3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item The learning process that best support the development of competence among nursing students in practice(2019) Munangatire, TakaedzaThe development of competence among student nurses is important to nurse educators, nursing regulatory bodies, employers and patients. Several teaching and learning strategies have been developed to support the development of competence among student nurses but the level of competence at the point of graduation remains below expected standards. This study explored students’ experiences of the learning processes that support the development of competence in nursing practice in Namibia. Gaining an understanding of learning from the student’s perspective can strengthen the current teaching and learning strategies, hence improve the development of competence. The qualitative phenomenographic study that investigated the learning processes that best support the development of competence was conducted in Namibia at a nursing college. Forty- nine (49) participants (lecturers, clinical instructors, nurses and student nurses) were purposively sampled to take part in the study. Data were collected through in-depth interviews and focus group discussions. The analysis of data was managed through ATLAS. ti 8.1 and followed the process of familiarisation, condensation, comparison, grouping, articulating labelling and contrasting of excerpts in order to generate the outcome space. Ethical principles were applied to ensure that the study complied with ethical requirements set by institutions and international guidelines. Five categories of description emerged and showed that the development of competence involves students increasing their understanding of what competence is, hence changing their learning strategies to meet the level of competence as they understood it. In order of hierarchy from the lowest, the categories of description were; competence is understood as task completion; competence is understood as passing assessments /satisfying facilitators; competence is understood as applying theory to practice; competence is understood as performance of nursing according to clinical standards/guidelines; competence is understood as performance that yields positive health outcomes. An analysis of the outcome space culminated in a proposed model for the development of competence, which shows that the development of competence among student nurses is influenced directly and indirectly by the students’ understanding of competence. Students with a shallow understanding of competence adopt superficial learning approaches. As students progress in their education and are exposed to real practice settings, their understanding of competence deepens and they shift their learning strategies to deep approaches.Item Comparing the Job Location Choices of University-trained and College-trained Professional Nurses in South Africa(2018) Vambe, DebrahBackground: In South Africa, university-trained professional nurses attain a degree after 4 years of training and college-trained professional nurses attain a diploma after 4 years of training. The competence of degree versus diploma nurses has been debated for a number of years. It is argued that degree programmes provide students with critical thinking skills, leadership and management, and a more in-depth study of the physical and social sciences, as well as community and public health nursing. There is also inconclusive evidence suggesting that university-trained nurses are more competent than college-trained nurses in certain areas. This has led to a shift towards university-trained nurses in many countries with the intention of improving patient safety and quality of care. The debates have mainly focused on the relative nursing skills of these two training routes, but there is limited evidence on the retention and job location choices of university-trained and college-trained professional nurses for different sectors (public or private), areas (rural or urban), or facility types (hospital, clinic/community health centre (CHC). Hence this study was conducted to compare the job location choices of college-trained and universitytrained professional nurses, as well as the factors associated with these choices over time as well. Methodology: This study was a secondary analysis of data from a prospective cohort study of South African college and university professional nursing graduates from two provinces in 2009 up to 2015. Job location choices, defined as working in the public or private sector; rural or urban area; and hospital, clinic/community health centre (CHC) or other facilities were the primary outcomes for this study. The main exposure variable was the training institution type which was defined as either university or college-training. Job location choices of these university-trained and college-trained professional nurses was assessed after 6 years of follow-up using Pearson’s chi-squared test followed by binary and multinomial logistic regression to adjust for confounders. Information on potential predictors of job location choices other than training institution type were assessed using Pearson’s chi-squared test and t-tests. All professional nursing graduates started in the public sector for community service, so we also evaluated the time to first move to the private sector during the period 2009-2015 using survival analysis. Kaplan-Meier curves were used to compare this outcome between university and college-trained nurses. A Cox proportional hazard model was used to determine the possible association of predictor variables and to obtain adjusted hazard ratios. Data were analysed using Stata version 14.0. Results: The results show that type of sector (public, private for-profit and private not-forprofit) was the only job location choice associated with training institution type after 6 years of follow up (p=0.019), with more