The role and responsibilities of the departmental head were identified. Methods whereby these individuals could obtain the required management skills were identified. An indication of the amount of time to be spent on each of these tasks are also given. Suggestions for further research as well as other recommendations are made in the last chapter. Nurses' training, now in its thirtieth year at South- African universities, is of utmost importance for the health of the nation. Their education must therefore be of a high standard. This can only be achieved if capable heads of departments (nursing) are available. / Thesis (MA et Scien (Verpleegkunde))--PU vir CHO, 1987

The Constitution of the Republic of South Africa 108 of 1996 (SA, 1996) makes provision for all citizens to receive quality health care. Legislation such as the White Paper on the Transformation of the Public Service of 1995, (SA, 1995a), the White Paper on Transforming Public Service Delivery (Batho Pele) (SA, 1997b), the Public Service Act 103 of 1994, as amended (SA, 1994), the Labour Relations Act 66 of 1995 (SA, 1995b) and the Employment Equity Act 55 of 1998 (SA, 1998) enshrines this right for all citizens by ensuring that health authorities put measures in place to improve the performance of nurse employee (NE), and thus ensuring quality health care. NE are only able to improve the quality of their performance, if their performance is systematically appraised and their potential for development is identified. However, researchers, for instance Du Plessis (2002:116), Nkosi (2002:37–44), Narcisse and Harcourt (2008:1154), Thompson et al. (1999:139), Fletcher (2001:473) studied the perceptions and experiences of employees and managers of performance appraisal (PA) and these studies indicated that there is a gap in the implementation of PA. The Performance Management and Development System (PMDS) policy (Policy no. NWPG 13) was implemented in the North West public health sector in clinics and hospitals in 2004 to provide guidelines for the implementation of PA. This policy is reviewed annually since it was first drafted. However the researcher’s personal experience with PA in practice was that there is a gap between the process provided by the PMDS policy (Policy no. NWPG 13) and the implementation thereof in the North West public health sector. This led to the following research questions: how is PA implemented from the perspectives of nurse line managers (NLM) and NE in clinics in the Dr Kenneth Kaunda District (KKD) and what guidelines can be developed to improve the implementation of PA in clinics in the KKD? The study aimed to develop guidelines to improve the implementation of PA in clinics in the KKD. The study had a cross–sectional quantitative design with exploratory, descriptive and contextual research strategies. Two questionnaires: one for NLM and the other for NE were developed from section 13.4.4 and 13.4.5 of the PMDS policy (Policy no. NWPG 13 amendment approved for 2008–2009 performance cycle) (SA, 2007), to explore and describe the perceptions of NLM and NE on the implementation of PA in clinics in the KKD. Twenty–three problems were identified from the empirical research with regard to communication, feedback and participation in PA, which served as the evidence base towards developing guidelines to improve the implementation of PA in clinics in the KKD. The guidelines were developed using inductive and deductive reasoning and were based on the ten–point plan of Juran. Finally the research was evaluated, limitations were identified and recommendations were formulated for practice, education, management, research and policy. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2012.

