It is a well-known fact that nurses generally work in challenging circumstances. Within the South-African context, a developing country, factors such as shortages of staff, lack of training and crowded hospitals are common occurrences. Large amounts of South-African-born nurses leave the country, or even the profession, with the hope of better career opportunities. The nurses that are left behind, automatically experience more pressure as their already heavy workload increases further. Staff shortages, which is a general problem in the nursing profession, is a great contributing factor to stress, as nurses sometimes need to work outside their scope of practice. A so-called "multi-skill" setup is then created, such as the Level-Two hospital where this research was conducted, where staff members did not necessarily receive formal training to carry out the tasks that are required from them. Multi-tasking from them then results in the nurse having to divide her attention. The above mentioned circumstances cause a great deal of stress for the nurse working within this setup. The aim of this research was to explore and describe the experience of nurses working in the multi-skill setup, as well as to explore and describe the nurses' view of effective coping mechanisms within the multi-skill setup, and to suggest guidelines for enhancing the emotional well-being of the nurse within the multi-skill setup. A purposive sample was conducted according to a list of inclusion criteria. The sample constituted of registered nurses, enrolled nurses, as well as enrolled nursing assistants employed at the particular Level-Two hospital in Gauteng. Semi-structured interviews were used in order to collect the richest data possible. Each of the interviews was recorded on digital compact discs, so that it could be transcribed verbatim. Data saturation was reached after ten interviews and the researcher analyzed the data, together with an independent co-coder. Consensus was reached between the researcher and the co-coder with regards to their individual analyses. Four main categories, each with their own sub-categories, were identified and discussed together with a literature control; namely; the experience of the multi-skill setup as positive, the experience of the multi-skill setup as negative, personal coping mechanisms within the multi-skill setup, as well as suggestions for the enhancing of the emotional well-being of the nurse within the multi-skill setup. Recommendations were formulated by the researcher relating to nursing research, nursing education, as well as to nursing practice. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2009.

It is a well-known fact that nurses generally work in challenging circumstances. Within the South-African context, a developing country, factors such as shortages of staff, lack of training and crowded hospitals are common occurrences. Large amounts of South-African-born nurses leave the country, or even the profession, with the hope of better career opportunities. The nurses that are left behind, automatically experience more pressure as their already heavy workload increases further. Staff shortages, which is a general problem in the nursing profession, is a great contributing factor to stress, as nurses sometimes need to work outside their scope of practice. A so-called "multi-skill" setup is then created, such as the Level-Two hospital where this research was conducted, where staff members did not necessarily receive formal training to carry out the tasks that are required from them. Multi-tasking from them then results in the nurse having to divide her attention. The above mentioned circumstances cause a great deal of stress for the nurse working within this setup. The aim of this research was to explore and describe the experience of nurses working in the multi-skill setup, as well as to explore and describe the nurses' view of effective coping mechanisms within the multi-skill setup, and to suggest guidelines for enhancing the emotional well-being of the nurse within the multi-skill setup. A purposive sample was conducted according to a list of inclusion criteria. The sample constituted of registered nurses, enrolled nurses, as well as enrolled nursing assistants employed at the particular Level-Two hospital in Gauteng. Semi-structured interviews were used in order to collect the richest data possible. Each of the interviews was recorded on digital compact discs, so that it could be transcribed verbatim. Data saturation was reached after ten interviews and the researcher analyzed the data, together with an independent co-coder. Consensus was reached between the researcher and the co-coder with regards to their individual analyses. Four main categories, each with their own sub-categories, were identified and discussed together with a literature control; namely; the experience of the multi-skill setup as positive, the experience of the multi-skill setup as negative, personal coping mechanisms within the multi-skill setup, as well as suggestions for the enhancing of the emotional well-being of the nurse within the multi-skill setup. Recommendations were formulated by the researcher relating to nursing research, nursing education, as well as to nursing practice. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2009.

Magister Curationis - MCur / The South African health care system shifted the focus of treating psychiatric disorders from institutional care level mental health services to facilitate this process of integration into the Primary Health Care (PHC) settings. All the provinces were thus engaged in improving mental health care services at community level by providing training for professional nurses in mental health at PHC settings. Consequently, mental health nursing has also changed considerably by shifting the focus of mental health care to the primary care level. It is however, suggested that the current revolving door syndrome experienced at psychiatric institutions was partly due to inadequate community-based psychiatric services. It was also suggested that the attitudes and knowledge of health professionals towards mental illness has a major impact on service delivery, treatment and outcome of mental illness. The aim of this research study was to assess the attitude of nursing staff working at a Community Health Centre (CHC) towards the mental health care user. A CHC was chosen that renders 24 hour services. The inclusive sample included all the different categories of nurses permanently employed at this CHC. The Attitude Scale for Mental Illness questionnaire was used to collect the data. Descriptive statistics: means, median and standard deviations were calculated for the following variables: separatism; stereotyping; restrictiveness; benevolence; pessimistic prediction and stigmatization. In conclusion it can be said that the nursing staff with more experience irrespective of category of nurse has less of a stereotyping attitude towards mental illness. The longer the nurse worked at the setting and irrespective of their nursing qualification the more positive their attitude towards the MHCU became.

