Academic literature on the topic 'Associate Nurse Unit Manager'

The insurmountable challenges confronting public hospitals globally jeopardize envisaged quality. South Africa health care system faces a number of challenges calling for strategic business approaches embodied through intrapreneurship practice. As a foreign concept in nursing, intrapreneurship is least understood. Views of unit nurse managers concerning their potential contribution towards improving services at public hospitals are least understood. A qualitative, descriptive and explorative study done through focus groups shed light. Data analysed through Tesch approach culminated in rich verbatim. The participants’ shared the following views concerning their intrapreneurial contribution; ability to take–risk in bureaucratic public hospitals; they associate the initiative with creativity and novelty through leading transformative projects in teams, the business leaders are knowledgeable, and share ideas internally or outside. The remarkable paradigm shift in nursing adopting business strategies has a significant impact on outcome of nursing care. The proposed recommendations adding significant value, transform health care policy, practice, education. On-going capacity development for the nurses in clinical practice is a necessary quality improvement initiative.

AimsPhysician Associates (PAs) are healthcare professionals with a general medical education background, having completed a two-year postgraduate degree. Whilst the number of PAs employed in healthcare trusts continues to increase, the number working in mental health settings remains small.Mersey Care NHS Foundation Trust employed two PAs two years ago. In August 2019, a third PA was recruited to work at Clock View Hospital, a general adult inpatient unit.This survey aims to establish what level of understanding different members of the inpatient teams across the inpatient wards have of the tasks PAs are permitted to undertake and those they are not.MethodA survey was designed, listing 37 tasks, e.g. completing an admission clerking. For each task, the participant was asked whether a PA is allowed to complete it or not, with three options provided – “can carry out the task”, “cannot carry out the task” and “do not know.” A score of + 1 was awarded if the correct answer was provided, –1 for an incorrect answer and 0 if the respondent didn't know. The highest possible score for a completed survey was + 37 points; the lowest possible score was –37 points.A sample of survey respondents was identified from the three general adult inpatient wards at Clock View Hospital and the Psychiatric Intensive Care Unit (PICU), comprising: senior doctors, junior trainees, Ward Manager, Deputy Ward Manager, Band 5 nurse and Assistant Practitioner.ResultTwenty-four members of staff completed the survey – 3 senior doctors, 4 junior trainees, 4 Ward Managers, 4 Deputy Ward Managers, 5 Band 5 nurses and 4 Assistant Practitioners. The respondents were distributed equally across the three general adult wards and the PICU. The highest survey score was 36 out of 37 (a Consultant); the lowest was 18 (a junior trainee). The lowest mean score was variable across the different grades of staff, with Consultants scoring highest at 29 and Assistant Practitioners and Ward Managers both scoring lowest at 25. There was little variability in mean score (only 2 points) across the three wards and PICU.ConclusionThe results from this survey demonstrate that different members of the inpatient team have a good understanding of what tasks PAs are and are not permitted to. There is still a need to provide further education to inpatient staff to ensure they utilise the PA at Clock View Hospital appropriately and that the PA is able to develop his skill set.

The leadership–culture phenomenon, a known explanatory construct for organizational performance, is understudied in nursing. Building on our previous work, we further addressed this knowledge gap through explorations of demographics and hospital variables which may have a significant influence on staff nurses’ (SNs) perceptions of their nurse managers’ (NMs) leadership and nursing unit culture. Furthermore, we explored the extent to which the NMs’ leadership predicted specific cultures which typify nursing unit effectiveness. Using dissertation data provided by 278 SNs, we found that SNs educated at the baccalaureate level or higher had favorable perceptions of their nursing unit performance and viewed their NMs’ leadership differently than the SNs with diploma or associate degrees. The frequent portrayals of transformational (TFL) leadership behaviors (e.g., visionary) by the NMs were paramount in shaping culture traits which exemplify high performance outcomes. TFL leaders were more likely to shape unit cultures which are flexible and adaptive to the environmental challenges within and outside the nursing unit. Thus, the type of NMs’ leadership and unit culture may provide an added value in explaining the performance level in patient care units which consequently affects the overall hospital/organizational outcomes. Implications for research and leadership practices are presented.

