Aim: The study aimed at describing the status of implementation of pre-service IMCI training in the public nursing colleges of South Africa as at 2010. Methods: A cross sectional descriptive survey of public nursing colleges of South Africa was conducted from May to June 2011. There are 32 public nursing colleges in South Africa, and each of the nine provinces has at least one. All 32 nursing colleges were included in the study. Study population: The study population included all nurse educators in the public nursing colleges teaching pre-service IMCI of student nurses in South Africa. Sampling: Two nurse educators teaching the IMCI strategy from each of the 32 public nursing colleges was included in the survey. Two nurse educators from each completed the questionnaire.Results: Pre-service IMCI training was introduced into the four-year basic diploma curriculum in the public nursing colleges between 2004 and 2009. Nurse educators teaching IMCI are not all trained in this strategy. Teaching methods used at these public nursing colleges include lectures, group discussions, practical and video shows. The availability of facilitators and training material are key success factors to IMCI teaching in the public nursing colleges. Constraints experienced included lack of human, material and financial resources, poor planning, and limited time for both theoretical and practical teaching due to a packed curriculum, as well as a lack of managerial support at all administrative levels. Conclusion: The success in pre-service IMCI training in the public nursing colleges depends on the availability of resources and ongoing managerial support to the nurse educators. New teaching methods and approaches, such as computerised tools, can be introduced to increase number of student nurses trained in this method. A mixed approach is recommended as it enables students to have continuous exposure to IMCI sessions throughout their years of study.

Student Number : 0317159E - MSc(Nursing) research report - School of Therapeutics - Faculty of Health Sciences / The learning environment and supervision in clinical placement play an important role in nursing education. The purpose of this study was to describe the opinions of student nurses with regard to the clinical learning environment and supervision at Malamulo Hospital, Malawi. A quantitative descriptive design was used. Data were collected from nursing students at Malamulo College of Health Science using the Clinical Learning Environment Scale (CLES) comprising structured questions. The questionnaire was administered to the total population of students (N=84) and the response rate was 87% (n=73). Descriptive statistics were used to analyze data. Relationships between variables were determined by using Fisher’s exact test and the t-test. The findings revealed that the majority of the participants were satisfied with their clinical learning environment and supervision in their latest clinical placement. Particularly, they were satisfied with the relationship that prevailed between students and members of nursing staff, feedback they received from their supervisors, the nursing care given to patients and the quality of learning opportunities. However, it was determined that nurse teachers did not regularly supervise students and also that some students were not clear about the nursing philosophy of their wards. Ward familiarization processes were not well planned as indicated by about a third of the participants. More than one third also indicated that the learning situations were not sufficient and not meaningful. While 73.98 % indicated that they received constructive feedback from their supervisors, about half of the participants indicated that the feedback was not given continuously.The majority (67.76%) of the participants experienced team supervision as opposed to individual supervision. Therefore it is recommended that nurse teachers increase the number of visits to the wards when students are in clinical placement to improve quality of clinical learning. The nursing college may need to have specific clinical instructors who are trained in clinical supervision and who will be available for students in the clinical placements regularly. The ward managers and the nursing staff need to clarify and display their ward nursing philosophy so that both nurses and students can have a common understanding and common goal in the provision of nursing care. It is also recommended that feedback be given to students continuously to enhance learning.