The overall aim of this thesis was to study palliative end-of-life care outside specialist palliative care settings, from an organizational perspective and from professionals’ and relatives’ experiences. In Study I 174 individuals were identified retrospectively from nursing records and palliative care identification forms as being in a palliative phase. Data were analyzed with descriptive and analytic statistical methods. In Study II a total of nine nurses working in primary home care, community care, and hospitals were interviewed. Phenomenological methodology was used to analyze data. In Study III 17 enrolled nurses, who worked in community or primary care and in a sitting service organization, participated in four focus group interviews. Data were analyzed with qualitative content analysis. In Study IV seven relatives from four families were interviewed twice. They had each cared in the private home for a dying family member who had received sitting service. Direct interpretation and categorical aggregation were used to analyze data. The results highlight challenges in palliative care, vulnerable situations, and a need of support (I–IV). Individuals’ needs for both palliative care and sitting service were identified, including those of a smaller part of the population who actually received the sitting service. (I). Registered nurses’ responsibilities included care at the same time for individuals in both palliative and curative phases. This created vulnerable situations for the nurses, since their ambitions concerning the care did not correspond to available resources (II). The enrolled nurses’ task was to manage ongoing life and dying in different care settings, to meet individual needs and still provide equivalent care. Despite experiences of vulnerable situations, they felt safe (III). Relatives experienced care situations differently, related to differences in families, the illness trajectory, the need for support, and the support offered. Without sufficient support, vulnerable situations occurred, which made the relatives feel insecure (IV). Thus, care situations in palliative end-of-life care can be experienced in different ways, with different levels of vulnerability. One implication of the research might be to suggest that professional caregivers, to supplement the relatives’ own resources with support tailored to the individual’s and the family’s needs

An exploratory, descriptive qualitative design was used to describe and explore how the students experienced their clinical accompaniment in a specific programme. The researcher conducted a tape recorded interview to a 14 individual students, who voluntarily agreed to participate in the study, transcription followed, then data analysis was done following the steps as described by De Vos, Srydom, Fouché and Delport (2005:334) citing Creswell (1998:142) where open coding leads to themes and subthemes. From the findings of this study it was discovered that the students experienced dissatisfaction in terms of their development of clinical skills to competence as they were not given an opportunity due to negative circumstances around their training. Recommendations were made to improve clinical accompaniment of student nurses for all involved so that the student nurses acquire clinical skills, knowledge and values. / Health Studies / M.A. (Health Studies)

An exploratory, descriptive qualitative design was used to describe and explore how the students experienced their clinical accompaniment in a specific programme. The researcher conducted a tape recorded interview to a 14 individual students, who voluntarily agreed to participate in the study, transcription followed, then data analysis was done following the steps as described by De Vos, Srydom, Fouché and Delport (2005:334) citing Creswell (1998:142) where open coding leads to themes and subthemes. From the findings of this study it was discovered that the students experienced dissatisfaction in terms of their development of clinical skills to competence as they were not given an opportunity due to negative circumstances around their training. Recommendations were made to improve clinical accompaniment of student nurses for all involved so that the student nurses acquire clinical skills, knowledge and values. / Health Studies / M.A. (Health Studies)

The purpose of this study was to explore and describe the perceptions of pupil-enrolled nurses with regard to the integration of theory into practice. The study was qualitative in nature and used exploratory and descriptive designs. The population of this study consisted of all the pupil-enrolled nurses at a private nursing school in Pretoria. These pupil-enrolled nurses had received theoretical instruction and had been given the opportunity to be placed in a clinical setting for practical experience. Purposive sampling method was used to select participants for the study. Data relevant to the study was collected through focus group interviews. Data analysis was done using Tesch’s method of analysis (cited in Creswell 1994:154) and categories, subcategories and themes emerged. Consequently, the following main categories were identified: evidence of cognitive/psychomotor and affective development, professional preparation, obstacles to theory practice integration, management issues in the nursing school and solutions to integration of theory into practice problems. In terms of the findings of the study, the following recommendations were made: better communication should be fostered between the school and the clinical practice area; there should be constant clinical accompaniment of pupil-enrolled nurses; skills laboratories should be better equipped and tutors employed who have a nursing education qualification as well as experience; student status should be recognised in the clinical area. Communication between the nursing school and the clinical practice area should be improved and pupil-enrolled nurses should be fully supported when they are in the clinical practice area. / Dissertation (MCur)--University of Pretoria, 2011. / Nursing Science / unrestricted

