Registered nurses are the first contact for individuals seeking medical attention in the health system. These nurses have leaders who encourage them and they have goals and dreams to reach. The leadership of a hospital are responsible for creating a positive working environment so as to maintain job satisfaction for all. When subordinates are satisfied with their job they tend to stay and become more productive in their workplace. Leadership has an influence on the level of job satisfaction and therefore influences whether they leave or stay in the workplace. The objectives of the study were to describe the status of leadership, job satisfaction and the intention to leave among registered nurses in hospitals in the North-West and Free State Provinces. The relationship between leadership, job satisfaction and intention to leave among registered nurses in hospitals in the North-West and Free State Provinces was also investigated. The research design in this study was quantitative, descriptive, explanatory and contextual in nature. The sample included registered nurses (RNs) in medical and surgical units in both private and public hospitals in the North-West and Free State provinces of South Africa, (n = 204). Data was collected using the RN4CAST questionnaire. EpiData and SPSS statistical programmes were used to analyze data. The results of the study showed that most registered nurses were satisfied with the items of leadership except for the praise and recognition item (55.7%). Most registered nurses showed high levels of overall job satisfaction (70.5%), but were dissatisfied with wages (50%), study leave (40.9%) and opportunity for advancement (40.1%). Furthermore, the registered nurses showed high intention to leave their current hospitals (46.1%). The results also indicated a relationship between leadership, job satisfaction and intention to leave among registered nurses in medical and surgical wards in both private and public hospitals. Recommendations for policy, education, practice and future research were made. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Registered nurses are the first contact for individuals seeking medical attention in the health system. These nurses have leaders who encourage them and they have goals and dreams to reach. The leadership of a hospital are responsible for creating a positive working environment so as to maintain job satisfaction for all. When subordinates are satisfied with their job they tend to stay and become more productive in their workplace. Leadership has an influence on the level of job satisfaction and therefore influences whether they leave or stay in the workplace. The objectives of the study were to describe the status of leadership, job satisfaction and the intention to leave among registered nurses in hospitals in the North-West and Free State Provinces. The relationship between leadership, job satisfaction and intention to leave among registered nurses in hospitals in the North-West and Free State Provinces was also investigated. The research design in this study was quantitative, descriptive, explanatory and contextual in nature. The sample included registered nurses (RNs) in medical and surgical units in both private and public hospitals in the North-West and Free State provinces of South Africa, (n = 204). Data was collected using the RN4CAST questionnaire. EpiData and SPSS statistical programmes were used to analyze data. The results of the study showed that most registered nurses were satisfied with the items of leadership except for the praise and recognition item (55.7%). Most registered nurses showed high levels of overall job satisfaction (70.5%), but were dissatisfied with wages (50%), study leave (40.9%) and opportunity for advancement (40.1%). Furthermore, the registered nurses showed high intention to leave their current hospitals (46.1%). The results also indicated a relationship between leadership, job satisfaction and intention to leave among registered nurses in medical and surgical wards in both private and public hospitals. Recommendations for policy, education, practice and future research were made. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Providing mental health care to involuntary mental health care users (MHCUs) is challenging and an ethical adversity nurses often have to deal with. The literature, in general, indicates that nurses might possess coping and resiliency in the work environment where they are often faced with adversities. However there is a paucity of information regarding the resilience of nurses providing mental health care (MHC) to involuntary MHCUs. Therefore the research objectives explored the resilience of nurses using the Connor-Davidson scale (CD-RISC), to explore and describe how nurses cope and strengthen their resilience in providing MHC to involuntary MHCUs and to formulate guidelines to strengthen the resilience of these nurses to provide quality nursing care in the work environment where MHCUs are often involuntarily admitted. To achieve these objectives, the research followed both a qualitative and quantitative approach and an exploratory and descriptive design which was contextual in nature. A convenience sampling method was used to achieve a sample size of 28 participants, who were handed