college-trained professional nurses in the public sector (78.3%) as compared to university-trained nurses (62.5%). Work area (urban or rural) and facility type (clinic/community health centre, hospital or other), were not associated with training institution type, (p=0.179) and (p=0.459) respectively. When adjusted for confounders, training institution type was found not to be significantly associated with any job location choice including type of sector. Instead being male (OR=2.57; 95%CI=1.11-5.44), being white (OR=7.70; 95%CI:2.02-29.36), under 30 years (OR=2.30; 95%CI:1.10-4.89), having a child (OR=0.46; 95%CI:0.23-0.91) and having nursing as first career choice (OR=0.47; 95%CI=0.22-0.99) were strong predictors of choosing private sector job location as compared to public sector. In the survival analysis, the proportion leaving the public sector at any given time was higher and earlier among university-trained compared to college-trained professional nurses (p=0.010). When adjusted for confounders, change from public to private sector was found not to be significantly associated with training institution type but age below 30 years (HR=2.21; 95%CI:1.35-3.62), being white (HR=3.16; 95%CI:1.64-6.03) and nursing as first career choice (HR=0.56; 95%CI:0.36-0.89) were strong predictors for moving to the private sector. The top 3 reasons for job location changes from public to private, rural to urban and clinic/CHC to hospital were job dissatisfaction (64.1%), wanting to be closer home (46.8%) and wanting to earn higher salary (33.7%). The main reasons for movement from public to private sector alone were job dissatisfaction (27.3%), wanting to earn higher salary (19.5%) and advancement in career/wanting new challenge (12.7%). Implications, Recommendations and Conclusions: The study found some association between sector (private or public) and training institution type of professional nurses on bivariate analysis. On multivariate analysis, the association was no statistically significant but certain sociodemographic factors such as gender, age, having children, ethnicity and choosing nursing as first career choice were stronger predictors of job location choice. This analysis suggests that retention of degree-trained nurses in the public sector or rural areas is not significantly different to that of diploma-trained nurses, although larger studies from a wider range of training institutions are required to confirm this. This study provides useful evidence for policy makers involved in the reform of nursing education in South Africa in order improve nursing skills and health care service quality, particularly in underserved communities. The South African government could therefore consider implementing the nursing education reforms and promoting primary health care re-engineering since these cadres have almost similar job location choices.Item Bullying and violence prevention programmes in nursing: integrative literature review(2018) Nalumansi, Esther CarolineBackground: Several studies have highlighted workplace bullying in the healthcare sector, especially its prevalence among nursing employees. Despite the recommendations by previous studies for control measures to be instituted, bullying and violence remain a major challenge in the nursing sector. Aim: The aim of the study is to identify and critically evaluate articles from scientific nursing publications, identified in specific databases, as to what makes bullying and violence prevention programmes for nurses effective. This is to gain a better understanding of the problem, and to see how it has been addressed in the past 5 years. The findings will serve to inform future interventions to reduce workplace bullying among nurses. Methodology: An integrative literature review framework was employed. Thirty-one (31) articles identified from Cochrane library, EBSCO host (CINAHL, ERIC and MEDLINE), PubMed, Wiley Online Library and Psych Info were included in this review. Results: The following characteristics, which make bullying and violence prevention programmes, were identified: leaders' involvement, empowerment programmes and institutionalisation ofbullying prevention policies. Recommendations: To incorporate evidence based training and techniques timeously and consistently within the undergraduate and orientation programmes as well as conducting more studies within South Africa to evaluate the effectiveness of the intervention strategies mentioned in literature. Keywords: bullying, prevention, effectiveness, nursingItem The development of an advanced practice nursing (Child Health Nurse Practitioner) curriculum framework for Sub-Saharan Africa: a multi-method study(2018) Christmals, Christmal DelaBackground: Nurses are the majority of readily available healthcare professionals in Sub- Saharan Africa (SSA), therefore, improving access to Advanced Practice Nursing (APN) programmes in order to improve healthcare within SSA where preventive services are much needed is essential. Sub-Saharan Africa is unique in terms of its challenges, opportunities and health need hence an APN (Child Health) curriculum must be designed and continually reviewed to meet the needs of the continent. Professional education has not kept pace with SSA’s special healthcare challenges, largely because of fragmented, outdated, and static curricula that produce ill-equipped graduates. Aim: The aim of this study is to develop a curriculum development framework to guide governments and Nursing Education Institutions in the development of relevant Advanced Practice Nursing (Child Health Nurse Practitioner) curriculum that responds to the child healthcare needs of Sub-Saharan Africa Methodology: A sequential multi-method research design was employed in this study. The study began with a scoping review, followed by a Delphi, then concept development, and the development, confirmation and evaluation of the curriculum framework. Findings: