A three-phased, cross-sectional study was conducted in the nursing schools in two Arab Gulf countries (the UAE and Bahrain) to assess the process of change in Nursing education. The illuminative approach to evaluation using a case study design was used. Different methods were utilized to collect data, namely interviews, documentary analysis and self-administered questionnaires. In the initial phase of the study, the directors of the Schools of Nursing were involved. A theoretical sample of a wide range of tutors, students and counselors was included. The interviews were conducted using a semi-structured interview format. Seventeen faculty members from Bahrain, and seventeen from two institutes of nursing in the UAE, namely Abu Dhabi and Sharjah, were interviewed. Students were interviewed from three academic levels of the program. Thirteen students in Bahrain and nineteen in the UAE participated in the interviews. The N-Vivo qualitative program was used to analyze the qualitative interviews. In the second phase of the study, all faculty who taught case-based courses in Bahrain and the UAE were asked to participate in the study; 24 from the UAE and 30 from Bahrain. A 20% random sample of students from the three academic levels in the UAE and 25% from the two academic levels in Bahrain was used. Sixty-four students from the UAE and forty-six from Bahrain answered the self-administered questionnaire. The questionnaire used data extrapolated from the qualitative interviews. The SPSS (version 11) was used to analyze the self-administered questionnaire. T-test and correlation tests were employed at this stage to analyze data. In both countries, innovation attributes, especially complexity and incompatibility with the students' and the faculty's background, were perceived by both faculty and students as hindering the dissemination of innovation. In both countries a strong training program that tackled concerns of both old and new faculty members was lacking. Planning for a sustainable system and team approach to change was lacking in both countries to varying degrees. Differences were noted between the UAE and Bahrain in the introduction and implementation of change. The UAE faculty perceived their involvement in the choice of a case-based curriculum as a major facilitating factor. Other factors perceived by the UAE faculty as facilitating the process of change were the planned series of workshops, involvement of the faculty in decision-making and the secondment of an external expert during the implementation of the innovation. The Bahrain faculty perceived the leadership style of forcing change as deterring the process of change. The institutional context, the lack of planning, the lack of a common meaning of change among faculty and other stakeholders, and the lack of structured professional development program were other factors perceived as hindering change. The study led to the development of a framework for introducing educational change in the Arab Gulf region. It is hoped that the framework would help decision-makers and leaders of educational institutions understand change better and be able to introduce and monitor change effectively. The major recommendations tackled developing a continuing staff development program, building multidisciplinary teams, planning and monitoring the change process and establishing a common meaning of change from the beginning of any change. Conducting further research on the perceptions of key political stakeholder towards change and researching the managerial practices of nursing leaders could serve as an initial step towards the validation of the suggested framework. / Thesis (Ph.D.)-University of KwaZulu-Natal, 2005.

