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 purpose of this quantitative, descriptive study was to identify shortcomings in the implementation of the Batho Pele Principles in a public hospital. Findings were obtained from a range of patients who had been admitted to specific units for three or more days, and more evidence was gathered from articles in mass media. Data was collected through a structured questionnaire from one hundred respondents (n=100) and analysed by means of descriptive statistics. The research findings revealed that none of the Batho Pele Principles were implemented effectively and that patients in general were not satisfied with treatment in public hospitals. Shortcomings are attributed to insufficient management skills and knowledge on different levels of the health care system, as well as a lack of awareness among patients of their rights and responsibilities in health care. / Health Studies / M.A. (Public Health)

The National Health Act aims to protect the health care users and workers by ensuring that their work environments are protected against injuries. Practice environment is described as a physical, social and psychological characteristic of a work setting in which policies, procedures and systems are designed so that employees can meet the organisational objectives and achieve personal satisfaction in their work environment. The aim of the study was to describe and analyze characteristics of the practice environment of nurses. A quantitative descriptive study was conducted in a public hospital in Gauteng Province. Practice Environment Scale-Nursing Working Index (PES-NWI) questionnaires were distributed to 207 nurses who were proportionately stratified. Data was analysed using the SPSS version 25. Findings identified gaps of the current characteristics of the practice environment and developed strategies that will assist managers to enhance practice environment. There was alignment and correlation between the means, standard deviation and the frequencies which were drawn from the findings. The overall Cronbach’s alpha was 89% which confirmed the internal consistency of the instrument. The majority of the variables demonstrated statistical significance which had a p value of 0.001. In conclusion, practice environment affects all health care professionals although the study only analyzed the practice environment of nurses. / Health Studies / M. P. H.

Text in English / In South Africa, retention of newly qualified professional nurses in public health institutions upon completion of their year of compulsory remunerated community service remains a challenge that exacerbates the shortage of professional nurses in these institutions. The literature indicates that many newly qualified professional nurses leave the public health institutions due to lack of professional development support and heavy workloads while they are still finding their feet. A mixed-methods design of concurrent triangulation approach was used to answer the question: How are the newly qualified professional nurses supported in terms of induction and professional development during community service in South Africa? Triangulation was achieved by using both quantitative and qualitative methods. Induction/orientation documents from public health institutions were analysed using a checklist. A survey questionnaire with mixed quantitative closed items (1–43) and qualitative open-ended questions (43–46) was sent to newly qualified professional nurses who had recently completed community service. Focus groups held with operational nurse managers and individual interviews with coordinators of community service for nurses yielded rich qualitative data. Descriptive and inferential statistics were used to describe and synthesise data. The qualitative findings confirmed the quantitative findings. Findings were lack of professional development support in some public health institutions, informal, non-comprehensive support where given, shortage of experienced professional nurses, reluctance by some professional nurses and operational nurse managers to supervise newly qualified nurses, and increased workload due to the shortage of experienced professional nurses in the public health institutions. Inadequate clinical skills, poor discipline and lack of professionalism in the newly qualified professional nurses also played a part. Respondents suggested constructive recommendations for the induction and professional development support of the newly qualified professional nurses, and these were incorporated in the recommended guidelines for the induction and professional development support of newly qualified professional nurses during community service. / Health Studies / D. Litt. et Phil. (Health Studies)

This study was designed to evaluate the quality of informed consent practiced by healthcare professionals in South Africa using an empirical quantitative methodology combined with medicolegal analysis to produce an interdisciplinary thesis on bioethics and medical law. Informed consent is an ethical and legal doctrine derived from the principle of respect for autonomy, whereas the rights to bodily integrity, privacy and human dignity are constitutionally protected in South Africa. The National Health Act 61 of 2003 codified requirements for informed consent by stipulating that healthcare providers must inform healthcare users about diagnosis, risks, benefits, treatment options, and the right of refusal, while taking into consideration users language and literacy levels. However, African communities are inherently challenged by problems of poverty, poor education, power asymmetry, and unfamiliarity with libertarian rights-based autonomy, which could affect informed consent practice. An empirical study was conducted at randomly selected public hospitals in EThekwini metropolitan municipality involving 927 participants; comprising 168 medical doctors, 355 professional nurses, and 404 patients. The study showed that healthcare professionals had limited knowledge regarding ethical and legal requirements for informed consent, and were partially compliant with current informed consent regulations. Barriers to informed consent identified were language, poor education, workload, and lack of interpreters. Most patients attending public hospitals were indigent, but preferred full information disclosure, and a shift from informed to shared-healthcare decision-making. The study recommends that a corps of trained interpreters should be introduced at public hospitals. This will improve providerpatient communications and minimize workloads, increase job satisfaction, and the overall quality of healthcare service delivery. Analysis of recent South African case law on informed consent revealed vacillations between the “reasonable doctor” and “prudent patient” standards of information disclosure which are inconsistent with the jurisprudence from comparative foreign common law jurisdictions. Therefore, South African court judgments on informed consent ought to be re-evaluated to establish a uniform standard of information disclosure consistent with international jurisprudence, current legislation, and constitutional protections relating to human dignity and security of the person. / Jurisprudence / LL. D.

