Thesis (Mcur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: A literature study showed that the topics of medication safety and medication error prevention have been studied in depth. Findings from the literature revealed that medication errors are reported to be common in neonatal and paediatric ICUs, that more than half of these errors are preventable and that risk reduction measures protect patients against untoward outcomes or adverse events (Clifton-Koeppel, 2008:72). If and when there is a failure in the process of safe medication administration, it results in a medication error, which is defined as a breach of one or more of the five rights of medication administration (Institute for Safe Medication Practices Alert, 2007:1). Medication administration, which is predominantly a nursing task, is of high risk and high volume in the intensive care unit (ICU). The accuracy of intravenous medication administration is critical for a neonatal and paediatric ICU patient since it can potentially heighten the patient’s vulnerability if further harm is caused. In view of the complexity of medication administration for neonatal and paediatric ICU patients, researchers confirm the diverse role of the registered nurse in safe medication administration practices. The purpose of the study was to describe the perceptions of registered nurses (RNs) regarding the factors that influence IV medication safety practice in the neonatal intensive care unit (NICU); paediatric intensive care unit (PICU); and paediatric cardiac intensive care unit (CSICU) in Saudi Arabia. The study objectives were set to describe the actual factors that have an influence on IV medication safety practices of RNs working in these ICUs; to determine the knowledge of registered nurses in the selected ICUs with regard to safe intravenous medication administration practices and to describe nursing medication administration strategies that are focused on medication error prevention. A quantitative research approach was selected for this study which had a descriptive, survey design. An 85% non-probability purposive sampling method was used to draw a sample (n=103) of the target population of NICU-, PICU- and CSICU-registered nurses (N=121) who were responsible for administering intravenous medication at King Faisal Specialist Hospital and Research Centre in Jeddah (KFSHRC-J). A self-administered questionnaire with closed-ended Likert and open-ended question was designed to describe the objectives under study. A pilot study was conducted to pre-test the questionnaire. A quantitative method was used to analyse the study data. MS Excel was used to capture the quantitative data after which it was analysed using descriptive statistics by means of STATISTICA 9 software. The open–ended questions (indicating “other” and Question 70) were also interpreted quantitatively after exploring the main aspects in the responses. The main findings were that multiple perceived factors influence the intravenous medication safety practices of RN’s working with neonatal and paediatric ICU patients in a particular Saudi Arabian tertiary hospital. It was found that these nurses’ had knowledge regarding safe medication administration practice that constitutes that all five medication rights have to be checked through nursing ‘double-checks’ in the steps of medication administration, as the method of checking as per hospital policy. However, from the findings, it is reflected that RNs perceptions of completely and correctly checking medication rights through complete and independent nursing ‘double-checks’, do not match the steps required by policy and that their knowledge is inadequate. It is evident from the perceptions of RNs that they are aware of the multiple factors influencing IV medication safety practice in this vulnerable patient setting. As perceived by RNs, it is possible to implement more safety strategies. Key recommendations on conclusion of the study include that there are more nursing medication administration strategies that could still be implemented for medication error