An exploratory retrospective study conducted on two differing educational programmes, both of which were for the diploma in community health nursing. The aims of the study were: i) To propose a conceptual framework in order to compare distance learning programmes in community health nursing. ii) To describe and compare two such programmes based on this framework: one content-based and the other community / problem based. The research design used case study methodology, after the development of a model for the education of professional nurses which was derived from literature. The constructs of the model were used as propositions in a case study protocol. The four constructs were each made up of two elements and each element consisted of the poles of a continuum by which that feature in a programme could be identified. The constructs were: a) The Conceptual Programme which included the elements of Base and Structure; Base being either institution or community and structure either content or process. b) The Student with elements of Professional or Personal attributes. Professional attributes were either empowered or disempowered and personal either self directing or passive. c) The Context which had Components and Relationships as elements. The former comprised either limited formal health services or all-embracing health related sectors, whilst the latter specified relationships would either be seen as linkages with unilateral formal communications or partnerships where collegial relations impacted on both parties involved. d) The Concrete Resources included both human and material resources. Human resources were either limited or additional and material either limited or varied. Application of the Conceptual Programme analysis demonstrated that programme A was institution and content based whilst programme B was community / problem (process) based. Programme documentation and student assignment and projects were analyzed in terms of the remaining three constructs. An interview with a tutor for each programme followed after they had read the case reports. A third interview was then held with a key person who had overseen both programmes and read case and interview reports in order to validate both content and the use of the model as framework for analysis. The following trends emerged: i) The content programme was associated with more disempowered and passive students as those were defined in this study. ii) The content programme also used more limited formal health sector settings for learning and in this linkage type relationships dominated although three instances of partnerships did occur, and some community based groups were used by students. iii) The content programme used one tutor per contact session for lectures with students and, cost, in 1991 currency, R150 per student to deliver. iv) The community / problem based programme showed a stronger trend to empowered and self directing students with several clear instances being documented. v) There was a greater variety of settings used for learning in this programme. vi) Several instances of partnership relationships occurred despite the limited contact time between students and communities or health settings. vii) The community / problem-based programme needed two facilitators per contact session at a cost of R1130 (1991) as small group discussions were the main strategy for learning. viii) Student evaluations of both programmes showed that students viewed them in much the same way despite the differences that were found. This indicates that student evaluations on their own provided insufficient evidence about the nature of a programme. ix) The community / problem based programme cost about 20% more to deliver than the content programme out of a total expenditure of R186 000 (1991 value). x) The model was revised to collapse professional and personal attributes into one element and to add another element 'metacognition' to the construct student. 'Access' was also recommended as an additional construct with elements of barriers and supports. This new model needs to be tested and reviewed by peers. The revised model for the education of professional nurses could be a useful yardstick for evaluating existing educational programmes, selecting newly proposed programmes and guiding policy formation. / Thesis (Ph.D.)-University of Natal, Durban, 1995.

AIM: The aim of this research was to describe how the health professionals manage sudden/abrupt deaths in the ED and to foster change in current practice by involving the clients (dead or dying clients and their families) and the health professionals. METHOD: Action research was the approach used in this four year research project, and co-researchers (nurses) from three Level I ED's in KwaZulu-Natal were actively involved in shaping and guiding the project. The participants involved in the research were health professionals, bereaved families and mortuary staff members. FINDINGS: An intervention model, the Dealing with Sudden Death Model, was developed in order to guide the therapeutic management of sudden/abrupt deaths in ED's. Along with this was the development of the family pamphlet, the Preparation Checklist and the Incident Evaluation Checklist. Following the implementation of this model the health professionals emphasized the fact that this model provided guidance and meaning to the care rendered to the dead or dying client, the bereaved families and fellow colleagues. The Dealing with Sudden Death Model had resulted in a production of knowledge and planned changes in the management of sudden/abrupt deaths in the ED's. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2004.

The Minister of Education's public statement In August 1999, that South African citizens should mobilize and build an education and training system for the 21'st century . among other things emphasized the application of procedures for recognition of prior learning as part of the restructuring process. On the other hand the resolution taken by the South African nursing Council at the beginning of 2000. that enrolled nurses should be upgraded through the process of recognition of prior learning further increased the urgency for nursing education institutions to develop and implement RPL policies In South Africa, Recognition of Prior learning (RPL)is seen as an appropriate approach to offer equity and redress of past imbalances in the education and training system. The purpose of the study was to develop and test an appropriate model that could be used for Recognition of Prior Learning for nurses. To test the model, it was implemented in a form of pilot projects by three institutions. It was important for the model development to identify and involve all the stakeholders of the nursing education system. An appropriate design for the study was a multiphase decision oriented evaluation research . Stuffelbeam's Context. Input, Process and Product evaluation model was used to guide the research process. The first phase was the development of the model which involved the Context evaluation. During the context evaluation phase, the Education Committee of the South African Nursing Council and the evaluative researcher developed the guidelines for the RPL process. These were refined by the stakeholders during the regional workshops. The results of this phase was the RPL guidelines. The second phase was the Input and the Process evaluations. Each institution had to make planning decisions for Implementation. The result was RPL policies for each institution Thereafter. the three institutions Implemented the RPL guidelines to specific target groups of nurses that were identified for the purpose of the pilot project. Data collection instruments varied according to the phase of the model development. Checklists were used to measure the extent to which each Institution had followed the RPL guidelines Dunng the Product (evaluation) phase. candidates' scores were compared with those of other candidates who accessed the specific programs through the traditional entry routes. According to the results all RPL candidates were successful In the programs they aimed at accessing DUring the testing phase after access, the RPL candidates compared favourably with other the other candidates who accessed the programs through traditional routes . The result indicate that the self- directed approach used during RPL helped the candidates in the actual programs. A process onented and competency- focused model was developed through an inclusive process. Nursing education Institutions and policy makers can use the model to structure and evaluate RPL implementation in nursing education institutions in South Africa. / Thesis (Ph.D.)-University of Natal, Durban, 2001.