Introduction: When enrolled nurses upgrade to newly-qualified professional nurses, they are considered more prepared to adapt to professional nurse roles and are expected to "hit the floor running". However, transitioning from enrolled nurse to newly-qualified professional nurse has been found difficult and stressful due to the shift from enrolled nurses' familiar dependent practitioner role to the less known professional nurses' independent practitioner role. Currently there is no official programme to address the transition support needs of newly-qualified professional nurses who upgrade from enrolled nurses in Mpumalanga private hospitals. In the Mpumalanga private hospitals, for the period 2012-2013, the estimated average turnover rate for newly-qualified professional nurses was 33-47%. Aim: The aim of this study was to explore and describe how newly-qualified professional nurses who upgraded from enrolled nurses experienced transition support during the transition period in private hospitals in the Mpumalanga Province. Research design: A qualitative holistic multiple case study research design was utilised to explore and describe how newly-qualified professional nurses who upgraded from enrolled nurses experienced transition support during the transition period in private hospitals in Mpumalanga Province. Method: Ten newly-qualified professional nurses, who graduated in 2012-2015 with a minimum of six months' and a maximum of four years' work experience in two private hospitals in Mpumalanga Province, participated in this study. In-depth semi-structured interviews were conducted and an inductive approach was utilised for content analysis of verbatim transcripts and field notes. Findings: The study found that at the private health care level, there is minimal understanding and recognition of the transition support needs of the newly-qualified professional nurse making the transition to clinical healthcare practice in private hospitals as professional nurses. Consequently, there is no newly-qualified professional nurse transition support programme during the transition period. Moreover, the newly-qualified professional nurse needs transition support mostly during the first two stages of the transition period. / Dissertation (MCur)--University of Pretoria, 2016. / Nursing Science / MCur / Unrestricted

The purpose of this longitudinal study was to evaluate the enrolled nurse/registered nurse (EN/RN) programme to determine the extent to which the graduates of the programme had acquired knowledge and skills to provide primary health care services to communities using the Stufflebeam CIPP model as a framework. The study determined the extent to which the graduates perceived that their knowledge and skills in provision of primary health care services have been strengthened and the extent to which their supervisors perceived the improvement of the graduates' knowledge and skills in provision of primary health care services in clinical and primary health care settings. The programme used two models for upgrading: one year full-time residential and two year distance education. The study used methodological triangulation for data collection. Data collection tools comprised of self-administered questionnaires to the EN/RN upgrade graduates, structured group interviews to their supervisors from the hospitals and district health teams and the review of the students' examination records from Institute of Health Sciences/University of Botswana (IHS/UB). Data were collected and analyzed from the one year full-time residential graduates who completed the programme from 1995-2000 and from the two year part-time distance education graduates who completed the programme 1996-2000. The findings from the academic records indicated that out of the 1116 enrolled nurses that were admitted into the EN/RN upgrade programme between 1994-2000 nine (0.8%) withdrew from the programme due to ill health or personal reasons before writing the final examinations. This is indicative of a high retention rate in the programme. In the one year full-time residential programme, out of the 695 enrolled nurses were admitted in the programme from 1995-2000 period five (0.7%) withdrew from the programme before writing the final examinations, 690 students sat for the final examination and 640 (92.8%) passed. In the two year part-time distance education programme, out of the 421 enrolled nurses were admitted in the programme from 1996-2000 period four (0.9%) withdrew from the programme before writing the final examinations, 417 students sat for the final examinations and 402 (96.4%) passed. Out of the 1107 students from both the one year full-time residential and the two year part-time distance education programme that sat for the final IHS/UB examinations, 1042 (94.1%) passed. The academic records revealed that the programme was efficient and effective because 1042 (94.1%) out of 1107 students completed the programme in one year and two years as planned because the programme was not repetitive and there were replacement costs. This high pass rate (94.1%) is an indication that the graduates did acquire knowledge and skills for provision of primary health care services. Data analysis from the self-administered questionnaires of the graduates also revealed that the graduates perceived that their knowledge and skills for provision of primary health care services have been strengthened because of the acquisition of the new knowledge in primary health care. This complemented the high academic performance of the graduates that the graduates knowledge and skills to deliver primary health care had been strengthened. Data analysis from the structured group interviews of the supervisors of the graduates further revealed that the supervisors perceived that the knowledge of the graduates in providing primary health care services in the hospitals and the district health teams had improved. The supervisors indicated that the graduates were now providing primary health care services with less supervision in the hospitals and the health districts. / Health Studies / D.Litt et Phil. (Health Studies)

