- ItemThe experiences of nurse managers on health system barriers and enablers to the empowerment and subsequent career advancement of nurses(Stellenbosch : Stellenbosch University, 2023-03) Esau, Racheal; Van der Heever, Mariana; van der Merwe, Anita; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.ENGLISH SUMMARY: Background - Promoting nurse empowerment is a critical responsibility of a nurse manager. Accordingly, the nurse manager must use the power contained in her position to enhance worker productivity through the mobilisation of workplace resources such as information sharing, support, resources and opportunities (structural empowerment). The nurse manager must also focus on cognitions of competence, impact, meaning and self-determination (psychological empowerment). However, nurse managers face systemic barriers in healthcare such as resource constraints, leadership incapacities, demanding workloads and political interferences that have an adverse influence on the empowerment process. Aim - The purpose of the study was to explore the lived experiences of nurse managers on the health system barriers and enablers that influence their duties to empower and advance nursing staff. The research objectives were: - To gain an understanding of how the hospital’s empowerment structures facilitate nursing staff empowerment and career advancement. - To explore the nurse managers’ experiences in their role of providing nurses access to power structures in the workplace. - To get insight into the possible barriers to nurse empowerment and advancement that may exist in the hospital. Method - A qualitative design with an interpretative phenomenological approach was employed. The study was conducted at a central public hospital in the Cape Metropole in the Western Cape province of South Africa. The sample comprised of 11 nurse managers from three tiers of nursing management employed at the study centre. Purposive sampling with maximum variation was applied to ensemble the study sample. Data analysis was done by applying Max Van Manen’s interpretative phenomenological approach. Ethical approval was obtained from the Health Research Ethics Committee of Stellenbosch University and institutional permission from the study centre. Participants provided written consent to participate in the study. Data collection took format of individual virtual interviews guided by a semi-structured interview guide and using Carl Roger’s technique of reflection. Trustworthiness of the study was enhanced by applying the principles of credibility, dependability, conformability, transferability and authenticity. Results - Four main themes with fifteen subthemes emerged from the data. The results showed that access to empowerment structures is accompanied with difficulties that have an adverse influence on the success of empowerment. Nurse managers acknowledge their responsibility towards their nurse subordinates of creating and sustaining opportunities for growth and development that will increase their chances of ascending the career ladder. However, they realised that this process is challenging and expressed a need for support to effectively discharge this responsibility. The findings also highlighted the challenges of human and budgetary constraints, demanding workloads, disengagement of staff, political and cultural issues, centralisation of power which slows down the process of empowerment. These challenges created barriers to nurse managers in the execution of their responsibility to empower the nursing staff.
- ItemNursing students’ perceptions of the barriers to applying theory to practice in clinical placement settings(Stellenbosch : Stellenbosch University, 2023-03) Chekerwa, Petronella; Cornelle, Young; Anneline, Robertson; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.ENGLISH SUMMARY: Background: Healthcare organisations today increasingly demand that nursing graduates be assertive, operational and able to make informed decisions regarding patient care and provide quality care to patients. To achieve this level of performance, nursing students should acquire sound theoretical information in various disciplines, while mastering their practical skills to successfully combine theoretical knowledge with practice. Hence, clinical placements are crucial in ensuring nursing students’ ability to master nursing competencies. Nursing knowledge is taught in the classroom as a theory, which is translated into skills in skills laboratory sessions. Skills are applied in the clinical setting to provide meaningful, patient-centred care. Because theoretical application takes place outside the classroom in a complicated and dynamic environment comprising staff, patients, and preceptors, this setting and relationships within can either enhance or hinder students’ professional development. Student nurses in the clinical setting often have difficulty correlating the taught theoretical material with what they practice in the clinical setting, hence, they are unable to provide competent care to patients. This study aimed to explore nursing students’ perceptions of barriers to applying theory to practice in clinical placement settings. Such information would be valuable to decrease patient care risk and provide a more satisfying learning experience for the student nurse.Methods: The study used a qualitative descriptive approach to explore the perceptions of 15 nursing students through three focus group interviews, on the barriers to applying theory to practice in clinical settings. The Health Research Ethics Committee of Stellenbosch University, and the selected Higher Education Institution in the Western Cape Province of South Africa, granted permission to conduct the study. Purposive sampling was used to select participants, and Creswell’s six step framework was used to analysis the data. Results: The themes that emerged were: The ability of the students to apply theory to practice; Situational barriers; Personal barriers; Interactions with other parties and Strategies suggested by the students to facilitate the application of theory to practice. The study determined the skills that the fourth-year students mastered and those that they still needed help. Furthermore, barriers to utilising theoretical knowledge in the clinical placements settings were related to the situation, the person and the interactions with other parties. Strategies suggested by the students to facilitate the application of theory to practice included improved communication between the nurse educator, clinical supervisor and preceptors. In addition, ideally one clinical supervisor for each facility should be assigned, for students to receive more supervision. Conclusion: The findings demonstrated that it was difficult for student nurses to engage in clinical activities or to learn effectively without the necessary supervision and guidance. Barriers exist in the clinical environment and faculty, which disabled them from translating theory into practice. From their experience with such barriers in the first three years of their study, nursing students shared some effective strategies in facilitating theory to practice. Additionally, clinical supervisors and preceptors are urged to support and mentor the students throughout their clinical placement by providing more supportive-educative environments.
