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The purpose of the study was to describe elderly care staff’s experiences of job satisfaction and working environment during the implementation of kinaesthetics. Job satisfaction refers to employees’ experiences of the characteristics of the work, the functioning of the work community, and organizational justice. The working environment is defined through its physical, social and symbolic characteristics. Kinaesthetic was implemented in three geriatric wards. The first sub study (I) described the baseline job satisfaction of elderly care staff (N = 364) in a joint social and health care collaboration area comprising four municipalities prior to the implementation of kinaesthetics. The second sub study (II) described the changes that took place during the implementation of kinaesthetics in the working environment of nursing care as perceived by nurses (N = 15). The third sub study (III) described the changes in staff job satisfaction during the implementation of kinaesthetics. The material used to compare the different time points was collected in 2012 ((N = 336), 2014 (N = 326) and 2017 (N = 370). The data in the sub studies were analysed using statistical methods and qualitative content analysis. During the implementation of kinaesthetics the changes were manifested in the nurse’s role, nursing mission and as increased meaningfulness of nursing. Job satisfaction was at a rather good level throughout the follow-up period. The line manager was present in everyday work and their actions were perceived as fair and just. The new operational model promoted a sense of community and setting goals. A common operational model and the support received from the line manager, colleagues and the person responsible for kinaesthetics promoted staff’s commitment to the new care practice model and work in elderly care. In change management, it is important to recognise the prevalent culture in the workplace and the changing operational environment. The new care practice model must be given sufficient time to take root, and necessary resources must be allocated so that the process of change can be taken forward. The study produced new information which can be utilised by nursing leaders both nationally and internationally in developing the rehabilitation care practice model. Tiivistelmä Tutkimuksen tarkoituksena oli kuvata iäkkäiden hoitotyössä toimivan henkilöstön kokemuksia työtyytyväisyydestä ja toimintaympäristöstä kinestetiikan käyttöönoton aikana. Työtyytyväisyydellä tarkoitetaan työntekijöiden kokemuksia työn piirteistä, työyhteisön toimivuudesta ja johtamisen oikeudenmukaisuudesta. Toimintaympäristö määritellään fyysisten, sosiaalisten ja symbolisten ominaisuuksien kautta. Kinestetiikka otettiin käyttöön kolmella geriatrisella osastolla. Ensimmäinen osatutkimus (I) kuvasi yhden neljän kunnan muodostaman yhteistoiminta-alueen vanhustenhuollon henkilöstön (N = 364) työtyytyväisyyden lähtötilannetta ennen kinestetiikan käyttöönottoa. Toinen osatutkimus (II) kuvasi kinestetiikan käyttöönoton aikana tapahtuneita muutoksia hoitotyön toimintaympäristössä hoitajien (N = 15) kokemana. Kolmannessa osatutkimuksessa (III) kuvattiin, millaisia muutoksia tapahtui henkilöstön työtyytyväisyydessä kinestetiikan käyttöönoton aikana. Aikavertailun aineisto kerättiin vuosilta 2012 (N = 336), 2014 (N = 326) ja 2017 (N = 370). Osatutkimusten aineistot analysoitiin tilastollisesti ja laadullisella sisällönanalyysillä. Kinestetiikan käyttöönoton aikana muutokset näkyivät hoitajan roolissa, hoitotyön toimintaideologiassa ja hoitotyön merkityksellisyyden lisääntymisenä. Työtyytyväisyys oli koko seuranta-ajan melko hyvällä tasolla. Lähijohtaja oli mukana arjessa ja hänen toimintansa koettiin oikeudenmukaiseksi. Uusi toimintamalli lisäsi yhteisöllisyyttä ja toiminnan tavoitteellisuutta. Yhteinen toimintamalli, lähijohtajan ja työtovereiden sekä kinestetiikasta vastavan tuki lisäsi sitoutumista uuteen toimintamalliin ja iäkkäiden hoitotyöhön. Muutosta johdettaessa on tärkeää tunnistaa työyhteisön taustalla oleva kulttuuri ja muuttuva toimintaympäristö. Uuden toimintamallin juurruttamiselle on annettava aikaa, ja se on resursoitava niin, että muutosprosessia voidaan viedä eteenpäin. Tutkimuksella tuotetaan uutta tietoa, jota hoitotyön johtajat voivat hyödyntää sekä kansallisesti että kansainvälisesti kuntoutumista edistävän hoitotyön kehittämistyössä.

