3. Electronic Theses and Dissertations (ETDs) - All submissions
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
Browse
16 results
Search Results
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 Effects of the stress management intervention amonsgt intensive care nurses in a Gauteng public hospital(2017) Haarde, MarliseBackground: South African professional nurses, working in an Intensive Care Unit (ICU) experience many physical and psycho-social hazards and risks. Stress, provoked by failure to meet work demands, leads to illness, injury and psychological suffering. This in turn may result in absenteeism and to the nurse abandoning the profession. It is therefore necessary for healthcare administrators to address the aspects leading to nurse stress and work burnout. Setting: The study was conducted in the adult intensive care units of a public sector hospital. Purpose of the study: The purpose of the study was to develop and pilot test a stress management intervention for professional nurses practising in ICUs. Method: A quasi-experimental non-equivalent control group design was selected for this study. It comprised of pre-testing, development and implementation of the intervention and post testing. Both groups of professional nurses were recruited from the same hospital by means of convenience sampling. Each group was asked to complete the Expanded Nurses Stress Scale (ENSS). The Intervention group participated in the educational intervention on stress management. The control group received no form of any intervention. Both groups completed the ENSS, four weeks after completion of the intervention. The intervention group of participants also completed a stress management intervention assessment form in order to collect feedback for the evaluation of the workshop and the researcher. The quantitative data was analysed by means of descriptive summary statistics. Results: There was clear evidence of significant differences (p=0.000) emerging in all 9 subscale total average scores with respect to level of stress when considering the pre-test score and the post-test score. This indicates the stress management intervention had an effect on the stress levels of nurses practicing in the ICUs at the selected study sites. Evaluation of stress management intervention workshop also revealed that an overwhelming (>87%) number of nurse participants experienced all activities as meaningful, with contributory worth. Recommendations arising from the study findings are put forward for intensive care nursing practice, occupational health nursing, executive hospital management and further research. Key words: intensive care, nurses, stress management intervention.Item A description of psychosocial stressors of final year student nurses in a Private Training Facility in Gauteng(2018) Freer, Karen AnnOverall purpose of the study To identify the nature of the psychosocial stressors of final year student nurses in a private clinical training facility experience, with a view at a later stage of developing a preventive and support programme. Problem Statement Student nurses in the private training facility are subjected to many psychosocial stressors. Anecdotal evidence shows that these students are not coping with these stressors, as evidenced by attrition and mental health issues. The nature and extent of the stressors was not known. While confidential counselling service is available to students, this is a short term (maximum 6 sessions) service, and reactive in nature. By identifying common psychosocial stressors, an intervention to prevent or mitigate these stressors will, at a later stage, be developed. Research question What is the nature of psychosocial stressors that final year student nurses in the private clinical training facility experience? Research methods This was a qualitative research study using semi-structured interviews as a data collection tool. It was conducted in a private nursing education institution in Gauteng. Sixteen student nurses were interviewed and the data was analysed by means of a content analysis according to the steps of Braun and Clarke (2006). Major findings In this study, four categories of psychosocial stressors were identified viz. Academic pressure, financial constraints, work stress and social issues. The various stressors are interrelated. Academic pressure and financial constraints were the two most stressful issues for the student nurses. Conclusion Despite their obvious high levels of stress, the student nurses seem to be driven to complete their training despite overwhelming odds.Item The attitudes and opinions of intensive care nurses on the use of physical restraints(2018) Maleho, Mabona EdnahBackground: Despite the uncertainty over the ability of physical restraints to maintain patient safety, as well as the potential for undesirable psychological and physical patient outcomes and ethical concerns, physical restraints use is still common in many ICUs in different countries. Physical restraints are prescribed by the physician but the ICU nurse remains the decision maker responsible in assessing the need, application and removal of physical restraints on patients in the ICU setting. Purpose of the study: The purpose of this study was to describe nurses’ attitudes and opinions on the use of physical