The Constitution of the Republic of South Africa 108 of 1996 (SA, 1996) makes provision for all citizens to receive quality health care. Legislation such as the White Paper on the Transformation of the Public Service of 1995, (SA, 1995a), the White Paper on Transforming Public Service Delivery (Batho Pele) (SA, 1997b), the Public Service Act 103 of 1994, as amended (SA, 1994), the Labour Relations Act 66 of 1995 (SA, 1995b) and the Employment Equity Act 55 of 1998 (SA, 1998) enshrines this right for all citizens by ensuring that health authorities put measures in place to improve the performance of nurse employee (NE), and thus ensuring quality health care. NE are only able to improve the quality of their performance, if their performance is systematically appraised and their potential for development is identified. However, researchers, for instance Du Plessis (2002:116), Nkosi (2002:37–44), Narcisse and Harcourt (2008:1154), Thompson et al. (1999:139), Fletcher (2001:473) studied the perceptions and experiences of employees and managers of performance appraisal (PA) and these studies indicated that there is a gap in the implementation of PA. The Performance Management and Development System (PMDS) policy (Policy no. NWPG 13) was implemented in the North West public health sector in clinics and hospitals in 2004 to provide guidelines for the implementation of PA. This policy is reviewed annually since it was first drafted. However the researcher’s personal experience with PA in practice was that there is a gap between the process provided by the PMDS policy (Policy no. NWPG 13) and the implementation thereof in the North West public health sector. This led to the following research questions: how is PA implemented from the perspectives of nurse line managers (NLM) and NE in clinics in the Dr Kenneth Kaunda District (KKD) and what guidelines can be developed to improve the implementation of PA in clinics in the KKD? The study aimed to develop guidelines to improve the implementation of PA in clinics in the KKD. The study had a cross–sectional quantitative design with exploratory, descriptive and contextual research strategies. Two questionnaires: one for NLM and the other for NE were developed from section 13.4.4 and 13.4.5 of the PMDS policy (Policy no. NWPG 13 amendment approved for 2008–2009 performance cycle) (SA, 2007), to explore and describe the perceptions of NLM and NE on the implementation of PA in clinics in the KKD. Twenty–three problems were identified from the empirical research with regard to communication, feedback and participation in PA, which served as the evidence base towards developing guidelines to improve the implementation of PA in clinics in the KKD. The guidelines were developed using inductive and deductive reasoning and were based on the ten–point plan of Juran. Finally the research was evaluated, limitations were identified and recommendations were formulated for practice, education, management, research and policy. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2012.

The practice environment of nurses plays a very important role in the delivery of quality health care. However, there is limited knowledge on what positive practice environments entail with specific reference to the primary health context of the public health care sector of South Africa. Nurses in this context are the frontline health personnel and are affected not only by nursing shortages, but also high workloads as the public health care sector serves 83% of the South African population and the private health care sector only 17%. In this study the researcher decided to conduct a study to explore the practice environment of nurses in the primary health care context as no studies have previously been undertaken in this regard. The researcher used a case study design with quantitative and qualitative approaches and implemented descriptive, explanatory and contextual strategies. This design, together with the findings of objectives one, two and three, the World Health Organization Strengthening of Health Systems and Fourteen Forces of Magnetism Frameworks and inductive and deductive logic enabled the researcher to achieve the overarching aim, which is objective four, of this study. Descriptive statistics, confirmatory factor analysis and Cronbach’s alpha assisted the researcher in assessing the demographic profile (objective 1) and the status of the practice environment of community health centres in North West Province (objective 2). Thereafter, the researcher was also able to identify the community health centre with the most favourable practice environment in order to conduct semi-structured individual interviews (objective 3). The descriptive data of objective 1 revealed that community health centres in the North West Province are located on average 36 km from the nearest referral hospital to which an average of five patients per day are referred. The average number of patients consulted per month is 3 545 of which the nurse consults an average of 40 and the physician 15 patients per day. In the community health centres the average age of nurses is 40, with 10 years of nursing experience. There were more female than male nurses of which 65% of the registered nurses had a diploma in nursing and had only started their careers at 31 years of age. There is an average of eleven registered nurses, five auxiliary and one enrolled nurse in the community health centres of which only four of the registered nurses (36%) had a qualification in Clinical Health Assessment, Treatment and Care. The overall staff turnover rates were very low and the satisfaction levels were high. The factor analysis of objective 2 revealed that the Practice Environment Scale of the Nursing Work Index’s sub-scales staffing and resource adequacy and nurse participation in primary health care/community health centre affairs had means below 2.5, indicating that nurses were not in agreement with these sub-scales. However, nurse manager ability, leadership and support; collegial nurse-physician relationships and nursing foundations for quality of care had a mean above 2.5 indicating that the nurses were in agreement with these sub-scales. Lastly, the qualitative findings indicated that although the community health centres with the most favourable practice environment were affected by factors that decrease quality of care which included a lack of resources, limited infrastructure, limited support from pharmacy and staff shortages. These mentioned factors were not in the control of the community health centres. Although the community health centres were affected by the above-mentioned factors these community health centres excelled in support, leadership and governance, collegial nurse-physician relationships and factors influencing quality of care which were in the control of the community health centre. / Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2013.

