3. Electronic Theses and Dissertations (ETDs) - All submissions

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    Analysing the nature and dynamics of nursing management at primary health care clinics in two South African provinces
    (2016) Munyewende, Pascalia Ozida
    Background: In South Africa, nurses form the backbone of the health system, because of their numerical dominance, their skills and training, their close contact with patients and communities and their prominence in managerial and leadership roles at all levels of the health system. Objective: The aim of this PhD was to analyse the nature and dynamics of nursing management at primary health care (PHC) clinics in two South African provinces. The specific objectives were to: describe the social-demographic characteristics of selected PHC nursing managers; determine their job satisfaction levels; examine the work environment; determine the functionality of PHC support systems; and assess their managerial competencies. Methods: In 2012, a mixed methods cross-sectional study was conducted in Gauteng and Free State Provinces. Using stratified random sampling, 111 PHC nursing managers working in eight hour clinics were selected. After obtaining informed consent, these managers were invited to participate in three surveys: job satisfaction, facility assessment and a 360 degree competency evaluation. A sub-set of these managers (n=22) was requested to keep a diary for six weeks. STATA® was used to do quantitative data analysis, while the qualitative data was analysed using thematic content analysis. Results: A 95% response rate was obtained for all surveys. The majority of PHC clinic nursing managers were female (92%), black, married, with a mean age of 49 years (SD = 7.9), 90% were in permanent positions, and 36% had between 21-30 years of professional nursing experience. The overall job satisfaction scores for Gauteng and Free State PHC clinic nursing managers were 142.80 (SD± 24.3) and 143.41 (SD± 25.6) out of a possible score of 215. The predictors of their job satisfaction were: working in a clinic of choice (RRR = 3.10), being tired at work (RRR = 0.19) and experience of verbal abuse (RRR = 0.18). The facility assessment found that none of the selected clinics obtained scores of 100% for the vital elements of the National Core Standards. Overall, clinic nursing managers rated themselves high on the domains of communication (8.6), leadership and management (8.67), staff management (8.75), planning and priority setting (8.6), and problem-solving (8.83). The exception was the financial management domain where the nursing managers gave lower ratings (7.94). Health system deficiencies, human resources challenges, leadership and governance, and unsupportive management dominated the diary entries, and coalesced to produce many negative emotions experienced by these PHC clinic nursing managers. Conclusion: This PhD study has underscored the importance of PHC nursing managers, and has generated new knowledge on the overall levels and predictors of job satisfaction, the perceived competencies of these managers, together with information on the work environment and support systems. The successful implementation of PHC revitalisation and universal health coverage reforms cannot be achieved without addressing the concerns of PHC nursing managers and the health system issues affecting them.
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    The role of the South African Nursing Council in promoting ethical practice in the nursing profession: a normative analysis
    (2015) Mathibe-Neke, Johanna Mmabojalwa
    In 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.
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    A discourse and content analysis of how nursing is framed in the mainstream press in South Africa: January-June, 2010
    (2012-03-15) Van Zyl, Greer
    Introduction: Globally and locally, the status of nurses and their profession is diminishing, ascribed partly due to the image of nursing portrayed in the media of a profession with heavy workloads, poor pay and no longer considered a career of choice. In South Africa, the increased disease burden due to HIV/AIDS and tuberculosis, together with a deteriorating health system and significant inequities in terms of nurse distribution, has led to grave public concerns about the profession. The media play a key role in national development, helping to shape public perceptions by influencing how society understands events. This cross-sectional study aimed to explore how nursing is framed in the mainstream press over a six-month period in 2010 using mixed methods of a quantitative content analysis and a qualitative discourse analysis. Methodology This cross-sectional study used a mixed method approach of both quantitative and qualitative methodologies. The content of all articles mentioning „nurse‟ or „nursing‟ from the press cutting agency Monitoring South Africa (1 January – 30 June 2010) was analysed, yielding a total of 242 articles. From these, 91 articles were purposively selected for the qualitative discourse analysis. A data coding sheet was developed to capture key dimensions from each article for the quantitative content analysis. Both descriptive and inferential analysis was carried out. For the qualitative discourse analysis press cuttings were converted and coded, and then thematic analysis was carried out Results The results of the quantitative analysis found that nursing is not well covered in the South African lay press, and when it is featured, articles appear in community publications with small circulations. Most articles on nursing were prominent (ie. full-length) and positive. International Nurses‟ Day (IND) was seen to influence the proportion of nursing articles with more than double the number of articles appearing in May compared to the total average of other months, and all coded „positive‟. However, when IND was excluded from analysis, negative articles were dominant, mainly around strikes and unprofessional behavior which featured in daily and larger circulation newspapers. In keeping with international literature, strikes as a theme received the most coverage, but unique to this study was the finding that nursing neglect or unprofessionalism received almost as much coverage as strikes, featuring in the majority of page 1 articles and in publications with large circulations. 5 Regarding voice, this study found that nurses were quoted in just over a quarter of articles which featured quotes, but that spokespeople were quoted twice as often, remarkably so even for IND. Most nurse quotes were around strikes and poor working conditions. Nurses were quoted more frequently in community newspapers and in Western Cape newspapers. Doctors were seldom quoted, and 90% of patient quotes were negative. While females were quoted first in the majority of articles, a third of their quotes were anonymous, mainly around negative topics such as labour, protest action and service delivery, indicating their fear of reprisal from their institutions. Males were quoted more often in second and third quotes of articles, with the extent of quotes approximately in proportion to their numbers in the profession. The results of the qualitative discourse analysis revealed a profession groaning under the weight of a crumbling health system. Articles on the working conditions, salaries and shortages of nurses were mostly sympathetic, but when nurses „went too far‟, they were portrayed as unprofessional, negligent and abusive. Nurses were also not taken seriously when they raised the alarm about deteriorating health systems, which is disturbing when they are at the forefront of healthcare delivery. Very few articles dealt with nursing as a profession or academic nursing in any detail. Although there were more positive than negative articles, and IND garnered significant positive coverage for the profession with nearly a third of all articles appearing in May when IND is celebrated, the lasting impression is that of negative coverage, particularly from the discourse on patient abuse, neglect or abandonment during strikes. Nurse voices are notably absent from these articles. Conclusion South African nursing would benefit from media advocacy and partnerships to promote the profession. As the majority workforce which undertakes essential, life-giving tasks, nurses are the backbone of the healthcare system and critical contributors to quality health care. Their place at the policy table and space in the press is well overdue.
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