The aim of the study was to explore the practice of caring in human resource management of nurses. Both the qualitative and quantitative research approaches were used to ensure that the richness and the complexities of caring is reflected in the study. A qualitative analysis of the interviews vvth nurse managers and nurses indicated that they saw caring as an important part of their task. They saw caring in human resource management of nurses mainly as dealing with the interpersonal aspects- personal problem-solving-, development and growth-, welfare needs-, and HIV/AIDS issues related to nurses. A quantitative survey of nurses from different levels was done to explore the presence and enactment of caring in the formulating strategies, structuring the work, workforce planning, staffing process and in the utilising and maintaining of nurses. It was found, according to respondents that caring was not present to satisfactory levels in the human resource management process of nurses, although caring concepts, as well as Christian principles, were present and clearly described in the mission, philosophies and goals and objectives of the hospitals. The fact that nurse managers are not solely responsible for the experiences of nurses and the way nurses expressed themselves on the caring issues in human resource management in the study should be emphasised. Organisational factors such as salaries and benefits of nurses, shortage of nurses at national and international levels, organisational structures and other financial ccnstrains in hospitals, contribute to the experiences of nurses in this study. Health service administrators, nurse managers and nurses should all take the responsibility to find means to improve and instil caring in hospitals. Therefore the decision to train nurse managers and to upgrade the management knowledge and the implementation of caring concepts in nursing management with relevant care and support to HIV/AIDS nurses, is of the utmost importance to equip nurse managers to survive in these demanding circumstances in the hospitals. / Thesis (Ph.D.)-University of Natal, Durban, 2000.

An extensive review of literature revealed that although CBE was a familiar concept and a national policy for health professionals' education in South Africa, there was, however, limited understanding of this phenomenon. Most of the existing CBE programmes were a reaction to the inadequacy of traditional nursing education and had emerged without any intellectual discourse on the phenomenon CBE. The aim of this study was to analyse the phenomenon CBE in basic nursing education and the meaning attached to it. Furthermore, the researcher aimed at developing a middle-range theory of CBE. Strauss and Corbin's (1990) grounded theory approach was used to guide the research process. The South African Nursing Council's (SANC) education committee and seven nursing education institutions with CBE programmes were included for participation in the study. Data were collected by means of observation, interviews and document analysis. Purposive and theoretical sampling was used for selecting interviewees, resulting in a total of 41 interviewees. Data collection and initial analysis took place concurrently. Descriptive analysis followed by conceptual analysis was performed using Strauss and Corbin's paradigm for qualitative data analysis. The primacy of the community as a learning environment, timing of first exposure, duration, frequency and sequencing of community-based learning experiences, as well as service provision, emerged as discriminatory core characteristics of CBE in basic nursing education. Irrelevance of traditional nursing education and political change emerged as antecedents of CBE. The need to respond to national health policies and community health needs was seen as conditions under which CBE had to operate in South Africa. The nature of the CBE educative process, which placed emphasis on active learning and curriculum relevance, emerged as essential for the realization of expected outcomes of CBE in basic nursing education. Based on these results, it was concluded that CBE in basic nursing education in South Africa is (a) relevant education, (b) responsive education, (c) education for social justice, (d) a conscious and deliberate PHC socialisation process and (e) a process and outcomes education. As this was a ground breaking study on the meaning of CBE in basic nursing education in South Africa, a number of further research studies are recommended. / Thesis (Ph.D.)-University of Natal, Durban, 2003.

