A value clarification on quality within a nursing service
- Authors: Kearns, Irene Josephine
- Date: 2012-02-06
- Subjects: Nursing standards , Nursing quality control , Nursing services evaluation
- Type: Thesis
- Identifier: uj:2027 , http://hdl.handle.net/10210/4379
- Description: M.Cur. , The nursing service manager is responsible and accountable for ensuring quality health care in a nursing service. The principle of liability requires a formal quality improvement programme in the nursing service according to which a specific level of quality nursing can be maintained. It is therefore clearly evident that a quality improvement programme, objectively maintain and evaluate the quality of a service. Opportunities for improvement are identified, and a mechanism is provided for taking remedial steps to bring about and maintain improvement, The abovementioned is of utmost importance and implies a constant commitment to health care service of a high quality. The overall objective of this study is to formulate and describe guidelines for a quality improvement programme for the nursing service of a referral hospital in the Gauteng Province. This study is an explorative, descriptive, qualitative and contextual research aiming to investigate the perceptions of quality in nursing/midwifery which will facilitate the exploration and description of a value clarification on quality, by the chief professional nurses, senior professional nurses, administrative personnel and patients within the nursing service of the referral hospital in the Gauteng Province. Focus group interviews, naive sketches and interviews as methods of data gathering was conducted. A simple random sampling method was used. A total number of three focus group interviews were conducted: one with seven chief professional nurses, one with fourteen senior professional nurses and one with twelve administrative personnel using tape recordings with the written consent of the participants. Naive sketches were obtained from the same groups. An expert psychiatric nurse, with a master's degree in the field and whose daily activities involved interviewing of the psychiatric nursing students and psychiatric patients, conducted the focus group interviews. The researcher conducted thirty individual patient interviews. Trustworthiness in this research was done according to Guba's model (!!! Krefting, 1991:214-222). Data analysis was done according to Tesch's (1990, in Creswell, 1994:155) protocol. An external coder with expertise in the field of coding in qualitative data was utilised to analyse and categorize the data. The researcher and the independent coder had consensus discussions for the formulation of the main categories and sub categories. Consensus discussions were also conducted with the study leader. The results were quantified based on the number of respondents whose perception on quality had reference to the same categories. The structured coding was based on the principles of quality: structure, process and outcome. A description of the conceptual framework was developed from the data analysis and a literature study. This framework with its content and criteria serves as scientific and theoretical basis of the quality improvement programme and are based on the values/value clarification on quality of the different roleplayers in the nursing service. Fifteen belief statements/values were described from the value clarification. The guidelines for the quality improvement programme of the nursing service in the referral hospital were described, based on the eight steps of the quality assurance model of Laing and Nish (Booyens, 1998: 576). A description of values is the first step and from these values on quality in the nursing service, the formulation of management standards was deduced in conjunction with the conceptual framework and the nursing/midwifery practice standards of the Nursing Department of RAU. Lastly the evaluation, limitations, recommendations and conclusion of the study were done.
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Verpleegstandaarde vir 'n pasiënt met 'n abdominale aorta aneurisme na 'n endovaskulêre stent herstel
- Authors: Badenhorst, Riani
- Date: 2010-11-22T07:52:13Z
- Subjects: Abdominal aneurysm , Aortic aneurysms , Nursing standards
- Type: Thesis
- Identifier: uj:7006 , http://hdl.handle.net/10210/3514
- Description: M.Cur. , The natural progress of an abdominal aortic aneurysm is enlargement and rupture. The incidence of abdominal aortic aneurysms has increased in the past 30 years and up to 50% of the patients with untreated aneurysms will die due to rupture within 5 years. Open surgery is effective in the prevention of rupture and can be performed with a mortality of 2 -5% in most cases. However, patients with aneurysms are generally older and have associated medical co-morbidities, which increase the risk in surgical intervention. In view of these associated risks with open surgery for abdominal aorta aneurysm repair, a less invasive option such as endoluminal stent-grafts, are often preferred. This new, less invasive technique with Parodi as pioneer has several advantages for patients, the greatest being the reduction in peri-operative risks of aneurysm repair. As in all new procedures, this new intervention sets specific requirements for quality peri-operative nursing. Within the legal-ethical framework of nursing there is no room for random nursing, and we as nurses must turn to protocols and standards applicable to quality nursing, and in effect the quality assurance process. Quality nursing care delivery to the patient remains the ideal of each nurse. The endovascular repair of abdominal aortic aneurysms, although less invasive, is still associated with major morbidity and mortality. The potential for complications is a reality. Complications are mainly systemic and/or procedure related. The reality of these complications affects the quality of nursing. Finally, the need to accommodate this problem requires that protocol/standards are established for the nursing of the patient with an endoluminal repair of an abdominal aortic aneurysm by means of an endovascular stent-graft. The following question can be asked in view of the above arguments and problem statement: How must these patients be nursed peri-operatively to ensure quality nursing care? The aim of this study is to compile protocol/standards for quality nursing of patients with an erldovascular stent-graft repair of an abdominal aortic aneurysm in a Coronary Intensive Care Unit in a private hospital in Cape Town.