questionnaires to complete, containing demographical information, the CD-RISC and a narrative. A response rate of 85.7% was reached. Quantitative data was analysed by using the SPSS programme while data from narratives, for the qualitative data, were grouped and themed. The results in the first phase indicated that resiliency was high amongst participants, as the mean score of the CD-RISC was 79.9 out of a total score of 100; whilst only one participant scored below 50. The mean for the highest scores was on item 25 (pride in your achievements) (3.8) and item 10 (best effort no matter what) (3.6) and two critical aspects which scored low were item 18 (make unpopular or difficult decisions) and item 19 (can handle unpopular feelings) (2.3) amongst participants. Interestingly, the majority of participants (66.7%) do not have training in psychiatric nursing. In the second phase, two themes were identified from the questions. The first theme “Coping mechanisms” identified four methods to cope with involuntary MHCUs. These subthemes are “support system”, “knowledge, skills and experience”, “nurse-patient relationship” and “spirituality and selfcare”. The second theme “Resilience strategies” brought forth five subthemes as follows: “support”, “trained staff”, “security measures and safety”, “teamwork” and “in-service training and education”. Conclusions suggest that nurses are resilient to provide MHC for involuntary MHCUs. Furthermore, they take pride in their achievements and have passion for their work. On the contrary, they find it difficult to make unpopular decisions which affect others and to handle unpleasant feelings. This is indicative of internal conflict and difficulty in being assertive. Nurses take pride in their achievements and want to give nursing care that’s in the best interest of the MHCUs whilst they feel that they might not always be able to do so due to the involuntary nature of the MHCUs admission and treatment. Recommendations for nursing practice, namely guidelines to strengthen the resilience of nurses providing mental health care to involuntary MHCUs could be developed from the research findings. Facilitating assertiveness and a supportive environment might strengthen resilience and should be addressed by management and supervisors. Recommendations for nursing education and further research were also formulated. / MCur, North-West University, Potchefstroom Campus, 2015

The aim of this study was to make recommendations for the facilitation of professional socialization of the newly qualified registered nurse (NQRN) through exploration and description of the NQRN„s experience of professional socialization at a specific private hospital and factors that may contribute to the resignation of bursary holders. The rationale behind this study was that bursary holders resign before or just after completing their contractual binding. An explorative, descriptive and qualitative research design was used. The sample included al the NQRN who met the inclusive criteria. Data collection was done by the writing of narratives by eight (8) participant‟s and followed with a focus group discussion to confirm the data. The contents was analyzed independently by two coders and three (3) themes and four (4) sub themes where identified. The first theme describes the NQRNs‟ experience of professional socialization and includes the sub themes, organizational climate and accompaniment. The second theme describes the reasons for resignation, namely salary and further study or training. A third theme describes the participants‟ recommendations to management to prevent resignation. The themes were described with relevant research- and subject literature. Each theme was summarized in a conclusion that served as basis for recommendations regarding the facilitation of the NQRNs‟ professional socialization to the private hospital‟s management and training department, as well as recommendations for further research. The study was concluded with the researcher‟s evaluation of the study, identification of limitations and the researcher‟s reflection on the study. / MCur, North-West University, Potchefstroom Campus, 2014

Providing mental health care to involuntary mental health care users (MHCUs) is challenging and an ethical adversity nurses often have to deal with. The literature, in general, indicates that nurses might possess coping and resiliency in the work environment where they are often faced with adversities. However there is a paucity of information regarding the resilience of nurses providing mental health care (MHC) to involuntary MHCUs. Therefore the research objectives explored the resilience of nurses using the Connor-Davidson scale (CD-RISC), to explore and describe how nurses cope and strengthen their resilience in providing MHC to involuntary MHCUs and to formulate guidelines to strengthen the resilience of these nurses to provide quality nursing care in the work environment where MHCUs are often involuntarily admitted. To achieve these objectives, the research followed both a qualitative and quantitative approach and an exploratory and descriptive design which was contextual in nature. A convenience sampling method was used to achieve a sample size of 28 participants, who were handed questionnaires to complete, containing