The practice environment of nurses plays a very important role in the delivery of quality health care. However, there is limited knowledge on what positive practice environments entail with specific reference to the primary health context of the public health care sector of South Africa. Nurses in this context are the frontline health personnel and are affected not only by nursing shortages, but also high workloads as the public health care sector serves 83% of the South African population and the private health care sector only 17%. In this study the researcher decided to conduct a study to explore the practice environment of nurses in the primary health care context as no studies have previously been undertaken in this regard. The researcher used a case study design with quantitative and qualitative approaches and implemented descriptive, explanatory and contextual strategies. This design, together with the findings of objectives one, two and three, the World Health Organization Strengthening of Health Systems and Fourteen Forces of Magnetism Frameworks and inductive and deductive logic enabled the researcher to achieve the overarching aim, which is objective four, of this study. Descriptive statistics, confirmatory factor analysis and Cronbach’s alpha assisted the researcher in assessing the demographic profile (objective 1) and the status of the practice environment of community health centres in North West Province (objective 2). Thereafter, the researcher was also able to identify the community health centre with the most favourable practice environment in order to conduct semi-structured individual interviews (objective 3). The descriptive data of objective 1 revealed that community health centres in the North West Province are located on average 36 km from the nearest referral hospital to which an average of five patients per day are referred. The average number of patients consulted per month is 3 545 of which the nurse consults an average of 40 and the physician 15 patients per day. In the community health centres the average age of nurses is 40, with 10 years of nursing experience. There were more female than male nurses of which 65% of the registered nurses had a diploma in nursing and had only started their careers at 31 years of age. There is an average of eleven registered nurses, five auxiliary and one enrolled nurse in the community health centres of which only four of the registered nurses (36%) had a qualification in Clinical Health Assessment, Treatment and Care. The overall staff turnover rates were very low and the satisfaction levels were high. The factor analysis of objective 2 revealed that the Practice Environment Scale of the Nursing Work Index’s sub-scales staffing and resource adequacy and nurse participation in primary health care/community health centre affairs had means below 2.5, indicating that nurses were not in agreement with these sub-scales. However, nurse manager ability, leadership and support; collegial nurse-physician relationships and nursing foundations for quality of care had a mean above 2.5 indicating that the nurses were in agreement with these sub-scales. Lastly, the qualitative findings indicated that although the community health centres with the most favourable practice environment were affected by factors that decrease quality of care which included a lack of resources, limited infrastructure, limited support from pharmacy and staff shortages. These mentioned factors were not in the control of the community health centres. Although the community health centres were affected by the above-mentioned factors these community health centres excelled in support, leadership and governance, collegial nurse-physician relationships and factors influencing quality of care which were in the control of the community health centre. / Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2013.