Tutkimuksen tavoitteena oli tuottaa hoitotyön ja sen toimintojen muotoutumista kuvaileva tilastollinen hoitotyön malli. Lisäksi tavoitteena oli kuvata seurantatutkimuksena Virossa tehtävän hoitotyön toimintoja potilaiden hyvinvoinnin kannalta sekä organisaatiokulttuurin ja toimintaympäristön yhteyksiä hoitotyöhön sairaanhoitajien näkökulmasta. Tutkimuksen painopiste on sairaanhoitajan ammatillinen toiminta, jota tarkasteltiin sairaanhoitajien toteuttamien hoitotoimintojen (fyysiset, psyykkiset, sosiaaliset, hengelliset) kautta. Lisäksi tarkasteltiin sairaanhoitajien arvioita hoitotoimintoihin käytetystä ajasta ja hoitoalan kehitystä. Tutkimus on peruslähtökohdiltaan hoitotieteellinen, mutta siinä on hyödynnetty monitieteellistä lähestymistapaa, erityisesti yhteiskuntatieteellistä ja kasvatustieteellistä tutkimusta. Tutkimuskohteena olivat sairaanhoitajien ammatillinen toiminta, työolosuhteet ja organisaatiokulttuuri sairaanhoitajien näkökulmasta. Tutkimuksessa käytettiin kvantitatiivista lähestymistapaa. Tutkimus perustui The Baltic-Finland NuRsE -projektin puitteissa Virosta kerättyyn aineistoon ja sen analyysiin. Projektiin osallistui Suomen, Viron, Latvian ja Liettuan hoitoalan asiantuntijoita ja työtä koordinoi projektityöryhmä. Tutkimuksessa käytettiin mittarina kyselyä, joka laadittiin vuonna 1997 ja pilotoitiin vuonna 1998, minkä jälkeen sitä muokattiin. Tutkimus toteutettiin seurantatutkimuksen mukaisesti kaksivaiheisena vuosina 1999 ja 2009. Alkuperäinen kyselylomake koostui 42 kysymyksestä, joista tässä tutkimuksessa on tutkimustavoitteiden mukaisesti käytetty 35 kysymystä. Vuonna 1999 tutkimukseen otettiin Viron 14 sairaalaa, jossa oli sisätautien ja kirurgian osastot. Kyselylomake lähetettiin 640 sairaanhoitajalle, joilla oli vähintään yhden vuoden työkokemus. Lomakkeita palautettiin 579 (vastausprosentti oli 94). Analyysiin hyväksyttiin 517 lomaketta, joten lopullinen vastausprosentti oli 81. Vuonna 2009, jolloin tehtiin uusi mittaus, Viron terveydenhuoltojärjestelmän rakenne oli uusittu ja sairaaloita vähennetty. Lomakkeita lähetettiin 260 kappaletta kuuteen sairaalaan, ja niistä palautettiin 244 (vastausprosentti oli 94). Analyysiin otettiin 215 lomaketta, joten lopulliseksi vastausprosentiksi muodostui 83. Kaikki aineiston käsittely toteutettiin Stata 14.2 tilasto-ohjelmistolla. Kahdessa tutkimusvaiheessa mitattuja muuttujia vertailtiin keskenään. Keskiarvojen vertailuun käytettiin t-testiä, mediaanien vertailuun Wilcoxonin testiä, jakaumien vertailuun khiin neliö -testiä (χ2) ja Kolmogorov-Smirnovin testiä. Eri tutkimusvaiheissa mitattuja muuttujia pidettiin merkitsevästi erilaisina, jos testin laskemalla saatu merkitsevyyden todennäköisyys sai arvon p < 0.05. Tulokset luonnehtivat vastaajien arvioita fyysisten, psyykkisten, sosiaalisten ja hengellisten hoitotoimintojen tärkeydestä potilaiden hyvinvoinnin takaamisessa. Muuttujat muodostettiin pääkomponenttianalyysilla. Tämän jälkeen laadittiin lineaariset regressiomallit, joilla selvitettiin eri taustamuuttujien vaikutusta potilaiden hyvinvoinnin takaavista hoitotoiminnoista esitettyihin tärkeysarvioihin molemmissa tutkimusvaiheissa. Aineiston analyysin tuloksena laadittuun tilastolliseen toimintamalliin valittiin ne riippumattomat muuttujat, joilla oli analyysin perusteella tilastollisesti merkitsevä vaikutus riippuviin muuttujiin. Tutkimuksen tuloksena saatiin tietoa Viron sairaanhoidon kehityksestä ja sairaanhoitajien ammatillisesta toiminnasta sairaanhoitajien näkökulmasta vuosina 1999 ja 2009. Lisäksi saatiin tietoa hoitotyön tavoitteista, potilaiden fyysisestä, psyykkisestä, sosiaalisesta ja hengellisestä hyvinvoinnista sekä ongelmista ja niihin liittyvistä hoitotoiminnoista, organisaatiokulttuurista ja toimintaympäristöstä. Kaksivaiheisen tutkimuksen tulosten perusteella laadittu tilastollinen hoitotyön toimintamalli esittää hoitotoimintojen merkittävät komponentit ja niihin vaikuttavat tekijät potilaiden hyvinvoinnin näkökulmasta. Potilaiden hyvinvointiin merkittävimmin liittyneet tekijät voi jakaa viiteen ryhmään: sairaanhoitajien työkokemus, organisaatiotekijät, hoitotoimintoihin kulunut aika ja potilailla esiintyvien hengellisten ja psyykkisten ongelmien tiedostaminen. Tutkimustuloksista saatua tietoa voidaan hyödyntää opiskelijoiden oppimis- ja tutkijoiden tutkimisprosessin tukemisessa, käytännön hoitotyön kehittämisessä