Wang, Yue. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 108-120). / Abstract and some appendixes also in Chinese. / Chapter CHAPTER 1: --- INTRODUCTION --- p.1 / Chapter CHAPTER 2: --- LITERATURE REVIEW / Clinical decision making in nursing --- p.4 / Definition of clinical decision making --- p.4 / How nurses make clinical decisions --- p.6 / The analytical model --- p.7 / The intuitive model --- p.10 / Cognitive continumm theory --- p.13 / Factors influencing clincial decision making --- p.17 / Knowledge --- p.18 / Clinical experience --- p.19 / Internal factors --- p.21 / External factors --- p.23 / Autonomy in nurses' clinical decision making --- p.27 / Clinical decision making among Chinese nurses --- p.31 / Summary of literature review --- p.35 / Chapter CHAPTER 3: --- METHODOLOGY / Aims and objectives of the study --- p.37 / Research design --- p.37 / Setting and sample --- p.39 / The setting --- p.39 / The informants --- p.40 / Data collection procedures --- p.42 / Interview guide --- p.42 / Data collection method --- p.43 / Data analysis --- p.45 / Data preparation --- p.45 / Content analysis --- p.46 / Rigour of data --- p.47 / Validity --- p.48 / Reliability --- p.49 / Pilot study --- p.50 / Ethical consideration --- p.50 / Chapter CHAPTER 4: --- FINDING AND DISCUSSION / Introduction --- p.53 / Socio-demographic characteristics of informants --- p.53 / Categories identified from content analysis --- p.54 / Understanding of clinical decision making --- p.55 / Understanding about patien´tةs health condition --- p.56 / Making nursing judgment --- p.57 / Taking intervention --- p.58 / Problem solving --- p.59 / A participatory process --- p.60 / Involving the patient --- p.61 / Role of the family --- p.62 / Involvement of other staff --- p.63 / Autonomy in clinical decision making --- p.65 / Depending on doctoŕةs instruction --- p.66 / Making judgment about doctoŕةs order --- p.68 / Making decisions independently in emergency --- p.69 / Making decisions within scope of nursing practice --- p.70 / Attributes required in clinical decision making --- p.75 / Effective communication skill --- p.75 / Use of critical thinking --- p.76 / Role of knowledge in clinical decision making --- p.78 / Facilitating nurses to solve patien´tةs health problems --- p.78 / Facilitating nurses to make efficient and accurate judgment --- p.79 / Contributions of clinical experiences to clinical decision making --- p.80 / Using clinical experiences to identify patients' problems --- p.81 / Use of previous clinical experiences in clinical decision for intervention --- p.82 / Helping nurses solve patien´tةs problems effectively --- p.83 / Making judgment efficiently and effectively --- p.84 / Workplace environment --- p.86 / Workload --- p.86 / Workplace atmosphere --- p.87 / Similarities and differences of concept of clinical decision making between clinical nurses and nurse educators --- p.88 / Intuition --- p.89 / Making decisions based on evidence --- p.91 / Teamwork spirit --- p.93 / Nurséةs attitude to drug administration --- p.94 / Chinese tradition of respecting older people --- p.95 / Chapter CHAPTER 5: --- CONCLUSION / Study limitations --- p.100 / Sampling method --- p.100 / Use of interview --- p.101 / Issue of data saturation --- p.102 / Recommendation for further research --- p.103 / Implications for practice --- p.104 / Conclusion --- p.106 / REFERENCES --- p.108 / APPENDICES --- p.121

Professional nurses comprise the largest number of health care professionals in South Africa. High turnover rates contribute to shortages of nurses in South Africa, aggravated by the emigration of nurses, inadequate recruitment of student nurses, and the expected retirement of many baby boomer nurses by 2016. This study addressed factors influencing the retention of professional nurses in the Gauteng Province of South Africa. In phase 1, postal questionnaires were completed by 101 registered nurses while semi-structured interviews were conducted with 21 nurse managers in phase 2. Personal, organisational and managerial factors influenced the retention potential of the professional nurses. In terms of Maslow' Hierarchy of Needs Theory, most factors influencing nurses' retention operated on the lowest (physiological) level and concerned remuneration. Safety needs were compromised by the lack of equipment and supplies, the shortage of nurses and unsafe working places. Esteem needs included respect from doctors, managers and colleagues as well as recognition for outstanding performance. In terms of Vogt et al's Theory of Nurse Retention Theory, the constrictions caused by inadequate remuneration and safety aspects should be addressed. Lewin's Force-Field Analysis Theory recommends that the factors that influence nurses' retention negatively should be unfrozen, changed and refrozen, including communication. Based on these results guidelines were compiled for enhancing the retention rates of professional nurses (Annexure G). / Health Studies / D.Litt. et Phil. (Health Studies)

Professional nurses comprise the largest number of health care professionals in South Africa. High turnover rates contribute to shortages of nurses in South Africa, aggravated by the emigration of nurses, inadequate recruitment of student nurses, and the expected retirement of many baby boomer nurses by 2016. This study addressed factors influencing the retention of professional nurses in the Gauteng Province of South Africa. In phase 1, postal questionnaires were completed by 101 registered nurses while semi-structured interviews were conducted with 21 nurse managers in phase 2. Personal, organisational and managerial factors influenced the retention potential of the professional nurses. In terms of Maslow' Hierarchy of Needs Theory, most factors influencing nurses' retention operated on the lowest (physiological) level and concerned remuneration. Safety needs were compromised by the lack of equipment and supplies, the shortage of nurses and unsafe working places. Esteem needs included respect from doctors, managers and colleagues as well as recognition for outstanding performance. In terms of Vogt et al's Theory of Nurse Retention Theory, the constrictions caused by inadequate remuneration and safety aspects should be addressed. Lewin's Force-Field Analysis Theory recommends that the factors that influence nurses' retention negatively should be unfrozen, changed and refrozen, including communication. Based on these results guidelines were compiled for enhancing the retention rates of professional nurses (Annexure G). / Health Studies / D.Litt. et Phil. (Health Studies)

Indiana University-Purdue University Indianapolis (IUPUI) / This qualitative study was successful in utilization of grounded theory methodology to ascertain nurses’ decision-making processes following their awareness of having made a medical error, as well as how and/or if they corrected and reported the error. Significant literature documents the existence of medical errors; however, this unique study interviewed thirty nurses from adult intensive care units seeking to discover through a detailed interview process their individual stories and experiences, which were then analyzed for common themes. Common themes led to the development of a theoretical model of thought processes regarding error reporting when nurses made an error. Within this theoretical model are multiple processes that outline a shared, time-orientated sequence of events nurses encounter before, during, and after an error. One common theme was the error occurred during a busy day when they had been doing something unfamiliar. Each nurse expressed personal anguish at the realization she had made an error, she sought to understand why the error happened and what corrective action was needed. Whether the error was reported on or told about depended on each unit’s expectation and what needed to be done to protect the patient. If there was no perceived patient harm, errors were not reported. Even for reported errors, no one followed-up with the nurses in this study. Nurses were left on their own to reflect on what had happened and to consider what could be done to prevent error recurrence. The overall impact of the process of and the recovery from the error led to learning from the error that persisted throughout her nursing career. Findings from this study illuminate the unique viewpoint of licensed nurses’ experiences with errors and have the potential to influence how the prevention of, notification about and resolution of errors are dealt with in the clinical setting. Further research is needed to answer multiple questions that will contribute to nursing knowledge about error reporting activities and the means to continue to improve error-reporting rates