The purpose of this quantitative, descriptive study was to identify shortcomings in the implementation of the Batho Pele Principles in a public hospital. Findings were obtained from a range of patients who had been admitted to specific units for three or more days, and more evidence was gathered from articles in mass media. Data was collected through a structured questionnaire from one hundred respondents (n=100) and analysed by means of descriptive statistics. The research findings revealed that none of the Batho Pele Principles were implemented effectively and that patients in general were not satisfied with treatment in public hospitals. Shortcomings are attributed to insufficient management skills and knowledge on different levels of the health care system, as well as a lack of awareness among patients of their rights and responsibilities in health care. / Health Studies / M.A. (Public Health)

Abstracts in English, Southern Sotho and Xhosa / Previous studies evidenced the association between work ethics climate, retention factors and organisational commitment separately. However, research combining all these variables have not yet been done. The purpose of the study was to investigate the relationship between work ethics climate, retention factors and organisational commitment of nurses in a South African public hospital. A quantitative research design was followed and a probability stratified sample (N=208) of nurses participated in the study. The results indicate significant relationships between work ethics climate and retention factors. Furthermore, the results indicate significant relationships between work ethics climate and organisational commitment. Moreover, the results indicate that work ethics climate moderates the relationship between training and development components of retention factors and organisational commitment. These findings provide new knowledge for the design of retention strategies, which adds value to the body of knowledge in relation to work ethics climate. Recommendations for further research and for the implementation of the results of the study by human resource professionals were made in terms of improving the ethical climate, the retention factors and organisational commitment of their employees. / Dinyakišišo tše di fetilego di file bohlatse bja kamano magareng ga seemo sa maitshwaro ka mošomong, mabaka a go tšwela pele le boikgafo ka fao go aroganego. Le ge go le bjale, dinyakišišo tšeo di kopanyago mehuta ye ka moka ga se tša hlwa di dirwa. Maikemišetšo a dinyakišišo tše e bile go nyakišiša kamano magareng ga seemo sa maitshwaro ka mošomong, mabaka a go tšwela pele le boikgafo bja bja baoki ka sepetleleng sa setšhaba sa Afrika Borwa. Tlhamo ya dinyakišišo tša boleng e dirišitšwe gomme sampole ya baoki ye e arogantšwego (N=208) ba kgathile tema ka dinyakišišong. Dipoelo di laetša kamano ye kgolo magareng ga seemo sa maitshwaro ka mošomong le mabaka a go tšwela pele. Godimo ga fao, dipoelo di laetša dikamano tše kgolo magareng ga seemo sa maitshwaro ka mošomong le boikgafo bja ka mokgatlong. Godimo ga fao, dipoelo di aletša gore seemo sa maitshwaro se lekanyetša kamano magareng ga dikarolo tša tlhahlo le tša tlhabollo tša mabaka a go tšwela pele le boikgafo bja ka mokgatlong. Dikutollo tše di fana ka tsebo ye mpsha ya tlhamo ya mekgwa ya go tšwela pele, yeo e tlišago boleng go tsebo mabapi le seemo sa maitshwaro a ka mošomong. Ditšhišinyo tša dinyakišišo go tšwela pele le tša go phethagatša dipoelo tša dinyakišišo ka bašomi ba sephrofešenale ba merero ya bašomi di dirilwe mabapi le go kaonafatša seemo sa maitshwaro, mabaka a go tšwela pele le boikgafo bja ka mokgatlong bja bašomi ba yona. / Amarhubhululo zesikhathi esidlulileko zifakazele itjhebiswano eliphakathi kobujamo bemigomo yokusebenza, imithelela yokubamba abasebenzi bangakhambi kanye nokuzibophelela kwihlangano ngendlela ehlukanisiweko. Nanyana kunjalo, ngokwerhubhululo ukuhlanganiswa kwazo zoke lezi zinto akhange kweziwe. Ihloso yaleli rhubhululo bekukuphenya itjhebiswano eliphakathi kobujamo bemigomo yokuziphatha emsebenzini, ukubamba abasebenzi bangakhambi kanye nokuzibophelela kuhlangano kwabahlengikazi esibhedlela sombuso eSewula Afrika. Ihlelo lerhubhululo elidzimelele kuzinga lekulumo lilandelwe kanti nesampula yabahlengikazi I (N=208) labadlale indima kurhubhululo lisetjenzisiwe.Imiphumela iveza itjhebiswano eliqakathekileko phakathi kobujamo bemigomo yokusebenza kanye nemithelela yokubanjwa kwabasebenzi bangakhambi. Ukuragela phambili, imiphumela iveza itjhebiswano eliqakathekileko phakathi kobujamo bemigomo yokusebenza kanye nokuzibophelela kwehlangano. Ngaphezu kwalokho, lemiphumela iveza ukobana ubujamo bemigomo yokuziphatha ilinganisa itjhebiswano phakathi kweengaba ezibandulako nezithuthukisako, iingaba ezimalungana nemithelela yokubamba abasebenzi bangakhambi kanye nokuzibophelela kwehlangano. Leli lwazi elitholakeleko linikela ilwazi elitjha malungana nokudizayinwa kwamasu wokubamba abasebenzi bangakhambi, okuyinto engezelela ivelu kumthombo welwazi malungana nobujamo bemigomo yokuziphatha emsebenzini. Iincomo ezinye ezimalungana nokuragela phambili nerhubhululo kanye nokusetjenziswa kwemiphumela yerhubhululo elimalungana nabasebenzi bomnyango wezokuqatjhwa kwabasebenzi zenziwe ngokuthi kuthuthukiswe ubujamo bemigomo yokuziphatha, imithelela yokubamba abasebenzi bangakhambi kanye nokuzibophelela kwabasebenzi kuhlangano. / Human Resource Management / M. Com. (Business Management)

Department of Advanced Nursing Science / MCur