Abstract
D.Cur.
With the dawn of the new democratic dispensation in South Africa, numerous structural changes in the form of new legislation on health care were introduced by government. The purpose hereof is to transform health care delivery in order to bring about equality, accessibility, availability and applicability of health care to the citizens of South Africa. However, such changes have given rise to rationalization and the restructuring of health care services and health care personnel. Against the background of the so-called brain drain of health care personnel, it possibly contributed to a situation where numerous health care services find themselves with a shortage of expert human and material resources. These changes have influenced the quality of decisionmaking
in health care services in general, and nursing in particular.
Furthermore, based on an investigation of disciplinary case studies of the SANe, it appears that there is an increase in the number of disciplinary cases against nurses. These disciplinary cases reflect the nature of the decisions made by nurses. From these disciplinary case studies, it appears that decision-making by nurses do not comply with the reasonable expectations as stipulated in the legal-ethical framework of the nursing profession. Furthermore, it appears that decisions made by nurses in order to promote the health of the individual, group and/or community, are unsafe, ineffective and unacceptable in terms of the reasonable expectations as stipulated in the legal-ethical framework of the nursing profession. It can be concluded, that decision-making by these nurses no longer complies with the regulation in terms of the Nursing Act (Act 50 of 1978, as ammended), namely to deliver safe nursing to the citizens of South Africa.
As a possible solution to the aforementioned problem, the researcher sees the description of a system for quality decision-making as being necessary in nursing. This goal can be achieved by the following objectives: the exploration and description of the expectations of the stakeholders with regard to quality decision-making in nursing, the integration of these expectations during
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the conceptualization of quality decision-making in nursing, as well as the formulation of standards for quality decision-making in nursing.Based on a qualitative, explorative, descriptive and standard-generation design, the study was conducted in four phases to achieve the objectives of the study. During the first phase, the expectations ofthe stakeholders with regard to quality decision-making in nursing were explored and described. In phase two, the identified themes on quality decision-making were conceptualized. In phase three standards for quality decision-making in nursing were formulated through inductive and deductive reasoning from the results of the previous two phases. In phase four a system for quality decision-making in nursing was described based on a theoretical foundation of the systems theory.