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The practice environment of nurses plays a very important role in the delivery of quality health care. However, there is limited knowledge on what positive practice environments entail with specific reference to the primary health context of the public health care sector of South Africa. Nurses in this context are the frontline health personnel and are affected not only by nursing shortages, but also high workloads as the public health care sector serves 83% of the South African population and the private health care sector only 17%. In this study the researcher decided to conduct a study to explore the practice environment of nurses in the primary health care context as no studies have previously been undertaken in this regard. The researcher used a case study design with quantitative and qualitative approaches and implemented descriptive, explanatory and contextual strategies. This design, together with the findings of objectives one, two and three, the World Health Organization Strengthening of Health Systems and Fourteen Forces of Magnetism Frameworks and inductive and deductive logic enabled the researcher to achieve the overarching aim, which is objective four, of this study. Descriptive statistics, confirmatory factor analysis and Cronbach’s alpha assisted the researcher in assessing the demographic profile (objective 1) and the status of the practice environment of community health centres in North West Province (objective 2). Thereafter, the researcher was also able to identify the community health centre with the most favourable practice environment in order to conduct semi-structured individual interviews (objective 3). The descriptive data of objective 1 revealed that community health centres in the North West Province are located on average 36 km from the nearest referral hospital to which an average of five patients per day are referred. The average number of patients consulted per month is 3 545 of which the nurse consults an average of 40 and the physician 15 patients per day. In the community health centres the average age of nurses is 40, with 10 years of nursing experience. There were more female than male nurses of which 65% of the registered nurses had a diploma in nursing and had only started their careers at 31 years of age. There is an average of eleven registered nurses, five auxiliary and one enrolled nurse in the community health centres of which only four of the registered nurses (36%) had a qualification in Clinical Health Assessment, Treatment and Care. The overall staff turnover rates were very low and the satisfaction levels were high. The factor analysis of objective 2 revealed that the Practice Environment Scale of the Nursing Work Index’s sub-scales staffing and resource adequacy and nurse participation in primary health care/community health centre affairs had means below 2.5, indicating that nurses were not in agreement with these sub-scales. However, nurse manager ability, leadership and support; collegial nurse-physician relationships and nursing foundations for quality of care had a mean above 2.5 indicating that the nurses were in agreement with these sub-scales. Lastly, the qualitative findings indicated that although the community health centres with the most favourable practice environment were affected by factors that decrease quality of care which included a lack of resources, limited infrastructure, limited support from pharmacy and staff shortages. These mentioned factors were not in the control of the community health centres. Although the community health centres were affected by the above-mentioned factors these community health centres excelled in support, leadership and governance, collegial nurse-physician relationships and factors influencing quality of care which were in the control of the community health centre. Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2013.

