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Background Enrolled Nurses (ENs) and Enrolled Nursing Auxiliaries (ENAs) are responsible for the monitoring of vital signs as an essential indicator of patients’ physiological deterioration. Monitoring are essential for early recognition of and responding to signs of deterioration as delayed responses could severely affect patient safety. Objectives This research study, (1) describe the accuracy of recording and the ability of ENs and ENAs (2) interpret the data presented during the assessment of vital signs at a selected private hospital in KwaZulu-Natal. Design and sample A quantitative, descriptive design was used. Methods The population (N = 89) consisted of permanent ENs (n = 27) and ENAs (n = 47). Part-time nurses working for an agency were also invited. A sample total of 64 respondents, comprising 20 ENs and 44 ENAs, participated in the study. Ethical permission Ethical clearance and permission from the organization head office was obtained. Results The data, reveals a young workforce, with 55% of respondents being between 26 and 35 years of age. Results from the questionnaire indicate that the nurses with more nursing experience and permanently employed achieved a higher score in the knowledge component. Analysis of the documentation, showed that the implementation record was not always correctly identified and that 29.6% of the ENs and ENAs did not enter the vital signs data correctly on the implementation record or rapport abnormalities to the professional nurse in charge. Conclusion The gaps identified during the assessment of vital signs while working at a private hospital put patients at risk and severely affect quality care.

Higher cognitive skills are essential competencies for nurses joining the technologically and increasingly complex health care environment to provide safe and effective nursing care. Educators and clinical facilitators have recognised that newly qualified nurses do not meet the expectations for entry level clinical judgement and are held accountable for finding adequate learning experiences as preparation for such practice demands. An explorative and descriptive qualitative design was followed in this study to reach an understanding of clinical judgement in the clinical nursing environment from the perspective of professional nurses. Eleven professional nurses (n = 11) working at primary health care clinics, public and private hospitals participated voluntarily. Data was collected by means of the “World Cafe” method, incorporating a combination of techniques such as interviewing, discussions, drawings, narratives and reflection. The focus was on professional nurses' knowledge of the meaning of clinical judgement and factors influencing the development of clinical judgement in the clinical environment. Qualitative thematic content analysis principles were applied during data analysis. The findings were integrated with the relevant literature to culminate in conclusions that should add to the knowledge base of clinical judgement as an essential skill for improving autonomous and accountable nursing care.Keywords: Clinical nursing environment, Cognitive reasoning skills, Quality nursing care, Nursing student

Reform in the South African healthcare and educational system were characterized by the ideals that the country needs to produce independent, critical thinkers. Nurses need to cope with diversity in a more creative way, defining their role in a complex, uncertain, rapidly changing health care environment. Quality clinical judgement is therefore imperative as an identified characteristic of newly qualified professional nurses. The objective of this study was to explore and describe clinical judgement through various data sources and review of literature to clarify the meaning and promote a common understanding through formulating the characteristics and developing a connotative (theoretical) definition of the concept. An explorative, descriptive qualitative design was used to discover the complexity and meaning of the phenomenon. Multiple data sources and search strategies were used, for the time frame 1982—2013. A concept analysis was used to arrive at a theoretical definition of the concept of ‘clinical judgement’ as a complex cognitive skill to evaluate patient needs, adaption of current treatment protocols as well as new treatment strategies, prevention of adverse side effects through being proactive rather than reactive within the clinical nursing environment. The findings emphasized clinical judgement as skill within the clinical nursing environment, thereby improving autonomous and accountable nursing care. These findings will assist nurse leaders and clinical nurse educators in developing a teaching-learning strategy to promote clinical judgement in undergraduate nursing students, thereby contributing to the quality of nursing care.

The South African health care and education systems are challenged to provide independent, critical thinking nurses who can cope with diversity in a creative way and define their role in a complex, uncertain, rapidly changing health care environment. Quality clinical judgement is an imperative characteristic that newly qualified professional nurses should possess. To accommodate these needs, SANC in line with the SAQA Act, advocated the development of teaching and learning strategies to balance theory and practice opportunities together with an outcome-based, student centred approach and appropriate clinical supervision. This resulted in a positive outcome to facilitate the integration/fusion of theory and practice. The purpose of this study was to synthesise a teaching–learning strategy for creating an enabling learning environment to facilitate clinical judgement in South African undergraduate nursing students. The proposed teaching–learning strategyis grounded in modern-day constructivist approach of learning. The conceptual or theoretical framework of this study aimed to link the central concepts that were identified from the conclusions of four (4) strategic objectives of the two preceding phases of the study into a new structure of meaning that served as a basis for the proposed strategy. The implementation of the proposed action plan to achieve the stated strategic objectives should empower the relevant role players to facilitate clinical judgement in undergraduate nursing students and thereby promote autonomous and accountable nursing care.