sekä hoitotyön historiallisen näkökulman ymmärtämisessä ajassa ja yhteiskunnallisessa muutoksessa. Laaja, koko Viron kattava tutkimus antaa huomattavan panoksen hoitoalan koulutukseen perus-, maisteri- sekä tohtoritasolla, ja tukee hoitotieteen kehitystä Virossa. Tutkimuksella on kansainvälistä merkitystä, sillä se tarjoaa kokonaiskatsauksen Virossa viime vuosikymmeninä tehtyyn hoitotyöhön ja sen tulevaisuudennäkymiin. Lisäksi tutkimus antaa lisätietoa hoitotyön prosessiin sisältyvistä monimutkaisista yhteyksistä. The purpose of the present study was to produce a statistical nursing model describing nursing care and its different functions. It also included a follow-up study designed to depict nursing practices employed in Estonia from the patient well-being viewpoint, and to examine registered nurses’ opinions on the interrelation between organisational culture and nursing environment. The research focused on registered nurses' professional activities, which were examined through nursing care (physical, mental, social, religious) activities. In addition, the nurses were asked to evaluate the time used on the different treatments and to analyse the development in the field. Although the study is based on nursing sciences, it is multidisciplinary in nature, drawing particularly from social sciences and pedagogical research. The research addressed nurses' professional activities, working conditions and organisational culture from the point of view of registered nurses. The study employed a quantitative approach. It was based on data collected in Estonia during the Baltic-Finland NuRsE -project. The project involved nursing professionals from Finland, Estonia, Latvia and Lithuania, and was coordinated by a working group.The indicator questionnaire used in the study was drawn up in 1997, piloted in 1998 and consequently modified. The study was conducted in two phases: the first phase in 1999 and a follow-up in 2009. The original questionnaire consisted of 42 questions, of which 35 were selected for the present study in line with its objectives. The 1999 research covered 14 Estonian hospitals with internal medicine and surgical departments. The questionnaire was sent to 640 registered nurses with a minimum of one year of work experience. Of the 579 questionnaires returned (response rate 94), 517 were accepted for analysis, making the final response rate 81. The questionnaire was repeated in 2009 after the restructuring of the Estonian health care system and reduction of hospitals. A total of 260 questionnaires were sent to six different hospitals, of which 244 were returned (response rate 94). Analysis was performed on 215 forms, making the final response rate 83. The data were analysed with the Stata 14.2. statistical analysis software. The variables measured during the two phases of the study were compared with each other. Mean values were compared with the t-test, medians with the Wilcoxon test, and distributions with the chi-squared test (χ2) and the Kolmogorov-Smirnov test. The variables measured during the different phases were considered significantly different, if the likelihood of statistical significance was p < 0.05. The results described the respondents' assessment regarding the importance of somatic, mental, social and religious nursing treatments on the well-being of the patients. The variables were formed by main component analysis. The next step was to develop linear regression models in order to examine the impact of various background variables on importance assessments of the different nursing treatments on patients' well-being in both research phases. The statistical nursing model created based on data analysis includes all independent variables, which impact on dependent variables was found to be statistically significant. The results offer an insight into nurses' perception of the development of Estonian nursing care and their own nursing activities in 1999 and 2009. In addition, the study provides information on the objectives of nursing, on patients' physical, mental, social and religious well-being, problems and related nursing treatments, as well as on organisational culture and nursing environment. The statistical nursing model created on the basis of the results of the two-phase research presents the most significant nursing care components and related factors from the patient well-being