prevention. These strategies relate to medication safety awareness, the role of the nurse and nursing managers, mandatory staff education, and review of knowledge and skills. / AFRIKAANSE OPSOMMING: Gebaseer op ʼn literatuurstudie blyk dit dat medikasieveiligheid en voorkoming van medikasiefoute reeds in diepte bestudeer are. Bevindings dui daarop dat medikasiefoute algemeen voorkom in neonatale en pediatriese intensiewesorgeenhede, dat meer as die helfte daarvan voorkombaar is, en dat maatreëls om risiko te vermindering pasiënte teen voorkombare uitkomste beskerm (Clifton-Koeppel, 2008:72). Indien en wanneer die proses vir veilige medikasietoediening faal, kom ʼn medikasiefout voor, wat gedefinieer word as die verbreking van een of meer van die vyf medikasieregte (Institute for Safe Medication Practices Alert, 2007:1). Medikasietoediening is hoofsaaklik ʼn verpleegtaak, wat ʼn hoërisiko- en hoëvolume-taak behels. Die akkuraatheid van intraveneuse medikasietoediening is kritiek vir neonatale en pediatriese intensiewesorgpasiënte, aangesien hul weerloosheid verhoog word indien verdere skade veroorsaak word. Omrede medikasietoediening vir neonatale en pediatriese intensiewesorgpasiënte kompleks is, bevestig navorsers dat geregistreerde verpleegkundiges se rol ten opsigte van veilige medikasietoediening veelsoortig is. Die doel van die studie was om die persepsies van geregistreerde verpleegkundiges aangaande die faktore wat medikasieveiligheid in die neonatale en paediatriese intensiewe eenhede in Saoedi-Arabië beinvloed, te beskryf. Studiedoelwitte is gestel om die spesifieke faktore te beskryf wat aanleiding gee tot medikasietoedieningsfoute in die genoemde intensiewesorgeenhede; om geregistreerde verpleegkundiges in die geselekteerde intensiewesorgeenhede se kennis van veilige medikasietoediening te bepaal; en die medikasietoedieningstrategieë wat op die voorkoming van medikasietoedieningsfoute fokus, te beskryf. ʼn Kwantitatiewe navorsingsbenadering is geselekteer vir die studie wat ʼn beskrywende navorsingsontwerp gehad het. ʼn 85% nie-waarskynlike gerieflikheidsteekproef is gebruik om ʼn steekproef (n=103) te selekteer vanuit die teikenpopulasie geregistreerde verpleegkundiges (N=121) wat verantwoordelik was vir medikasietoediening in die geselekteerde intensiewesorgeenhede by King Faisal Specialist Hospital and Research Centre, Jeddah (KFSHRC-J). ʼn Self-geadministreerde vraelys met geslote Likert- en oop-eindevrae is opgestel om die gestelde studiedoelwitte te ondersoek. ʼn Vooraf-toetsing van die vraelys is tydens die loodsstudie uitgevoer. ʼn Kombinasie van kwantitatiewe en kwalitatiewe metodes is gebruik vir die ontleding van die studie-data. Die kwantitatiewe data is op MS Excel ingevoer, waarna beskrywende statistiek deur middel van Statistica 9-sagteware gebruik is om dit te ontleed. Die studie het hoofsaaklik bevind dat veelvuldige faktore die veiligheidspraktyk ten opsigte van intraveneuse medikasie van geregistreerde verpleegkundiges wat met neonatal en pediatriese intensiewesorgpasiënte in ʼn spesifieke tersiêre hospitaal in Saoedi-Arabië werk, beïnvloed. Dit blyk dat hierdie verpleegkundiges se kennis voldoende is aangaande ‘n veilige medikasie toedieningspraktyk wat bestaan uit die kontrolering van al vyf medikasieregte deur verpleegkundige dubbel-kontrolering, soos beskryf is in die hospitaalbeleid. Volgens die bevindinge blyk dit egter dat die verpleegkundiges se persepsie van volledige and korrekte verpleegkundige dubbel-kontrolering, nie met die stappe volgens die hospitaalbeleid ooreenstem nie en dat hulle kennis onvoldoende is. Dit is duidelik dat die verpleegkundiges bewus is van die veelvuldige faktore wat intraveneuse medikasieveiligheidpraktyk vir weerlose pasiënte beïnvloed. Die verpleegkundiges se persepsie is dat daar meer verpleegkundige medikasietoedieningstrategieë is wat geïmplementeer kan word om medikasiefoute te voorkom, insluitende veiligheidsbewustheid ten opsigte van medikasie, die rol van verpleegkundiges en verpleegbestuurders, verpligte personeelopleiding, en hersiening van kennis en vaardighede.