This study investigated the needs assessment phase of the health education process for school children. The objectives of the study were to identify health education needs of school children using three approaches, namely, the epidemiological, consumer and social science approaches. In the social science approach, a PRECEDE model has been used. Time taken in using each approach and the skills of PHC nurses necessary to use each, were investigated in order to determine the most effective and efficient approach. A comparative case study design has been used, whereby each approach was considered as a case, hence, an embedded case study. One rural administrative area in the district of Umtata, which has a health centre in its catchment area, was selected. The population for the sudy were school children aged 12 to 16 years doing standard five. Four out of ten Junior Secondary schools in the area were randomly selected. In the epidemiological approach, records from the health centre and three of the four selected schools were analysed. In the consumer approach, focus group interviews (two groups of boys and two groups of girls) were conducted. In the social science approach, focus group interviews of school children(four groups) from the other two remaining schools, focus group interviews of mothers as carers( four groups), and in-depth interviews of standard five teachers from each of the four schools were conducted. Data analysis was done using Tesch's method of qualitative data analysis.A time activity sheet was used to estimate time used in each approach. A questionnaire was distributed among PHC nurses to determine their skills in relation to the approaches used. Results showed that the social science approach was the most comrehensive approach but used the longest time. The consumer was balanced and efficient though the least time was used. The epidemiological was found to have identified physical problems to the exclusion of the social and psychological problems. / Thesis (Ph.D.)-University of Natal, Durban, 1998.

Aim: The aim of the study was to do an epistemological analysis of the power of women as nurses working in one of the larger and more deprived regions of South Africa, namely KwaZulu-Natal. This research was based on the premises of the Standpoint theory. Concurrent to the collection of data, a literature review and a concept analysis of power, powerfulness, powerlessness and empowerment were done and incorporated where applicable in the final theoretical framework. Methodology: A phenomenological approach was used. This incorporated two to three in depth interviews with each participant, lasting an average of thirty minutes each, was used. Women, relating to the gender factor, as nurses were also marginalised in terms of class, as they belonged to the enrolled category of nurses, and race, being African. A fourth selection criterium was added to analyse the reality of locality, called rurality. The researcher applied the principle of theoretical saturation and a total number of nine women, who belonged to the enrolled category of nurses and who worked in a distinct rural health care setting, were interviewed. A second group consisting of five women enrolled nurses and working in an urban setting were interviewed, as were a third relatively contrasting group of four women registered nurses. All forty four interviews were audio taped and transcribed, and a qualitative software package called NUD*IST was used to identify and refine experiential themes. Findings: The relationship between power and rights was often layered in contradiction during the interviews and the participants portrayed a picture of being oppressed or marginalised and powerless. The women as nurses belonging to the enrolled category were alienated as women and as nurses in terms of being severed from the nursing profession and from the ruling gender of men, of being lost in an ever present routinization of activities, of being misused, maternalised and domesticated at home and at work. These phenomena were quantitatively more voiced by the rural group of women and these participants strongly emphasized the limiting influence of their prescribed scope of practice, the approach of the senior category of nurses and they conveyed a traditionalist and altruistic view of nursing and nurses. The women as registered nurses created their own freedom often away from their men as in divorce. They also sought for solutions concerning powerlessness in more global and distant terms, for example in relation to cultural practices. They communicated a sense of empowerment in terms of for example education, personal qualities and increased job satisfaction. Culture rather than race was emphasized as an essence of womens' oppression. An epistemological framework of the power of women as nurses developed by the researcher constructed the totality of empowerment in terms of fifteen transformational and hierarchial actions incorporating and adapting Dooyeweerd's theory of modalities and the surfaces of class (categorial divide), gender (the eternal carer), race (culture) and locality (rurality). These actions and reformulated concepts could be used for the development of specific strategies to facilitate the empowerment of individuals, groups and communities of women as nurses and nurses as women. Further collaborative research into the phenomenon of power, a reconceptualization of nursing education and levels of expertise and hierarchies within nursing were some of the suggestions for the way forward. / Thesis (Ph.D.)-University of Natal, Durban, 1996.

