese professionele verpleegpersoneel in akademiese, tersiêre hospitale in die Wes-Kaap. Daarbenewens, het deelnemers se opinies die waarde van ’n opvolgplan wat ’n beroepsplan insluit, die veelvoudige voordele wat dit inhou getoon wat die uitdagings sal oortref, sodra dit ontwikkel en geïmplementeer word. Aanbevelings is gebaseer op die wetenskaplike bewys wat dui op die dringende behoefte vir die ontwikkeling en implementering van ’n formele vyfvlak vaardigheidsgebaseerde kliniese opleidingsprogram wat ’n 360-grade terugvoersisteem insluit vir pediatriese professionele verpleegpersoneel deur middel van ’n geïntegreerde, medewerkende benadering. Die ontwikkeling en implementering van ’n formele opvolgplan sal die retensie van die verskeie vlakke van bekwame, vaardige en kundige pediatriese professionele verpleegpersoneel versterk en bevorder. Boonop sal ’n formele opvolgplan nuwelinge en gevorderdes trek en motiveer om te ontwikkel tot bekwame, vaardige en kundige vlakke.

Magister Curationis - MCur / As South Africa continues to experience the highest prevalence of HIV/AIDS globally, co-occurring mental illness poses challenges for public health. Mental illness has increased among people living with HIV/AIDS (PLWHA), as infected individuals succumb to the psychological stress and trauma of the disease. Key research issues, not yet well established, relate to whether professional nurses, working in psychiatric hospitals in South Africa, are equipped with the necessary knowledge and skills to be able to provide effective mental healthcare services, given the increase in mental illness of PLWHA. An increase in mental illness translates into an increase in demand for psychiatric services by PLWHA. There is a paucity of research on HIV/AIDS knowledge of professional nurses working in psychiatric hospitals in South Africa, despite the established acknowledgement of the increase of mental illness amongst PLWHA. The aim of this study was to assess the HIV/AIDS knowledge, attitude and perceived risks of professional nurses working in a psychiatric hospital in the Western Cape, South Africa. A quantitative, descriptive survey design, using an all-inclusive sampling method, was used to select 121 professional nurses employed at a psychiatric hospital in Western Cape to participate in the study. The objectives of the study were to: describe professional nurses’ knowledge of HIV/AIDS; describe the attitudes of professional nurses towards PLWHA and mental illness; and determine professional nurses’ perceived HIV risks in a psychiatric hospital.

Magister Curationis - MCur / In 2011, a structured electronic system for the staffing of agency nurses was implemented in the Western Cape as part of the Nursing Information Management System (NIMS). This electronic system was developed to ensure a fair tendering process for the procurement of agency staff, providing information on agency expenditure, maximum wage rates and adherence to principles and rules of supply chain management. Although technology is used more and more in healthcare services within the Western Cape, some professional nurses could lack the skills needed to implement the electronic system appropriately. A descriptive and quantitative design was followed to determine the competence levels of professional nurses in utilising the electronic staffing system for agency nurses in public hospitals in the Metropole, Western Cape. The aim of the study was to develop guidelines for nurse managers according to which they can train professional nurses in hospitals to utilise the electronic system for staffing of agency nurses. Assumptions were adapted from the theoretical framework of Benner (1984) on different levels of competencies and used as theoretical departure of the study. The accessible population for this study was all the professional nurses in hospitals within the Metropole of the Western Cape Government Health registered as users on the database, called the Nursing Information Management System (NIMS) (N=278). This population served as the total inclusive sample for the study. The method of data collection was a self-administered structured questionnaire. The data was analysed by using the SPSS Version 24 software program and descriptive and inferential statistics were conducted.