point of view. On the basis of the analysis, the most significant factors affecting the well-being of patients can be divided into five groups: nurses’ work experience, organisational factors, estimated time used on nursing care, and the awareness of any religious and mental problems experienced by the patients. The information obtained may be utilised in future learning and research processes, help in developing practical nursing skills, and provide understanding of nursing in both a historical context and in the context of social change.The study is comprehensive and covers the whole of Estonia, and can thus contribute greatly to nursing education on basic, master's and doctorate levels, and support the development of nursing sciences in Estonia. It carries international value by providing a synoptic view on the nursing care provided in Estonia in the past few decades as well as its future prospects, and by offering additional information on the complex relations involved in nursing processes.

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

Bakgrund: Tidigare forskning visar att patienter inom rättspsykiatrisk vård upplever saknad av autonomi, delaktighet och respekt. Det ligger i sjuksköterskans intresse att värna om patientens resurser och planera omvårdnadsarbetet därefter. Genom att arbeta med förbättringsförslag från patienter, anhöriga och vårdpersonal kan vården anpassas efter önskat behov. Syfte: Syftet med denna studie är att utforska områdena delaktighet, vårdrelation, vårdmiljö och bemötande i genomförda PDSA-cykler riktade mot patientens vård i ett kliniskt förbättringsarbete i rättspsykiatrisk vård. Metod: Studien består av två delar, en explorativ kvalitativ design med en induktiv ansats samt en deskriptiv kvantitativ design. Datamaterial från nio enheter samlades in från det redan pågående implementeringsarbetet i den aktuella verksamheten. Kvalitativ innehållsanalys enligt Graneheim och Lundman användes sedan vid analysen av datamaterialet. Resultat: Resultatet har kategoriserats i åtta subkategorier; påverka sin vårdprocess, möjligheten till inflytande, eget ansvar, förbättringar av gemensamma ytor, att skapa en trivsam miljö, stimulans för kropp och själ, ökad kännedom och att tillsammans uppnå uppsatta mål, som senare ledde till fyra huvudkategorier: delaktighet, vårdrelation, vårdmiljö och bemötande Diskussion: Med hjälp av kvalitetsbegreppen trovärdighet, konfimerbarhet, pålitlighet och överförbarhet diskuteras studiens metodavsnitt. Studiens resultat ställs emot tidigare forskning och kopplas även samman med Erikssons teori om vårdandet och vilken betydelse det har i delaktighet, vårdrelation, vårdmiljö och bemötande. Background: Research has shown that patients in forensic psychiatric care experience a lack of autonomy, participation and respect. It is in the nurse's interest to take care of the patient's resources and to plan the nursing thereafter. Care can be adapted to the desired needs by working with improvement suggestions from patients, relatives and healthcare professionals. Aim: The aim of this study is to explore the areas of participation, care relationship, nursing environment and treatment in implemented PDSA cycles aimed at patient care in a clinical improvement work in forensic psychiatric care. Method: The study consists of two parts, an explorative qualitative design with an inductive approach and a descriptive quantitative design. Data from nine units were collected from the ongoing implementation in the current work. The qualitative content analysis was used according to Graneheim and Lundman in the analysis of the data. Results: The result has been categorized into eight subcategories; implicate the care process, ability to influence, own responsibility, improvement of social areas, creating a pleasant environment, stimulus for body and mind, increased awareness and jointly achieving set goals, which later resulted in four main categories: participation, care relationship, nursing environment and treatment. Discussions: The methodology of the study is discussed using the quality concepts credibility, confidentiality, reliability and transferability. The results of the study are compared to previous research and are also linked to Eriksson's theory of care and its importance in participation, care relationship, nursing environment and treatment.

