The aim of the study was to explore the perceptions of nurses regarding communication with nurse managers in the workplace. The design of the study was a generic qualitative. The methodology of choice was qualitative, explorative method. The sample was non-probability and the approach or technique used was purposive sampling method. It comprised of thirty nurses, ten of each category. The category was a component of professional nurses, enrolled nurses and enrolled nursing auxiliary nurses. The data collection method used in the study was in-depth interviews using a self-designed interview guide. Face to face interviews was conducted in a quiet room within the hospital ward as a natural setting. Data was collected using a voice recorder for the sake of protecting the missing of information which may be important. The data analysis was with the help of employing transcribing and coding of voice recorded data and observation noted during the collection of data. The data collection method used in the study was in-depth interviews using a self-designed interview guide. Face to face interviews was conducted in a quiet room within the hospital ward as a natural setting. Data was collected using a voice recorder for the sake of protecting the missing of information which may be important. The data analysis was with the help of employing transcribing and coding of voice recorded data and observation noted during the collection of data. The findings showed that there were dynamics in communication from all nurse categories and that also indicated that there was a need to conduct a research so that the root cause may be identified and suggestions to be put in place to curb the challenges. In conclusion it showed that communication is the key problem of all and it is a worldwide problem. / Health Studies / M.A. (Health Studies)

A influência das características laborais sobre a saúde mental dos trabalhadores pode decorrer de inúmeros fatores ou formas de organização do trabalho. Na atualidade, verifica-se os crescentes índices de sintomas psíquicos entre determinadas categorias profissionais, com destaque para os trabalhadores de saúde atuantes em ambiente hospitalar Objetivo: Este estudo objetivou identificar a ocorrência de Transtornos Mentais Comuns (TMC), a ocorrência da síndrome de Burnout, e a associação de ambos os transtornos nos trabalhadores de enfermagem, bem como elaborar propostas de intervenção para redução do desgaste psíquico. Metodologia: Trata-se de um estudo exploratório, transversal com abordagem quanti-qualitativa. A pesquisa foi realizada em Hospital Público Universitário especializado em cardiologia, pneumologia e cirurgias cardíacas e torácicas. A amostra foi composta por trabalhadores de enfermagem que atuam em unidades de terapia semi-intensiva e intensiva pediátrica e neonatal, perfazendo um total de 92 participantes. Para a coleta de dados quantitativos foram utilizados: instrumento de caracterização sócio demográfica, Self-Reporting Questionnaire (SRQ-20), e o Maslach Burnout Inventory (MIB). Para os dados qualitativos, optou-se pela técnica de grupo focal, conduzido por questões norteadoras, com uma amostra de 17 trabalhadores de enfermagem. O período de coleta foi nos meses de junho e julho de 2012. Resultados: A análise dos resultados evidenciou a ocorrência de TMC em 44,60%(41) dos trabalhadores e a ocorrência de Burnout em 8,7%(8) trabalhadores. Houve associação estatística entre os TMC e o Burnout p=0,003, considerando nível de significância de 5%. Em relação aos TMC, as respostas dos trabalhadores foram distribuídas de acordo com os quatro grupos de sintomas avaliados pelo SRQ-20: Grupo somático, Decréscimo de energia vital, Humor depressivo-ansioso e Pensamentos depressivos. Em relação à sindrome de Burnout, os trabalhadores foram avaliados considerando-se a ocorrência de escores alto nas três dimensões (Desgaste Emocional, Despersonalização e Reduzida Realização Profissional) ou em uma delas apenas. Não foi constatada associação entre os transtornos e as variáveis sócio-demográficas. Houve associação entre ambos os transtornos. As sessões de grupo focal evidenciaram propostas de intervenção mediante três temas que emergiram das discussões: Aprender a lidar com a criança cardiopata grave, Receber o reconhecimento profissional e Repensar a gestão de pessoas. Conclusão: Os achados, em conjunto, evidenciam necessidade de medidas protetoras à saúde mental do trabalhador que assiste crianças cardiopatas graves. Palavras-chave: Estresse psicológico, Esgotamento profissional, Equipe de enfermagem, Hospitais públicos, Unidades de terapia intensiva pediátrica, Unidade de terapia intensiva neonatal, Saúde do trabalhador. / The influence of work characteristics on mental health workers may be due to numerous factors or forms of work organization. At present, there is the growing rates of psychiatric symptoms among certain professions, especially health workers working in hospitals Objective: This study aimed to identify the occurrence of Common Mental Disorders (CMD), the occurrence of Burnout, and the association of both disorders among nursing staff, as well as elaborate proposals for intervention to reduce wear psychic. Methodology This is an exploratory study, cross-sectional with quantitative and qualitative approach. The research was conducted in a public University Hospital specialized in cardiology, pulmonology, thoracic and cardiac surgery. The sample consisted of nursing workers of care units, semi-intensive and intensive, pediatric and neonatal, making a total of 92 participants. For quantitative data collection was used: instrument of socio demographic, Self-Reporting Questionnaire (SRQ-20), and the Maslach Burnout Inventory (MIB). For qualitative data, we chose the technique of focal group, conducted by leading questions, with a sample of 17 nurse workers. The collection period was between June and July, 2012. Results The result of the analysis revealed the occurrence of CMD in 44.60% (41) of the workers and the occurrence of Burnout in 8.7% (8) of the workers. There was a statistical association between CMD and Burnout p = 0.003, considering level of significance 5%. Regarding CMD, the answer of the workers was distributed according to the four groups of prognostic evaluated by the SRQ-20: Somatic Group, Decrease of vital energy, Anxious-depressive humor and Depressive thoughts. Regarding Burnout syndrome, workers were evaluated considering the occurrence of high scores in all three dimensions (Emotional Exhaustion, Depersonalization, and Reduced Professional Accomplishment) or only in one of them. There was no association between the disorders and sociodemographic variables. There was an association between both disorders. The focal group sessions revealed proposals for intervention through three issues that emerged from the discussions: Learn to deal with severe heart disease children, professional acknowledgment and rethink people management. Conclusion: Findings, during the sessions, highlight the need for protective measures of mental health for workers who assist children with heart disease