Children are the majority of Sub-Saharan Africa. Between 70-90% of the Sub- Saharan African population is rural and lack access to quality and cost-effective healthcare services as most healthcare facilities are located in the cities and small towns. The implementation of Advanced Practice Nursing programmes is essential in increasing access to quality healthcare services for the majority and marginalized rural population of Sub-Saharan Africa. The introduction of Advanced Practice Nursing programmes is challenged by the opposition from the medical profession, the existence of lower cadre medical professionals, meagre resource allocation, lack of scope of practice, lack of context-specific benchmark programmes and lack of political will. The need to increase access to quality healthcare to the rural population, the push for Primary Health Care, the dominance of nursing professionals in the healthcare system of Sub-Saharan Africa, the existence of resource sharing opportunities were facilitating factors. A concept-based Child Health Nurse Practitioner curriculum framework for Sub-Saharan Africa was developed. Conclusion: The Child Health Nursing Practitioner curriculum framework is comprehensive, context-specific, has the potential to respond to the special child healthcare needs of Sub-Saharan Africa and is adaptable for other Advanced Practice Nursing speciality programmes in Sub-Saharan Africa.Item Evaluation of undergraduate nursing students' clinical learning in a developing country: a formative assessment framework(2017) Msosa, Annie NancySimulation laboratories help students build a strong foundation of clinical competence in an environment that is stress free prior to clinical placements. A number of Investigations regarding simulation impact in college-based training institutions in developed countries have taken place. However, there is paucity of such research from nursing education institutions in developing countries. With this in mind, an evaluation study was conducted to assess how clinical teaching, learning and the OSCE method of evaluation are experienced from the nurse educators’ and students’ perspectives in the skills laboratory. Additionally, the study sought to determine the effect of the Formative Assessment Framework for learning in the skills laboratories. The specific objectives were to explore the students and educators’ perspectives of teaching and learning and describe how the current mode of assessment, namely, the OSCE is experienced. From these perspectives, the researcher extrapolated the factors and issues that affect students’ clinical learning and the OSCE. Finally, the objective was to develop, validate, implement and evaluate the impact of a Formative Assessment Framework (FAF) by determining and comparing students’ competence in selected general nursing and midwifery skills between and within the experimental and control groups. A sequential, mixed methods design was chosen, starting with a qualitative approach in phase 1 followed by a quantitative approach using a quasi-experimental design in phase 2. In phase 1, in-depth and focus group interviews were used to collect data from nurse educators (n=6) and students (n=45). Data were organized and managed with the MAXQDA software version 11 and were analysed thematically. The synthesis of the teaching, learning and evaluation gaps with input from the literature reviewed on concepts of formative assessment and deliberate practice supported the development of a Formative Assessment Framework (FAF). The FAF involved a minimum of 2 demonstrations on each procedure before and after practise sessions, a minimum of two supervised return demonstrations, feedback and supervised practise. Nursing education experts validated the FAF using the Delphi technique. Quantitative data from the senior students (n= 101) and junior students (n= 160) was collected using the FAF. Data was collected using structured checklists from the eighteen selected nursing and midwifery procedures. Pre and post-testing of the students’ performance and competence was tested. Quantitative data were analysed using the STATA software version 13. Qualitative findings showed that demonstrations and return demonstrations contribute effectively to students teaching and learning in the skills laboratories. The practise sessions, presence of the nurse educators and availability of resources make the learning environment more conducive than teaching and learning in the practice sites. However, students have limited practise sessions, which seriously affect teaching and learning in the skills laboratories negatively. In terms of the OSCE, the method is good because the environment resembles the clinical setting; it is appropriate for large student numbers and ensures standardization of the examinations. However, the preparation for the OSCE is inadequate. Quantitatively, the paired t-tests, Wilcoxon sum rank and Wilcoxon, sign rank tests, were used to test the results. Usage of a formative assessment framework had a significant effect on senior students’ clinical performance in physical examination of a pregnant woman, the triage process in under five clinic, contraceptive implant insertion, contraceptive implant removal, breast examination, episiotomy repair, management of the third stage of labour, subsequent examination of the newborn and speculum examination procedure among the junior students. There were also significant effects on the junior students’ performance in the procedures of blood transfusion, female catheterisation, health education, and insulin intravenous injection, naso-gastric tube insertion, airway suctioning and wound dressing except on colostomy care. The mean differences between the control and experimental groups for most of the tested procedures were significantly different. The results were statistically significant with a p-value of <0, 05, set at 95 % confidence intervals. In conclusion, the integration of the FAF in students’ learning in the skills laboratories has the capacity to improve the student’s clinical performance and competence. The use of the FAF has the capacity to prepare a student adequately for the summative OSCE in the skills laboratory and ultimately, his/her clinical competence for better patient and client care.Item Perceptions of participants of management development programmes in the Gauteng Health Department.