AimsPhysician Associates (PAs) are healthcare professionals who have a general medical education background, having completed a two-year postgraduate degree. Whilst the number of PAs employed in healthcare trusts continues to increase, the number working in mental health settings remains small.Mersey Care NHS Foundation Trust employed two PAs two years ago. In August 2019, a third PA was recruited to work at Clock View Hospital, a general adult inpatient unit.This analysis aimed to establish the views of different members of the team across the three general adult wards and the Psychiatric Care Unit (PICU) at Clock View Hospital on the role of the PA.MethodA sample of members of staff was identified from across the three general adult inpatient wards at and the PICU, comprising: senior doctors (Consultants and Specialty Doctor), junior trainees (Core Trainee and Foundation Trainees), Ward Manager, Deputy Ward Manager, Band 5 nurse and Assistant Practitioner. Each member of staff was asked to answer the question “On a scale of 1 to 10 (with “1” being completely unhappy, “10” being completely happy), how happy are you to have a PA working on your ward?” Each staff member was then asked to provide comments on their views on the role of the PA.ResultTwenty-three members of staff participated – 3 x senior doctors, 4 x junior trainees, 4 Ward Managers, 4 Deputy Ward Managers, 4 x Band 5 nurses and 4 x Assistant Practitioners. The respondents were distributed equally across the three general adult wards and the PICU. All 23 members of staff provided a score of 10 out 10 to the question about how happy they were to have a PA working on the ward. Many of the staff members provided some very positive comments on their respective views about the role of the PA at Clock View Hospital. No negative comments were provided by any members of staff.ConclusionIt is clear from the large sample of members of staff of different grade at Clock View Hospital that were surveyed that the PA has been a warmly received and welcome addition to the inpatient team and that the PA is viewed as having become an important and valued member of the inpatient team. This provides a strong argument for both Mersey Care NHS Foundation Trust, and other mental health trusts across the U.K., to consider employing more PAs to work in their inpatient units.

Multidisciplinary rounds (MDRs) have been instituted for patient care since June 2005. Before June 2005, all care was provided by individual practitioners. MDRs include the surgical intensivist, surgical resident, patient's nurse, case manager, pharmacist, chaplain, nutritionist, and respiratory therapist. Our study examined the effect of MDRs on ventilator-associated pneumonia in trauma patients in open intensive care units (ICUs). Group 1 included patients from June 2003 to May 2005 before the implementation of MDRs, and Group 2 included patients after the institution of MDRs from June 2005 to May 2007. In Group 1, there were 83 ventilator-associated pneumonias (VAPs) during 2414 ventilator days. In Group 2, there were 49 VAPs during 2094 ventilator days. The ratio of VAPs per thousand ventilator days decreased from 34.4 to 23.4 between the two groups ( P = 0.04). When comparing trauma patients in our open ICU with similar mean Injury Severity Score and mean Abbreviated Injury Score for chest and for head and neck, implementing MDRs significantly decreased our incidence of VAP.