Submitted in fulfillment of the requirements for the degree of Master of Health Sciences (Nursing), Durban University of Technology, Durban, South Africa, 2017. / BACKGROUND: Quiet often when students return from clinical placement, complain of being abused by patients and their relatives. Student nurses view clinical placement as an anxiety producing part of the nursing programme (Magnavita and Heponiemi 2011: 208). As a result, some resign and leave nursing fearing for their lives. AIM OF THE STUDY: To determine the extent and types of violence experienced by student nurses from patients and their relatives or friends in public hospitals in KwaZulu-Natal, and whether this leads to intentions to leave the nursing profession. METHODOLOGY: A quantitative, descriptive cross sectional survey approach conducted amongst student nurses (n=421) at KwaZulu-Natal College Nursing R425 Program starting from their first year of training up to the midwifery module. Self-Administered Questionnaires (SAQ) were used to collect data and data analysed using SPSS version 23. RESULTS: All respondents (n=421) completed the SAQ (annexure B). Many student nurses, especially female students, are victims of intimidation, bullying and verbal abuse as opposed to physical and sexual abuse by patients’ relatives and patients. The workplace violence against student nurses resulted in anger and absenteeism. The majority have not reported any abuse and they were not even aware of any policy that exists in their institutions against any form of violence. DISCUSSION: Findings in this study revealed that student nurses, like all other nurses, were also at a high risk of workplace violence. This may be because nurses have the closest contact with patients and their relatives; hence they are at high risk of exposure to violence. Since all settings are potentially high risk for violence, it is therefore necessary for the management to improve security in all high-risk areas for the student nurses to be safe. RECOMMENDATIONS: Public hospitals and the Department of Health (DOH) needs to formulate clear policies regarding violence against student nurses, and information on how to report the occurrence. There is a need for development or improvement of policies, procedures and intervention strategies. The DOH needs to address the issues of violence by implementing strategies to create a supportive environment that facilitates empowerment for the positive emotional wellbeing of student nurses. Managers have the responsibility to create and maintain zero tolerance regarding workplace violence. Public hospitals need to employ Managers with required skills and higher education to deal with workplace violence. There is a need for further research and more details on workplace violence and its cause. / M

In South Africa, the quality of health care is directly related to the concept of patient-centred care and the enactment of the Batho Pele Principles and the Patients’ Rights Charter. The quality of health care delivery has dropped drastically, and reports in the media indicate that public hospitals in the Eastern Cape Province are on the brink of collapse, with thousands of patients being treated in condemned hospitals. Receiving and rendering health care in the face of such challenges, the question arose: “Are patients receiving patient-centred care in public hospitals?” The answer to this rhetorical inquiry appeared to be obvious, but this research study explored and described professional nurses’ perceptions of patient-centred care in public hospitals and their understanding of evidence-based practice and best practice guidelines. The proposed study followed a qualitative, exploratory, descriptive and contextual design. The research population included professional nurses who are employed in public hospitals in Nelson Mandela Bay, and consisted of nurse managers and nurses who work in the wards. The research study consisted of three phases. In Phase 1, semi-structured interviews and focus groups were conducted with nurse managers and professional nurses working in the wards in order to collect data about their perceptions of patient-centred care and their understanding of evidence-based practice and best practice guidelines. The interviews were transcribed and Tesch’s eight steps of data analysis were followed to create meaning from the data collected. Themes were identified and grouped together to form new categories. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness, which consists of the following four constructs: credibility, transferability, dependability and confirmability. An independent coder assisted with the coding process. In Phase 2, an integrative literature review was conducted in order to identify previous guidelines regarding best practice for patient-centred care. Relevant guidelines were selected, critically appraised, data was extracted and synthesised for the development of a best practice guideline for patient-centred care. An independent appraiser critically appraised the guidelines, thereby ensuring trustworthiness. In Phase 3, the data in Phase 1 and Phase 2 were integrated to formulate a draft best practice guideline for patient-centred care. The guideline was submitted to an expert panel for review and was modified according to the recommendations of the panel, whereby the best practice guideline for patient-centred care in public hospitals in Nelson Mandela Bay was finalized.