restraints in adult ICUs of a tertiary academic hospital in Johannesburg, with the intention to suggest and create awareness to nurse educators on what needs to be included in the curriculum on topic of physical restraints. This may also provide guidance to policy makers on the best practice that need to be considered when implementing a policy in the clinical setting. Method: A descriptive, non-experimental, quantitative survey design was used. Data was collected using an eighteen (18) item questionnaire developed by Freeman, Hallett and McHugh (2015) titled “Attitudes and opinions of ICU nurses on the use of physical restraints’’. The questionnaire was divided into four sections. Convenience sampling was used and a sample size of 113 was used. Descriptive and comparative statistics were used for data analysis. The statistical test used includes Chi-square test and Fisher’s exact test and testing was set at 5% level of significance Results: Most nurses indicated that there is a need for physical restraints use in the ICU setting in order to provide an environment that is safe for the patient. Physical restraints as a management option were preferred over sedation. There was no consensus about the maximum time that an individual patient can be restraint, agitated behaviors such as pulling of endotracheal tubes and medical devices has been noted as the most reason for exceeding the maximum time that an individual patient can be restraint. Nurses were happy to discuss the use of physical restraints with relatives. There was a perceived need for training on use of physical restraints, availing a written policy on physical restraints and support from the medical staff. There was association between ICU nurses’ years of experience, report on availability of written policy on the use of physical restraints, reports on having training on the application of physical restraints and their attitudes and opinions on the use of physical restraints in some statements regarding such. Conclusion: Nurses need support and guidance from other health care workers in cases of using physical restraints. There is need for availability of physical restraints policy to aid nurses’ clinical decision making. Relevance to clinical Practice: There have to be alternative methods and thorough patient assessment of managing agitated patients before implementation of physical restraints, these methods can be pain management and allowing relatives to be at the patient bed side. Key words: Physical restraints, Attitudes, Opinions, Intensive Care, Nurses, Clinical decision makingItem Clinical leadership competency: newly qualified nurses' understanding and needs(2018) Mathumo-Githendu, Gugulethu WaigeClinical leadership is essential for safe, effective and sustainable nursing services. The aim of this study was to establish the newly qualified nurses‟ understanding of clinical leadership and then explore their competency needs. This qualitative study used a convenience sample of 35 newly qualified nurses who were interviewed using a semi-structured interview guide. Template and content data analysis were used as well as the clinical leadership competency framework to identify a priori codes. Only one of the themes on the template was on average mentioned by 50% of the participants while the rest of them had scores below 50%. The competency needs that emerged included continuing personal development support in working with teams, applying knowledge and evidence as well as use of power and authority in setting direction. This study showed that newly qualified nurses have a limited understanding of clinical leadership and they have competency needs that can be addressed in nursing education curricula.Item Knowledge, attitudes and practices of nurses and pharmacists towards adverse drug reaction reporting in the Private Sector(2018) Bogolubova, SophiaBackground: Pharmacovigilance is an important tool not only in protecting patients from potentially harmful effects of medicines, but it plays a role in providing good quality of care and monitoring efficacy of drug products within a population. Spontaneous reporting is a system of reporting adverse drug reactions (ADRs) practiced worldwide as part of the WHO Programme for International Drug Monitoring. Unfortunately, the major drawback of this system is the underreporting of ADRs. Methodology: A cross-sectional questionnaire-based survey was conducted amongst pharmacists and nurses in six private hospitals in Gauteng. A pre-designed and structured multiple choice questionnaire containing 20 close-ended questions was used to assess demographics (four questions), knowledge (six questions), attitudes (five questions) and practices (five questions) of participants. E-mail and manual questionnaires were provided to target as many nurses and pharmacists as possible. Electronic responses were captured as they were submitted, while manual responses were collected by the principle investigator from a contact person identified within each hospital. The data obtained was analysed using appropriate statistical analysis through Microsoft Excel 2010 and Google Forms software. Results: A total of 233 healthcare professionals participated in the study. Although three quarters of participants believed ADR reporting to be important, most had received