demographical information, the CD-RISC and a narrative. A response rate of 85.7% was reached. Quantitative data was analysed by using the SPSS programme while data from narratives, for the qualitative data, were grouped and themed. The results in the first phase indicated that resiliency was high amongst participants, as the mean score of the CD-RISC was 79.9 out of a total score of 100; whilst only one participant scored below 50. The mean for the highest scores was on item 25 (pride in your achievements) (3.8) and item 10 (best effort no matter what) (3.6) and two critical aspects which scored low were item 18 (make unpopular or difficult decisions) and item 19 (can handle unpopular feelings) (2.3) amongst participants. Interestingly, the majority of participants (66.7%) do not have training in psychiatric nursing. In the second phase, two themes were identified from the questions. The first theme “Coping mechanisms” identified four methods to cope with involuntary MHCUs. These subthemes are “support system”, “knowledge, skills and experience”, “nurse-patient relationship” and “spirituality and selfcare”. The second theme “Resilience strategies” brought forth five subthemes as follows: “support”, “trained staff”, “security measures and safety”, “teamwork” and “in-service training and education”. Conclusions suggest that nurses are resilient to provide MHC for involuntary MHCUs. Furthermore, they take pride in their achievements and have passion for their work. On the contrary, they find it difficult to make unpopular decisions which affect others and to handle unpleasant feelings. This is indicative of internal conflict and difficulty in being assertive. Nurses take pride in their achievements and want to give nursing care that’s in the best interest of the MHCUs whilst they feel that they might not always be able to do so due to the involuntary nature of the MHCUs admission and treatment. Recommendations for nursing practice, namely guidelines to strengthen the resilience of nurses providing mental health care to involuntary MHCUs could be developed from the research findings. Facilitating assertiveness and a supportive environment might strengthen resilience and should be addressed by management and supervisors. Recommendations for nursing education and further research were also formulated. / MCur, North-West University, Potchefstroom Campus, 2015

The aim of this study was to make recommendations for the facilitation of professional socialization of the newly qualified registered nurse (NQRN) through exploration and description of the NQRN„s experience of professional socialization at a specific private hospital and factors that may contribute to the resignation of bursary holders. The rationale behind this study was that bursary holders resign before or just after completing their contractual binding. An explorative, descriptive and qualitative research design was used. The sample included al the NQRN who met the inclusive criteria. Data collection was done by the writing of narratives by eight (8) participant‟s and followed with a focus group discussion to confirm the data. The contents was analyzed independently by two coders and three (3) themes and four (4) sub themes where identified. The first theme describes the NQRNs‟ experience of professional socialization and includes the sub themes, organizational climate and accompaniment. The second theme describes the reasons for resignation, namely salary and further study or training. A third theme describes the participants‟ recommendations to management to prevent resignation. The themes were described with relevant research- and subject literature. Each theme was summarized in a conclusion that served as basis for recommendations regarding the facilitation of the NQRNs‟ professional socialization to the private hospital‟s management and training department, as well as recommendations for further research. The study was concluded with the researcher‟s evaluation of the study, identification of limitations and the researcher‟s reflection on the study. / MCur, North-West University, Potchefstroom Campus, 2014

Registered counsellors were regarded as part of the solution to the ever-increasing void in mental healthcare and were acknowledged by the South African government over a decade ago. Some challenges have however arisen regarding the implementing of their vocations in the community, that impact service delivery as well as career satisfaction of registered counsellors, but limited information is available in terms of the exploration of the perceptions of registered counsellors regarding their role in the South African context. This study focused on exploring how registered counsellors perceive their role in South Africa and describing these perceptions. This research is important because little is known about the perceptions of registered counsellors and their experience of their role in the South African context. The research was conducted in Johannesburg and Kwa-Zulu Natal, South Africa. 