The number of older persons is growing at a shocking rate. In spite of this reality, the South African health care sector does not prioritise older persons, causing their health to be poorly managed. Not only does poor health management affect the health of the older person, but also economic factors. This causes a high burden on the public health sector of South Africa, with specific reference to the Primary Health Care (PHC) clinics. PHC clinics in this country are not only overcrowded due to staff shortages, but also owing to the rapidly ageing population and the large number of younger persons affected by the high unemployment rate of South Africa. The above-mentioned factors keep the professional nurses in the clinic from spending time on proper physical examinations and provision of health education to older persons. This causes older persons to lack knowledge regarding self-care, potentially leading to unintentional self-neglect, which decreases their quality of life. Studies conducted on older persons concluded that the older person wants to be involved in health promotion, but needs the necessary knowledge to take care of him- or herself. Therefore, the researcher's overarching aim with this study was to develop guidelines to facilitate self-care amongst older persons. Such guidelines aim at constituting an indirect approach to promote the health of the older person. Health education on self-care should be conducted in self-care support groups, since community experience teaches that some older persons in the community do not apply self-care skills learned without some form of support. The aim with these guidelines is to decrease unintentional self-neglect by empowering the older person to make autonomous decisions regarding self-care, in order to increase quality of life. RESEARCH AIM AND OBJECTIVES In order to reach the overarching aim of this study, which comprises the development of guidelines to facilitate self-care amongst the older persons in the Potchefstroom district, the study firstly includes a literature review to understand self-care and related constructs from a theoretical perspective. Secondly, the Appraisal of self-care agency scale-A (ASA-A) and Exercise of self-care agency scale (ESCA) were used as questionnaires to assess the self-care of the selected older persons. Lastly, after determining the self-care of the older persons, the study investigates the relationship between these two questionnaires through correlational analysis. RESEARCH DESIGN A quantitative, descriptive, correlational and contextual design was used in this study to .reach the overarching aim and respective objectives. RESEARCH METHOD The researcher firstly conducted a literature review to understand self-care and related constructs. Thereafter the researcher employed two structured questionnaires, the ASA-A and ESCA, were employed to collect data. The questionnaires were developed to measure self-care (self-care is determined by measuring the self-care agency). These questionnaires were based on Dorothea OrenYs self-care deficit theory of nursing, the same theory that this research study is based on. Minor adaptations were made to both the questionnaires prior to administration to the predominantly Setswana-speaking older population. The study formed part of the larger Multinational Prospective Urban and Rural Epidemiological study (PURE-SA study - ethical approval number 04M10). All the older persons identified in the peri-urban population of the PURE-SA study living in the Potchefstroom district and who were willing to participate were included in the sample. Trained fieldworkers assisted the researcher in data collection. Of the 198 older persons, 192 participated, accumulating to a 98% response rate. Lastly the researcher correlated the ASA-A and ESCA to determine their relationship as an added benefit to this research study. RESULTS The findings indicate that although the studied older population was of a lower socio-economic status with a lower literacy level, their overall self-care was relatively good. Seven self-care deficits were identified namely time management skills affecting self-care, energy deficit affecting self-care, sleep deprivation, lack of knowledge and ability to acquire knowledge with regard to health and self-care, lack of a rest, exercise and self-care programme, self-care deficit caused by physical deterioration and, lastly, the lack of performance of activities to prevent/decrease self-care deficits. These identified self-care deficits supported the development of guidelines to facilitate self-care amongst older persons, together with Menon's psychological health empowerment model, as well as an in-depth literature review on self-care and related constructs to understand self-care from a theoretical perspective. Furthermore, the study compared the ASA-A and ESCA questionnaires to determine the relationship between these questionnaires. The two questionnaires had a very good correlation with each other, conclusion that either of these two questionnaires could be used to measure self-care of a population. Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2010.