The lack of nurses and the increasing turnover rate have been the main subjects when looking at the news about the health care sector. The constant lack of nurses can cause a lack of motivation and the nurses are leaving the workplaces, as the stress level rises. Nurses have also been discovered to have an impact on the patient satisfaction, which is why it is important to keep the nurses satisfied in their work. To understand what motivates the nurses and what could be done in order to make the situation better, more research is needed.  Non-financial motivation has been seen as a preferred way of motivating nurses in the hospital environment, which is why this study has a focus on it. Earlier studies have mainly focused on the nurse viewpoint of motivation and to further develop the understanding on the area, the viewpoint of managers is needed to be taken into consideration, to understand the issue more in-depth. To research the subject more, a study was conducted focusing on the emergency room at the University Hospital of Umeå and the nurses and managers working there.  The aim of this study is to understand how the views and preferences regarding non-financial motivation meet between the nurses and managers in the emergency room at the University Hospital of Umeå and which factors are the most preferred. Further, it is of interest to understand how this meeting of thoughts affects the everyday work and the motivation of the nurses. The following research questions was formed to answer the question:  How do nurses and their managers in the emergency room assess non-financial motivation factors?  The study has been conducted using qualitative methods and semi-structured face-to-face interviews. Additional data was gathered through e-mail interviews, as well as over telephone, and a reflective interviewee from another hospital was interviewed to gain more insight on the subject from another viewpoint.  The results from the study highlight the common importance for effective and emotionally intelligent leaders, who listen and have time for the subordinates. Further, work colleagues and the possibility for competence development were seen as commonly important factors to affect to the non-financial motivation of the nurses.  Practical implications from the study provide new data concerning the non-financial preferences and how the viewpoints meet and differ between nurses and managers who work in different roles in the hospital. Furthermore, this study could be of use to help to understand what could be done to better in order to motivate the nurses. Although, as the study is focusing on a specific department, it is important to acknowledge the impact and possible differences between the personnel chemistry and recent position changes.

Background: Every year, about 800 000 people in the world commits suicide, which makes ita serious global public health problem. There are several risk factors that increases the risk ofa person committing suicide. The stigma is a major problem and suicidal patients hasexperienced a poor treatment from nurses in emergency care. Nurses has a significant role inthe care of suicidal patients. Aim: The aim was to describe nurses experience in the care of suicidal patients in emergencycare. Method: A literature review based on 12 scientific articles. Results: The literature review resulted in four different themes; a meeting that evokesfeelings, the nurses approach, shortcomings in the department and the need for education. Conclusion: Nurses experience discomfort and difficulties in the care of suicidal patients.Prejudices and religious values could result in a negative attitude which could have aninfluence on the quality of the nursing care. Nurses are in need of education and to haveguidelines for the care of suicidal patients. Suggestions for continued research: Suggestions for continued research is how religiousvalues affect the suicidal patient. Another suggestion is that more studies within emergencycare are made related to what kind of effects education has on the nurse in the care of suicidalpatients.

Identificar e analisar a representação social dos enfermeiros de Hospital Geral frente ao paciente alcoolista e à etiologia para o alcoolismo. Os sujeitos do estudo foram 20 enfermeiros de três Hospitais Gerais de uma cidade do interior de São Paulo (Brasil). Os dados foram coletados por meio de entrevistas autogravadas que foram transcritas e analisadas pelo método da Análise de Conteúdo, tendo como categoria para análise o referencial teórico da representação social. Da análise dos dados, emergiram duas categorias empíricas: 1-Representação social dos enfermeiros frente ao paciente alcoolista e 2- Representação da etiologia para o alcoolismo Os resultados apontaram que os enfermeiros concebem o paciente alcoolista como uma pessoa doente, portanto, o alcoolismo como uma doença. Em relação ao trabalhar com esse tipo de paciente, alegaram que é de difícil manejo, tendo em vista que os profissionais não estão preparados para atuar com este tipo de paciente e que sua assistência é permeada pelo estigma e preconceito. Na representação desses enfermeiros, a etiologia do alcoolismo está relacionada às questões sociais, psicológicas, emocionais e biológicas. Concluiu-se que a representação dos sujeitos do estudo frente ao paciente alcoolista e a etiologia para o alcoolismo estão atreladas mais ao senso comum do que ao conhecimento técnico-científico, o que em última análise remete à necessidade de melhor preparo e capacitação dos profissionais enfermeiros sobre a temática álcool e alcoolismo, uma vez que o pouco conhecimento da temática pode contribuir para uma assistência fragmentada e pautada nas questões de ordem moral que permeiam o senso comum. / Identify and analyzed the social representation of General Hospital nurses front of the alcoholic patient and the etiology in order to alcoholism. The subjects of the study were 20 nurses from three General Hospital in a country town of São Paulo (Brazil).The data were collected through interviews self recorded that were transcribed and analyzed by The content Analysis Method, having as category for analysis the theoretical reference of social representation. From analysis of empirical data emerged two categories: 1 - Social representation of nurses front of alcoholic patient. 2- Representation of the etiology in order to alcoholism. The results pointed out that the nurses conceive the alcoholic patient as a sick person, therefore, the alcoholism as a disease. In relation to working with this type of patient, claimed that it is unwieldy, in order that professionals are not prepared to work with this type of patient and that its assistance is permeated by the stigma and prejudice. In the representation of these nurses, the etiology of alcoholism is related to social, psychological, emotional and biological issues. It was concluded that the representation of subjects of the study front of the alcoholic patient and the etiology in order to alcoholism are more tied to common sense than to scientific-technical knowledge, wich ultimately refers to the needs for better preparation and professional training of nurses on the thematic alcoholism, in that the few knowledge about the theme can contribute to a fragmented assistance and guided in matters of moral order that pervade common sense.