12 participants (one man and 11 women) volunteered to be part of the research. The size of the sample was not predetermined, but was rather based on data saturation. The participants were purposefully selected on the basis of having acquired the registration of registered counsellor with the Health Professions Council of South Africa (HPCSA). Data was collected through conducting semi-structured interviews with all the participants. An interview schedule was used to facilitate the interview process for consistency in the interviews. Thematic analysis was utilised to delineate different themes. To ensure the trustworthiness of the research process, the guidelines suggested by Lincoln and Guba (1985) were followed. The current researcher found that the registered counsellors experienced conflicting perceptions of their role in South Africa. They felt that their role was a necessary and important one in South Africa and in the context of the development of mental healthcare in South Africa. However, some negative feelings were also expressed as they experienced uncertainty regarding their role in the profession as well as the changing scope of practice for registered counsellors in South Africa. Additional negative perceptions were associated with a lack of acknowledgement of their role by other mental healthcare professionals and some ignorance from the public regarding the work of registered counsellors. To promote adequate mental healthcare in South Africa, mental health professionals such as registered counsellors are particularly important. But what appears to be the uncertainty and a lack of information related to the role of registered counsellors, has impacted negatively on their perception of their role in South Africa and, as a result, many individuals do not work in the professional mental healthcare field. It is recommended that the perception of the registered counsellors be acknowledged and taken into consideration to further the development of mental healthcare and treatment for mental health difficulties within the South African context. / MA (Psychology), North-West University, Potchefstroom Campus, 2014

Registered counsellors were regarded as part of the solution to the ever-increasing void in mental healthcare and were acknowledged by the South African government over a decade ago. Some challenges have however arisen regarding the implementing of their vocations in the community, that impact service delivery as well as career satisfaction of registered counsellors, but limited information is available in terms of the exploration of the perceptions of registered counsellors regarding their role in the South African context. This study focused on exploring how registered counsellors perceive their role in South Africa and describing these perceptions. This research is important because little is known about the perceptions of registered counsellors and their experience of their role in the South African context. The research was conducted in Johannesburg and Kwa-Zulu Natal, South Africa. 12 participants (one man and 11 women) volunteered to be part of the research. The size of the sample was not predetermined, but was rather based on data saturation. The participants were purposefully selected on the basis of having acquired the registration of registered counsellor with the Health Professions Council of South Africa (HPCSA). Data was collected through conducting semi-structured interviews with all the participants. An interview schedule was used to facilitate the interview process for consistency in the interviews. Thematic analysis was utilised to delineate different themes. To ensure the trustworthiness of the research process, the guidelines suggested by Lincoln and Guba (1985) were followed. The current researcher found that the registered counsellors experienced conflicting perceptions of their role in South Africa. They felt that their role was a necessary and important one in South Africa and in the context of the development of mental healthcare in South Africa. However, some negative feelings were also expressed as they experienced uncertainty regarding their role in the profession as well as the changing scope of practice for registered counsellors in South Africa. Additional negative perceptions were associated with a lack of acknowledgement of their role by other mental healthcare professionals and some ignorance from the public regarding the work of registered counsellors. To promote adequate mental healthcare in South Africa, mental health professionals such as registered counsellors are particularly important. But what appears to be the uncertainty and a lack of information related to the role of registered counsellors, has impacted negatively on their perception of their role in South Africa and, as a result, many individuals do not work in the professional mental healthcare field. It is recommended that the perception of the registered counsellors be acknowledged and taken into consideration to further the development of mental healthcare and treatment for mental health difficulties within the South African context. / MA (Psychology), North-West University, Potchefstroom Campus, 2014