M (Nursieng Science), North-West University, Potchefstroom Campus INTRODUCTION The South African public health sector is facing the crisis of a shortage of healthcare professionals, particularly physicians. Even though the shortage is global, South Africa is more affected due to the high number of citizens receiving their medical care from the public healthcare sector. In developing countries such as South Africa, the shortage of healthcare professionals, particularly physicians and nurses, inequitable distribution of workforce, and a lack of resources have seen to it that the global policy on universal health coverage, which was developed to ensure positive service delivery and quality patient care, is not met. The South African government employed multiple strategies to address the shortage of physicians with varying degrees of success. One of the strategies was adopting a double-pronged strategy to increase the number of physicians to meet the healthcare needs; this entailed an output of local training institutions and outsourcing medical training to Cuba by annually sending 1 000 students from poor rural communities to train as physicians. The other strategy adopted was the introduction of the relatively new cadre of professionals known as clinical associates. Clinical associates were introduced to augment the shortage of physicians especially in district hospitals and primary healthcare settings. This meant that the clinical associates have to work closely together with professional nurses. Due to the relative newness of the clinical associates’ profession and lack of clarity about the role of clinical associates, some of the healthcare professionals, especially professional nurses, were not well informed about their scope of practice and role and that has led, in the practical experience of the researcher as a professional nurse, to conflict in the practice environment, causing a lack of professional relationships among especially these healthcare professionals which could negatively affect service delivery. RESEARCH PURPOSE The purpose of the study was to explore and describe the professional nurses and clinical associates’ perceptions of the professional relationship between them. RESEARCH DESIGN A qualitative description design was used in this study. RESEARCH METHOD Data collection took place in district hospitals (N=7; n=4) in Gert Sibande district, Mpumalanga province. Twelve (N=12) semi-structured individual interviews were done consisting of six (n=6) professional nurses and six (n=6) clinical associates. All interviews were recorded with a digital voice recorder in a private room after consent had been obtained from all participants. The anonymous interviews were then transcribed by an independent transcriptionist and thereafter data were analysed using Tesch’s eight steps of data analysis with the assistance of a co-coder. After independent analysis of the data by the researcher and co-coder, the results (main themes, and sub-themes) where confirmed by both parties and the supervisors to ensure a true reflection of the results to ensure trustworthiness. RESULTS The findings of the study indicate that although professional nurses and clinical associates understand what a professional relationship is and their role in the district health system, challenges are present and could negatively impact service delivery. Many of the findings between the professional nurses and clinical associates were similar, but there were a few unique findings. Three main themes emerged from the professional nurses’ interviews namely professional relationship defined (1), professional relationship characteristics (2) and professional relationship challenges (3). The first main theme professional relationship defined had two sub-themes namely colleagues working together and relationship amongst professionals. Sub-themes for main theme two named professional relationship characteristics consisted out of positive and negative characteristics and main theme three professional relationship challenges included sub-themes attitude, functional – clinical associates and ministerial, interdepartmental and intra-professional collaboration. Four main themes emerged from the clinical associates’ interviews, namely: (1) professional relationship defined, (2) professional relationship characteristics, (3) professional relationship challenges, and (4) personal professional challenges. Main theme one (professional relationship defined) had interaction between two people, collegial relationships, and goal orientation as sub-themes. The second main theme’s (professional relationship characteristics) sub-theme was positive characteristics. Main theme three (professional relationship challenges) had the sub-themes attitude, functional – clinical associates, functional – professional nurses, and ministerial collaboration. Lastly, the fourth main theme (personal professional challenges) included the sub-themes lack of independence, poor remuneration, poor career progression, and supporting profession to physician shortages. CONCLUSION Professional relationships form the basis of success for the healthcare system. The professional relationship between professional nurses and the relatively new cadre of healthcare professionals called clinical associates has not been the focus of research studies. There are various challenges in this relationship that need to be addressed as it can negatively impact service delivery. Although some challenges revealed by both professional nurses and clinical associates were very similar in the practice environment, there were also unique personal professional challenges that the clinical associates had. Both populations could define a professional relationship between themselves, although the clinical associates had perceptions of a more personal connection in their professional relationships by mentioning that it is a ‘collegial relationship’, ‘interaction between two people’, and ‘goal orientation’, whereas the professional nurses’ perception was that it was only ‘colleagues working together’ and ‘relationship amongst professionals’, i.e., there does not have to be a relationship between themselves. The professional nurses added positive and negative professional relationship characteristics whereas the clinical associates only perceived positive characteristics in their relationship with professional nurses. The professional relationship challenges revealed that both populations perceived attitude as a challenge, whereas the professional nurses only experienced functional challenges related to clinical associates; clinical associates, on the other hand, perceived that there were functional challenges for themselves and the professional nurse. Both populations revealed that there is a ministerial collaboration challenge that needs to be addressed, while the professional nurses added interdepartmental and intra-professional collaboration. Lastly, clinical associates also added that they have personal professional challenges, such as a lack of independence, poor remuneration, and career progression, and that it is a supporting profession to physician shortages which was not perceived by the professional nurses. Although there are many types of challenges affecting the professional relationship between professional nurses and clinical associates, these challenges could be addressed without difficulty through ministerial, interdepartmental, and intra-professional collaboration. Ministerial collaboration though media, workshops, and roadshows could be an accomplishable method to communicate. Interdepartmental (outpatient, casualty, and theatre departments) communication could be improved through meetings and availability of the scope of practice of all healthcare practitioners including the new cadre of clinical associates in the standard operating procedure files. Intra-professional communication signifies two or more disciplines (professional nurses and clinical associates) within the same profession (healthcare) engaging in learning and collaborating together in the practice environment through in-service training. In-service training can focus on what a professional relationship entails and how to improve and address positive and negative professional relationship characteristics and professional relationship challenges. Lastly, personal professional challenges of the clinical associates should be addressed on a governmental level by the Minister of Health or a regulating body such as the Health Professions Council of South Africa. Masters