Methicillin-resistant Staphylococcus aureus (MRSA)によって療養環境表面が汚染すると，その環境における当該菌の生存期間は数週間におよぶとの報告がある．しかし，入院患者と接触する可能性のある医療器具や患者の療養環境にあるベッド柵やリネンなどに使用される材質の違いによる生存状況についての検討は少ない．我々はS. aureusを用いて，患者の療養環境にある綿布，ポリプロピレン布，シリコーンゴム片，銅片，真鍮片，アルミニウム片，ステンレス片を用いて各材質の違いによる生存状況を，5℃, 20℃, 35℃の異なる温度条件も含めて検討を行った．その結果，ポリプロピレン布，アルミニウム片，ステンレス片では，5℃, 20℃の条件でmethicillin-sensitive S. aureus〔MSSA (ATCC 29213)〕, MRSA (ATCC 43300)，医療施設の療養環境から分離されたMRSA〔環境由来MRSA(L1)〕のいずれの菌株も30日後に生存が認められた．綿布においてMSSA, MRSA，環境由来MRSA(L1)の菌株は，5℃, 20℃で15日後の生存が確認されたが，35℃ではいずれも7日後から生存は見られなかった．銅片，真鍮片において，5℃, 20℃, 35℃のMSSA, MRSA，環境由来MRSA(L1)は，いずれも試験菌の付着直後は生存が認められたが，乾燥直後の生存は見られなかった．これらのことからMRSAは，付着した材質の違いによって，生存期間が異なると考えられた． S. aureusは，付着する材質によっては，長期に生存するため，療養環境における器材や資材を介する接触伝播を阻止するために適切な消毒や清掃等を定期的に行う必要があると考えた．, Reportedly, methicillin-resistant Staphylococcus aureus (MRSA) can survive for a few weeks on surfaces in nursing environments. However, the survival of MRSA attached to different materials used in medical devices which may come into contact with inpatients, such as bedside rails, linen, and other equipment in nursing environments, has not been fully discussed. We examined the survival of Staphylococcus aureus (S. aureus) attached to different materials found in nursing environments, such as cotton and polypropylene cloth, as well as silicone rubber, copper, brass, aluminum, and stainless steel, at 5, 20, and 35°C. Among the strains attached to polypropylene cloth or aluminum or stainless steel, methicillin-sensitive S. aureus [MSSA (ATCC 29213)], MRSA (ATCC 43300), and MRSA [environmental-origin MRSA (L1)] strains isolated from nursing environments in the health-care facility survived after 30 days at 5 or 20°C. Among strains attached to cotton cloth, MSSA, MRSA, and environmental-origin MRSA (L1) survived after 15 days at 5 and 20°C, but no strains survived after 7 days at 35°C. Among strains attached to copper or brass, MSSA, MRSA, and environmental-origin MRSA (L1) survived just after attachment in suspension, but no strains survived after drying at 5, 20, or 35°C. These results suggest that the survival of MRSA depends on the attached material. Therefore, adequate disinfection and cleaning of surfaces is essential to prevent transmission of MRSA through equipment or materials in nursing environments, because MRSA may survive for more than 30 days on some metal or nonmetal materials.