(2003) Bassed, Philistas JaneManagement development has been identified as one of the priorities in the Gauteng Health Department [GHD]. The nature of public service management is changing. There is an emphasis on new and more flexible management approaches in the public sector; this requires public service managers to acquire new kinds of skills. Further to this, the changing nature of management in general, caused by globalization increases the need for new kinds of skills amongst managers. This changing framework is facilitated by various new laws, which provide a watershed in the way that human resource development is undertaken in South Africa. It is necessary to ensure that training and development initiatives in the Department are aligned to the new legislative framework. The Employment Equity Act requires representivity in the workplace; there is a need for management skills development programmes to redress past imbalances. The GHD provides several management development programmes for its employees every year. In keeping with current trends and legislation it is necessary to evaluate these programmes to identify strengths and weaknesses in order to improve future management development programmes in the GHD, and ensure that money is well spent. The main goal of this research is to formulate guidelines for the effective implementation of management development programmes in the GHD. The objective of the study is to explore and describe the perceptions of the participants of management development programmes provided by the Department between 1999 and 2001. The researcher used focus groups for data collection and individual interviews for methodological triangulation. The population (N) in this study comprises of all the people who attended management development programme/s purchased by the Department between 1999 and 2001. Three Hundred and forty eight managers attended the programmes between 1999 to 2001 (N = 348).Purposive samples were used for the focus groups and individual interviews. An independent interviewer was used to conduct the interviews in order to ensure objectivity, and anonymity of the participants. Fields notes were taken and the interviews audio-recorded. Written consent was obtained from the participants for the audio recording of the interviews. The data were transcribed verbatim. The Tesch method was employed to analyse the data. The data were grouped and coded. Emerging themes and sub-themes were identified and contextualised through a literature control. Scrutiny of the study by the Ethics Committee of the University of the Witwatersrand ensured ethical rigor. The findings were used to formulate guidelines for future management development programmes in the GHD. The research report was communicated to the GHD.Item The role of the South African Nursing Council in promoting ethical practice in the nursing profession: a normative analysis(2015) Mathibe-Neke, Johanna MmabojalwaIn response to an increasing number of litigations relating to nursing care errors, negligence or acts and omissions that arise mostly due to unprofessional or unethical behaviour by nurse practitioners, compounded by the growing awareness of patient’s rights, nurse practitioners as such need an intervention by the regulatory body, the South African Nursing Council (SANC). The argument presented in this report is regarding the obligatory role of SANC to uphold professional and ethical practice for nurses in terms of the curriculum, the scope of practice, the code of ethics, continuing professional development and by offering an appropriate workplace ethical climate. The basis of the argument is philosophical perspectives, legislation and moral theories related to ethical practice. The moral theories applied to this study are deontology, utilitarianism, virtue ethics and Ubuntu as an African moral theory, whereas legislation relates to rules and regulations related to nursing practice. The overall significance of the study is to enhance nursing care with specific focus on upholding ethical principles from the SANC position, that will positively impact on the improvement of health care by nurses with reference to the Nursing Act No. 33 of 2005, The Bill of Rights (Constitution of South Africa), The Universal Declaration of Human Rights, the Patient’s Rights Charter, the International Council of Nurses (ICN) , the South African Nursing Council Code of ethics and the National Health Act 61 of 2003.Item The roles and perceptions of career guidance teachers in influencing learners' choice of nursing as a career(2014) Sathekge, Hazel SadieCareer guidance teachers have an important role to play in the career choices of high school learners by presenting them with information on different careers so that informed decisions can be made. It follows that the amount and quality of information that such teachers have and their views or perceptions of a career may have either a positive or negative influence on learners’ choices, in this instance, nursing as a career choice. High school learners’ declining interest in nursing as a career of choice has led to questions about career guidance teachers’ knowledge regarding nursing as a career, the attributes and contemporary roles of nurses and to what extent they suggest nursing to enquiring learners. If career guidance teachers’ perceptions about nursing influence recruitment into the profession, then it is important to determine what these perceptions are and what