PhD (Health Sciences) / Department of Advanced Nursing Science

MCur / Department of Advanced Nursing Science / Background: The heavy workload of hospital nurses is a major problem globally. Nurses are experiencing higher workloads than ever before due to four main reasons, increased demand for nurses, inadequate appointment of new nurses, reduced staffing and increased overtime and reduction in patient length of stay. It is necessary for South Africa to find ways to reduce nursing workload and improve patient safety particularly in rural areas, to understand these effects of nursing workload on patient safety, the study was conducted with professional nurses from selected hospitals in Vhembe district, Limpopo Province. Purpose: The purpose of this study was to determine and to assess the effects of nurses‘ workloads on patient safety in the selected public hospitals, Vhembe District, Limpopo Province, South Africa. Methodology: Quantitative, exploratory descriptive design was adopted. Self-administered questionnaires were used for data collection from the sampled hospitals in Vhembe district. Hospitals were sampled based on the statistics of admitted patients in medical and surgical wards. Target population were professional nurses with at least two years working in the sampled wards. Ethical considerations were maintained. Results: There are several important consequences of high nursing workload. Findings show that a heavy nursing workload adversely affects patient safety. The study also shows that majority 80 (79.0%) of the respondents were overloaded by nursing responsibilities and this negatively affects nursing job satisfaction. As many as 55 (54.4%) indicated that such v workload contributes to high turnover and the nursing shortage. In addition to the higher patient acuity, work system factors and expectations also contribute to the nurses‘ workload: nurses are expected to perform non-professional tasks such as delivering and retrieving food trays; housekeeping duties; transporting patients; and ordering, coordinating, or performing ancillary services Conclusion: Nursing workload is affected by staffing levels and the patients‘ conditions, but also by the design of the nurses‘ work system. The study showed that a work situation above the assumed optimal level increases the risk for adverse events and patient mortality. However, the resources for nursing staff are limited in all public hospitals where the study focused. Professional nurses, therefore, must use available resources in the most optimal way. The study also recommended that there should be a creation of the nursing posts and the filling of all vacant positions in South Africa. Continuity of in-service training to empower professional nurses on patient safety was emphasised. / NRF

The contribution of Emergency Obstetric Care (EmOC) in reducing maternal mortality in Ethiopia is very minimal as evidenced by poor provision and low utilization of EmOC. Client centred EmOC provision improves the provision and utilization of EmOC; leading to the treatment of the majority of obstetric complications which are the main causes of maternal mortality. This study describes clients’ views and perspectives concerning the quality of EmOC provision in Ethiopian public health facilities. An explorative and descriptive phenomenological qualitative study design was used in the study in order to explore and describe the lived experiences of clients with EmOC services. Key informant interviews with women who had direct obstetric complications and received EmOC at three public health facilities in Addis Ababa generated rich data on their lived experiences. Content analysis was used to analyze the data as it complies with the phenomenological data analysis and Atlas ti version 6.2 qualitative data analysis software was employed. The findings revealed that quality EmOC is a welcoming, life-saving timely care given in a clean environment with humility, respect, equal treatment and encouragement. It is care that is safe for the client, technically sound, responsive and meets clients’ needs and expectations. Accessibility of life saving care at all time and collaborative and coordinated care created good experiences for the clients. The causes of clients’ disappointment with the provision of EmOC were higher expectations from female providers, underestimation by providers, non responsive providers, and ethical misconduct by providers such as mocking, insulting, yelling, advantage taking providers, undelivered promises by providers, expectation with place of delivery, expectation with newborn care and a limited number of health workers attending delivery. Discrimination, high cost of care and asking client to buy drugs and supplies and referrals from centres, are some of the barriers on r the use of EmOC at public health facilities. The provision of EmOC is constrained by overloaded staffs, shortage of space to accommodate clients and inadequate number of beds. In conclusion, clients have expectations and experiences of provision of EmOC that influence their future decision to seek care. Finally, a client centred guideline for the provision of client centred EmOC provision was developed. / Health Studies / D. Litt. et Phil. (Health Studies)