Introdução: O consumo mundial do alcool e de outras substancias psicoativas vem crescendo significativamente nas ultimas decadas, fenomeno que tem contribuido para o aumento da carga de doencas em todo o mundo. No Brasil, os levantamentos realizados sobre o uso de álcool e drogas vem apontando elevadas taxas de dependentes dessas substancias, fato que tem contribuido para ampliar o contato dos profissionais da saude, dentre eles, os enfermeiros, com situacoes que envolvem o uso e o abuso de substancias psicoativas, independente do local onde atuem. O fato justifica a importancia da realizacao de estudos para investigar as atitudes e os conhecimentos desses profissionais frente ao alcool, o alcoolismo e ao alcoolista. Objetivo: verificar e comparar as atitudes e os conhecimentos de dois grupos de enfermeiros frente ao alcool, ao alcoolismo e ao alcoolista. Método: Tratou-se de um estudo exploratório de abordagem quase-experimental, realizado com uma amostra de 280 enfermeiros, destes, 140 foram submetidos a um curso de capacitacao na area de alcool e outras drogas e constituiram o Grupo experimental. Na coleta de dados, foram aplicados um questionario sociodemografico, um questionario de conhecimento e a Escala de Atitudes frente ao alcool, alcoolismo e alcoolista EAFAAA. Para verificar e comparar as atitudes e os conhecimentos entre os dois grupos, procederam-se analises estatísticas descritivas e para analisar a associacao entre as variaveis do estudo e as atitudes e conhecimentos, procedeu-se uma analise por Regressão logistica. Todas as analises foram feitas por meio do pacote SPSS versão 17.0. Resultados: A amostra final contou com 185 participantes, 101 enfermeiros do grupo controle e 84 do grupo experimental. Os participantes de ambos os grupos tenderam a apresentar atitudes mais positivas, observando-se uma discreta predominancia de atitudes positivas no GE. Com relacao aos conhecimentos, nao foram observadas diferenças significativas entre os dois grupos. Os maiores preditores para atitudes positivas encontrados neste estudo foram possuir preparo para atuar com dependentes quimicos (z=2,895), ter recebido maior carga-horaria durante a graduacao sobre a tematica alcool e outras drogas (z=2,202) e possuir pos-graduacao (z=1,806). Conclusão: O nivel de conhecimento influencia diretamente nas atitudes de enfermeiros frente ao alcool, alcoolismo e ao alcoolista, a relacao entre as atitudes e conhecimentos e proporcional, ou seja, quanto maior o conhecimento maior a tendencia de apresentar atitudes mais positivas. Enfermeiros que receberam maior carga horaria de conteudos relacionados ao tema durante a formacao profissional, apresentaram atitudes mais positivas e melhor conhecimento frente ao tema do estudo do que aqueles que nao receberam nenhuma formacao ou a receberam-na em menor carga horaria. / Introduction: Global consumption of alcohol and other psychoactive substances has significantly increased in recent decades. This phenomenon has contributed to increase the disease burden around the world. In Brazil, surveys on alcohol and drugs use have appointed high rates of dependence on these substances, a fact that has contributed to increase health professionals contact, including nurses, with situations that involve psychoactive substance use and abuse, independently of their place of work. This fact justifies the importance of research on these professionals attitudes and knowledge regarding alcohol, alcoholism and alcoholics. Aim: to verify and compare attitudes and knowledge regarding alcohol, alcoholism and alcoholics in two groups of nurses. Method: An exploratory study with a quasi-experimental approach was carried out in a sample of 280 nurses, 140 of whom were submitted to a training course in alcohol and other drugs, who constituted the Trial group (TG). For data collection, a socio-demographic questionnaire was applied, as well as a knowledge questionnaire and the Scale of Attitudes towards alcohol, alcoholism and alcoholics