Philosophiae Doctor - PhD / The Wellness Leadership White Paper states that leadership is needed in a supportive environment with the purpose of guiding clients to lasting wellness. Wellness can be defined as an active process that enables an individual to become aware of all aspects of the self and to make choices in terms of a more healthy existence by means of balancing and integrating various life dimensions. Health care professionals are leaders who play an important role in creating an environment that contributes to wellness. Their leadership is, therefore, viewed as a wellness strategy. Leadership has been identified as an essential role of health care professionals with a responsibility to attend to the needs of their clients, such as youth victims of violence, with the aim of leading them towards wellness. The Provincial Nursing Strategy of the Western Cape in South Africa emphasises the need for health care professionals to demonstrate their leadership capacity in practice. In the communities of the Western Cape Province of South Africa, many youth victims of violence report for treatment at the health care facilities; it places a high burden on the health care system. Even though health care professionals provide treatment to this group of youth, it is not clear how health care professionals lead them towards wellness after an incidence of violence. The purpose of this study was to develop a conceptual framework that can be implemented by health care professionals to gain a better understanding about the important role they play in leading youth victims of violence towards wellness in a rural community in the Western Cape Province of South Africa. This research study applied a qualitative, exploratory, descriptive and contextual design. The study population who were selected by means of a purposive sampling technique consisted of youth attending a high school and who had been victims of violence and of health care professionals (professional nurses, medical doctors and social workers) working at the health care facilities in the community where the study was conducted. The study was conducted in four phases. Phase 1 of the study focused on the exploration and description of the expectations of the youth victims of violence about how health care professionals should lead them towards wellness. Focus group discussions (FGDs) were conducted at a high school at the study site. Phase 2 explored and described the experiences of health care professionals who were supporting youth victims of violence at the health care facilities in the community of study. The execution of this phase comprised of unstructured individual interviews. The total number of the FGDs and unstructured individual interviews conducted in this study was determined by data saturation. Data analysis of the data collected involved transcription of the voice recordings of the all the interviews and writing up of field notes. The steps of Tesch’s coding technique were used at the end of Phases 1 and 2. To ensure trustworthiness of the collected data, Guba and Lincoln’s strategies of credibility, transferability, dependability, confirmability and authenticity were applied. Phase 3 of this study entailed the development of a conceptual framework for health care professionals to lead youth victims of violence towards wellness. It was based on the findings from Phases 1 and 2 of the study; Phase 4 of the study involved peer debriefing and validation of the developed conceptual framework. In Phase 1 of the study, a total of nine (n = 9) FGDs were conducted among fifty eight (n = 58) youth participants between the ages of 15 and 19 years. Each group consisted of 6 to 8 participants and the interviews did not last more than an hour per session. The data analysis in this phase showed that the youth victims of violence did have expectations from the health care professionals in guiding them towards wellness. They shared their interpretation of the term wellness and were also quite aware of the challenges in their community. Four categories emerged from the data in Phase 1: Category 1 - Dimensions of wellness as it related to healthy body, mind, spirit and positive interactions: The findings of this category revealed that youth participants described wellness as a holistic concept that comprised healthy living, self-care and a healthy personality and mind (emotional, psychological) as well as spiritual well-being. They did not necessarily consider wellness as the absence of sickness or illness, Category 2 - Common problems among youth in the context of the community: They articulated that drug abuse, teenage pregnancy and violent behaviour were important issues of concern to them in their community. Category 3 – Building a sound and trusting relationship: They expressed their need for health care professionals to have a positive attitude towards them, to be respectful and to provide them with accurate information, as well as confidential and supportive services. Category 4 - Guidance of youth to wellness: The youth also proposed strategies that they believe could be used by the health care professionals while guiding them towards wellness. These strategies were: Provision of information / health education, school and community outreach programmes, provision of counselling services and role modelling. For the second phase, seven (n = 7) health care professionals were interviewed. Two (n = 2) were professional nurses, three (n = 3) medical doctors and two (n = 2) social workers. The findings of the individual interviews indicated that the health care professionals recognised the fact that wellness is very important. However, they felt that guiding youth victims of violence toward wellness was a challenging process. Three categories emerged from the data in Phase 2: Category 1 - Different points of view about the concept of wellness: The health care professionals described wellness as the holistic wellbeing of a person, an absence of illness or disease and living a healthy lifestyle. Category 2 - Barriers to leading youth victims of violence towards wellness: The health care professionals reported challenges while attempting to lead youth victims of violence towards wellness which included low socioeconomic status of families, unsupervised youth, violent behaviour, drug and substance abuse, a lack of resources in the community, negative staff attitudes, inadequate physical infrastructure and human resources as well as the absence of a process of guiding youth victims to wellness. Category 3 - Guidance to leading youth victims to wellness: The health care workers proposed strategies for guiding youth victims towards wellness. Those strategies included the provision of support in the form of counselling services, use of support groups, family and community support; recreational activities, dedicated staff to work with youth victims of violence and a multidisciplinary team approach. The findings from the first two phases were triangulated during the third phase of this study with the purpose of developing a conceptual framework. The survey list of Dickoff, James and Wiedenbach formed the foundation of the reasoning map for the development of the framework. The unique contribution of this study is the development of an original, participative leadership framework that provides health care professionals with information for leading youth victims of violence towards wellness in a rural community in the Western Cape. This study was conducted in a single rural community of the Western Cape Province of South Africa. Despite this limitation, the framework could be evaluated for use in similar settings. Finally, guidelines to implement the framework and recommendations for improving community health care practice, nursing education and nursing research were suggested based on the findings from the study.