Syfte: Att undersöka hur sjuksköterskor inom särskilt boende resonerar kring kvalitetsuppföljningar och dess eventuella konsekvenser för omvårdnaden. Metod: Semistrukturerade intervjuer efter öppen intervjuguide med sex sjuksköterskor. Kvalitativ innehållsanalys enligt Graneheim och Lundmans metod. Huvudresultat: I vilken grad kvalitetsregistren och kvalitetsuppföljningarna integreras i omvårdnadsarbetet och dess utveckling är centralt för om dessa uppfattas som stöd eller hinder för god kvalité i omvårdnaden. Dubbel dokumentation bidrar till att sjuksköterskorna omprioriterar arbetstiden och arbetar mer konsultativt och administrativt. Detta minskar tiden för omvårdnadsobservationer och handleding av omvårdnadspersonal samt gör att kvalitetsregistreringar snarast uppfattas som ett hinder. Sjuksköterskorna använde sin professionella kunskap och kliniska erfarenhet i högre grad än registerdata vid omvårdnadsbedömningar. Dessa sågs som alltför komplexa för att kunna fångas i kryssfrågeformulär. Mer kliniska observationer efterfrågas i kvalitetsuppföljningarna för ökad medvetenhet om hög arbetsbelastning och dess eventuella konsekvenser samt för att garantera de boende god omvårdnadskvalité. Konklusion: Sjuksköterskorna upplever att de arbetar under svår tidspress. Tiden anges som essentiell för vilken omvårdnadskvalité som erbjuds. Vid beslut om registreringar av kvalitetsindikatorer bör sjuksköterskornas totala arbetsbörda beaktas. Registreringarna bör integreras i befintliga journalsystem så att sjuksköterskornas omprioriteringar inte får negativa konsekvenser för omvårdnadskvaliten. / Objective: How nurses in residential care reflect on quality follow-ups and its possible consequences for nursing care. Method: Semi-structured interviews with six nurses. Qualitative content analysis according to Graneheim and Lundman's method. Main Results: To witch degree quality follow-ups and national quality registers are integrated in Nursing care and its development is central to if these are seen as support or as obstacle to good nursing care quality. Double documentation contributes to nurses working more consultative and administrative. This reduces the time for nursing observations and guiding the nursing staff as well as contributes to national quality registers being perceived as hindrance. The nurses used their professional expertise and clinical experience to a greater degree than registry data in nursing care assessments. These were seen as too complex to be captured in questionnaires. Conclusion: The nurses perceive that they work under severe time constraints. Time is specified as essential for quality of nursing care. In decisions about quality indicators registrations nurses’ total workload should be taken into account. Registrations should be integrated into medical record used so nurses’ re-prioritizations not have negative consequences for nursing care quality.

Bakgrund: Svensk och internationell forskning berörande transpersoners hälsa och livssituation visar att diskriminerande behandling av transpersoner sträcker sig över så gott som alla samhällsinstitutioner. Diskriminering av transpersoner i hälso- och sjukvård är ett allvarligt problem som resulterat i en misstro till och ett undvikande av att söka hälso- och sjukvård bland transpersoner. I denna studie har problemet utforskats från perspektivet av sjuksköterskor i kontexten av somatisk akutsjukvård där sjuksköterskan kan vara den första kontakten mellan patienten och sjukvården. Trots att vårdtiderna kan vara korta, kan sjuksköterskans bemötande av patienten på akutmottagningen ha en stor påverkan på patientens fortsatta förtroende för sjukvården. Syfte: Avsikten var att identifiera förbättringsområden i omvårdnad av transpersoner genom att utforska sjuksköterskors upplevda möjligheter och begränsningar i vården av patienter med transidentitet på somatiska akutmottagningar. Metod: I arbetet användes en kvalitativ ansats med fokusgrupper. Studiedeltagarna innefattade tjugotvå sjuksköterskor från fem olika somatiska akutmottagningar i Mellansverige. Materialet bearbetades och analyserades enligt kvalitativ innehållsanalys med induktiv ansats. Resultat: Innehållsanalysen resulterade i tre huvudkategorier och sex underkategorier. Resultaten visar att sjuksköterskorna upplever sig vårda patienter med ett likvärdigt förhållningssätt, utan att påverkas av sina personliga åsikter. Sjuksköterskorna upplevde en avsaknad av kunskap gällande vården av transpersoner. Sjuksköterskorna identifierade brister i vården, såsom möjlighet till mer personcentrerade inställningar på sjuksköterskornas arbetsinstrument och hjälpmedel. Slutsats: Personcentrerad omvårdnad identifierades som ett område för förbättring i sjuksköterskornas arbete för att stärka transpersoners position inom hälso- och sjukvård. Sjuksköterskor kan genom att representera professionen