The main aim of this research was to identify a family support programme which could be used as a primary prevention strategy against child abuse as a first positive step within the family, the basic unit of society, towards reducing community violence. The central focus of this intervention was that it should be appropriate for use in a multi-ethnic South African context and implementable by community health nurses or related lay health personnel with minimal training. No such programme was identified. The researcher attempted to integrate the most appropriate and scientifically substantiated features of existing programmes and develop a unique South African programme. This programme was developed and tested in a participatory manner with multiethnic communities. Community health nurse facilitators were trained and evaluated and the developed programme was then implemented by these facilitators in several sites. The influences of the developed programme were extensively evaluated. Changes in attitudes, feelings and behaviour of the child, the mother, the maternal-child interaction and the family system were explored. A quasi-experimental design with pre and post testing of the experimental group and two control groups (control 1 received social support and control 2 receiving routine clinic nursing only) was utilized. Completed analysis has yielded some exciting and provocative results. There are clear differences in each of the groups attitudes to their children. On the Mother-Child Relationship Evaluation (MCRE) positive gains in maternal-child relationship were established for the experimental group and this was greater than that of both controls (t-test = 4.151 @ alpha = 0.0013; H=4.0734 @ alpha = 0.04 and F=7.031 @ alpha = 0.0004). On the Family Assessment Device (FAD) some limited changes were observed in the experimental group over the controls (F= 3 .33 @ alpha = 0.05). This is a positive outcome indicating that the family support programme evidenced significant changes in the participants relationships with their children and in their families and wider social life. Mothers and facilitators qualitative feedback reported positive interaction with young and older children and changed maternal and child attitude and behaviour. Despite the critical shortage of staff in community health settings facilitators continue to implement the programme voluntarily in their service settings. / Thesis (Ph.D.)-University of Natal, Durban, 1995.

The purpose of this study was to describe and identify the leadership style that prevails in health care institutions, in order to establish the influence of multilevelleadershipon the effeciveness of hospitals in KwaZulu-Natal. Hunt's extended multilevel leadership Model was used as a conceptual framework. Six institutions were selected by random sampling, categorised into three sizes i.e. large institutions with number of beds above 400, midddle sized between 200-400 and smaller institutions with a bed state below 200. Three categories of leaders were as top, middle and operational leadership. The 8 leaders included the chief medical superintendent, the hospital secretary, the chief nurse manager, two area nurse managers and the three operational nurse managers in each of the six institutions. A total of 48 MLQ instruments designed by Bass and Avolio (1989) focused on leadership style was used to identify transformational, transactional and nonleadership styles. 121 Questionnaires were distributed to staff and community to measure hospital effectiveness. Interviews were carried out on patients and visitors to establish patients' satisfaction. The effectiveness of health care services was described by goal attainment, level of support and system's achievement. The instruments to measure goal attainment and level of support were designed by the researcher. The 6 institutions were measured for system's achievement by using the instrument designed by Beattie, Rispel and Cabral (1995). The criteria used to assess infrastructure, access to the institution, management of personnel, management of resources, patient satisfaction, community outreach programmes and the process of care, was based on the criteria developed by Beattie, Rispel, and Cabral (1995). A correlation was done to establish the relationship between leadership style and hospital effectiveness. Findings; the area manager exhibited the leadership style that is predominantly Transformational, the other four categories identified in the study, revealed a leadership style that was predominently Transactional. Of the six institutions two revealed a transfomational leadership style and three revealed a transactional leadership style. One institution reflected a Laissez-Faire leadership style. The overall leadership style was transactional. On comparing the three effectiveness criteria goal attainment was identified as the most effective area of achievement followed by system's achievement and the least being level of support. A MANOVA multivarate analysis of variance revealed that the relationship between leadership style and goal attainment was not significant. The relationship between leadership style and level of support was significant. On further analysis using the Shetre test, it was found that the level of support was significantly related to transformational leadership. The relationship between leadership style and stystem's achievement was not established, because the sample size of six institutions was too small. The overall relationships between leadership style and hospital effectiveness was significant at p-< 0.01 level. Recommendations; included that all all categoties of leadership at institutions are to increase their diagnostic level of awareness of their leadership styles. Rigorous education and training on leadership and support were essential. A further recommendation was that the methodology used in this study to measure hospital effectiveness be used more widely as a management tool. A common instrument used to evaluate acceptable standards of health care assessment should be used to ensure comparison between and within institutions in KwaZulu- Natal There was a need for further research to establish the influence of leadership style on hospital effectiveness in order to ensure quality care by health care providers and to increase professional efficiency and effectiveness in the hospitals of KwaZulu-Natal. / Thesis (Ph.D.)-University of Natal, Durban. 1998.