MCur, North-West University, Potchefstroom Campus Masters

Objective In South Africa, appropriate criteria to measure the professional standing of professional nurses are essential. Internationally, there are professionalism scales by which to measure professionalism, but none could be identified that were particular to the South African context. Hall’s Professionalism Scale consists of 50 items and was specifically developed to measure the attitudes and ideologies held by professionals in various professional occupations by measuring five attitudinal components of professionalism, namely: Sense of calling to the field; Autonomy; Using professional organisation as major referent; Belief in self-regulation; and Belief in public service. In this study, the construct validity and internal consistency of the constructs of Hall’s Professionalism Scale were assessed among professional nurses in the South African context. Results Originally Hall’s Professionalism Scale comprises 50 items. This scale was reassessed by Snizek, who retained only 25 items of the original scale to measure professional standing. During preliminary analysis of the South African data, 23 items were included. Electronic supplementary material The online version of this article (10.1186/s13104-019-4515-6) contains supplementary material, which is available to authorized users.

MA (Human Resource Management), North-West University, Potchefstroom Campus, 2019 Human resource development as a function or sub-function of human resource management plays a vital role in reaching organisation goals by aligning training and development initiatives with organisational strategy. One of the strategic goals of health care organisations, with specific reference to the clinical practice environment, is the delivery of quality patient care. The South African Department of Health also looks upon quality patient care to be a strategic priority to create the quality of life for all South Africans. Clinical practice environments in the public health-care sector are affected by various factors such as staff shortages, poor infrastructure and high workloads. This caused many newly graduated nurses to apply for posts in the private health care sector. In order to guard against this the Minister of Health implemented a compulsory community service year for all nursing graduates also known as comserve ("community service") nurses in the public health care sector. When comserve nurses enter the clinical practice environment they are faced with the challenges of the public health care sector. At the same time they also need to deal with their own challenges such as not being adequately prepared for the new role and feelings of incompetence, theory-practice gaps, poor support and an absence of role-models. All these issues may influence the quality of care delivered by these nurses. The South African Department of Health considers nursing education one of the main challenges to revitalise the nursing profession, as anecdotal evidence indicates that many nurses do not possess adequate competencies in various fields of nursing, which can cause poor-quality care. This problem is intensified by poor communication between clinical practice environments and nursing education institutions. Competence is a combination of knowledge, skills and attitudes needed to perform in specific situations in the clinical practice environment. Human resource development (HRD), in conjunction with relevant stakeholders can assist in addressing this problem by means of a learning needs analysis. A learning needs analysis is used to identify the specific knowledge, skills and attitudes prospective comserve nurses need to be considered competent in the delivery of quality patient care. The identification of learning needs will assist in the development of education, training and development initiatives specifically aimed at delivering quality patient care which is regarded as the main strategic goal of CPEs. The current study formed part of a larger project comprising two separate studies. The intention of the larger project is to conduct a 360-degree learning needs analysis so as to determine the knowledge, skills and attitudes needed by community service nurses to deliver quality patient care. These aspects were only based on perceptions of participants and not on existing nursing education curricula. The current study focussed on the perceptions of nursing educators and final-year nursing students, representing the views of the Nursing Education Institution. The alternative study focussed on the perceptions of nursing managers and community service nurses, representing the perceptions that existed within the clinical practice environment. The larger project will also reflect a perceived competency profile from a 360-degree perspective for community service nurses which can later be compared with existing curricula to determine any educational gaps. The research approach followed in this study was qualitative within a constructivism paradigm using exploratory and descriptive strategies. Semi-structured individual interviews were conducted with (N=42) participants which consisted of (n=23) nurse educators and (n=19) final-year nursing students. Multi-level sampling which consisted of an all-inclusive sampling which was two nursing colleges ((N(=2; n=2) and one university ((N(=2; n=1) and purposive sampling (nurse educators and final-year nursing students) was followed during data collection. A digital recorder was used to capture the data during the interviews and field notes were taken after the interviews. All interviews were transcribed verbatim. The researcher and co-coder applied thematic analysis following a deductive approach in contrast to an inductive approach for analysing and interpreting the data. A deductive approach is a top-down approach for which the researcher already has available predetermined codes based on concepts, ideas or topics for interpreting the data. In this study the predetermined codes were knowledge, skills and attitudes. Phase 1 of the current study explored and described the perceptions held by nurse educators and final-year nursing students regarding the knowledge, skills and attitudes to enable prospective comserve nurses to delivering quality patient care. The results consisted of main themes, sub-themes and sub-sub-themes for both populations. The findings included knowledge, broken down into: theoretical knowledge, practical knowledge, knowledge of holistic care, cultural diversity and code of conduct. Each of these was further broken down into their respective sub-sub-themes. Skills included interpersonal, cognitive, management, administrative, practical and personal skills with their respective sub-sub-themes. Attitudes such as the following were also identified: being caring, positive, humble, compassionate, passionate, friendly, empathetic, sensitive, helpful, life-long learners and walking the extra mile. Masters