i organisationer som rör hbtq-frågor stärka relationen mellan hbtq-personer och sjukvården. / Background: Swedish and international research regarding the general health and living situation of transgender persons demonstrates experiences of discrimination from several community institutions. Discrimination of transgender persons in health care is a serious issue that has been shown to result in loss of faith and an avoidance of seeking medical attendance. This paper examines the issue from the perspective of registered nurses in a context of somatic emergency medical care, where nurses may be the first contact between the patient and the health care system. Despite the relatively fast treatment patients receive in emergency medical care, the treatment by a registered nurse can have a big impact on patients’ future perception of the health care system. Aim: The purpose of the study was to identify areas of improvement in the care of transgender persons by exploring registered nurses experiences of challenges and possibilities in the care of patients who identify as trans, in emergency medical care units. Method: The study held a qualitative approach with focus groups as a method. Study participants included twenty-two registered nurses emerging from five separate emergency wards in central Sweden. Data was processed and analyzed with content analysis with an inductive approach. Results: The content analysis resulted in three main categories and six subcategories. The results demonstrated that participating nurses perceived their treatment was given in a ‘natural’ manner, not affected by their personal attitudes. Nurses experienced a lack of knowledge regarding the care of transgender persons and believed education and a more inclusive work environment to be factors having a big impact on the relationship between a nurse and a transgender patient. Conclusion: Person-centered care was identified as a possible area for improvement in the registered nurses work with the aim to strengthen the position of transgender patients in healthcare. By representing the profession of registered nurses in organizations concerning lgbt-issues, the relationship between lgbt-persons and healthcare can be improved.

The purpose of this study was to determine whether the job satisfaction and motivating potential of nursing jobs would be higher for nurses using Patient Focused Care (PFC) compared with nurses not using PFC. Nurses from a large metropolitan hospital served as subjects. Data were collected using three instruments designed to measure job satisfaction and motivating potential. Those instruments were the Job Diagnostic Survey, the Job Descriptive Inventory, and the McCloskey/Mueller Satisfaction Scale. It was hypothesized that nurses working on PFC nursing units would demonstrate greater job satisfaction and motivating potential than nurses working on non-PFC nursing units. The hypotheses were not supported. Results were explained by, among other things, accounting for the nature of the instruments used. The two instruments which gave data counter to the hypothesized direction were not nursing-oriented.

Bakgrund: Tidigare forskning har visat att patienter som överrapporteras från intensivvårdsavdelning till vårdavdelning är i en särskilt sårbar situation och att bristfälliga överrapporteringar är ett internationellt patientsäkerhetsproblem. Syfte: Syftet var att beskriva intensivvårdssjuksköterskors och avdelningssjuksköterskors upplevelser av överrapportering av patienter från intensivvårdsavdelning till vårdavdelning. Syftet var också att beskriva vad intensivvårdssjuksköterskor och avdelningssjuksköteskor ansåg vara viktigt vid överrapporteringen. Metod: Studien hade en kvalitativ ansats med beskrivande design. Åtta semistrukturerade intervjuer gjordes med intensivvårdssjuksköterskor (n=4) och legitimerade sjuksköterskor på vårdavdelning (n=4). Intervjuerna analyserades därefter med kvalitativ innehållsanalys. Huvudresultat: Vid analys av intervjuerna framträdde sex kategorier 1) Att se vikten av samverkan, 2) Att ta emot och ge relevant information för den fortsatta vården på vårdavdelningen, 3) Att ge och ta emot information från ett kunskapsområde till ett annat, 4) Miljöns betydelse vid överrapportering, 5) Att ha behov av strukturerad rapport och 6) Att känna ansvar. Intensivvårdssjuksköterskor och sjuksköterskor från vårdavdelning upplevde att brist på förberedelser inför överrapportering försvårade samarbetet. De upplevde att olika information var viktig vid överrapportering på grund av deras olika kunskapsområden. Båda yrkesgrupperna önskade att informationen skulle vara tydlig med relevant information för den fortsatta vården. De upplevde att miljön med frekventa störningar gjorde att information missades och att en strukturerad rapport gjorde överrapporteringen tydligare. De uttryckte också att de