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All mothers and newborns deserve competent care and continuous support during the intrapartum period (Tinker et al., 2006:269). According to the Saving Mothers: Fifth Report on Confidential Enquiries into Maternal Deaths in South Africa, 2008-2010 (SA, 2011:4), the maternal mortality rate (MMR) is 176.22/100 000 live births (SA, 2011:4). The majority of maternal deaths are preventable and have many common preventable factors which are mostly related to the knowledge and skills of the healthcare providers and the challenges within the health care system (SA, 2011:5). The research was conducted in an attempt to make a meaningful contribution to the body of knowledge, specifically knowledge related to the experiences of women regarding the quality intrapartum care in a public hospital in Gauteng Province, and to make recommendations to enhance the quality of intrapartum care. A qualitative study design was used and data collected with the use of individual in-depth interviews. Purposive sampling was used to select participants who represent the target population. The sample used for the study included all women who had given birth within 24 hours before the interviews by normal vaginal delivery. A pilot study was conducted and the interview schedule was finalised. Sixteen individual in-depth interviews were done until data saturation had been achieved. Trustworthiness was ensured according to the principles of credibility, transferability, dependability and confirmability. A digital voice recorder was used to capture data and the data were transcribed verbatim. Field notes were written down for each interview. Data analysis was done by means of content analysis by the researcher and an independent co-coder. Themes and sub-themes were identified. The findings indicated that most of the women‟s experiences were positive regarding the quality of intrapartum care while a lesser percentage had had negative experiences. Identified areas of concern are staff attitudes, communication and staff shortages. Conclusions drawn are that women‟s experiences of quality of intrapartum care were that it is not of the highest standard. There is a need for provision of continuous emotional support during labour, improvement of staff attitudes and promotion of rooming-in, and a need not to be separated from their babies for long periods of time The research concluded with the researcher‟s recommendations for policy, nursing practice, nursing research and nursing education, for the enhancement and adherence of midwives to recommendations in improving the quality of intrapartum care in public hospitals. / MCur, North-West University, Potchefstroom Campus, 2014

The world of cancer care is a strange land to a person newly diagnosed with cancer. Like someone who leaves the familiarity of home and arrives in a foreign place, the person with cancer loses equilibrium and feels lost, experiences an assault on self-identity, and encounters an alien language and culture. It is this person who knocks as a stranger on the door of cancerland. Many philosophic and religious traditions obligate those receiving the stranger to provide a deep hospitality. One model of the practice of deep hospitality is summarized as door, table, space. When applied to the relationship between the cancer care provider and the patient/stranger, this hospitality can humanize the experience for both parties and is education in its elemental sense of drawing out and leading forth—into healing and wisdom.

The management of critically ill patients at end-of-life (EOL) is concerned with shifting the focus of care from curing disease to maximizing comfort and ensuring the needs of the patient and family (Carey & Cosgrove 2006). Despite the availability of a wide range of EOL care studies, there appears to be inadequate knowledge of how best intensive care nurses can cope and provide ethical, quality, humane, holistic and comfort care for the dying patients including these patients’ family members in the ICU. Purpose: To develop best practice guidelines for end-of-life care for intensive care nurses in adult intensive care units at three tertiary level III hospitals in Gauteng province. Objectives: 1) To search and analyze for quality research discourse on EOL care by means of a systematic review, 2) To search for evidence on EOL care through interviews with family members, interviews with critically ill patients and focus group discussions with intensive care nurses. 3) To develop best practice guidelines for intensive care nurses on EOL care. 4) To verify the tentative best practice guidelines using an Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. Design: Both quantitative and qualitative approaches were used to achieve the aim of the study. Systematic review, semi structured interviews and focus group discussions were utilized during data collection in the various steps of the study. During data analysis, meta-synthesis was utilized for systematic review; Tesch’s (1992) eight steps of analysis were used for semi structured interviews whereas the long-table approach was used to analyze transcripts from focus groups. The process of guideline development was divided into three stages: Stage I involved the search for quality research evidence on EOL care (this was conducted in 4 steps: In step 1, a systematic review of both qualitative and quantitative articles on EOL care was conducted yielding 23 articles, step 2 included individual interviews with 17 purposively selected family members, step 3 involved individual interviews with 16 purposively selected critically ill patients whereas step 4 included three focus group discussions with 24 purposively selected intensive care nurses). Stage II involved development of best practice guidelines in form of recommendations by means of synthesising and integrating conclusions from stage I. stage III involved verification of the guidelines by four purposively selected verifiers using the AGREE II instrument. Findings: The main findings obtained from the four steps in stage I of the study were as follows: step 1) the findings from systematic review were grouped as factors that enable or complicate EOL care, patients’/family members’/nurses’ experiences of EOL care and decision making processes at EOL. Step 2) Five major themes emerged from the experiences of family members on EOL care. These included: “most of the time we are in darkness”, “emotional support”, “involvement”, “you feel you should see her face more often” and “spiritual support”. Step 3) Five major themes were identified from the experiences of critically ill patients on comfort care and they included: “being in someone’s shoes”, “communication”, “trust”, “presence” and “religion and spirituality”. Step 4) Focus group discussion with the intensive care nurses led to five major themes including: “difficulties we get”, “discussion and decision making”, “support for patients”, support for families” and support for nurses. Conclusions drawn from stage I provided evidence for the development of best practice guidelines. Based on the conclusions drawn, guidelines developed were divided into three categories related to: communication, caring and negative aspects impacting on EOL care. The tentative guidelines were verified by a panel of four experts. The verifiers’ feedback, recommendations, criticisms and suggestions were analysed and incorporated into the guidelines. Conclusions: Guidelines were developed to inform nursing practice, nursing management and nursing education. Communication recommendations focused on how to effectively communicate as a health care team as well as instituting communication strategies in dealing with dying patients and their families. Caring recommendations were intended to promote quality care for patients and families at EOL and more so, the care needed by nurses in order for them to continue rendering holistic nursing care. Negative factors impacting on EOL care reflected on what need to be improved so as to ensure quality EOL care. In general, the guidelines were rated to be of high quality and were recommended for use by the verifiers.