no previous pharmacovigilance training and did not know how to report an ADR. 87.1% of participants believed that all ADRs should be reported, with 75.5% of participants believing they would report all ADRs they encountered in the future provided they had sufficient training and knowledge. The major factors discouraging participants from reporting was a lack of awareness with respect to the process of reporting as well as a lack of access to the ADR reporting form. Conclusion: This study indicates that the majority of participants require further training regarding ADR reporting. Although the knowledge of most participants was acceptable, the transition into practice needs to be improved.Item Nurses' perceptions of their role in the management of sedation in intensive care units(2018) Tshibha, NoluvuyoBackground: Sedation is regarded as a common and essential part of treatment for intensive care patients. Clinicians frequently sedate critically ill patients to aid the following: patient-ventilation synchrony, relief of anxiety, promotes sleep or rest, prevent patient self-harm, induce amnesia, alleviate agitation, promote hemodynamic instability, and reduce intracranial pressure. Sedation should be administered with the aim of reaching predetermined end results, because both unsatisfactory and over sedation can lead to negative consequences for patients. The current sedation practice in intensive care has changed, hence the need to explore nurses’ role. Setting: The study was conducted in the adult ICUs (n=5) of a 1,200 bedded universityaffiliated, public sector hospital, and tertiary/quaternary level institution in Johannesburg. These ICUs included: trauma, cardiothoracic, coronary care, neurosurgery and multidisciplinary unit. Purpose of the Study: The purpose of this study was to explore nurses’ perceptions of their role in the management of sedation in the intensive care units of a major public sector hospital in Johannesburg, with an intention of making recommendations for clinical practice and education of intensive care nurses. Methods: A non-experimental, quantitative, descriptive and cross-sectional design was utilised to achieve the study objectives. A sample size of 80 (n=80) nurses participated in the study. The questionnaire used in the study was developed by Walker and Gillen (2006). It comprised of 29 items with a combination of multiple responses which included dichotomous responses, a 5-point Likert Scale and open ended questions. Descriptive and inferential statistics were used to analyse the data. Statistical tests included the Proportions test, univariate and multivariate regressions and Chi-squared tests. Testing was done on the 0.05 (p=0.05) level of significance. Results: The findings of the study showed that nurses have a high (>97%) percentage of agreement that they have a major role in sedation management for the care of critically ill patients. An equal (56.3%) percent of nurses agreed that sedation scoring is used in the assessment of the sedation level and that, sedation is titrated by the nurse in collaboration with medical personnel to a pre-determined target level. Most (58.7%) of the nurses rated themselves (out of 10) with a high confidence level (M = 7.45). However, a statistically (p<0.05) significantly difference in nurse’s perceptions of this role depends on age >50 years (OR = 38.98, 95% CI = 0.99-1.535.79; p=0.051) experience >6 to 10 years (OR = 0.26, 95% CI = 0.07-0.99, p = 0.048) and contribution of this nurse as knowledge and skills are required in order to provide effective sedation for patients. Recommendations from this study are to incorporate a multi-disciplinary team approach within a locally developed sedation protocol. This should be supported by an education programme aiming to improve decision-making about sedation management for all nurses at the bedside.Item Aspirations, economic and social well-being of professional nurses in selected provinces of South Africa(2017) Mabuda, Tendani BernardBackground and objectives: The purpose of the study was to explore and describe the economic and social wellbeing and aspirations of professional nurses in selected provinces of South Africa. The objectives of the study were: to explore the existing evidence on the nature and meaning of aspirations and their impact on wellbeing, to formulate an aspiration questionnaire based on existing evidence, to explore and describe the economic and social wellbeing and aspirations of professional nurses in selected provinces of South Africa, to determine if there is any difference between the economic and social wellbeing and the aspirations of professional nurses in urban and rural provinces and to formulate recommendations for addressing the economic and social wellbeing and aspirations of professional nurses in South Africa. Method: An exploratory, sequential mixed method design was used. The study was conducted in four phases (scoping review, Delphi study, a survey and formulation of recommendations with the assistance of experts through a focus group and follow up verification. The results of qualitative phase were used to build onto the quantitative phase. One thousand, one hundred and thirty-eight (1138) professional nurses participated in the study. The data from all phases of the research was integrated