har ett ansvar vid informationsöverföringen. Slutsatser: Samverkan, strukturerad information för den fortsatta vården, kunskap, miljö och ansvar kan ha betydelse vid överrapportering och att utrymme för förbättring finns för att öka patientsäker överrapportering av patient mellan vårdinrättningar. / Background: Studies have shown that the patients that are handed over from the intensive care unit to ward are in a particular vulnerable situation, and that deficient handover is an international patient safety problem. Aim: The aim was to describe the intensive care nurse's and ward nurse's experiences of handover patients from the intensive care unit to the ward. The aim was also to describe what the intensive care nurses and ward nurses considered important during the handover. Method: The study had a qualitative approach with descriptive design. Eight semi structured interviews with intensive care unit nurses (n=4) and registered ward nurses (n=4) were conducted. The interviews were analyzed with qualitative content analysis. Main results: Thorough the analyze six categories emerged 1) To see the importance of collaboration, 2) To receive and provide relevant information for the continuum of care, 3) To give and receive information from one level at knowledge to another, 4) The importance of the environments during handover, 5) The need of a structured handover, and 6) To feel the responsibility. The intensive care nurses and the registered ward nurses experienced that lack of preparation before the handover complicated the cooperation during handover. They expressed that different information was important during handover and that they had different areas of knowledge. Both professional groups wanted the information to be clear and relevant for the continued care. They felt that the environment, with frequent interruptions, resulted in missing information and that a structured report made the handover more direct. They also felt that they had a responsibility in the transfer of information. Conclusions: Collaboration, structured information relevant for the continued care, knowledge, the environment, and responsibility can be important during handover and there is room for improvement to increase patient safe handover between healthcare facilities.

Bakgrund – Stress påverkar kroppen både fysiskt och psykiskt, för att stressen inte ska ge negativa effekter är det viktigt med återhämtning. Stress i arbetet är vanligt förekommande framförallt inom sjukvården och kan uppstå då det ställs höga krav på individen. För att undvika att stressen ska påverka individen används olika former av hanteringsstrategier, det kan vara allt från problemlösande- till emotionellstrategier. Syfte – Att beskriva vårdpersonalens hanteringsstrategier vid arbetsrelaterad stress. Metod – En litteraturstudie med elva kvalitativa studier inkluderades, dessa analyserades med hjälp av Forsberg och Wengström, inspirerad av metod för innehållsanalys. Resultat – Författarnas resultat visade på två kategorier, ”problemlösande hanteringsstrategier” och ”känslomässiga hanteringsstrategier”, samt åtta underkategorier, ”att söka, ge och erhålla stöd”, ”att prioritera och planera arbetet”, ”att utföra aktiviteter”, ”reflektion och pauser”, ”att använda humor”, ”ilska och undvikande”, ”substansanvändning” och ”andlighet och tro”. Konklusion – Omvårdnadsyrket är ett krävande område där stress är oundvikligt, därför är det viktigt att hantera den stress som uppkommer i arbetet för att kunna bibehålla fokus. Mer forskning på effektiva strategier för stresshantering krävs. / Background - Stress affects the body both physically and mentally, to avoid negative effects of stress, it’s important with recovery. Occupational stress is common especially in health care personal and can occur when there are high work demands on the individual. To avoid occupational stress affect on the individual the use of various forms of coping strategies, it can vary from problemsolving- to emotional coping strategies. Purpose - To describe healthcare personnel management of occupationalstress. Method - A Literaturereview with eleven qualitative studies were included, these were analyzed by Forsberg and Wengströms, inspired by the method of content analysis. Results - The authors' results demonstrated in two categories, "problemsolving coping strategies" and "emotional coping strategies" and eight subcategories, "to seek, give and receive support", "to prioritize and plan work", "to perform activities", "reflection and breaks","use of humor", "anger and avoidance", "substance use" and "spirituality and faith". Conclusion – The nursing profession is a demanding area where stress is inevitable, therefore it is important to manage the stress that arises in the workplace in order to maintain focus. More research on effective strategies for stress management is required.