Hierdie navorsing het die bevordering van die regering se gesondheidsbevorderingsdoelwitte soos vervat in die Witskrif vir die Transformasie van die Gesondheidstelsel in Suid-Afrika, Kennisgewing 667 van 1997 (White Paper for the Transformation of the Health System in South Africa Notice 667 of 1997) ten doel. 'n Verdere doel was om die behoefte na beroepsgesondheidsbevorderende programme in geselekteerde beroepsituasies vanuit 'n verpleegkundige perspektief vas te stel. Die resultate van hierdie navorsing het aangedui dat daar wel 'n behoefte bestaan aan beroepsgesondheidsbevorderende programme in geselekteerde beroepsituasies. Hierdie behoefte is vasgestel deur middel van die literatuurstudie en deur die versameling van inligting deur middel van 'n opname. 'n Holistiese en bemagtigingsbenadering tot beroepsgesondheidsbevorderende, asook 'n gesondheidsbevorderende verplegingsbenaderingsraamwerk word voorgestel. Addisioneel word riglyne vir die ontwikkeling en implementering van beroepsgesondheidsbevorderingsprogramme asook 'n gesondheidsbevorderende verpleegopleidingsprogram voorgestel. Daar word aanbeveel dat gesondheidsbevorderende verpleegkunde ingesluit word in alle verpleegkunde praktyke en verpleegkunde kurrikula. Aanbevelings ten opsigte van toekomstige navorsing sentreer rondom 'n ondersoek na die huidige status van beroepsgesondheidsbevordering, navorsing met betrekking tot die gesondheidsbevorderende werkplek en kampus - wat alle belanghebbendes insluit - die status van gesondheidsbevorderende opleiding; en navorsing gelyksoortig aan hierdie een in ander streke van Suid-Afrika. Die skeiding tussen beroeps- en primere gesondheidsorg in werkplekke behoort ook ondersoek te word. / This research is aimed at furthering the health promotion and occupational health objectives of the government as is set out in the "The White Paper for the Transformation of the Health System in South Africa Notice 667 of 1997". The aim of this research was to determine the need for occupational health promotion programmes in selected occupational settings from a nursing perspective. The overall outcome of this research demonstrated that a need exists for occupational health promotion programmes in selected occupational settings. This was illustrated by the literature study and by the information collected through a survey. Three frameworks are proposed, namely a holistic approach to an occupational health promotion programme, an empowerment occupational health promotion approach, and a health promoting nursing framework. In addition, guidelines for the development and implementation of an occupational health promotion programme and a health promotion and health promoting nursing training programme are recommended. It is also recommended that health promoting nursing be included in all nursing practice and nursing training curricula. Recommendations for future research centred on the investigation of the present status of occupational health promotion, research regarding the health promoting workplace and campus that involves all stakeholders, the status of health promotion training, and research similar to this one in other regions of South Africa. The division of occupational health and primary health care in occupational health settings needs to be investigated as well. / Health Studies / M.A. (Advanced Nursing Sciences)

Hierdie navorsing het die bevordering van die regering se gesondheidsbevorderingsdoelwitte soos vervat in die Witskrif vir die Transformasie van die Gesondheidstelsel in Suid-Afrika, Kennisgewing 667 van 1997 (White Paper for the Transformation of the Health System in South Africa Notice 667 of 1997) ten doel. 'n Verdere doel was om die behoefte na beroepsgesondheidsbevorderende programme in geselekteerde beroepsituasies vanuit 'n verpleegkundige perspektief vas te stel. Die resultate van hierdie navorsing het aangedui dat daar wel 'n behoefte bestaan aan beroepsgesondheidsbevorderende programme in geselekteerde beroepsituasies. Hierdie behoefte is vasgestel deur middel van die literatuurstudie en deur die versameling van inligting deur middel van 'n opname. 