In the setting of the critical care unit, the nurse is caring for the critically ill patients and is the care giver who is present at the bedside for 24 hours. The nurse comes into contact with all other disciplines attending to the patient and is thus often the common link in the multidisciplinary team. It is therefore essential that there is effective collaboration between the physician and the nursing practitioner.With the world-wide shortage of skilled nurses worsening, it is imperative that we look at a means of retaining our current nursing personnel and attracting new nurses into the profession. Many studies examining the relationship between a healthy work environment and the retention of nurses have rated collaboration as a key aspect. The setting for this study was five critical care units within the private health care sector. The study investigated both nurses’ and physicians’ attitudes towards collaboration in critical care units, as well as identifying factors which facilitate and constrain effective physician-nurse collaboration. Recommendations for enhancing collaboration within the critical care unit were explored. In this study a non-experimental descriptive design was be used. The Jefferson Scale of Attitudes toward Physician-Nurse Collaboration, a 15 statement Likert scale, was utilized to collect data from both the nurses and the physicians. The data was analysed using factor analysis and descriptive statistics. The results showed that nurses had a slightly more positive attitude toward collaboration as compared to the physicians, however the difference in the overall scores was not statistically significant.

This research investigates the relationship between the crises of care and finance, and efforts to ensure that care is valued more highly. It explores why investment funds have acquired care homes, how they realise value, and the implications for workers and residents. It also examines the factors that have limited financialisation, including the activities of social and labour movements. These developments are studied through empirical case studies of three major UK care companies, and analysis of the strategies of selected movements in the UK and US. The research involved 64 interviews, observation and document analysis. A geographical perspective helps to illuminate uneven investment in real estate, the quality of the care homes produced, and the spatial dimensions of organising within globalised care systems. The research finds that financial ownership of care companies has been driven by their real estate assets, the availability of debt financing, and specific business models. Corporate debt has also enabled governments to displace and depoliticise responsibility for funding care. However, finance has not replaced labour as a source of value: care remains labour intensive and value can be extracted from low-status, poorly organised workers and clients. The thesis deploys feminist care ethics to analyse the effects of financial ownership and crisis on labour and residents, including evictions that result from care home closures and the production of new, 'hotel-like' facilities. Financialisation has, though, been limited by a lack of material resources in care and political opposition. In contesting financialised care, movements have used stories to locate economic agency; to address political, experiential and affective divides; and to promote alternative social relations of interdependence. Organising is crucial to creating space for such stories. Overall, financialisation has been enabled by the undervaluing of care, but it has also been limited by social values and relationships associated with care.

Thesis (M.A.)--University of Texas at Arlington, 2008.

Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008. / Full text also available online. Scroll down for electronic link.