Hurricane Katrina devastated New Orleans in 2005. Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) were impacted by the storm. CRNAs were required to be on duty during the storm and SRNAs’ education was disrupted by the storm. This dissertation is a compilation of three papers that represent the initial exploratory research into the impact of natural disasters on CRNAs and future CRNAs. The first article was a focused ethnography utilizing focus groups and described the shared experiences of CRNAs who were on duty in New Orleans during Hurricane Katrina and the psychosocial impact the storm had on them. Ten CRNAs participated in focus groups that were audio-recorded, transcribed and analyzed. Six major themes emerged from the study and represented how the CRNAs appraised and coped with the stressful events surrounding Hurricane Katrina. The psychosocial impact of Hurricane Katrina on the CRNAs resulted in short-term sleep disturbances and a temporary increase in alcohol consumption. The second article was also a focused ethnography that utilized focus groups to describe the shared experiences of SRNAs whose senior year was disrupted by Hurricane Katrina and the psychosocial impact the storm had on them. Ten former SRNAs participated in focus groups that were audio-recorded, transcribed, and analyzed. Three major themes emerged from the study and represented how the SRNAs appraised and coped with the stressful events surrounding Hurricane Katrina. The psychosocial impact of Hurricane Katrina on the SRNAs resulted in temporary increased alcohol consumption and anxiety. The third article discussed the results of an observational study regarding the impact of Hurricane Katrina on the outcome of the Self-Evaluation Exam (SEE) taken by senior-level students in the Louisiana State University Health Sciences Center Nurse Anesthesia Program. A convenience sample consisted of 174 former students. Regression analysis revealed the relationship between the overall percentile score of the SEE and the year the test was taken (prior to or after Hurricane Katrina) while adjusting for potential confounding variables. The findings suggest that Hurricane Katrina did not have an impact on the outcome of the SEE taken by these individuals.

Error! Unknown document property name. English summary The aim of the thesis is to present the possible ways of a relocation of a registered office of a company to other member state of the European Union. Furthermore, I tried to focus on common complication which can be faced in practical realization of such transfer, as well as on forthcoming legislation and possible perspectives which can be expected. I believe that this topic is very current and progressive and that the wish for cross-boarder movability of companies will be increasing. The thesis is composed of ten chapters, each of them dealing with different aspects of relocation of the registered office. Chapter One is introductory and defines basic terminology used in the thesis and reasons why I've devoted myself to this subject matter. Chapter Two examines the term "personal statute of a company". The chapter consists of six parts. Part One focuses on registered office of a legal entity. Part Two investigates the term personal statute itself. Part Three addresses the issue of theory of the Registered office and the Part Four the opposite theory of Incorporation. Part Five briefly introduces some other theories and Part Six contains a summary and my own opinion. Chapter Three is subdivided into three parts and provides an outline of relevant Czech...

This thesis deals with the issue of two today very important institutes, namely the registered partnership and the alternative family care. The aim of the thesis is to focus on areas where the two institutes overlap. Current registered partnership legislation contains some problematic provisions in relation to forms of alternative family care. The text of the thesis has focused on the description of these problem areas and try to outline possible future changes even in the context of the situation on the international level.

The aim of the diploma thesis is to evaluate various forms of living in couple in French legal system with regards to the principle of equality. The choice of France is not random considering the fact that French lawmaker has been regulating this field since late 1990's. The thesis centres on different aspects of living in couple that differ from each other and contribute to their unique identities. In addition, the thesis assesses the issue whether the French model could be a suitable inspiration to Czech lawmakers. This topical subject is influenced by sociology and therefore there must be taken into account homosexuality as a social phenomenon and evolution of its acceptance in French society. This thesis is divided into 6 chapters. The opening chapter discusses fundamental institution of family law, which is family itself, from historical and social perspectives. The second chapter focuses on long-lasting effort of French deputies and non-governmental organizations to adopt legal regulation for same-sex couples. The third chapter describes Civil Solidarity Act and cohabitation. Civil Solidarity Act, commonly known as PACS, is a form of civil union between to adults concluded in order to organise their joint life. Provisions regarding PACS were amended in 2006. Cohabitation reffers to unmarried...