Bakgrund: Vårdpersonalen på en akutmottagning har stora krav på sig, ansvar för många patienter och måste fatta många egna beslut, ibland med mycket kort betänketid. Vårdpersonalen möter många olika patienter med olika problem och personligheter, och måste bemöta varje patient så att denne känner sig bekräftad och sedd. Syfte: Syftet med litteraturöversikten är att undersöka patienters upplevelse av att vårdas på en akutmottagning. Metod: Artiklar till arbetet har söks i olika databaser. Aktuella artiklar har lästs och relevanta fynd har markerats, för att analyseras och sammanställa ett resultat. Resultat: Analysen resulterade i tre underrubriker: Information, Bemötande och Vårdmiljö, med uppdelning av positiva och negativa upplevelser. Många patienter var nöjda med vården, men hade låga förväntningar från början. Patienterna har förstående för personalens tuffa arbetsmiljö, men önskade att få bättre information om väntetid och undersökningar. De tyckte att väntetiden var för lång, och kände sig ofta ensamma och övergivna. Slutsats: Mycket behöver förändras för att patienterna ska få en mer positiv upplevelse av akuten. Detta arbeta kan hjälpa till att belysa vilka punkter som vården måste arbeta extra mycket med för att patienterna ska känna sig trygga, exempelvis bättre information om väntetider och ett bemötande där sjusköterskan ser hela patienten. Background: The demands and expectations on a nurse in the emergency room are high. They are responsible for many patients and have to make many decisions on their own, sometimes with very short reflection time. They face a wide variety of patients with different problems and personalities, each requiring their own method of approach and interaction in order for him or her to feel acknowledged. Aim: The aim of the literature review is to examine patient's experiences of being cared for in an emergency room. Method: Articles for the work has been searched in different databases. Articles in-question has been read and the relevant finding has been highlighted, to analyze and compile the results. Results: The analysis resulted in three subheadings: Information, Treatment and Care environment, with sectioning of positive and negative experiences. Many patients were satisfied with the care, but had low expectations from the start. Conclusion: There is much that needs to be changed to allow patients to have a more positive experience of the emergency room. Care units must work harder with to ensure that patients will feel secure and safe, for example, better information on waiting times and a treatment where the nurse sees the whole patient.

Recent reforms in the South African health care and educational system were founded in the ideal that the country would 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. Learning facilitators are held accountable for finding adequate learning experiences to prepare nursing students for such practice demands so that newly qualified nurses do meet expectations for entry level clinical judgement ability. Quality clinical judgement is therefore imperative as an identified characteristic of newly qualified professional nurses. There is a scarceness of information on the concept of clinical judgement especially within the South African nursing environment. Relevant information in this regard can assist in clarifying the meaning, which will facilitate a common understanding of the concept within the clinical nursing environment. This in turn can lead to the formulation of a teaching-learning strategy to facilitate clinical judgement in undergraduate nursing students, which would be of benefit in the nursing care environment. The objective of this study was addressed in three phases. The first phase of this research analysed the concept of clinical judgement through various data sources and a review of literature to clarify the meaning and facilitate a common understanding through identification of the characteristics and to develop a connotative (theoretical) definition of the concept. The second phase of the research investigated professional nurses‟ understanding of the meaning of clinical judgement, as well as the factors that influence the development of clinical judgement within the nursing environment. During the third phase a conceptual framework for an enabling teaching-learning environment was constructed from a modern day constructivist approach to facilitate clinical judgement. The section included a description and diagrammatic presentation of the framework. The conceptual framework formed the scientific basis from which a teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African nursing environment was synthesised. A qualitative design was used for the study. During the first phase (manuscript 1) an explorative, descriptive qualitative design was used to discover the complexity and meaning of the phenomenon. Multiple data sources and search engines were consulted for the time frame 1982-2013. An extensive concept analysis resulted in a theoretical definition of the concept „clinical judgement‟, a complex cognitive skill to evaluate patient treatment alternatives within the clinical nursing environment. The second phase (manuscript 2) is qualitative in nature and explored professional nurses‟ understanding of clinical judgement, as well as the factors influencing the development of clinical judgement in undergraduate nursing students. The findings emphasised clinical judgement as skill within the nursing environment. This assisted in the development of teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African Nursing environment as the third phase (manuscript 3). Such an environment should impact positively to promotion of autonomous and accountable nursing care. PhD (Nursing), North-West University, Potchefstroom Campus, 2015