prior to the formulation of recommendations which were organized according to the Walt & Gilson framework (1994) in order to answer the research question. Results: Important lessons were learned in terms of professional nurses’ aspirations for job satisfaction, possessions, financial success, self-acceptance income and status and power. The quantitative data revealed that professional nurses as a group are mainly mature (the majority >40 years old) unmarried females, working irregular hours, highly indebted and who carry the financial and social burden of caring for extended families. They value education, both for themselves and their children, but are part of the ‘missing middle’ as far as accommodation is concerned as they earn too much to qualify for grants and too little to qualify for housing mortgages. Overall, professional nurses’ have aspirations that are not met which impacts on their economic and social wellbeing. There is no significant difference between the economic and social wellbeing of urban and rural participants. Conclusion: Recommendations aimed at addressing the aspirations, economic and social wellbeing of professional nurses in South Africa were formulated. However, it is clear that an inter-sectoral and inter-departmental approach is required to address the aspirations, economic and social wellbeing of nurses if a positive impact is to be made. Keywords: professional nurses, aspirations, economic wellbeing, social wellbeing, wellbeing.Item Disaster preparedness of registered nurses in a central hospital in Johannesburg(2017) Messe, Lorato BaikanneBackground: Approximately 250 million people per year are affected by disasters (manmade or natural). In South Africa, the types of disasters that occur commonly are road accidents, manmade fires, explosions, storms, river floods and wild fires. The challenges faced in dealing with the complexity of disasters requires each nurse to have a knowledge base and minimum set of skills to enable them to plan for and respond to a disaster in a timely and appropriate manner. Purpose: To ascertain whether registered nurses, practicing in medical and surgical wards in a central hospital in Johannesburg are prepared for disasters. Design: A quantitative, descriptive, exploratory survey study design was used in this study. Method: The study was conducted in a central hospital in Johannesburg. A survey questionnaire, developed by Fung et al. (2008) and modified for the South African setting, was used for this study. The population for this study was 192 registered nurses, working in the medical and surgical wards of a central hospital in Johannesburg. A total sample of 192 participants was used. The data was analysed using descriptive statistics, ordinal logistic regression and summative content analysis. Statistical assistance was sought from a statistician. Results: Four major findings emerged from the data. The data revealed the majority of the nurses(52.45%: n=75)had not previously participated in disaster activities and had limited disaster training and education. Previous participation in disaster activity had influenced nurse’s disaster preparedness, however nurses perceived themselves generally prepared. Conclusion statement: even though nurses have indicated the need and interest in attending educational courses on disaster, the majority have not attended them. Disaster drills have also been found to be an important exercise to assist the nurses in disaster preparedness. Therefore hospitals are urged to be consistent with their disaster drills and regularly update their disaster management protocols. Clinical significance: An understanding of how prepared registered nurses perceive themselves to be, to respond to a disaster, would help assist in identifying the weaknesses and strengths in disaster preparedness in medical and surgical wards.Item Job satisfaction of occupational health nurses at a private occupational health service provider in South Africa(2015-04-20) Alberts, IgnaBackground: Job satisfaction is one determinant of employees’ health and an important component in the retention of employees. It is evident from literature that job satisfaction is a factor in the retention of nurses and the prevention of a high turnover. Literature also revealed that job satisfaction is seen as an important component that can have an impact on several areas such as patient safety, quality care and performance as well as commitment to the organisation and dedication to the profession. However, limited literature is available on job satisfaction of occupational health nursing practitioners internationally or nationally. Purpose: The overall purpose of this study is to determine the factors which contribute to the levels of job satisfaction and dissatisfaction among occupational health nursing practitioners working for a private occupational health service provider in South Africa. Methodology: A cross sectional survey design, using a structured self-administered questionnaire with close-ended questions and items relating to demographic date, professional status, doctor-nurse relationships, administration, autonomy, task requirements and interaction, was used in this research. Data was collected in this research by means of a structured questionnaire namely, the Index of Work