Abstract Values are foundational guidelines that underpin nurses’ actions. They serve as fundamental points of reference for nurses; and, as such, determine their moral nursing practice. Understanding how nurses’ experience of living their values amidst organizational change sheds light on how this social condition influences the narrative composition of nurses’ lives and their practice. This Narrative Inquiry (Clandinin & Connelly, 2000) illuminates the temporal connections of life events; how social conditions mutually shape personal conditions; and how actions that occur within a place give meaning to the experience. Six nurses from a large academic health centre in Southern Ontario were recruited and interviewed over eight months. During initial analysis, letters were constructed for each co-participant to reveal the experience of living values amidst organizational change. Subsequently, a composite narrative in the form of a letter was composed, revealing four plotlines: responsive relationship, moral distress, reflection and reconstruction, and knowledge and identity. These plotlines intersect to describe the extent to which nurses meet their moral obligations within relational practice. This inquiry brings to the foreground four narrative terms, including stories to commit by, that contribute to a new way of thinking about familiar issues. It illuminates the personal and the active movement of reflection that reside in a person and the choice(s) she/he makes to re-craft a life. Considerations for practice, education, policy, and research highlight the importance of a deeper level of reflective practice, the connection between personal and ethical knowledge, and the need for becoming aware of one’s moral horizon. / Thesis / Doctor of Philosophy (PhD)

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Nursing is influenced by the values of each nurse (Mellish & Paton, 1999: 6). Values form an integral part of human reality; they predict thoughts, feelings, actions and perceptions. Nursing in South Africa, is defined as a "caring profession” (Act No. 33 of 2005) and forms a subculture of the South African population, with nurses coming from different cultural and ethnic groups, being of various ages and both genders. It was identified that a need exists to understand nursing values and the factors influencing these values. Consequently, together with the lack of research data regarding values in South Africa and the factors influencing them, the importance to do an investigation into the factors influencing nursing values was identified. The aim was to do an in-depth study into the factors influencing nursing values of nurses working in nursing facilities in the Paarl district employed by the Provincial Administration of the Western Cape, in the West Coast Winelands Region of the Western Cape. The objectives were to determine the main reason for entering the nursing profession for nurses working in these facilities; to identify the most important part of nursing practice; to identify the core nursing values; to determine the factors influencing nursing values and the factors influencing nursing care. A quantitative research design using a descriptive, explorative survey was conducted. The population included the three categories of nurses, with a total population of 470 nurses (N = 470). Research questionnaires were distributed to 388 participants working on the days of data collection in all nursing departments, excluded nurses not permanently employed by the Provincial Administration Western Cape, including nursing agency staff, students doing practica and personnel on leave. The return rate was 60.56% (n = 235). The questionnaire was based on a literature review and the objectives, and a pilot test ensured reliability and validity. The results of the pilot study (n =10) were included in the findings, leading to 245 respondents (n = 245) being included in the main study. The questionnaire consisted of four sections and was validated by an expert in nursing science and research methodology, a biostatistician, a quality assurance manager and ethical committees. Four open-ended questions were included to provide richer and more diverse data. Only the researcher was involved in data collection that took place during day and night duty. Descriptive statistics and appropriate inferential statistical tests were used in analysing the data. Ethical approval was obtained. Anonymity and confidentiality of respondents were observed and written consent