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'n Sisteem vir gehaltebesluitneming in verpleging
- Authors: Arries, Eben Jacobus
- Date: 2010-11-22T07:40:08Z
- Subjects: Nursing decision making , Nursing standards
- Type: Thesis
- Identifier: uj:6998 , http://hdl.handle.net/10210/3507
- Description: 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 iv 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.
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Standaarde vir waardesensitiewe kliniese begeleiding in gemeenskapsverpleegkunde
- Authors: Beukes, Sonya
- Date: 2008-11-18T07:55:23Z
- Subjects: Nursing standards , Community health nursing standards
- Type: Thesis
- Identifier: uj:14710 , http://hdl.handle.net/10210/1714
- Description: D.Cur. , Nursing is a clinical discipline, strongly anchored in clinical practice. In order to learn the art and science of Nursing, it should be kept in mind that nursing is a complex and intrinsic process that entails skills that are highly cognitive. Community Nursing is one of the clinical disciplines in which clinical guidance takes place. Guidance in Community Nursing takes place on district health level and is based on the primary health care approach. With clinical guidance from a community nurse in the community nursing practice, students are given the opportunity to apply in clinical practice what they have learned in theory. Students learn in the clinical practice by working alongside a competent, experienced and registered community nurse. They are guided to realise their full potential, to develop self-confidence in psychomotor skills, as well as the good values which are an inherent part of nursing. Due to the fact that the clinical learning environment is dynamic, it is necessary to ensure value-sensitive clinical guidance in the community nursing practice. This implies that the values of all role players involved in clinical guidance, namely the students and nurses (the patients during clinical guidance) should be handled with the necessary sensitivity. The goal of the study was to explore and describe to what extent value-sensitive clinical guidance in Community Nursing takes place. As a result of the findings a concept analysis of the categories identified was done and standards for value-sensitive clinical guidance in Community Nursing were developed and refined. For the purposes of this study an explorative, descriptive and contextual design was used. Interactions taking place between the nurses and students during clinical guidance were explored for value-`sensitivity by means of video-recordings, participative observation, diaries, focus-group and semi-structured interviews. The data collected were analysed and coded by the researcher and the external coder. As a result of the findings in this research a concept analysis was done of the different categories (identified in phase 1). The findings were compared with the literature in the concept analysis and similarities and differences were highlighted. As a result of the concept analysis standards for value sensitive clinical guidance in Community Nursing were developed, described and refined after it was presented to experts from academic training institutions and the community nursing practice. The four main categories identified were communication, attitudes, respect and clinical opportunities during clinical guidance. Due to the fact that professional socialisation mainly takes place in the clinical practice clinical guidance should be well-planned. Nurses acting as clinical guides should always keep in mind that they are acting as role models who are in possession of sufficient theoretical and clinical knowledge, and that they must maintain high nursing care standards. Nurses must approach the clinical guiding situation with an open and accommodating attitude. Students should be respected as human beings in order to establish open communication channels whereby clinical learning in students could be facilitated. Therefore a supportive, non-threatening clinical practice should be established, so that students will take the liberty to ask questions and will have the confidence to participate in clinical nursing actions under the direct supervision of nurses. The standards for value-sensitive clinical guidance in community nursing are aimed at all role players involved with clinical guidance. These role players include the service providers (the nurses, clinical co-coordinators and managers), as well as the academic training institutions (lecturers and students).
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