MCur / Department of Advanced Nursing Science / Professional nurses have the responsibility of supervising the care that is rendered, the nursing personnel and patients throughout 24 hours of the day, for the purpose of ensuring quality patient care and patient safety. However, it seems that this is not happening as expected because there are continuous complaints from the patients about the poor quality of care. This study was aimed at exploring the challenges that are encountered by professional nurses during supervision of care in the district hospitals of Vhembe. A qualitative study was conducted which was explorative, descriptive, contextual and guided by an Appreciative inquiry approach. A purposive sample was used where thirty-six (36) participants were recruited and consent was obtained. Individual semi structured interviews were conducted. Data was analysed according to Tesch‟s eight steps. Trustworthiness was ensured through following the principles which are credibility, dependability, confirmability, transferability and authenticity. The findings revealed multiple challenges that professional nurses encountered during supervision of care. The main themes found were lack of resources, challenges related to the supervisees, cultural changes in nursing affecting supervision, and challenges related to education and training. Apart from challenges, there were positive aspects verbalised that enhance supervision The researcher recommended that nursing practice through the Department of Health should address issues such as shortage of staff, shortage of equipment and inadequate and/or poor infrastructure. Professional nurses should be trained on diversity management and emotional intelligence in order address the ever changing culture in nursing. Students‟ accompaniment and clinical exposure should be addressed. Future research should be conducted to outline what causes these challenges in supervision in other districts so that the findings could be representable. / NRF

Philosophiae Doctor - PhD / Postpartum family planning (PPFP) is the initiation of family planning methods among postpartum women, within 12 months after delivery. During this period, the women are a vulnerable group of people with high unmet need for family planning. They are exposed to the risks of unwanted pregnancy, which potentially, could increase maternal mortality, due to the consequences of too frequent pregnancies. Studies have revealed a consistent low use of family planning during the postpartum period. Additionally, it has been documented that the low use of postpartum family planning, most likely, was attributed to inadequate services that had been rendered at healthcare centres, as well as poor motivation by those providing family planning services.

Background: Research is essential for the development of a unique body of knowledge, a hall mark of any profession. It should be utilised to provide the basis for professional theory and practice. Aim: The purpose of the study was to develop guidelines that will assist professional nurses in the utilisation of research findings. Design and setting: Quantitative, descriptive research was used to determine professional nurses’ (N=284) perception of utilization of research findings in practice. The structured questionnaire was used to collect data. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23 since this is a quantitative study. The study focused on professional nurses at the two selected hospitals that were providing the comprehensive programme in the uMgungundlovu district. Results: 284 respondents answered the questionnaire. Of the respondents, 73.3% agreed that they lacked knowledge of research. The frequency of respondents that lacked research knowledge was 208. Of the respondents, 211 (74.3%) recommended use of research findings in practice versus 24 (8.5%) who were unsure and 9 (3%) respectively who did not know whether research should be used or not. Conclusions: The findings revealed that there is a need for changes to be made in the nursing education system to try and improve research utilisation by professional nurses in practice since the professional nurses working in the clinical area are produced by nursing education institutions / Health Studies / M.A. (Health Studies)