EAFAAA. To verify and compare attitudes and knowledge between both groups, descriptive statistical analyses were carried out. To check for associations between the study variables and the attitudes and knowledge, logistic regression analysis was applied, using SPSS version 17.0. Results: The final sample included 185 participants, 101 nurses in the control group and 84 in the trial group. Participants in both groups tended to present more positive attitudes, showing a slight predominance of positive attitudes in the TG. Regarding knowledge, no significant differences were observed between the two groups. The main predictors of positive attitudes found in this study were being prepared to work with chemical addicts (z=2.895), having received more hours on alcohol and other drugs in the undergraduate program (z=2.202) and having a graduate degree (z=1.806). Conclusion: The knowledge level directly influences the nurses attitudes towards alcohol, alcoholism and alcoholics, the relation between attitudes and knowledge is proportional, i.e. the greater the knowledge, the stronger the trend to present more positive attitudes. Nurses who received more hours of contents on the theme during their professional education displayed more positive attitudes and better knowledge on alcohol, alcoholism and alcoholics than those who did not receive any or less hours of education.

Sammanfattning Bakgrund: Anestesisjuksköterskan har omvårdnadsansvaret för patienter under sekundärtransport i Sverige och har därför en viktig roll. Nuvarande forskning beskriver att anestesisjuksköterskor upplever bristande kommunikation och svårigheter med att vårda i ambulans. Forskning som belyser just anestesisjuksköterskors upplevelser av att vårda patienter under sekundärtransport är sparsam och därmed önskvärd. Syfte: Syftet med studien var att beskriva anestesisjuksköterskors upplevelser av att vårda patienter under sekundärtransport. Metod: Studien genomfördes med en beskrivande design och kvalitativ ansats. Data samlades in genom semistrukturerade intervjuer med tio anestesisjuksköterskor på två sjukhus i Mellansverige. En kvalitativ innehållsanalys tillämpades för att transkribera och analysera intervjuerna. Resultat: Studiens resultat delades in i fyra olika kategorier, Att vara steget före, Yrkesroll och ansvarsförhållanden, Att vårda under specifika omständigheter och Teamarbete samt åtta underkategorier. Dessa underkategorier var; Att ha en handlingsplan, Att vara förberedd, Ansvar och personlig utveckling, Yrkeserfarenhet och kompetens, Att vårda unga patienter, Att vårda i ambulans, Stöd från kollegor samt Kommunikation och information. Slutsats: Att ha en handlingsplan, tidigare yrkeserfarenhet, kommunikation samt stöd från kollegor var faktorer som påverkade anestesisjuksköterskornas upplevelser av att vårda patienter under sekundärtransport. Dessa faktorer var avgörande för om anestesisjuksköterskorna upplevde vårdandet som positivt eller negativt. Studiens resultat tyder på behov av tydliga rutiner samt gemensamma utbildningstillfällen för alla involverade yrkesgrupper. Nyckelord: anestesisjuksköterska, sekundärtransport, upplevelser / Abstract Background: The nurse anesthetist is responsible for the patient care during interhospital transport in Sweden and therefore has an important role. Current research describes how nurse anesthetists’ often experience difficulties in their work, in the forms of inadequate communication and the challenges of out-of-hospital patient care. When it comes to nurse anesthetists’ experiences of patient care, however, there is a lack of research in the area of interhospital transport, which thus deserves further attention. Purpose: The purpose of the study was to describe nurse anesthetists’ experiences of caring for patients during interhospital transports. Method: The study was conducted according to a descriptive design using a qualitative approach. Semi-structured interviews were conducted with ten nurse anesthetists’ at