Background: Central-line–associated bloodstream infections (CLABSIs) are a significant contributor to morbidity and mortality for neonates; they also increased healthcare costs and duration of hospitalization. This population is susceptible to infections because of their undeveloped immune systems, and they require intravenous access until they can tolerate enteral feedings, which for extremely premature infants can take several weeks (if not months) to achieve. Our hospital is a regional-referral teaching hospital with 772 licensed beds. The neonatal intensive care unit (NICU) is a level 3, 35-bed unit where the most critically ill neonates receive care. After a sustained 3-year period of zero CLABSIs, we identified 10 infections between September 2016 through April 2018. Methods: A multidisciplinary team known as the neonatal infection prevention team (NIPT) was reinstated. This team included members from nursing and infection prevention (IP) and from NICU Shared Governance, as well as a neonatal nurse practitioner (NNP) and a neonatologist to review these CLABSIs. Evidence-based practices, policies, and procedures were implemented to help reduce CLABSIs. Nurse educators provided education and training. The infection prevention team reinstated and modified the central-line maintenance and insertion tools to document compliance and to identify any gaps in care. Nurses were expected to document line maintenance once per shift (a.m. and p.m.). All CLABSIs were entered into the CDC NHSN and the hospital’s safety event reporting system, which required follow-up by a clinical manager. The infection prevention team monitored NHSN standardized infection ratios (SIRs) monthly. The SIR is the number of observed events divided by the number predicted (calculated based on national aggregate data). Results: The highest reported quarterly SIR was 1.423, which occurred in the third quarter of 2018 (Fig. 1). Overall compliance with line maintenance protocols was 86% on the morning shift and 89% on the afternoon shift. With implementation of an evidence-based bundle, the NICU had a rolling 12-month SIR of 0.00 as of October 2019. Conclusions: Multidisciplinary team development, implementation of evidence-based bundle elements, and education on catheter care contributed to the long-term success in decreasing CLABSI rates in our NICU. Although this implementation achieved a zero CLABSI rate, we experienced some barriers, including compliance issues with staff not completing the audit tools, staff turnover, and high patient census.Funding: NoneDisclosures: None

Background: Knowing the organizational factors that predict burnout in perioperative nurses is paramount for improving the care of patients and promoting nurses’ psychosocial well-being and health. Objective: To determine the influence of organizational factors of the perioperative nurse's work environment on the three burnout dimensions: emotional exhaustion, despersonalization, and personal accomplishment. Method: A cross-sectional study was conducted among 136 nurses in a perioperative care unit at a university hospital in Barcelona, Spain. Data were collected using a demographic data form, and the Spanish versions of the Practice Environment Scale of the Nursing Work Index and Maslach Burnout Inventory. Results: Findings showed emotional exhaustion in 43% (56) of nurses, depersonalization in 21% (28), and reduced personal accomplisment in 53% (69). The degree of general burnout was moderate. The work environment was considered unfavourable as only one factor of five was favourable (Nursing foundations of quality care). Multiple regression analyses showed three organizational factors were associated with all three dimensions of burnout: “Nurse manager ability, leadership, and support of nurses”; “Staffing and resources adequacy”; and “Nursing foundations of quality care”. Conclusions: In this study three organizational factors played a significant role in predicting burnout among perioperative nurses. We recommend hospital management implement policies to improve these organizational factors. Promoting positive leadership styles, providing necessary resources, and creating a positive climate in the work environment could increase psychosocial wellbeing and decrease burnout among perioperative nurses.

Abstract Background Central line-associated blood stream infections (CLABSI) have a significant impact on mortality, morbidity and length of stay. Data collected by the Infection Prevention Department revealed progressive increases in the rate of CLABSI on an Abdominal Transplant Unit. Recognizing a drift from best practice, front line staff, the IP team and vascular access specialists, collaborated to identify opportunities for improving care of patients with vascular access devices. Methods An increase in CLABSI rate was observed on the Abdominal Transplant Unit beginning in 2016. An initiative began in 2017 to evaluate whether CLABSI rate reduction was sustainable for at least 1 year and to identify key determinants of this sustainability. Interventions were aimed at infection prevention best practices, care standardization, and team-based monitoring. Interventions included (1) re-education on CLABSI reduction, (2) two RN dressing changes to validate practice during central line dressing change, (3) blood draws from central lines (during non-emergent situations) had to be approved by nurse manager, physician lead and transplant quality physician, (4) CLABSI prevention nurses were chosen as designated phlebotomists for patients with prior approval, (5) daily line review was performed to address line days, indication of line (remove latent lines) and plan of care (transition to permanent access) and this information was shared with the unit physician lead and transplant quality team. Assuring compliance with audits and timely feedback with clinician accountability were vital with compliance with best practices. Results Conclusion During the intervention, CLABSI infection rates dropped from 4.825 to 1.533 in 1,000 CVC days. The sustainability plan for this program is to continue line audits, assessing line necessity and review the effectiveness of the initiatives, review all new CLABSI data with staff and implement new changes as necessary. Joint, ongoing multidisciplinary collaboration is essential to reduce CLABSIs and optimize quality in a challenging, high-acuity patient population. Disclosures All Authors: No reported disclosures