was obtained from respondents. It was identified that nurses enter the nursing profession due to altruism and the most important part of nursing encompasses caring. Differences in values important for behaviour of a nurse, patient care and ethical decision making were identified. Findings depicted that age, years of experience, qualification obtained, job description and department influence different values. Results identified that political and social factors, as well as motivation influence nursing practice. Recommendations include setting a clear value structure for nursing in South Africa; attention to the evaluation of staff performance and management; enhancing motivation of staff and the development of a management-for-nurse strategy. / AFRIKAANSE OPSOMMING: Verpleging word beïnvloed deur die waardes van elke verpleegster (Mellish & Paton, 1999:6). Waardes vorm ’n integrerende deel van die menslike realiteit, dit voorspel gedagtes, gevoelens, handelinge en gewaarwordinge. Verpleging in Suid-Afrika word gedefinieer as ’n versorgingsberoep (Wet No. 33 van 2005) en vorm ’n subkultuur van die Suid-Afrikaanse bevolking, met verpleegsters van verskillende kulturele en etniese groepe wat verskeie ouderdomme en albei geslagte insluit. Dit is geïdentifiseer dat ’n behoefte bestaan om verplegingswaardes en die faktore wat hierdie waardes beïnvloed, te verstaan. Gevolglik, gesamentlik met die gebrek aan navorsingsdata aangaande verpleegwaardes en die faktore wat dit beïnvloed, in Suid-Afrika, is die belangrikheid geïdentifiseer om ’n ondersoek te doen aangaande die faktore wat verpleegwaardes beïnvloed. Die doel was om ’n dieptestudie te doen van die faktore wat die verpleegwaardes van verpleegsters beïnvloed wat in verpleeg instansies in die Paarl-distrik werk in diens van die Provinsiale Administrasie van die Wes-Kaap, in die Weskus Wynlandstreek van die Wes-Kaap. Die doelwitte was om die hoofrede te bepaal waarom verpleegsters wat in hierdie fasiliteite werk die verpleegberoep betree het; om die belangrikste aspek van die verpleegpraktyk te identifiseer; die kern verplegingswaardes te identifiseer; en die faktore te bepaal wat verplegingswaardes en verpleegsorg beïnvloed. ’n Kwantitatiewe navorsingsontwerp is toegepas deur van ’n beskrywende, ondersoekende opname gebruik te maak. Die bevolking het die drie kategorieë van verpleegsters ingesluit, met ’n totale bevolking van 470 verpleegsters (N=470). Navorsingsvraelyste is versprei aan 388 deelnemers wat op die dae van data-insameling gewerk het in die verpleegdepartemente en het verpleegsters uitgesluit wat nie permanent indiens was van die Provinsiale Administrasie van die Wes-Kaap, asook verpleegagentskap personeel, studente wat praktika verrig en personeel op verlof. Die terugkeerkoers was 60.56% (n=235). Die vraelys was gebaseer op ’n literatuurstudie en die doelwitte van die studie, ’n loodsstudie het betroubaarheid en geldigheid verseker. Die resultate van die loodsstudie (n=10) is ingesluit in die bevindinge, wat gelei tot 245 respondente (n=245) in die hoof studie. Die vraelys het bestaan uit vier afdelings en is geldig verklaar deur ’n spesialis op die gebied van verpleegkunde en navorsingsmetodologie, ’n biostatistikus, ’n kwaliteitversekeringsbestuurder en etiese komitees. Vier oop-vrae is ingesluit om omvattende en meer uiteenlopende data te voorsien. Slegs die navorser was betrokke by data-insameling wat gedurende dag en nag skofte plaasgevind het. Beskrywende statistiek en geskikte afleibare statistiese toetse is gebruik in die analisering van die data. Etiese goedkeuring is verkry. Anonimiteit en vertroulikheid van respondente is behou en geskrewe toestemming is verkry van respondente. Bevindinge het getoon dat verpleegsters die verpleegberoep betree weens hul onbaatsugtigheid en dat die belangrikste aspek van verpleging versorging is. Verskille in waardes wat belangrik is vir die gedrag van ’n verpleegster/verpleër, pasiënt versorging en etiese besluitneming is geïdentifiseer. Daar is bevind dat ouderdom, ondervinding in jare, kwalifikasies behaal, posbeskrywing en die departement verskillende waardes beïnvloed. Resultate het bewys dat politieke en sosiale faktore, asook motivering verpleegpraktyk beïnvloed. Aanbevelings sluit die daarstelling van ’n duidelike struktuur van verpleegwaardes in Suid-Afrika; die nodigheid vir aandag aan die evaluering van personeelprestasie en -bestuur; die verheffing van personeelmotivering en die ontwikkeling van ’n bestuur-vir-verpleegster strategie.

