Bakgrund: Vårdpersonalen på en akutmottagning har stora krav på sig, ansvar för många patienter och måste fatta många egna beslut, ibland med mycket kort betänketid. Vårdpersonalen möter många olika patienter med olika problem och personligheter, och måste bemöta varje patient så att denne känner sig bekräftad och sedd. Syfte: Syftet med litteraturöversikten är att undersöka patienters upplevelse av att vårdas på en akutmottagning. Metod: Artiklar till arbetet har söks i olika databaser. Aktuella artiklar har lästs och relevanta fynd har markerats, för att analyseras och sammanställa ett resultat. Resultat: Analysen resulterade i tre underrubriker: Information, Bemötande och Vårdmiljö, med uppdelning av positiva och negativa upplevelser. Många patienter var nöjda med vården, men hade låga förväntningar från början. Patienterna har förstående för personalens tuffa arbetsmiljö, men önskade att få bättre information om väntetid och undersökningar. De tyckte att väntetiden var för lång, och kände sig ofta ensamma och övergivna. Slutsats: Mycket behöver förändras för att patienterna ska få en mer positiv upplevelse av akuten. Detta arbeta kan hjälpa till att belysa vilka punkter som vården måste arbeta extra mycket med för att patienterna ska känna sig trygga, exempelvis bättre information om väntetider och ett bemötande där sjusköterskan ser hela patienten. / Background: The demands and expectations on a nurse in the emergency room are high. They are responsible for many patients and have to make many decisions on their own, sometimes with very short reflection time. They face a wide variety of patients with different problems and personalities, each requiring their own method of approach and interaction in order for him or her to feel acknowledged. Aim: The aim of the literature review is to examine patient's experiences of being cared for in an emergency room. Method: Articles for the work has been searched in different databases. Articles in-question has been read and the relevant finding has been highlighted, to analyze and compile the results. Results: The analysis resulted in three subheadings: Information, Treatment and Care environment, with sectioning of positive and negative experiences. Many patients were satisfied with the care, but had low expectations from the start. Conclusion: There is much that needs to be changed to allow patients to have a more positive experience of the emergency room. Care units must work harder with to ensure that patients will feel secure and safe, for example, better information on waiting times and a treatment where the nurse sees the whole patient.

Recent reforms in the South African health care and educational system were founded in the ideal that the country would produce independent, critical thinkers. Nurses need to cope with diversity in a more creative way, defining their role in a complex, uncertain, rapidly changing health care environment. Learning facilitators are held accountable for finding adequate learning experiences to prepare nursing students for such practice demands so that newly qualified nurses do meet expectations for entry level clinical judgement ability. Quality clinical judgement is therefore imperative as an identified characteristic of newly qualified professional nurses. There is a scarceness of information on the concept of clinical judgement especially within the South African nursing environment. Relevant information in this regard can assist in clarifying the meaning, which will facilitate a common understanding of the concept within the clinical nursing environment. This in turn can lead to the formulation of a teaching-learning strategy to facilitate clinical judgement in undergraduate nursing students, which would be of benefit in the nursing care environment. The objective of this study was addressed in three phases. The first phase of this research analysed the concept of clinical judgement through various data sources and a review of literature to clarify the meaning and facilitate a common understanding through identification of the characteristics and to develop a connotative (theoretical) definition of the concept. The second phase of the research investigated professional nurses‟ understanding of the meaning of clinical judgement, as well as the factors that influence the development of clinical judgement within the nursing environment. During the third phase a conceptual framework for an enabling teaching-learning environment was constructed from a modern day constructivist approach to facilitate clinical judgement. The section included a description and diagrammatic presentation of the framework. The conceptual framework formed the scientific basis from which a teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African nursing environment was synthesised. A qualitative design was used for the study. During the first phase (manuscript 1) an explorative, descriptive qualitative design was used to discover the complexity and meaning of the phenomenon. Multiple data sources and search engines were consulted for the time frame 1982-2013. An extensive concept analysis resulted in a theoretical definition of the concept „clinical judgement‟, a complex cognitive skill to evaluate patient treatment alternatives within the clinical nursing environment. The second phase (manuscript 2) is qualitative in nature and explored professional nurses‟ understanding of clinical judgement, as well as the factors influencing the development of clinical judgement in undergraduate nursing students. The findings emphasised clinical judgement as skill within the nursing environment. This assisted in the development of teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African Nursing environment as the third phase (manuscript 3). Such an environment should impact positively to promotion of autonomous and accountable nursing care. / PhD (Nursing), North-West University, Potchefstroom Campus, 2015