Purpose The purpose of this paper is to discuss health services managers’ experiences of management in a special health-care unit and development efforts from the point of view of the Lean method. Additionally, the aim is to deepen the knowledge of the managers’ work and nature of the Lean method development processes in the workplace. The research focuses on those aspects and results of Lean method that are currently being used in health-care environments. Design/methodology/approach These data were collected through a number of thematic interviews. The participants were nurse managers (n = 7) and medical managers (n = 7) who applied Lean management in their work at the University Hospital in the Northern Ostrobothnia Health Care District. The data were analysed with a qualitative content analysis. Findings A common set of values in specialized health-care services, development of activities and challenges for management in the use of the Lean manager development model to improve personal management skills. Practical implications Managers in specialized health-care services can develop and systematically manage with the help of the Lean method. This emphasizes assumptions, from the point of view of management, about systems development when the organization uses the Lean method. The research outcomes originate from specialized health-care settings in Finland in which the Lean method and its associated management principles have been implemented and applied to the delivery of health care. Originality/value The study shows that the research results and in-depth knowledge on Lean method principles can be applied to health-care management and development processes. The research also describes health services managers’ experiences of using the Lean method. In the future, these results can be used to improve Lean management skills, identify personal professional competencies and develop skills required in development processes. Also, the research findings can be used in the training of health services managers in the health-care industry worldwide and to help them survive the pressure to change repeatedly.

Background and significance: Nurses' job dissatisfaction is associated with negative nursing and patient outcomes. One of the most powerful reasons for nurses to stay in an organisation is satisfaction with leadership. However, nurses are frequently promoted to leadership positions without appropriate preparation for the role. Although a number of leadership programs have been described, none have been tested for effectiveness, using a randomised control trial methodology. Aims: The aims of this research were to develop an evidence based leadership program and to test its effectiveness on nurse unit managers' (NUMs') and nursing staff's (NS's) job satisfaction, and on the leader behaviour scores of nurse unit managers. Methods: First, the study used a comprehensive literature review to examine the evidence on job satisfaction, leadership and front-line manager competencies. From this evidence a summary of leadership practices was developed to construct a two component leadership model. The components of this model were then combined with the evidence distilled from previous leadership development programs to develop a Leadership Development Program (LDP). This evidence integrated the program's design, its contents, teaching strategies and learning environment. Central to the LDP were the evidence-based leadership practices associated with increasing nurses' job satisfaction. A randomised controlled trial (RCT) design was employed for this research to test the effectiveness of the LDP. A RCT is one of the most powerful tools of research and the use of this method makes this study unique, as a RCT has never been used previously to evaluate any leadership program for front-line nurse managers. Thirty-nine consenting nurse unit managers from a large tertiary hospital were randomly allocated to receive either the leadership program or only the program's written information about leadership. Demographic baseline data were collected from participants in the NUM groups and the nursing staff who reported to them. Validated questionnaires measuring job satisfaction and leader behaviours were administered at baseline, at three months after the commencement of the intervention and at six months after the commencement of the intervention, to the nurse unit managers and to the NS. Independent and paired t-tests were used to analyse continuous outcome variables and Chi Square tests were used for categorical data. Results: The study found that the nurse unit managers' overall job satisfaction score was higher at 3-months (p = 0.016) and at 6-months p = 0.027) post commencement of the intervention in the intervention group compared with the control group. Similarly, at 3-months testing, mean scores in the intervention group were higher in five of the six "positive" sub-categories of the leader behaviour scale when compared to the control group. There was a significant difference in one sub-category; effectiveness, p = 0.015. No differences were observed in leadership behaviour scores between groups by 6-months post commencement of the intervention. Over time, at three month and six month testing there were significant increases in four transformational leader behaviour scores and in one positive transactional leader behaviour scores in the intervention group. Over time at 3-month testing, there were significant increases in the three leader behaviour outcome scores, however at 6-months testing; only one of these leader behaviour outcome scores remained significantly increased. Job satisfaction scores were not significantly increased between the NS groups at three months and at six months post commencement of the intervention. However, over time within the intervention group at 6-month testing there was a significant increase in job satisfaction scores of NS. There were no significant increases in NUM leader behaviour scores in the intervention group, as rated by the nursing staff who reported to them. Over time, at 3-month testing, NS rated nurse unit managers' leader behaviour scores significantly lower in two leader behaviours and two leader behaviour outcome scores. At 6-month testing, over time, one leader behaviour score was rated significantly lower and the nontransactional leader behaviour was rated significantly higher. Discussion: The study represents the first attempt to test the effectiveness of a leadership development program (LDP) for nurse unit managers using a RCT. The program's design, contents, teaching strategies and learning environment were based on a summary of the literature. The overall improvement in role satisfaction was sustained for at least 6-months post intervention. The study's results may reflect the program's evidence-based approach to developing the LDP, which increased the nurse unit managers' confidence in their role and thereby their job satisfaction. Two other factors possibly contributed to nurse unit managers' increased job satisfaction scores. These are: the program's teaching strategies, which included the involvement of the executive nursing team of the hospital, and the fact that the LDP provided recognition of the importance of the NUM role within the hospital. Consequently, participating in the program may have led to nurse unit managers feeling valued and rewarded for their service; hence more satisfied. Leadership behaviours remaining unchanged between groups at the 6 months data collection time may relate to the LDP needing to be conducted for a longer time period. This is suggested because within the intervention group, over time, at 3 and 6 months there were significant increases in self-reported leader behaviours. The lack of significant changes in leader behaviour scores between groups may equally signify that leader behaviours require different interventions to achieve change. Nursing staff results suggest that the LDP's design needs to consider involving NS in the program's aims and progress from the outset. It is also possible that by including regular feedback from NS to the nurse unit managers during the LDP that NS's job satisfaction and their perception of nurse unit managers' leader behaviours may alter. Conclusion/Implications: This study highlights the value of providing an evidence-based leadership program to nurse unit managers to increase their job satisfaction. The evidence based leadership program increased job satisfaction but its effect on leadership behaviour was only seen over time. Further research is required to test interventions which attempt to change leader behaviours. Also further research on NS' job satisfaction is required to test the indirect effects of LDP on NS whose nurse unit managers participate in LDPs.