Background: Worldwide, patients visiting health care facilities in the public health care sector have to wait for attention from health care professionals. In South Africa, the Cape Triage Score system was implemented successfully in hospitals’ emergency departments in the Cape Metropole. The effective utilisation of triage could improve the flow of primary health care (PHC) patients and direct the patients to the right health care professional immediately. Aim: No literature could be traced on the implementation of triage in PHC facilities in South Africa. Consequently, a study addressing this issue could address this lack of information, reduce waiting times in PHC facilities and improve the quality of care. Setting: PHC facilities in a sub-district of the North West province of South Africa. Method: A quantitative, exploratory, typical descriptive pre-test–post-test design was used. The study consisted of two phases. During phase 1, the waiting time survey checklist was used to determine the baseline waiting times. In phase 2, the Cape Triage Score system that triaged the patients and the waiting time survey checklist were used. Results: Data were analysed using Cohen’s effect sizes by comparing the total waiting times obtained in both phases with the waiting time survey checklist. Results indicated no reduction in the overall waiting time; however, there was a practical significance where triage was applied. Referral was much quicker to the correct health professional and to the hospitals. Conclusion: Although the results indicated no reduction in the overall waiting time of patients, structured support systems and triage at PHC facilities should be used to make referral quicker to the correct health professional and to the hospitals.

Background: The Integrated Management of Childhood Illness (IMCI) strategy provides guidelines for supporting and improving the health system to reduce under-5 children’s mortality rates. This strategy specifically assists professional nurses with the case management of children aged birth–5 years. Aim: The purpose of this study was to investigate how professional nurses provided counselling to caregivers of under-5 children based on the IMCI strategy in Primary Health Care facilities of one district in the North West Province of South Africa. Setting: Primary Health Care (PHC) facilities of one district in the North West Province. Method: A quantitative, descriptive and observational design was used. Counselling provided by the professional nurses was observed and a checklist was completed. This IMCI counselling checklist was based on aspects in the counselling section of the Health Facility Survey, formulated according to the IMCI strategy’s requirements. Results: Counselling that focused on feeding, administration of medication and counselling skills used during the consultation were good. However, counselling of caregivers of children aged 13 months to 5 years could be improved and the caregivers’ health status should also be addressed. Conclusion: Counselling provided to caregivers of under-5 children regarding feeding, administering of medication and caregivers’ health status used effective communication skills. However, technicalities of feeding such as lactation and nutritional guidance posed challenges.

MSc (Health Sciences), North-West University, Potchefstroom Campus Perinatal mortality refers to the stillbirth of baby and a baby's death up to one week after birth. The purpose of the current study was to identify maternal and neonatal factors associated with perinatal deaths in one selected district hospital in the Free State Province of South Africa. Most births and neonatal deaths occur in district hospitals, explaining the rationale for selecting a district hospital as the study site. A quantitative retrospective descriptive design was utilised. Ex post facto data were collected from the Perinatal Problem Identification Programme's (PPIP's) data collection tool. An additional MSExcel data collection instrument was developed to transfer specific data elements from the PIPP data base to the MSExcel data instrument to facilitate the data analysis. At the participating hospital, 2319 neonates were born during 2015 comprising the study's population. A random sample of 384 live neonates and an all-inclusive sample of 43 dead neonates were included in the current study's data collection procedures. Descriptive statistics were calculated and Cohen's effect sizes-d (for continuous variables) as well as phi-coefficients (for categorical variables) were calculated to determine practically significant differences between the variables for neonates in the alive and dead groups respectively. A logistical regression analysis, to determine the major factors associated with neonatal deaths, was also compiled. The SAS (2016) statistical program was used to analyse the data. These analyses indicated that the neonates' Apgar scores 10 minutes after birth, gestational age, weight at birth and the parity of the mother were the most practically significant indicators of neonates' chances to live or die. The study's findings supported the assumption that practically significant factors are associated with maternal and neonatal factors that contribute to perinatal deaths. Masters