Satisfaction, part B (IWS-Part B), developed by Stamps to measure American hospital based nurses level of job satisfaction.A total sample of 183 participants, all occupational health-nursing practitioners employed by the private occupational health service provider in three regions, was used, namely Gauteng, Mpumalanga and Pretoria Northern region Data Analysis: Data analysis was done through descriptive statistics using statistical assistance from a statistician from the University of the Witwatersrand Postgraduate Research Support Services. Setting: The setting for this study was in three regions namely Mpumalanga, Pretoria North and Gauteng, in which the private occupational health service provider operates. Findings: A total of a 180 questionnaires were completed and analysed, yielding a response rate of 97%. The findings relating to age distribution revealed that majority response presented an age group of 63% (n=114) between 30 and 49 years and predominantly female 88%, (n=159). The majority of the nurses, (78.3%: n=141) had one to four years occupational health nursing experience; 74.5% (n=134) of the participants were in possession of a general nursing qualification and 78.3% (n=41) had an additional diploma in occupational health nursing. The findings revealed that nurses who held a diploma in occupational health nursing were more likely to have a higher level of work satisfaction than nurses with a general diploma in nursing. The level of work satisfaction was higher for nurses holding a degree in occupational health nursing than either the diploma or certificate in occupational health nursing. The level of work satisfaction was higher for nurses who held a Master’s degree than a degree, diploma or certificate in occupational health nursing. The second part of the research instrument intended to attain the level of job satisfaction. The questionnaire consisted of forty items divided into six main components. The findings are reflected based on the majority responses from the different categories. vi Remuneration was found to be a major area of dissatisfaction as 72% (n=130) of the participants indicated being less satisfied with remuneration and 89% (n=160) agreed a remuneration upgrade was required. Based on the overall findings, it was apparent the participants were more dissatisfied with their remuneration. Professional status revealed 86% (155) of the participants were proud of their work and 88% (n=159) considered the profession to be important. From the general findings on professional status it was obvious OHN’s have a strong satisfied view with their professional status. The findings related to nurse-doctor relationship indicated occupational health nurses are more likely to be satisfied than dissatisfied with their doctor/nurse relations as validated by the response of 76% (n=136), who agreed occupational health doctors understand and appreciate OHNs and 70% (n=127) agreed that in general, the doctors cooperate with the nursing staff. Another section which indicated more dissatisfaction than satisfaction, was on administrative work as 87% (n=157) of nurses agreed there was too much administrative work required from them. The component on autonomy indicated the majority of nurses (74%; n=133) agreed that a great deal of independence was permitted, if not required of them, as well as 70% (n=125) agreeing to having freedom at work to make important decisions. The final element of the questionnaire on task interaction and relationships reflected that 82% (n=148) agreed that nurses in their specialty help one another when things are uncertain and 72% (n=128) agreed they were satisfied with the different types of work activities. Based on the findings, it was evident that the OHNPs appeared to be more satisfied that dissatisfied with their task interaction and relationships. Conclusion: The ideal work environment consists of staff satisfaction and continuity. Evident from literature, job satisfaction plays an important role in the preservation of workforce numbers, as well as a reduction in staff turn-over. This paper revealed that overall there are more areas of job satisfaction in comparison to job dissatisfaction. The findings of the present study increases the understanding of what contributes to satisfaction of occupational health nursing practitioners. Aspects such as nurse-doctor relationships, task interaction and relationships, professional status and autonomy contributed to OHN job satisfaction levels, whereas remuneration and administrative work created more job dissatisfaction. Recommendations: It is the aspiration of the researcher that this study of job satisfaction levels of OHNP’s contributes to a frame of information and that the data will create awareness of what contributes to the satisfaction and dissatisfaction levels within the profession of an occupational health nurse in South Africa. Within this study the researchers was able to present recommendation relating to nursing practice, management education as well as further research. It is the researcher’s opinion that the information on job satisfaction of nursing staff must be disseminated to interested parties throughout the field of occupational health. Key words: Job satisfaction, occupational health nurses, occupational health service provider, South-Africa