two hospitals located in the middle part of Sweden to collect data. A qualitative content analysis was used to transcribe and analyze the interviews. Result: The study results were divided into four categories: To be one step ahead, Profession and responsibility, Patient care during specific circumstances and Teamwork with eight subcategories. These subcategories were; To have a plan of action, To be prepared, Responsibility and personal development, Work experience and competence, To care for young patients, Patient care in ambulance, Support from colleagues and Communication and information. Conclusion: To have a plan of action, previous work experience, communication and support from colleagues were factors that affected the nurse anesthetists’ experiences of caring for patients during interhospital transport. These factors were decisive for whether the nurse anesthetists’ experienced caring as positive or negative. The study results indicate that there is a need for clear routines as well as team-based training sessions for every professional involved within interhospital transport. Keywords: experiences, interhospital transport, nurse anesthetist

Bakgrund: Ansvar som enskild term är bara ett ord, ett språkligt uttryck. När ordet sedan upplevs av en individ bildas det ett begrepp som en mental bild och när termen ytterligare sätts i kontext tillsammans med upplevelsen skapas referenten, som blir de verkliga handlingarna i vardagens sammanhang. Sjuksköterskans huvudansvar är att bidra till patienternas egenvård men även att övervaka patienters tillstånd, något som försvåras då ansvarets innebörd är otydligt i organisationen. Otydligheten i organisationen leder till att personcenterad vård inte kan utföras i den utsträckning som egentligen önskas. Syfte: Att belysa sjuksköterskans ansvar gentemot patienten inom omvårdnad. Metod: Allmän litteraturöversikt med inspiration av innehållsanalys tillämpades under analysen av de åtta vetenskapliga artiklarna. Resultat: De teman som framkom var sjuksköterskans ansvar som: term – evidensens skyldigheter, begrepp – det personliga ansvaret och referent – den bristande organisationen.  Litteraturöversiktens resultat visade på att ansvar i många fall sågs som en negativ upplevelse då sjuksköterskans professionsansvar inom omvårdnadsprocessen försummades på grund av flera faktorer, där bland underbemanning och att påminna läkare om deras ansvarsuppgifter. Konklusion: I nuläget finns det tydliga riktlinjer och lagar om vad sjuksköterskans ansvar inom omvårdnad är men i verklighetens praxis försvåras tolkningen av ordet då egna erfarenheter och upplevelser har stor inverkan. / Background: Responsibility as an individual term is just a word, a linguistic expression but when perceived by an individual a concept is formed as a mental image. When the term is put into context with the experience, the referent is created, actions in everyday context. Nurse's main responsibility is to contribute to the patients' self-care and monitor the patients' condition, but the unclear responsibility in the organization leads to inability to perform person-centered care. Aim: To highlight the nurse's responsibility towards the patient in nursing. Method: A general literature review with inspiration from content analysis was applied during the analysis of the eight scientific articles. Result: The themes that emerged were the nurse's responsibility as: term - the obligations of the evidence, concepts - the personal responsibility and referent - the insufficient organization. The results showed that in many cases responsibility was a negative experience when the professional responsibility in the nursing process was neglected due to several factors, including under-staffing and reminding doctors of their responsibilities. Conclusion: Clear guidelines and laws on what the nurse's responsibility in nursing exists, but the interpretation of the word makes it difficult since the nurse's former experiences have a great impact.