Det övergripande syftet var att beskriva och jämföra sjuksköterskors och underskö­terskors bedömningar av patienters smärta, näringstillstånd och hudkostym samt de­ras uppfattningar om att använda bedömningsinstrument. Vidare att beskriva sjuk­sköterskors och undersköterskors uppfattningar om hur de bedömer patienters smärta, näringstillstånd och hudkostym. Metod: Etthundrasjuttio pati­entjournaler granskades. Intervjuer med sjuksköterskor (n=9) och undersköterskor (n=9) genomfördes. Resultatet av sjuksköterskors (n=34) och undersköterskors (n=43) bedömningar jämfördes. Interbedömarreliabilitet undersöktes när sjuk­sköterskor (n=50) och undersköterskor (n=61) använde bedömningsinstrument.  Resultat: Sextio pro­cent av patientjournalerna vid inskrivningen och 78 % vid utskrivningen innehöll do­kumentation om patientens hudstatus. Det fanns dokumentation om trycksår i 15 % respektive 20 % av patientjournalerna. Patienter som var i risk för trycksårutveckling enligt Modifierad Nortonskala (MNS) erhöll i medeltal 4,6 omvårdnadsåtgärder och patienter som ej var i risk erhöll i medeltal 3,8. Det var inte några tydliga grän­ser för hur sjuksköterskor och undersköterskor genomförde bedömningar, vem som gjorde vad och på vilket sätt det gjordes. Det var inga skillnader mellan sjukskö­terskors och undersköterskors bedömningar av risk för undernäring och trycksår när det gäller poäng för initial bedömning och totalpoäng. Det var dock skillnader i deras bedömningar av enskilda delskalor och smärta. Sjuksköterskors och undersköterskors uppfattning om hur det var att använda bedömningsinstrument varierade. Inter­bedömarreliabiliteten avseende MNS, Short- Form Mini Nutritional Assessment och trycksårkortet varierade mellan och inom sjuksköterskegruppen och undersköterskegruppen. Konklusioner: Sjuksköterskor dokumenterar inte alltid bedömning av patienters hudkostym och risk för trycksårutveckling. Det är såväl likheter som skillnader mellan sjuksköterskor och undersköterskor när det gäller hur de genomför bedömningar och resultatet av deras bedömningar. Interbedömarreliabilite­ten mellan och inom sjuksköterske- och undersköterskegruppen varierar vid deras bedömning med olika bedömningsinstrument och trycksårkort. Ett viktigt led i arbetet med att säkerställa patientsäkerhet och hög vårdkvalitet är att vara steget före och fortlö­pande bedöma patienters smärta, näringstillstånd och hudkostym. / The overall aim was to describe and compare registered nurses’ (RNs’) and enrolled nurses’ (ENs’) assessments of pain, nutrition and skin and their perceptions of using assessment tools. Further to describe RNs’ and ENs’ perceptions of how they assess patients’ pain, nutrition and skin. Methods: One hundred and seventy patient records were reviewed for patients with hip fracture. Interviews were conducted with RNs (n=9) and ENs (n=9). Results of the RNs’ (n=34) and ENs’ (n=43) assessments of patients with hip fracture were compared. Interrater reliability was examined between and among RNs (n=50) and ENs (n=61) using assessment tools for assessments (n=228) of patients with hip fracture and stroke. Results: Sixty percent of patient records on admission and 78% at discharge had documentation of the patient’s skin status. Pressure ulcers were documented in 15% and 20% of patient records respectively. Patients at risk for developing pressure ulcers according to the Modified Norton Scale (MNS) received a mean of 4.6 nursing interventions, while those not at risk received a mean of 3.8. There were no established boundaries between RNs’ and ENs’ assessment who performed it and in what way it was done. There were no differences between RNs’ and ENs’ as­sessments of risk for malnutrition and pressure ulcer regarding screening or total scores. However, there were differences regarding their assessments on the subscales and patients’ pain.  RNs’ and ENs’ perceptions of using assessment tools varied. Interrater reliability regarding MNS total score was very good among RNs, good among ENs and between RNs and ENs. For Short- Form Mini Nutritional Assessment screening score, interrater reliability was good between RNs and ENs and among RNs, while it was moderate among ENs. Interrater reliability between and among RNs and ENs varied for Pressure Ulcer Card. Conclusions: RNs do not always document assessment of patients’ skin and risk for pressure ulcer. Patients at risk for pressure ulcers receive more nursing interventions than patients not at risk. There are both similarities and differences between RNs and ENs regarding how they perform their assessments and what the results of their assessments are. Interrater reliability between and among RNs and ENs varies regarding the different assessment tools. An important part of the work in establishing patient safety and high quality of care is to be one step ahead and continuously assess the patients’ pain, nutrition and skin.