- ItemNurses’ knowledge, attitudes and practices of logrolling patients with a spinal cord injury in the Western Cape Metropole(Stellenbosch : Stellenbosch University, 2023-03) Vorster, Humeri; Anthonie, Ramona; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.ENGLISH SUMMARY: Background: A spinal cord injury (SCI) is potentially a life-threatening crisis. In South African healthcare facilities, the logrolling technique is used throughout the hospitalisation of patients suffering a SCI. Unfortunately, there are inconsistencies in logrolling practices, techniques and nursing practice as well as a lack of standard operating procedures (SOP), staff shortages and differences in nurses’ attitudes towards SCIs; all of these issues are of global concern. The aim of this study was to investigate the knowledge, attitudes, and practices (KAP) of nurses regarding logrolling SCI patients. The study took place in two tertiary hospitals in the Western Cape Metropole. The objectives of the study were to determine the knowledge and attitudes of nurses towards SCI patients and the logrolling of SCI patients; to determine the practices of nurses when logrolling SCI patients; to determine the management strategies influencing logrolling of SCI patients and to identify factors associated with nurses’ logrolling knowledge, attitudes, and practices. Method: A non-experimental, descriptive research approach was employed. A total of 304 nurses (all registered and enrolled nurses, enrolled nursing assistants) employed in two tertiary hospitals in the Western Cape Metropole formed the study sample. The data was collected between April and July 2021 by means of a structured self-administered questionnaire. The main study had been preceded by a pre-test which involved seven participants, but these results were excluded from the final data analyses. The Health Research Ethics Committee (HREC) of Stellenbosch University granted approval for the study. Descriptive and inferential statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS), version 27. Results: The results indicated that nurses generally had good KAP scores: thus, 88.5% of the participants had good knowledge, 93.1% had positive attitudes and 81.9% good practices. However, only 23% of participants reported good management strategies as evidenced by low levels of training (41.1%), the availability of SOPs (35.6%) and lack of sufficient staff (48.4%). Registered nurses and those with more nursing experience were more likely to be knowledgeable (p<0.01 and p=0.01). Participants with positive attitudes were more likely to be knowledgeable (p<0.01), have positive practices (p<0.01) and report good management strategies (p<0.01). There was no association between knowledge and practices (p=0.21). Management strategies were not associated with knowledge (p=0.98) or practices (p=0.19). Conclusion: The results indicated that most participants had good KAP but good management strategies were lacking. Insufficient training, the lack of SOPs and staff shortages may lead to inconsistent practices. Recommendations to address gaps included the development and implementation of a mentorship and training programme and competency tools in logrolling and managing SCI patients. Evidenced-based SOPs and logrolling teams are needed to assist with consistent and safe logrolling especially when there are staff shortages. Finally, frequent evaluation and health checks are needed to address the issue of back injuries suffered by nurses working in SCI units, as this could influence their attitudes and practices.
- ItemCompassion satisfaction, compassion fatigue, and intention to leave among critical care nurses in private hospitals of the Cape Metropole(Stellenbosch : Stellenbosch University, 2023-03) Shelton, Jamie Lee; Van der Heever, Mariana; Baron, Justine; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.ENGLISH SUMMARY: Background: Global studies have found that compassion fatigue is a problem among critical care nurses, causing them to lose empathy and compassion for their patients and, moreover, to leave the profession. Since nurse recruitment and retention rates are already low in South Africa, compassion fatigue could have particularly serious consequences. This study investigated the levels of and relationships between compassion satisfaction, compassion fatigue, and intention to leave among critical care nurses in private hospitals in the Cape Metropole, South Africa. Methods: The study was conducted using a quantitative research approach with a cross-sectional descriptive correlational design. Critical care nurses were recruited through Facebook advertising and n=78 nurses completed the online survey. Our survey used a custom demographic and intention to leave scale in addition to the established Professional Quality of Life (ProQOL) instrument. The demographic, intention to leave, and ProQOL variables were described and visualized using descriptive statistics. The direction and strength of the relationships between variables were examined using Spearman's rank correlation coefficient. Ethical principles of autonomy, privacy, confidentiality, justice, beneficence, and nonmaleficence were maintained throughout the study. Results: The findings showed that the nurses experienced average levels of compassion satisfaction, burnout, and secondary traumatic stress. Compassion satisfaction and burnout had a strong negative correlation (r=-0.761, p<0.01). Likewise, compassion satisfaction and secondary traumatic stress had a moderate negative correlation (r=-0.539, p<0.01). Secondary traumatic stress and burnout had a strong positive correlation (r=0.743, p<0.01). Males scored significantly lower on compassion satisfaction (mean=38.6, SD=3.7) than females (mean=50.5, SD=9.9) (t=2.056, p=0.04). The