Text in Afrikaans / Die effek van die klient-verpleegkundige-verhoudings op kliente se keuse en volgehoue gebruik van kontraseptiewe metodes het tot op hede baie min aandag geniet. Die doel van hierdie studie was 'n ondersoek na die ongetroude klient se persepsie van die verpleegkundige se houding. Die steekproef het bestaan uit 99 kliente (tussen die ouderdomme van 15 en 50 jaar) wat die betrokke reproduktiewegesondheidsklinieke in die Kaapse Metropool besoek het. Die eerste 20 kliente wat die kliniek besoek het, is genader om 'n vraelys in te vul. Hierdie studie toon 'n algehele positiwiteit, naamlik 58,3% teenoor die houding van geregistreerde verpleegkundiges. Die meerderheid van die kliente (88,0%) het aangedui dat hulle weer die kliniek sal besoek wat dus die kliente se tevredenheid toon. / The effect of the client-registered nurse relationship on clients' choice and continuous use of contraceptive methods has until now received very little attention. The purpose of this study was to explore unmarried clients' perception of the attitude of the registered nurse. The sample existed of 99 clients (between the ages of 15 and 50 years) who visited the relevant reproductive health clinics in the Cape Metropole. The first 20 clients who visited the clinic were approached to complete a questionnaire. This study shows an overall positivity of 58,3% with regard to the attitude of registered nurses. Most of the clients (88,0%) indicated that they would visit the clinic again, which indicate their satisfaction. / Health Studies / M.A. (Nursing Science)

“Off-label use” is defined as the use of medicine for indications other than recommended or registered for, e.g. the prescribing of a particular active substance for a patient younger than the substance is recommended or indicated for, or different formulations or dosages of a substance (Ekins-Daukes et al., 2004:349; Stedman’s medical dictionary, 2006). Off-label prescribing is common, and fluctuates by physician, patient and drug (Eguale et al., 2012:781). Drug classes most commonly prescribed off-label include anti-asthmatic, cardiovascular drugs and antidepressants. Lee et al. (2012:140) found that 9 out of 10 antidepressants prescribed were associated with unapproved usage of antidepressants. An antidepressant can be defined as a substance that prevents or relieves depression or depressive episodes (Mosby, 2009:115). There is paucity of information on the off-label prescribing practices of antidepressants in the South African private health sector. According to Eguale et al. (2012:781), the paucity of information on off-label prescribing practices may be, in part, ascribed to the difficulty in the establishment of reasons for treatment. The objective of this study was to determine the prescribing patterns of antidepressants as well as to identify off-label prescribing of antidepressants among adults in a section of the private health sector of South Africa by using a medicine claims database. A quantitative and observational, descriptive cross-sectional design was followed in this study. Data for a period of a year, from January to December 2010 were obtained for analysis. The data set consisted of medicine claims for a total number of 1 220 289 patients, containing a total of 8 515 428 prescriptions and 20 527 777 medicine items. The study population (patients receiving antidepressants 18 years and older) accounted for 14.8% (n = 1 220 289) of the total data set. The average age of patients receiving antidepressants was 56.1 ± 16.6 (median = 56.2) (Inter quartile range = 43.3–68.1). Results of the study showed that antidepressant prescriptions accounted for 8.3% (n = 8 515 428) of all prescriptions claimed during 2010. A total 3.5 % (n = 20 527 777) of antidepressants were claimed during the study period. Using the DU90% method it was established that the majority of antidepressant medicine items were prescribed by general practitioners (i.e. 75.7%, n = 702 285) and psychiatrists (14.9%, n = 702 285). Almost 72% (n = 702 885) of antidepressant medicine items claimed for the study population were for women. The most prescribed antidepressants (based on the DU90%) were amitriptyline (20.6%, n = 702 885), citalopram (19.2%), escitalopram (14.6%), fluoxetine (11.7%), venlafaxine (5.7%), paroxetine (5.2%), duloxetine (4.4%), sertraline (3.8%), bupropion (3.1%) and mirtazapine (2.6%). Amitriptyline accounted for 82.4% of off-label prescriptions (n = 2 635), whereas escitalopram and fluoxetine accounted for 4.2% and 3.8%, respectively. The tricyclic antidepressants (TCAs) were mostly prescribed off-label for migraine, headache and sleep disorders. The off-label prescribing of selective serotonin re-uptake inhibitors (SSRIs) included menopause, schizophrenia and headache. The off-label indicated prescriptions of the serotonin and noradrenaline re-uptake inhibitors (SNRIs) were mostly for schizophrenia and other anxiety disorders. Mirtazapine, a serotonin modulator/tetracyclic antidepressant, was mostly prescribed off-label for anxiety disorders. Off-label prescriptions for bupropion, a noradrenaline and dopamine re-uptake inhibitor mainly included other anxiety disorders and attention deficit hyperactivity disorder (ADHD). Furthermore, the prescribed daily dose (PDD) of each active antidepressant for all off-label indications was determined. In conclusion: This study investigated the off-label prescribing patterns of antidepressants among adults a section of the private health sector of a South Africa, using a large medicine claims database. Recommendations for future research were made. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014