This study sought to determine whether job demands and job resources predicted conflict handling styles among nurses within South African public hospitals. A convenience sample of 205 nurses were included (males = 10.7%; age range 46 to 60 years = 38. 5%, experience of 5 years and more = 70. 8%, African = 92. 2%). They completed Rahim’s Organisational Conflict Inventory – II (ROCI–II: Rahim, 1986) and a job characteristics measure developed for this study. Data were analysed to assess which job demands and resources predicted which conflict handling styles. From the results, time demands, crisis management and colleague support predicted the use of an avoiding style, whereas workload, time demands, job security, feedback and colleague support predict the use of the integrating style. Time demands and payment predicted the use of the obliging style, while workload, crisis management and payment predicted the use of the dominating style. The compromising style was predicted by colleague support. It seems from the findings that conflict is frequently predicted by time demands.

Aim The aim of this study was to explore and describe the perceptions of nurse managers, nurses, and a physician in the community health centre with the most positive practice environment in a province of South Africa. Methods Ten (N = 10) semistructured individual interviews were conducted with personnel of the community health centre with the most positive practice environment. Results Personnel cited the following as the most important characteristics of a positive practice environment in a primary health care setting: support, leadership and governance, collegial nurse-physician relationships, and quality of care. Conclusion In a primary health care setting, it is important to train, appoint, and support managers who in turn will be able to train and support their personnel. Furthermore, reciprocal community involvement must be encouraged between personnel of the community health centre and stakeholders in the community to improve the health status of the community. Finally, group cohesions between all health care workers and managers at different organisational levels should be encouraged, as this enhances teamwork and a culture of teaching-learning and improves the competence of all staff.

This study’s sought to establish the relationship of emotional intelligence, job characteristics and wellness within the nursing environment. A cross-sectional survey design was used. A random probability sample (N=511; females =96.70%; white =77.10%) was taken from hospitals in three South African provinces. Nurses (enrolled auxiliary (20.50%), enrolled staff (12.30%), registered (49.30%)), unit managers (7.60%), process managers (0.60%) and paramedics (0.20%) were included in the study. They completed the Emotional Intelligence Scale (EIS), Maslach Burnout Inventory – Human Services Survey (MBI-HSS), Utrecht Work Engagement Scale (UWES) and Work Evaluation Scale (WES). The statistical analysis on the variables was conducted by the use of the SPSS and AMOS programs. Descriptive statistics and the Cronbach alpha coefficients for each variables were computed. Structural Equation Modelling (SEM) for the variables of emotional intelligence, job characteristics and wellness were conducted. The proposed structural model shows that there are clear paths between job demands and job resources; job demands, emotional intelligence and work wellness; job resources, emotional intelligence and work wellness. The study showed a clear indication that there is a relationship between emotional intelligence, job characteristics and work wellness within a nursing environment. http://www.tandfonline.com/toc/rpia20/23/1#.VefzIpdGRfk http://dx.doi.org/10.1080/14330237.2013.10820615

The practice environment plays an important role in nursing. Currently, limited information seems to exist on the nature of practice environments within the primary health care (PHC) context of the public health care sector of South Africa. This study describes the demographic profile of community health care centres (CHCs) and professional nurses (PNs) as well as the current status of the practice environment of nurses in the PHC context. A quantitative, descriptive cross-sectional survey design was used. Firstly, demographic data of the CHCs (N=41; n=26) was obtained. Secondly, PNs (N=291; n=195) were surveyed using the Practice Environment Scale of the Nursing Work Index (PESNWI) and questions focussing on their demographic profile. The demographic profile of CHCs and PNs was described and the confirmatory analysis of the PES-NWI showed that the survey was valid in the PHC context of South Africa. The Cronbach alpha ranged between 0.68 and 0.86. Nurses disagreed that the sub-scales named staffing and resource adequacy and nurse participation in PHC/CHC affairs were present in their practice environments. Development and implementation of a positive practice environment programme for the South African PHC context could improve the wellbeing of nurses and assist in the delivery of quality care to patients.