Recent reforms in the South African health care and educational system were founded in the ideal that the country would produce independent, critical thinkers. Nurses need to cope with diversity in a more creative way, defining their role in a complex, uncertain, rapidly changing health care environment. Learning facilitators are held accountable for finding adequate learning experiences to prepare nursing students for such practice demands so that newly qualified nurses do meet expectations for entry level clinical judgement ability. Quality clinical judgement is therefore imperative as an identified characteristic of newly qualified professional nurses. There is a scarceness of information on the concept of clinical judgement especially within the South African nursing environment. Relevant information in this regard can assist in clarifying the meaning, which will facilitate a common understanding of the concept within the clinical nursing environment. This in turn can lead to the formulation of a teaching-learning strategy to facilitate clinical judgement in undergraduate nursing students, which would be of benefit in the nursing care environment. The objective of this study was addressed in three phases. The first phase of this research analysed the concept of clinical judgement through various data sources and a review of literature to clarify the meaning and facilitate a common understanding through identification of the characteristics and to develop a connotative (theoretical) definition of the concept. The second phase of the research investigated professional nurses‟ understanding of the meaning of clinical judgement, as well as the factors that influence the development of clinical judgement within the nursing environment. During the third phase a conceptual framework for an enabling teaching-learning environment was constructed from a modern day constructivist approach to facilitate clinical judgement. The section included a description and diagrammatic presentation of the framework. The conceptual framework formed the scientific basis from which a teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African nursing environment was synthesised. A qualitative design was used for the study. During the first phase (manuscript 1) an explorative, descriptive qualitative design was used to discover the complexity and meaning of the phenomenon. Multiple data sources and search engines were consulted for the time frame 1982-2013. An extensive concept analysis resulted in a theoretical definition of the concept „clinical judgement‟, a complex cognitive skill to evaluate patient treatment alternatives within the clinical nursing environment. The second phase (manuscript 2) is qualitative in nature and explored professional nurses‟ understanding of clinical judgement, as well as the factors influencing the development of clinical judgement in undergraduate nursing students. The findings emphasised clinical judgement as skill within the nursing environment. This assisted in the development of teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African Nursing environment as the third phase (manuscript 3). Such an environment should impact positively to promotion of autonomous and accountable nursing care. / PhD (Nursing), North-West University, Potchefstroom Campus, 2015

Ronald McDonald Hus är en ackommodering som ger familjer med sjuka barn möjlighet att kunna bo och uppleva en hemlik miljö samtidigt som deras barn vårdas på sjukhuset. Syftet med studien var att undersöka om det förelåg något samband mellan vistelsens längd på Ronald McDonald Hus och hur nöjda föräldrarna var avseende den fysiska och psykosociala boendemiljön. Vistelsens längd i denna studie definierades som “mindre än tre nätter” och “mer än tre nätter.” Metoden var en komparativ och kvantitativ enkätstudie. Konsekutivt urval användes för att rekrytera deltagare. I studien deltog 34 föräldrar som bodde på Ronald McDonald Hus under sommaren och hösten 2014. Efter internt bortfall återstod 27 föräldrar varav 14 hade bott mindre än tre nätter och 13 mer än tre nätter. Insamlad data analyserades med hjälp av Statistical Package for the Social Sciences (SPSS). Resultatet visade att samtliga deltagare skattade den fysiska miljön på Ronald McDonald Hus högt. Majoriteten av deltagarna upplevde den psykosociala boendemiljön på Ronald McDonald Hus som positiv. Det förelåg inget signifikant samband mellan vistelsens längd och hur nöjda föräldrarna var med den fysiska och psykosociala boendemiljön på Ronald McDonald Hus. Slutsatsen är att Ronald McDonald Hus är betydelsefullt för familjer med sjuka barn. Detta boende har en positiv påverkan på hela familjens tillvaro. Familjer är i stor utsträckning nöjda med den fysiska boendemiljön på Ronald McDonald Hus. Boendet bidrar till minskad ekonomisk oro för många familjer. / Ronald McDonald House provides accommodation for families with hospitalized children where they can experience a home like environment while their children are getting hospital treatment. The aim of this study was to examine if there is a correlation between the length of stay and the parents’ satisfaction with the physical and psychosocial environment. The length of stay was divided into "less than three nights" or "more than three nights". The method used in the study was a comparative and quantitative questionnaire study. Consecutive selection was used to recruit participants. Thirty four parents participated who all stayed at Ronald McDonald House during the summer and autumn 2014. After internal dropouts, 27 parents remained of which 14 stayed less than three nights and 13 more than three nights. Data was analyzed using Statistical Package for Social Sciences (SPSS).  The results showed a high rating by all participants on the physical environment at Ronald McDonald House. A majority of the participants also had a positive experience with regards to the psychosocial environment. No significant correlation between the length of stay and the parents’ satisfaction with the physical and psychosocial environment was found. The conclusion was that Ronald McDonald House is an important facility for families with hospitalized children. The accommodation has a positive impact on the experience of the whole family. Families are satisfied to a large extent with regards to the physical environment at Ronald McDonald House. Accommodation at Ronald McDonald House contributes to a reduced economic worries for these families.