Background: International Service Learning (ISL) is becoming widely used in nursing education as a means to provide global learning opportunities. Concrete outcomes for these experiences have not been clearly supported in previous research. Determining if ISL experience facilitate the development of Professional Nursing Values (PNV) can support the use of ISL as a viable pedagogy. Purpose: The purpose of the study was to determine if there were a difference in PNV development in students who participate in ISL as part of their clinical experiences compared to those who do not. The hypothesis was that there was a difference in the two groups. Theoretical framework: The study utilized Kolb’s experiential learning theory, which has a focus on the experiences of students as an impetus for learning. Methods: The research was a quasi-experimental study with a pretest, posttest design. Consecutive sampling was utilized for the experimental group and stratified random sampling for the control group. Results: Pretest analysis did not demonstrate any significant difference in the two groups at baseline. Post-test analysis indicated that while the mean PNV of the ISL group was higher, the results were not statistically significant. However, the difference in the pretest and posttest scores across all participants was statistically significant. Conclusions: While the findings were not significant in determining a difference between the two groups, the findings indicated that experiential learning in itself does support the development of PNV. Further research using a larger sample size may support the difference in these two groups and support the use of ISL as a viable pedagogy.

Research has shown that, worldwide the nursing profession is faced with image-related challenges impacting on its status, prestige, power and the ability to attract more young and suitably qualified students to nursing. There is adequate evidence of a link between the image of nursing and the number of young people entering and leaving the profession. A positive image of nursing attracts applicants and the intention to leave nursing correlates positively with holding a negative image of nursing. There is also evidence of poor perception of the image of nursing among student nurses. The study aimed at exploring the potential of appreciative inquiry (AI) as a teaching strategy to transform the image of nursing among 3rd and 4th year, college and university student nurses in the Gauteng province of South Africa. The second aim was to describe student nurses’ experiences regarding their participation in the process of AI. A qualitatively dominant, sequentially embedded, mixed methods design with explorative-descriptive and quasi-experimental features was utilised. Sequential data collection and analysis were conducted during five stages comprising: a pre-test survey, intervention (appreciative inquiry), a post-test, description of the experiences of student nurses of AI and an integration stage. The pre-test results showed more positive than negative perceptions of the image of nursing among student nurses. The negative perceptions of the image of nursing among student nurses that needed intervention included the working conditions of nurses and the perception of nursing as a profession that was not respected and appreciated. The student nurses who took part in appreciative inquiry showed a significant and positive change in their perception of the image of nursing as a respected and appreciated profession. From the individual interviews on the student nurses’ experiences of AI, the themes “experience of positive emotions” and “experiential learning” emerged. The student nurses experiences described their engagement in AI as a positive and enjoyable experience from which multidimensional learning resulted. / Health Studies / Ph. D. (Health Studies)

Research has shown that, worldwide the nursing profession is faced with image-related challenges impacting on its status, prestige, power and the ability to attract more young and suitably qualified students to nursing. There is adequate evidence of a link between the image of nursing and the number of young people entering and leaving the profession. A positive image of nursing attracts applicants and the intention to leave nursing correlates positively with holding a negative image of nursing. There is also evidence of poor perception of the image of nursing among student nurses. The study aimed at exploring the potential of appreciative inquiry (AI) as a teaching strategy to transform the image of nursing among 3rd and 4th year, college and university student nurses in the Gauteng province of South Africa. The second aim was to describe student nurses’ experiences regarding their participation in the process of AI. A qualitatively dominant, sequentially embedded, mixed methods design with explorative-descriptive and quasi-experimental features was utilised. Sequential data collection and analysis were conducted during five stages comprising: a pre-test survey, intervention (appreciative inquiry), a post-test, description of the experiences of student nurses of AI and an integration stage. The pre-test results showed more positive than negative perceptions of the image of nursing among student nurses. The negative perceptions of the image of nursing among student nurses that needed intervention included the working conditions of nurses and the perception of nursing as a profession that was not respected and appreciated. The student nurses who took part in appreciative inquiry showed a significant and positive change in their perception of the image of nursing as a respected and appreciated profession. From the individual interviews on the student nurses’ experiences of AI, the themes “experience of positive emotions” and “experiential learning” emerged. The student nurses experiences described their engagement in AI as a positive and enjoyable experience from which multidimensional learning resulted. / Health Studies / Ph. D. (Health Studies)