role they play in suggesting or not suggesting nursing as a career to high school learners. The purpose of the study was to determine the perceptions of career guidance or Life Orientation (LO) teachers in influencing high school learners’ choosing or not choosing nursing as a career. The study was delimited to Life Orientation teachers of three Johannesburg districts in Gauteng. The study objectives were to determine the frequency and source of requests for nursing information directed to career guidance teachers; to explore what career guidance teachers believe are important attributes of nurses; to determine the type of student in respect of personality and academic attributes that career guidance teachers would typically refer to a nursing programme, and to determine career guidance teachers’ perceptions of the roles and responsibilities of nurses currently and in the future. Data were collected in 2011 from September to December. The results showed that Life Orientation (LO) teachers in Gauteng do not receive a high number of requests about nursing from neither learners nor parents; just over 40% receive between one to five learner requests per year. A few teachers have suggested nursing to approximately 20 learners in the past five years; experienced teachers are more likely than inexperienced ones (p=0.0139) to suggest nursing as a career; LO teachers’ age and gender have no influence on them suggesting nursing as a career. Having studied the subject Life Sciences is the most important academic variable for referral to study nursing; learners who are caring and who enjoy working with people are considered suitable for nursing; these are also ranted as the most important personality attributes, followed by being hardworking/diligent and loving. Most LO teachers (63.0%) in this study were aware that nurses’ roles have changed over time but were not knowledgeable about the extent of role change and what the roles and responsibilities of contemporary nurses are.Item The role of the patient liaison nurse in the ambulatory care context of a Middle Eastern teaching hospital: a practice model(2012-07-13) Bodrick, Mustafa Morris ElstonThe commencement of the role of patient liaison nurse (PLN) in the ambulatory care context of a Middle Eastern teaching hospital was an organizational response to patient care concerns during the site absence of physicians and the healthcare team. The PLN consequently evolved as a functional role of the registered nurse (RN) in ambulatory care nursing. The core research question asked was: how can a model be developed to describe the PLN role? The related topics for research included (i) the lived experiences of nurses in the functional role of the RN as PLN, (ii) what the nursing management team in the ambulatory care context considered as the functional role of the RN as PLN, (iii) the core and related concepts of the functional role of the RN as PLN, (iv) a conceptual framework to describe the PLN role, (v) the relational statements of the model that describes the functional role of the RN as PLN, (vi) the evaluation of the model, and (vii) formulation of guidelines for operationalization of the model. A qualitative process of scientific research inquiry followed two phases. The first phase included the research methods on the critical incident technique and reflective journaling to study the lived experiences of the PLN participants, and vignette responses that were used to investigate what nursing management respondents considered to be the functional role of the RN as PLN. The empirical results that emerged from the data analyses of the reflective journals and vignette responses were stated as conclusion statements of the emergent themes, and were used in phase two as the starting point for model development. The process of scientific inquiry concluded with an evaluation of the model, and the generation of guidelines for the operationalization of the model for patient liaison nursing in the ambulatory care context of a Middle Eastern teaching hospital.Item School leavers’ perceptions of Nursing as a career of choice(2011-11-23) Mphahlele, Nomonde EuphoniaThis quantitative study used a cross-sectional descriptive survey to determine school leavers' perceptions of nursing as a career of choice and how those perceptions influence them in choosing or not choosing nursing as a career. A sample size of Grade 12 school leavers was (n=328). Respondents were invited to participate voluntarily In the study and were selected from 11 public schools from five regions in the Johannesburg district stratified random sampling was employed to select the participating public schools In order to determine the number of respondents per region while the school regions were used as strata. Simple random sampling was used to select participating schools with school names from the sampling frame printed on paper, separated and placed in each bowl representing each of the five regions. Schools were selected randomly from each bowl until the desired sample size was reached. Data was collected by using a 21-itern self-administered questionnaire with closed- and open-ended questions to elicit and describe the school leavers' perceptions of nursing as a career of choice and how those perceptions influence them in choosing or not choosing nursing as a career. Data was analysed through SPSS (Statistical Package for The Social Sciences) Version 13. Results of the study revealed that the perceptions held by school leavers are that nursing as a career of choice is amongst the least popular, less interesting and poorly appealing. This supports the hypothesis that nursing is rated poorly when compared to other career choices of school leavers. Interest in nursing as a career of choice could only be stimulated if the school leavers are given clear, accurate and continuous information on nursing to create awareness about nursing as a career of choice.