Ronald McDonald Hus är en ackommodering som ger familjer med sjuka barn möjlighet att kunna bo och uppleva en hemlik miljö samtidigt som deras barn vårdas på sjukhuset. Syftet med studien var att undersöka om det förelåg något samband mellan vistelsens längd på Ronald McDonald Hus och hur nöjda föräldrarna var avseende den fysiska och psykosociala boendemiljön. Vistelsens längd i denna studie definierades som “mindre än tre nätter” och “mer än tre nätter.” Metoden var en komparativ och kvantitativ enkätstudie. Konsekutivt urval användes för att rekrytera deltagare. I studien deltog 34 föräldrar som bodde på Ronald McDonald Hus under sommaren och hösten 2014. Efter internt bortfall återstod 27 föräldrar varav 14 hade bott mindre än tre nätter och 13 mer än tre nätter. Insamlad data analyserades med hjälp av Statistical Package for the Social Sciences (SPSS). Resultatet visade att samtliga deltagare skattade den fysiska miljön på Ronald McDonald Hus högt. Majoriteten av deltagarna upplevde den psykosociala boendemiljön på Ronald McDonald Hus som positiv. Det förelåg inget signifikant samband mellan vistelsens längd och hur nöjda föräldrarna var med den fysiska och psykosociala boendemiljön på Ronald McDonald Hus. Slutsatsen är att Ronald McDonald Hus är betydelsefullt för familjer med sjuka barn. Detta boende har en positiv påverkan på hela familjens tillvaro. Familjer är i stor utsträckning nöjda med den fysiska boendemiljön på Ronald McDonald Hus. Boendet bidrar till minskad ekonomisk oro för många familjer. Ronald McDonald House provides accommodation for families with hospitalized children where they can experience a home like environment while their children are getting hospital treatment. The aim of this study was to examine if there is a correlation between the length of stay and the parents’ satisfaction with the physical and psychosocial environment. The length of stay was divided into "less than three nights" or "more than three nights". The method used in the study was a comparative and quantitative questionnaire study. Consecutive selection was used to recruit participants. Thirty four parents participated who all stayed at Ronald McDonald House during the summer and autumn 2014. After internal dropouts, 27 parents remained of which 14 stayed less than three nights and 13 more than three nights. Data was analyzed using Statistical Package for Social Sciences (SPSS). The results showed a high rating by all participants on the physical environment at Ronald McDonald House. A majority of the participants also had a positive experience with regards to the psychosocial environment. No significant correlation between the length of stay and the parents’ satisfaction with the physical and psychosocial environment was found. The conclusion was that Ronald McDonald House is an important facility for families with hospitalized children. The accommodation has a positive impact on the experience of the whole family. Families are satisfied to a large extent with regards to the physical environment at Ronald McDonald House. Accommodation at Ronald McDonald House contributes to a reduced economic worries for these families.

Titel: Omvårdnadsmiljön på två somatiska vårdavdelningar i Bangkok, Thailand Bakgrund: Miljö ur ett hälsoperspektiv omfattar den fysiska, kulturella och psykosociala aspekten av omvårdnad. Miljön på en vårdavdelning kan både främja hälsa och ha en ogynnsam verkan. Omvårdnad är ett universellt fenomen men kulturen formar människans syn på hälsa och även hur hälsa kan uppnås. Sjukvården i Thailand präglas av buddhismen. Syfte: Beskriva omvårdnadsmiljön kring patienter på två somatiska vårdavdelningar i Bangkok. Design: Studien har inspirerats av etnografisk metod. Data insamlades genom observationer, utförda under tio arbetspass, nedtecknades i loggböcker för att därefter bearbetas genom kvalitativ innehållsanalys. Resultat: Två teman formades: Dagliga rutiner och patientens omgivning, med kategorierna rang/attityd, omvårdnad, miljö/aktivitet och ljud/lukt. Första temat beskriver vardagen för patienter och vårdpersonal samt vilka omvårdnadsmetoder som användes. Det andra temat beskriver miljön och pågående aktiviteter. Slutsats: Den thailändska kulturen speglas i omvårdnadsmiljön på avdelningarna; det råder en stark hierarki bland vårdpersonalen och det utförs många rutinmässiga omvårdnadsåtgärder. Vårdpersonalens största fokus i det dagliga arbetet är arbetsuppgifterna; det är svårt att tyda om patienternas omvårdnadsbehov styr omvårdnadsarbetet. Patienterna är omgivna av mycket personal som orsakar rörelse och ljud i patientsalen, men skapar också trygghet i form av att ha nära kontakt till patienten. Title: Nursing environment in two somatic wards in Bangkok, Thailand Background: Environment from a health perspective includes the physical, cultural and psychosocial aspects of nursing. The environment in a ward can both promote health and have an adverse effect. Nursing is a universal phenomenon, but culture shapes people's views on health and also how health can be achieved. Medical care in Thailand is characterized by Buddhism. Aim: Describe the nursing environment around the patients in two somatic wards in Bangkok. Design: This study was inspired by ethnographic method. Data were collected through observations, conducted over ten sessions, was recorded in logbooks and then processed by content analysis. Results: Two themes were formed: Daily routines and Patient environment, with the categories rank/attitude, care, environment/activity and sound/smell. First theme describes daily lives for patients and caregivers and the nursing methods used. Second theme describes the environment and the ongoing activities. Conclusion: The Thai culture is reflected in the nursing environment at the wards; there is a strong hierarchy among health professionals and many routine nursing activities are performed. The health professionals’ main focus in their daily work was the work tasks; it is hard to decipher whether the patients’ care needs govern the nursing. Patients are surrounded by staff members who cause movement and sound in the patient room, but also create peace of mind by having close contact to the patient.

