Masters Degrees (Nursing and Midwifery)

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    Exploring registered nurses' understanding of the concept of critical thinking in a private hospital in the Gauteng Province, South Africa
    (Stellenbosch : Stellenbosch University, 2023-12) Mboqoka, Khululwa Nomangwekazi; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
    ENGLISH SUMMARY: Background: In hospital environments, registered nurses are faced with difficult scenarios needing appropriate critical thinking skills. As health care systems become more sophisticated, these critical thinking abilities help registered nurses to be able to synthesise information and make swift, appropriate clinical decisions that lead to safe and efficient health care delivery. The current study was based on the researcher’s concern regarding an apparent lack of disposition towards critical thinking amongst registered nurses working in medical and surgical wards. Registered nurses are essential healthcare professionals in meeting patient needs in a health care system. Method: This study aimed to explore and describe registered nurses’ understanding of critical thinking in their clinical practice in medical and surgical wards in a private hospital in South Africa. The objective of this study was to explore how registered nurses understand critical thinking as a concept in their clinical practice. The researcher used a qualitative approach for this study. The approach applied an exploratory, descriptive design to explore the understanding and description of the concept of critical thinking by registered nurses who are working in medical and surgical wards. Data was analysed using a thematic analysis approach, which entailed a process of reading and re-reading data, coding, and generating themes from which data was interpreted and findings deduced. To conduct this research study participants were drawn from the group of registered nurses working in the medical and surgical wards of the study site who met the inclusion criteria. The final sample size comprised twelve registered nurses (RNs). Semi-structured individual interviews supported by an interview guide were used to gather data from participants. Results: The findings indicated a lack of understanding of the concept of critical thinking by registered nurses. Even though some nurses had an idea of the concept, it appeared that there is a big gap in nursing education and clinical teaching when facilitating achieving critical thinking as one of the objectives. The themes that emerged from the data indicated that there are factors that have a negative influence on how registered nurses think and apply their minds in clinical wards. Conclusion: The study concludes that registered nurses need support in developing critical thinking skills. It was also deduced that some demarcations and limited resources impede critical thinking in the wards.
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    Perceptions of primary healthcare nurses regarding the management of noncommunicable diseases by community health workers in the Tshwane District
    (Stellenbosch : Stellenbosch University, 2023-12) Shalang, Lehlohonolo Olga; Kitshoff, Danine; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
    ENGLISH SUMMARY: Background: Primary healthcare services are essential services which are made available by the government to the public. Primary healthcare services offer affordable, accessible, quality healthcare to communities. Despite the availability of laws, policies and guidelines that regulate provision of primary healthcare, the vulnerable in society have limited access to free healthcare services. This infringes their right to healthcare. Low socioeconomic status, poverty, unemployment, substance abuse, and other predisposing factors contribute to the high number of people diagnosed with noncommunicable disease. As a result, there is an increase in the number of users of public healthcare services to access noncommunicable disease management and treatment. Therefore, this necessitates the involvement of community health workers as role players in the public healthcare setting. As part of public healthcare supporting structure, the lack of proper scope of community health workers in the public healthcare setting creates confusion and low utilisation of community health workers in the management of patients. This has a negative impact on patients’ treatment outcomes. Aim: The study aimed to explore perceptions of primary healthcare nurses and to provide insight about the role of community health workers in public healthcare and policy implementation. Methods: An exploratory-descriptive qualitative research design, was used. Participants from three primary healthcare facilities in Tshwane, Region 6, were invited to participate using a purposive sampling method. Eleven primary healthcare nurses who met the inclusion criteria were individually interviewed using a semistructured interviewing tool in their respective primary healthcare facilities. A pilot interview was conducted to refine the study sampling process and probe relevant responses from participants. The data was analysed using the Braun & Clarke thematic analysis method. This assisted the researcher to set aside participants’ preconceived ideas. Ethical principles, such as respect for persons, confidentiality, anonymity, beneficence, and non-maleficence, were applied and maintained throughout the study process. Trustworthiness encompassing credibility, transferability and dependability were also applied. Results: Eleven semi-structured one-on-one interviews were conducted in private areas in the primary healthcare facility. The participants highlighted the following as issues that were affecting the utilisation of community health workers in primary healthcare: work environment challenges, supervision challenges, allocation and delegation challenges, reporting, poor role clarification of community health workers, professionalism and professional development, patient compliance, return to care and continuity of care in households. Conclusion: This study provided an opportunity for participants to voice their perceptions and experiences. The key finding of the study highlighted the perceptions of primary healthcare nurses about the management of noncommunicable diseases by community health workers in the Tshwane District.
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    The role of professional nurses practising in the medico-legal field in South Africa
    (Stellenbosch : Stellenbosch University, 2023-12) Van de Wall, Carina; Stellenberg, Ethelwynn; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
    ENGLISH SUMMARY: Background: The healthcare services in South Africa are in crises due to the number of medico-legal claims and moneys paid out to claimants. The researcher, being a professional nurse practising in the medico-legal field, realised that such a nurse may play a valuable role as part of the legal team. However, the concept of such a nurse is not known in this country. Therefore, the purpose of this research was to investigate the role of professional nurses practising in the medico-legal field in South Africa. Methodology: A descriptive quantitative research methodology was applied, and data was collected through a self-report online questionnaire. The researcher developed a questionnaire to specifically investigate the role of the professional nurse practising in the medico-legal field in South Africa. A process to validate the questionnaire was followed and included peer reviews which demonstrated content validity in that the questionnaire measured what it was supposed to measure. A Cronbach Alpha coefficient was also calculated by a biostatistician for each subsection of the instrument. All results calculated more than 0.7 which indicated internal reliability of the instrument. Furthermore, a pilot study was conducted to support the reliability and validity of the research instrument and the research methodology. Ethics approval was obtained from the Health Research Ethics Committee of Stellenbosch University (S21/08/153). Ethical considerations, namely the right to self-determination, the right to confidentiality and anonymity, and protection from discomfort and harm, were taken into consideration. The population consisted of participants who were professional nurses living in South Africa and who were members of specialist nursing organisations, as well as attorneys involved in medical malpractice in South Africa. Unfortunately, participant numbers were limited as only N=69 participated of which n=13 were males and n=56 were females. Participants from the legal profession were n=16, from the nursing profession n=44, and n=5 participants were qualified in both professions. The participation numbers were very low for a quantitative study. The data was analysed through SPSS v.28. A biostatistician assisted to establish frequency tables. The Chi Pearson statistical test was mostly used to assess the relationship between the various variables and p-values indicate if a significant difference was found. Results: The results indicate that the objectives of the study were reached. The population was demographically described and most of the participants agreed about the requirements necessary for the professional nurse to practise in the medico-legal field. Differences in the views between the nursing and legal professions were identified and most of the participants agreed about the different roles of professional nurses practising in the medico-legal field, such as acting as an advocate or part of the legal team in medical malpractice claims. Conclusion: Advanced nursing practice in the medico-legal field in South Africa may be a specialty worth developing through advanced education. Further research is necessary to develop a curriculum compliant with educational purposes to enable the medico-legal nurse to practise according to identified requirements.
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    The 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.
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    Nursing 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.