Health Management Information System (HMIS) in developing countries lags seriously behind as compared to the developed countries; and the existing HMIS in many countries is insufficient to support health management functions. The purpose of this study was to describe the implementation of Anti-retroviral Therapy (ART) pharmacy management information system in public health facilities. Quantitative, descriptive research was conducted at 38 public health facilities. The participants of the study were Pharmacists and Druggists those are working at ART Pharmacy. Data collection was done by using structure questionnaire. 76 respondents were recruited to participate in the study. The participants ages ranged from 26-50 years and all had more than 2 years’ work experience. The study indicated that even if there is a system at most health facilities their utilization of information technology (IT) for pharmacy practice were not appreciated. The findings indicated that the need for creating awareness among professionals in giving more skill oriented and also a formal in-service information technology related trainings for the professionals. To achieve better utilization of information technology at health care delivery system particularly pharmacy practice, government and stakeholder should consider capacity building activities through proper training and it should also viewed as a long term socio-cultural and technical development process. / Health Studies / M.A. (Public Health with specialization in Medical Informatics)

Text in English / The purpose of this research was to investigate occupational health and safety challenges and their impact on health care workers (HCWs) in selected public hospitals from the Gauteng Province, South Africa. Method: A quantitative descriptive cross-sectional survey was conducted among HCWs in the study sites. A two-staged sampling that include purposive sampling of study sites and census sampling of 2000 HCWs was used. Self-administered questionnaires were used to obtain data from HCWs. In addition, two different checklists were used to conduct retrospective records reviews to assess occupational health and safety (OHS) policy compliance and occupational injuries and diseases occurrence. The SAS Release 9.3 was used to analyse data. The Fischer Exact test and Chi-square were also used to determine the association of variables and P-value was set at <0.05 to indicate significant association. Results: A total of eight public hospitals and 926 (46.3%) HCWs who were all females nurses participated in this survey. Major occupational health hazards reported by the participants include: needle-stick injuries 275 (54.67%), slips trips and falls 67 (13.32%) and splashes 57 (11.33%). The analysis of open-ended responses indicated increased workloads, long hours of work and shift work as the most reported psychosocial hazards among HCWs. The reviewed records indicated that back injuries 22 (4.37%), tuberculosis (TB) 17 (3.38%) and asthmatic reactions 8 (1.59%) were the commonly reported occupational injuries and diseases among the HCWs. The records review also revealed a lack in the conducting of adequate medical surveillance among participants. The results showed poor compliance with the OHS policy and a negative impact of biological and psychosocial hazards on the HCWs. Conclusion: There was a high risk of exposures to biological hazards whilst providing care to patients, thus warranting the implementation of robust preventive measures. As a result, the guidelines were developed to promote the health and safety of HCWs with a view to promoting policy compliance and preventing the occurrence of occupational injuries and diseases as well as their impact among HCWs. / Health Studies / D.Litt et Phil. (Health Studies)

The purpose of this study was to develop and test a measuring instrument based on the Gibb’s Defensive Communication Climate Paradigm (1961) to assess the communication climate focus of professional nurses in selected public hospitals in the Gauteng province. This focus involves the communication behaviour orientation of the professional nurses and their perceptions of the communication behaviour orientation of their operational managers. The Gibb’s model comprises six bipolar conceptual continuums, namely Evaluation-Description, Control-Problem orientation, Strategy-Spontaneity, Neutrality-Empathy, Superiority-Equality and Certainty-Provisionalism Continuums. The study consisted of a non-experimental design, including a developmental phase and a testing phase. During the developmental phase the researcher developed a measuring instrument (a Semantic Differential Scale questionnaire); used a simple, random sample method to pre-test the instrument; analysed the data by applying Cronbach’s Alpha reliability analysis and refined the instrument. Further refinement of this new instrument by future researchers is recommended. During the testing phase the researcher also used a simple, random sample, consisting of professional nurses (N = 270) from three selected public hospitals in Gauteng; tested the items against the biographical data and the three research questions and analysed the obtained data by utilising both descriptive and inferential statistics. A Delphi panel of experts were involved in both phases of the study. The results of the study indicated that although the respondents had a predominantly supportive communication behaviour orientation, they were more focused on the communication behaviour of their operational managers than on their own. Furthermore, the results indicated no significant differences in the influencing factors: age, tenure (periods in hospital), gender, language and institution (public hospital), in terms of the six conceptual continuums. Significant differences were found only in the factor: unit/ward, indicating that the supportiveness of the communication behaviour of professional nurses could be dependent on their specific work environment. Guidelines aimed at the development of a supportive climate were drawn up for the National Department of Health, Gauteng Department of Health, public hospitals, operational managers and professional nurses. It is recommended that implementation of the newly developed guidelines be pivotal for public hospitals, to refocus their communication climates towards supportive communication. / Health Studies / D. Litt. et Phil. (Health Studies)