Bakgrund: Suicid är ett folkhälsoproblem som globalt visat sig vara den näst vanligaste dödsorsaken för personer mellan 15–29 år. Psykisk ohälsa och psykiatriska diagnoser kan i många fall kopplas till suicid. Suicidnära patienter berättar om sitt lidande och vikten av stöd i form av tillit, förståelse och bekräftelse. Sjuksköterskor förväntas, i sin yrkesroll, vara lyhörda och ge ett respektfullt bemötande oberoende av vårdkontext. Syfte: Syftet med litteraturöversikten var att belysa sjuksköterskors attityder och erfarenheter i mötet med suicidnära patienter. Metod: Litteraturöversikt i enlighet med Fribergs (2017) metod. Litteraturöversikten är baserad på tolv vetenskapliga artiklar från databaserna PsycINFO, Cinahl Complete samt PubMed. Analysen genererade två huvudteman och fem subteman. Resultat: Resultatet består av två huvudteman samt fem subteman. Det första huvudtemat innefattar Inre faktorer som påverkar sjuksköterskor med subteman den känslomässiga reaktionen samt sjuksköterskors tro och kulturens påverkan. Det andra huvudtemat innefattar Yttre faktorer som påverkar vårdandet med subteman brister i sjuksköterskors utbildning, behovet av stöttning samt barriärer för vårdandet. Diskussion: Sjuksköterskors attityder och erfarenheter hade en direkt påverkan på omvårdnaden av suicidnära patienter. Sjuksköterskor hade olika attityder och erfarenheter kring suicid vilket kunde relateras till bland annat utbildningsnivån. I mötet med suicidnära patienter är det viktigt att sjuksköterskor lägger sina egna värderingar åt sidan. Phil Barker betonar vikten av att skapa ett samspel mellan sjuksköterskor och patienter samt vara lyhörda inför patienternas upplevelser i det enskilda mötet. / Background: Suicide is a public health issue that has proved to be the second most common cause of death globally for people aged 15–29. Mental illness and psychiatric diagnoses can in many cases connect to suicide. Suicidal patients communicate their suffering and the importance of support in the form of trust, understanding and confirmation. In the nurse's professional role, it is expected to be responsive and to give a respectful receiving regardless of the care context. Aim: The aim of this literature review was to highlight nurses' attitudes and experiences in the encounter with suicidal patients. Method: Literature review in accordance with Friberg's (2017) method. The literature review is based on twelve scientific articles from the databases PsycINFO, Cinahl Complete and PubMed. The analysis generated two main themes and five sub-themes. Results: The result consists of two main themes and five sub-themes. The first main theme included Inner factors affecting nurses with sub-themes the emotional reaction as well as nurses’ faith and the impact of culture. The second main theme includes External factors affecting caring with sub-themes deficiencies in nursing education, the need for support and barriers for caring. Discussion: Nurses’ attitudes and experiences had a direct impact on the care of suicidal patients. Nurses had different attitudes and experiences regarding suicide which could be related to, among other things, the level of education. In the meeting with suicidal patients, it is important that nurses put their own values aside. Phil Barker emphasizes the importance of creating an interaction between nurses and patients and being responsive to the patients’ experiences in the individual meeting.

Magister Curationis - MCur / The provision of mental health care, treatment and rehabilitation of the acutely ill mental health care users (MHCUS) poses a major challenge to the nurses working in acute units. Nurses spend long hours ensuring that acutely ill psychiatric patients receive quality patient care in acute admission units in different psychiatric hospitals in South Africa. With few studies showing a rise in the prevalence of mental disorders in the South Africa and the Western Cape Province, acute psychiatric inpatient units across the province have experienced intense pressure and persistent rise in the number of acute patient admissions. Dealing with this group of patients is a difficult task particularly for nurses who spent prolonged hours caring for them. Despite the continuing provision of care to MHCUS by nurses in acute admission units, very little is known about the lived experiences of nurses in acute admission units. The aim of this study was to explore and describe the lived experiences of nurses who care for the acutely ill MHCUS in an acute male admission unit at a psychiatric hospital in the Western Cape. Acutely ill MHCUS in acute psychiatric units show severely disturbed behaviour at times, aggression, hostility, acute psychotic symptoms and many other symptoms related to psychiatric illness. Methods: a qualitative, descriptive phenomenological research design was used to explore and describe the lived experiences of nurses who care for acutely ill patients in an acute admission unit. A purposive sample of eight nurses was selected. Individual, semi structured phenomenological interviews were used to collect data from nurses caring for MHCUS in an acute admission unit. Data saturation was reached after carrying out the eight interviews. These interviews were audio taped and transcribed verbatim and Collaizi’s (1978) seven steps method of qualitative data was applied to analyse the collected data. Findings: The study found that nurses in the acute admission unit experienced several challenges while caring for MHCUs. Nurses reported both negative and positive experiences. Positive experiences included MHCUs recovery, teamwork and passion for caring while negative experiences were feeling unappreciated and unsupported by authorities. Furthermore, they reported physical assault by MHCUs which led to fear. Challenges experienced included shortage of staff and increased workload which led to burnout amongst nurses in acute admission units.