'n Holistiese en bemagtigingsbenadering tot beroepsgesondheidsbevorderende, asook 'n gesondheidsbevorderende verplegingsbenaderingsraamwerk word voorgestel. Addisioneel word riglyne vir die ontwikkeling en implementering van beroepsgesondheidsbevorderingsprogramme asook 'n gesondheidsbevorderende verpleegopleidingsprogram voorgestel. Daar word aanbeveel dat gesondheidsbevorderende verpleegkunde ingesluit word in alle verpleegkunde praktyke en verpleegkunde kurrikula. Aanbevelings ten opsigte van toekomstige navorsing sentreer rondom 'n ondersoek na die huidige status van beroepsgesondheidsbevordering, navorsing met betrekking tot die gesondheidsbevorderende werkplek en kampus - wat alle belanghebbendes insluit - die status van gesondheidsbevorderende opleiding; en navorsing gelyksoortig aan hierdie een in ander streke van Suid-Afrika. Die skeiding tussen beroeps- en primere gesondheidsorg in werkplekke behoort ook ondersoek te word. / This research is aimed at furthering the health promotion and occupational health objectives of the government as is set out in the "The White Paper for the Transformation of the Health System in South Africa Notice 667 of 1997". The aim of this research was to determine the need for occupational health promotion programmes in selected occupational settings from a nursing perspective. The overall outcome of this research demonstrated that a need exists for occupational health promotion programmes in selected occupational settings. This was illustrated by the literature study and by the information collected through a survey. Three frameworks are proposed, namely a holistic approach to an occupational health promotion programme, an empowerment occupational health promotion approach, and a health promoting nursing framework. In addition, guidelines for the development and implementation of an occupational health promotion programme and a health promotion and health promoting nursing training programme are recommended. It is also recommended that health promoting nursing be included in all nursing practice and nursing training curricula. Recommendations for future research centred on the investigation of the present status of occupational health promotion, research regarding the health promoting workplace and campus that involves all stakeholders, the status of health promotion training, and research similar to this one in other regions of South Africa. The division of occupational health and primary health care in occupational health settings needs to be investigated as well. / Health Studies / M.A. (Advanced Nursing Sciences)

The aim of this study was to describe the nurses‘ perception of termination of pregnancy and her perception of her conduct towards clients that request termination of pregnancy guided by Kings‘ Systems Approach and Goal Attainment Theory. A non-experimental quantitative descriptive correlational design was used. A non-probability purposive sampling method was used consisting of institutions in the Western Cape, available to participate in this study, which deliver termination of pregnancy services, gov ernment health care institutions (21) and Marie Stopes clinics (3). Non-probability convenience sampling was used consisting of registered nurses who are working in termination of pregnancy units in these facilities (N=82). Data were collected through the administration of a self-designed questionnaire. The main findings of the study indicate that respondents (personal system) appear to feel positive about the work they are doing. Formal improvement and development are however not utilised optimally. Regarding the interpersonal system, respondents also show a positive orientation to both the woman opting for termination of pregnancy and the foetus. The potential towards transaction and ultimately goal attainment reside within this system. The respondents are also positive about legislation, employers and policies (social system) relating to termination of pregnancy. This orientation creates a milieu that is conducive to transactions, interactions and goal attainment.The main recommendation is that three systems as proposed by King be continuously integrated within the termination of pregnancy setup through, amongst other measures: values clarification, management support, in service education, the inclusion of termination of pregnancy in undergraduate programmes, focus groups and the like. / Die doel van hierdie studie was om die verpleegkundige se persepsie van terminasie van swangerskap en haar persepsie van haar houding en gedrag teenoor kliёnte wat terminasie van swangerskap versoek, aan die hand van King se Sisteembenadering en Doelwitbereikingsteorie te ondersoek en te beskryf. `n Nie-eksperimentele kwantitatiewe beskrywende korrelasie navorsingsontwerp was gebruik. `n Nie-waarskynlike doelbewuste-steekproefneming van die staatsgesondheidsorg-instansies wat terminasie van swangerskapdienste aanbied, is geneem en wat beskikbaar vir hierdie studie was (21) asook die Marie Stopesdienste (3), in die Wes-Kaap. `n Nie-waarskynlike gerieflikheidsteekproefneming is van verpleegkundiges geneem wat swangerskappe in hierdie afdelings termineer of moet termineer (N=82). Data is met behulp van `n selfontwerpte vraelys ingesamel. Die hoofbevindings van die studie dui daarop dat respondente (persoonlike sisteem) positief voel