mean scores of compassion satisfaction (t=-0.993, p=0.38), burnout (t=0.706, p=0.48), and secondary traumatic stress (t=1.249, p=0.22) did not differ between participants with or without a postgraduate critical care nursing diploma. However, nurses who were critical care trained had slightly higher compassion satisfaction mean scores (mean=51.1, SD=10.3) compared to nurses who were not critical care trained (mean 49.0, SD=9.7). Almost half of the nurses in the study expressed an intention to leave nursing (42.3%, n=33). Burnout was moderately positively correlated with intention to leave (r=0.633, p<0.01) and secondary traumatic stress (r=0.438, p<0.01), while compassion satisfaction was moderately negatively correlated with intention to leave (r=-0.615, p<0.01). Conclusion: Burnout and secondary traumatic stress were among the physical, mental, and emotional stresses critical care nurses experienced during the COVID-19 pandemic. However, despite the reported burnout and secondary traumatic stress, nurses still reported average levels of compassion satisfaction. Recommendations: The work environments of critical care nurses must be improved to prevent compassion fatigue, prevent nurse attrition, and assist them in finding fulfilment at work. Support and assistance should be provided to younger and less experienced critical care nurses as they grow in their careers to prevent anxiety and burnout, and postgraduate training should be encouraged to improve clinical competence and critical care knowledge. Compassion fatigue needs to be identified and combated by nurses and healthcare organizations to protect nurses and the nursing profession.
- ItemFactors that influence the attendance of in-service training by nurses in district hospitals in the Cape Winelands District(Stellenbosch : Stellenbosch University, 2023-03) De Silva, Rene Zureen; Anthonie, Ramona; Van der Heever, Mariana; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.ENGLISH SUMMARY: Background - The provision and attendance of in-service training of nurses are important to ensure skilled and competent nurses to provide quality patient care. The attendance or participation of nurses in in-service training appears to be compromised due to heavy workloads, lack of time, and the availability of resources. The aim of this study was to investigate the factors that influenced the attendance of in-service training by nurses in district hospitals in the Cape Winelands District and the objectives were to determine the individual, organisational and patient related factors and to assess associations between demographic or career-related factors and the attendance of in-service training by nurses. Methods - A quantitative approach with a descriptive design was used. A total of 122 nurses comprising different nursing categories (registered, enrolled, and enrolled auxiliary nurses) employed at four rural district hospitals in the Cape Winelands District in the Western Cape participated in the study. Participants were sampled by means of stratified random sampling. Ethical clearance to conduct the study was obtained from the Health Research Ethics Committee of Stellenbosch University and institutional permission was obtained from the management of each hospital. Throughout this study ethical principles such as the right to autonomy, confidentiality, anonymity, justice, benevolence, and non-maleficence were maintained to protect participants. Data was collected over a seven-week period (25 April to 9 June 2022) using a structured self-administered questionnaire. The main study was preceded by a pilot test with 25 participants. The data of the pilot test was excluded from the findings of the main study. The data was analysed with the assistance of a biostatistician using the Statistical Package for the Social Sciences Software (SPSS), version 28. Results - The individual factors influencing the attendance of in-service training of nurses is the importance of in-service training for nurses (61% n=71 of participants strongly agreed that it was important), and relevant in-service training that would improve their knowledge, skills, and qualifications (72.5% n=87 strongly agreed) to provide better patient care (69% n=83 of participants strongly agreed). Adequate resources for in-service training and reimbursement of traveling expenses (32% n=38 of participants strongly agreed) were also identified as factors influencing participation in in-service training. The attendance of in-service training seemed to be influenced by organisational factors such as the lack of a nurse education and training department with a designated nurse trainer (33% n=37 strongly disagreed that they had one) to impact direct patient care, ensure induction and orientation of new staff (37% n=43 agreed), logistical and resource support for in-service training of nurses (43% n=50 agreed). The patient factors identified to influence the attendance of in-service training were complaints received about care (30% n=36 agreed), patient safety incidents (63% n=75 agreed) and patient diseases and conditions (50%n=60 agreed) to be used as topics for in-service training. Conclusion - To ensure participation in in-service training, regular training needs analyses and analyses of complaints and patient safety incidents must be conducted to identify the specific skills and clinical competence nurses need to provide appropriate care for their patients and their training needs for career advancement. Practical implications: Hospital management need to establish a nurse education and training department with designated nurse eduators at the hospitals to coordinate and communicate in-service programmes and assist with logistical support that would improve nurses’ participation in in-service training.