Within the health care sector in South Africa, the nursing profession is known as one of the four most stressful work environments, which is characterised by high workload, staff shortages and overcrowding situations. This stressful and emotionally draining environment can be the cause for large numbers of nurses experiencing symptoms of burnout and negative work-home interference. However, there seems to be a lack of research investigating specific job demands and job resources associated with burnout and negative work-home interaction in a nursing environment. The first objective of this study was to determine the construct validity and reliability of the adapted Maslach Burnout Inventory - General Survey (MBI-GS). The second objective was to determine which job characteristics within the nursing environment predict burnout and negative work-home interference (WHI). The last objective was to determine whether negative WHI mediated between the most prominent job characteristics and burnout within the nursing environment and whether it was a partial or full mediating effect. A cross-sectional survey design was used. Random samples (n = 300) were taken from nurses working in the Johannesburg, Klerksdorp, Krugersdorp, Pretoria and Potchefstroom areas. A job characteristics questionnaire, the 'Survey Work-Home Interaction - Nijmegen' (SWING) and an adapted version of the Maslach Burnout Inventory - General Survey were administered. Cronbach alpha coefficients, exploratory factor analysis, Pearson product moment correlations, multiple regression analysis and structural equation modelling were used to analyse the data. Regarding the first objective, it was found that burnout consists of exhaustion and mental distance, whereas cynicism and depersonalisation collapse into one dimension (e.g. mental distance). Regarding the second objective, the results indicated that the most prominent job demands and job resources associated with exhaustion are pressure, autonomy, role clarity, colleague support and financial support. It seemed that mental distance is primarily predicted by role clarity, colleague support and financial support, while negative work-home interference is predicted by pressure, time demands, role clarity and colleague support. Results obtained for the last objective provided evidence for a partial mediating role of negative WHI in the relationship between the most prominent job characteristics (pressure, role clarity and colleague support) and burnout (consisting of exhaustion and mental distance). Recommendations were made for the organisation and for future research. / Thesis (M.Com. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2006.

Bakgrund: Tidigare forskning visar att patienter inom rättspsykiatrisk vård upplever saknad av autonomi, delaktighet och respekt. Det ligger i sjuksköterskans intresse att värna om patientens resurser och planera omvårdnadsarbetet därefter. Genom att arbeta med förbättringsförslag från patienter, anhöriga och vårdpersonal kan vården anpassas efter önskat behov. Syfte: Syftet med denna studie är att utforska områdena delaktighet, vårdrelation, vårdmiljö och bemötande i genomförda PDSA-cykler riktade mot patientens vård i ett kliniskt förbättringsarbete i rättspsykiatrisk vård. Metod: Studien består av två delar, en explorativ kvalitativ design med en induktiv ansats samt en deskriptiv kvantitativ design. Datamaterial från nio enheter samlades in från det redan pågående implementeringsarbetet i den aktuella verksamheten. Kvalitativ innehållsanalys enligt Graneheim och Lundman användes sedan vid analysen av datamaterialet. Resultat: Resultatet har kategoriserats i åtta subkategorier; påverka sin vårdprocess, möjligheten till inflytande, eget ansvar, förbättringar av gemensamma ytor, att skapa en trivsam miljö, stimulans för kropp och själ, ökad kännedom och att tillsammans uppnå uppsatta mål, som senare ledde till fyra huvudkategorier: delaktighet, vårdrelation, vårdmiljö och bemötande Diskussion: Med hjälp av kvalitetsbegreppen trovärdighet, konfimerbarhet, pålitlighet och överförbarhet diskuteras studiens metodavsnitt. Studiens resultat ställs emot tidigare forskning och kopplas även samman med Erikssons teori om vårdandet och vilken betydelse det har i delaktighet, vårdrelation, vårdmiljö och bemötande. / Background: Research has shown that patients in forensic psychiatric care experience a lack of autonomy, participation and respect. It is in the nurse's interest to take care of the patient's resources and to plan the nursing thereafter. Care can be adapted to the desired needs by working with improvement suggestions from patients, relatives and healthcare professionals. Aim: The aim of this study is to explore the areas of participation, care relationship, nursing environment and treatment in implemented PDSA cycles aimed at patient care in a clinical improvement work in forensic psychiatric care. Method: The study consists of two parts, an explorative qualitative design with an inductive approach and a descriptive quantitative design. Data from nine units were collected from the ongoing implementation in the current work. The qualitative content analysis was used according to Graneheim and Lundman in the analysis of the data. Results: The result has been categorized into eight subcategories; implicate the care process, ability to influence, own responsibility, improvement of social areas, creating a pleasant environment, stimulus for body and mind, increased awareness and jointly achieving set goals, which later resulted in four main categories: participation, care relationship, nursing environment and treatment. Discussions: The methodology of the study is discussed using the quality concepts credibility, confidentiality, reliability and transferability. The results of the study are compared to previous research and are also linked to Eriksson's theory of care and its importance in participation, care relationship, nursing environment and treatment.