Thesis (M.A. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2006. Over the past few years, workers have been confronted with increasing pressures at work and at home. This is mainly the result of the growing number of dual-earner couples as well as changes and pressures in the nature of the workplace. Workers are challenged to manage multiple roles in both their work and home domains. Recently, a new measuring instrument was developed to measure work-home interaction, namely the Survey Work-Home Interaction - Nijmegen (SWING). This instrument measures both the direction of influence (work-to-home and home-to-work) and the quality of influence (negative vs. positive). The objectives of this study were firstly to determine the construct validity and reliability of the Survey Work-Home Interaction - Nijmegen (SWING), and secondly to determine the prevalence of work-home interaction in various demographic groups in the nursing environment. A cross-sectional survey design was used. Random samples (N = 363) were taken from hospital nursing staff in Johannesburg, Klerksdorp, Krugersdorp, Potchefstroom and Pretoria. The SWING and a biographical questionnaire were administered. Structural equation modelling (SEM), Cronbach alpha coefficients, multivariate analysis of variance (MANOVA) and one-way analysis of variance (ANOVA) were used to reach the objectives. SEM showed that a four-factor model, which measures negative work-home interference, positive work-home interference, negative home-work interference and positive home-work interference, fitted the data best. Cronbach alpha coefficients showed that all four factors were reliable. Regarding the prevalence of work-home interaction among different demographic groups, the results indicated that there were statistically significant differences between demographic groups based on race, educational level, type of position, flexibility of arrangements at the workplace as well as between full-time and part-time work. Recommendations for future research are made. Masters

Thesis (M.Com. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2006. Within the health care sector in South Africa, the nursing profession is known as one of the four most stressful work environments, which is characterised by high workload, staff shortages and overcrowding situations. This stressful and emotionally draining environment can be the cause for large numbers of nurses experiencing symptoms of burnout and negative work-home interference. However, there seems to be a lack of research investigating specific job demands and job resources associated with burnout and negative work-home interaction in a nursing environment. The first objective of this study was to determine the construct validity and reliability of the adapted Maslach Burnout Inventory - General Survey (MBI-GS). The second objective was to determine which job characteristics within the nursing environment predict burnout and negative work-home interference (WHI). The last objective was to determine whether negative WHI mediated between the most prominent job characteristics and burnout within the nursing environment and whether it was a partial or full mediating effect. A cross-sectional survey design was used. Random samples (n = 300) were taken from nurses working in the Johannesburg, Klerksdorp, Krugersdorp, Pretoria and Potchefstroom areas. A job characteristics questionnaire, the 'Survey Work-Home Interaction - Nijmegen' (SWING) and an adapted version of the Maslach Burnout Inventory - General Survey were administered. Cronbach alpha coefficients, exploratory factor analysis, Pearson product moment correlations, multiple regression analysis and structural equation modelling were used to analyse the data. Regarding the first objective, it was found that burnout consists of exhaustion and mental distance, whereas cynicism and depersonalisation collapse into one dimension (e.g. mental distance). Regarding the second objective, the results indicated that the most prominent job demands and job resources associated with exhaustion are pressure, autonomy, role clarity, colleague support and financial support. It seemed that mental distance is primarily predicted by role clarity, colleague support and financial support, while negative work-home interference is predicted by pressure, time demands, role clarity and colleague support. Results obtained for the last objective provided evidence for a partial mediating role of negative WHI in the relationship between the most prominent job characteristics (pressure, role clarity and colleague support) and burnout (consisting of exhaustion and mental distance). Recommendations were made for the organisation and for future research. Masters