oor hul werk. Formele ontwikkelingshulpbronne word egter nie optimaal deur die sisteem benut nie. Wat die interpersoonlike sisteem betref, toon respondente ook ‗n positiewe oriëntasie tot beide die vrou wat terminasie van swangerskap aanvra en die fetus. Die potensiaal tot transaksie-sluiting en uiteindelike doelwitbereiking is binne hierdie sisteem geleë. Die respondente is ook positief oor wetgewing en die werkgewer en beleid (sosiale siteem) ten opsigte van terminasie van swangerskap. Hierdie oriëntering laat ‗n milieu wat bevorderlik is vir transaksie-sluiting, interaksie en doelwitbereiking. Die hoofaanbeveling is dat voortdurend gepoog moet word na die integrasie van King se drie sisteme binne die terminasie van swangerskapafdelings deur onder meer: waarde-uitklaringswerkswinkels, ondersteuning van bestuur, indiensopleiding, die insluiting van terminasie van swangerskap in voorgraadse kurrikula, fokusgroepe en so meer. / Health Studies / D. Litt. et Phil. (Gesondheidstudies)

The aim of this study was to describe the nurses‘ perception of termination of pregnancy and her perception of her conduct towards clients that request termination of pregnancy guided by Kings‘ Systems Approach and Goal Attainment Theory. A non-experimental quantitative descriptive correlational design was used. A non-probability purposive sampling method was used consisting of institutions in the Western Cape, available to participate in this study, which deliver termination of pregnancy services, gov ernment health care institutions (21) and Marie Stopes clinics (3). Non-probability convenience sampling was used consisting of registered nurses who are working in termination of pregnancy units in these facilities (N=82). Data were collected through the administration of a self-designed questionnaire. The main findings of the study indicate that respondents (personal system) appear to feel positive about the work they are doing. Formal improvement and development are however not utilised optimally. Regarding the interpersonal system, respondents also show a positive orientation to both the woman opting for termination of pregnancy and the foetus. The potential towards transaction and ultimately goal attainment reside within this system. The respondents are also positive about legislation, employers and policies (social system) relating to termination of pregnancy. This orientation creates a milieu that is conducive to transactions, interactions and goal attainment.The main recommendation is that three systems as proposed by King be continuously integrated within the termination of pregnancy setup through, amongst other measures: values clarification, management support, in service education, the inclusion of termination of pregnancy in undergraduate programmes, focus groups and the like. / Die doel van hierdie studie was om die verpleegkundige se persepsie van terminasie van swangerskap en haar persepsie van haar houding en gedrag teenoor kliёnte wat terminasie van swangerskap versoek, aan die hand van King se Sisteembenadering en Doelwitbereikingsteorie te ondersoek en te beskryf. `n Nie-eksperimentele kwantitatiewe beskrywende korrelasie navorsingsontwerp was gebruik. `n Nie-waarskynlike doelbewuste-steekproefneming van die staatsgesondheidsorg-instansies wat terminasie van swangerskapdienste aanbied, is geneem en wat beskikbaar vir hierdie studie was (21) asook die Marie Stopesdienste (3), in die Wes-Kaap. `n Nie-waarskynlike gerieflikheidsteekproefneming is van verpleegkundiges geneem wat swangerskappe in hierdie afdelings termineer of moet termineer (N=82). Data is met behulp van `n selfontwerpte vraelys ingesamel. Die hoofbevindings van die studie dui daarop dat respondente (persoonlike sisteem) positief voel oor hul werk. Formele ontwikkelingshulpbronne word egter nie optimaal deur die sisteem benut nie. Wat die interpersoonlike sisteem betref, toon respondente ook ‗n positiewe oriëntasie tot beide die vrou wat terminasie van swangerskap aanvra en die fetus. Die potensiaal tot transaksie-sluiting en uiteindelike doelwitbereiking is binne hierdie sisteem geleë. Die respondente is ook positief oor wetgewing en die werkgewer en beleid (sosiale siteem) ten opsigte van terminasie van swangerskap. Hierdie oriëntering laat ‗n milieu wat bevorderlik is vir transaksie-sluiting, interaksie en doelwitbereiking. Die hoofaanbeveling is dat voortdurend gepoog moet word na die integrasie van King se drie sisteme binne die terminasie van swangerskapafdelings deur onder meer: waarde-uitklaringswerkswinkels, ondersteuning van bestuur, indiensopleiding, die insluiting van terminasie van swangerskap in voorgraadse kurrikula, fokusgroepe en so meer. / Health Studies / D. Litt. et Phil. (Gesondheidstudies)