Over the past few years, workers have been confronted with increasing pressures at work and at home. This is mainly the result of the growing number of dual-earner couples as well as changes and pressures in the nature of the workplace. Workers are challenged to manage multiple roles in both their work and home domains. Recently, a new measuring instrument was developed to measure work-home interaction, namely the Survey Work-Home Interaction - Nijmegen (SWING). This instrument measures both the direction of influence (work-to-home and home-to-work) and the quality of influence (negative vs. positive). The objectives of this study were firstly to determine the construct validity and reliability of the Survey Work-Home Interaction - Nijmegen (SWING), and secondly to determine the prevalence of work-home interaction in various demographic groups in the nursing environment. A cross-sectional survey design was used. Random samples (N = 363) were taken from hospital nursing staff in Johannesburg, Klerksdorp, Krugersdorp, Potchefstroom and Pretoria. The SWING and a biographical questionnaire were administered. Structural equation modelling (SEM), Cronbach alpha coefficients, multivariate analysis of variance (MANOVA) and one-way analysis of variance (ANOVA) were used to reach the objectives. SEM showed that a four-factor model, which measures negative work-home interference, positive work-home interference, negative home-work interference and positive home-work interference, fitted the data best. Cronbach alpha coefficients showed that all four factors were reliable. Regarding the prevalence of work-home interaction among different demographic groups, the results indicated that there were statistically significant differences between demographic groups based on race, educational level, type of position, flexibility of arrangements at the workplace as well as between full-time and part-time work. Recommendations for future research are made. / Thesis (M.A. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2006.

Over the past few years, workers have been confronted with increasing pressures at work and at home. This is mainly the result of the growing number of dual-earner couples as well as changes and pressures in the nature of the workplace. Workers are challenged to manage multiple roles in both their work and home domains. Recently, a new measuring instrument was developed to measure work-home interaction, namely the Survey Work-Home Interaction - Nijmegen (SWING). This instrument measures both the direction of influence (work-to-home and home-to-work) and the quality of influence (negative vs. positive). The objectives of this study were firstly to determine the construct validity and reliability of the Survey Work-Home Interaction - Nijmegen (SWING), and secondly to determine the prevalence of work-home interaction in various demographic groups in the nursing environment. A cross-sectional survey design was used. Random samples (N = 363) were taken from hospital nursing staff in Johannesburg, Klerksdorp, Krugersdorp, Potchefstroom and Pretoria. The SWING and a biographical questionnaire were administered. Structural equation modelling (SEM), Cronbach alpha coefficients, multivariate analysis of variance (MANOVA) and one-way analysis of variance (ANOVA) were used to reach the objectives. SEM showed that a four-factor model, which measures negative work-home interference, positive work-home interference, negative home-work interference and positive home-work interference, fitted the data best. Cronbach alpha coefficients showed that all four factors were reliable. Regarding the prevalence of work-home interaction among different demographic groups, the results indicated that there were statistically significant differences between demographic groups based on race, educational level, type of position, flexibility of arrangements at the workplace as well as between full-time and part-time work. Recommendations for future research are made. / Thesis (M.A. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2006.

Within the health care sector in South Africa, the nursing profession is known as one of the four most stressful work environments, which is characterised by high workload, staff shortages and overcrowding situations. This stressful and emotionally draining environment can be the cause for large numbers of nurses experiencing symptoms of burnout and negative work-home interference. However, there seems to be a lack of research investigating specific job demands and job resources associated with burnout and negative work-home interaction in a nursing environment. The first objective of this study was to determine the construct validity and reliability of the adapted Maslach Burnout Inventory - General Survey (MBI-GS). The second objective was to determine which job characteristics within the nursing environment predict burnout and negative work-home interference (WHI). The last objective was to determine whether negative WHI mediated between the most prominent job characteristics and burnout within the nursing environment and whether it was a partial or full mediating effect. A cross-sectional survey design was used. Random samples (n = 300) were taken from nurses working in the Johannesburg, Klerksdorp, Krugersdorp, Pretoria and Potchefstroom areas. A job characteristics questionnaire, the 'Survey Work-Home Interaction - Nijmegen' (SWING) and an adapted version of the Maslach Burnout Inventory - General Survey were administered. Cronbach alpha coefficients, exploratory factor analysis, Pearson product moment correlations, multiple regression analysis and structural equation modelling were used to analyse the data. Regarding the first objective, it was found that burnout consists of exhaustion and mental distance, whereas cynicism and depersonalisation collapse into one dimension (e.g. mental distance). Regarding the second objective, the results indicated that the most prominent job demands and job resources associated with exhaustion are pressure, autonomy, role clarity, colleague support and financial support. It seemed that mental distance is primarily predicted by role clarity, colleague support and financial support, while negative work-home interference is predicted by pressure, time demands, role clarity and colleague support. Results obtained for the last objective provided evidence for a partial mediating role of negative WHI in the relationship between the most prominent job characteristics (pressure, role clarity and colleague support) and burnout (consisting of exhaustion and mental distance). Recommendations were made for the organisation and for future research. / Thesis (M.Com. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2006.

Kunskap om vårdmiljöns betydelse för patienten och dennes delaktighet i utformningen av miljön främjar välbefinnande hos patienten. I en personcentrerad omvårdnad är miljö en viktig komponent i människans läkeprocess. Syftet med denna studie var att beskriva upplevelsen av den fysiska och psykosociala vårdmiljön för kvinnor som opererades på dagkirurgisk avdelning på grund av bröstcancer från inskrivning till omedelbart innan sedering. Metoden var en kvalitativ, semistrukturerad intervjustudie. Strategiskt urval användes för att rekrytera informanter och åtta personer deltog. Kvalitativ innehållsanalys valdes för att utföra analys på intervjumaterialet. Studiens resultat visade att informanterna hade en positiv upplevelse av vårdmiljön på avdelningen. Beskrivningar av upplevelsen av den fysiska vårdmiljön på avdelningen varierade men var generellt positiv. Ren och trevlig miljö var betydelsefullt för informanternas upplevelse. En hemlik känsla upplevdes. Eget rum uppskattades högt av informanterna vilket förknippades med integritet. Det förekom dock upplevelser av brister i hur integriteten bevaras på grund av vårdmiljöns utformning, i synnerhet i det gemensamma väntrummet. Informanterna upplevde professionalism och kompetens hos personalen vilket skapade en känsla av trygghet och förtroende. Personalens goda arbetssätt och bemötande skapade en känsla av harmoni och trygghet vilket upplevdes som lugnande. Slutsatsen är att vårdmiljön på avdelningen påverkade informanternas upplevelse generellt positivt. Även om upplevelsen av den fysiska miljön på avdelningen inte beskrevs vara optimal vägde upplevelsen av den psykosociala vårdmiljön och det goda bemötandet upp informanternas helhetsupplevelse. / Knowledge about the importance of nursing environment and patients’ participation in its design promote patients’ well-being. In person centred care, environment is an important component of the human healing process. The aim of this study was to describe the experience of the physical and psychosocial nursing environment in women who underwent day surgery due to breast cancer from registration to immediately before sedation. The method used was qualitative semi structured interview study. Strategic selection was used to recruit informants where eight patients participated. Qualitative content analysis was chosen to analyse the data. The results showed that the informants had a positive experience of the nursing environment at the department. Described experiences in the physical nursing environment varied but were generally positive. Clean and friendly environment was important for the informants’ experience. A “just like home” experience was described. Having a private room was highly appreciated by the informants, which they associated with experienced integrity. However, there were experiences of deficiencies in how integrity was preserved in the common waiting room due to its design. Experienced professionalism and skills in the nursing staff resulted in a sense of security and trust. The nursing staff’s good working methods and patient treatment created a sense of harmony and security that was experienced as calming. In conclusion, the department’s nursing environment affected the informants' experience generally positive. Although the experience of the physical nursing environment was described as not optimal, experience of the psychosocial nursing environment and good patient treatment outweighed the informants' overall experience.