Background and purpose of the study. The professionalisation of nursing saw the emergence of nurses in management roles including that of the Nurse Unit Manager (NUM). These NUMs are usually experienced in their designated clinical area. However, they are now expected to have business and management skills. Some nurse leaders with whom the researcher discussed her proposed research before its commencement and a review of the literature, indicated a gap in the research on how NUMs could better prepare for their role, what needs to be included in management and leadership courses, and more importantly, how NUMs acquire the necessary skills. This study investigated how case writing can be used as a professional development tool to help existing NUMs improve their skills and how it will help aspiring NUMs prepare for their role. The aims of this study were: (1) to identify how well prepared NUMs are for assuming their role; (2) to identify the skills required for the role of the NUM; (3) to identify the management challenges of the NUM’s role; (4) to identify the barriers in acquiring the skills required for the role; and (5) to explore how reflection through case writing can improve skills. Methods. Three primary samples: NUMs, ANUMs (Associate Nurse Unit Managers) and RNs (Registered Nurses) participated in this study. The study utilised both qualitative and quantitative methodologies by employing in-depth interviews and a survey. Case and commentary writing was also employed with NUMs. Results. The findings of the study show that NUMs were promoted to their positions by chance and not by conscious choice, or pre-chosen by management having been perceived to have the leadership and management skills for the role. Although NUMs found leadership workshops and courses very helpful, they found it difficult to put the knowledge gained into practice. They commented that they valued the knowledge they gained from reading and commenting on other NUMs’ case scenarios. Methods and results of the study will be discussed in more detail in the thesis.

M.Cur.
The overall purpose of this study is to describe empowerment strategies for the nurse unit manager to create a climate conducive to clinical learning at the nursing college in the North-West Province. In view of the South African Nursing Council report (1990), it clearly indicates that the nurse unit managers do not apply their theoretical knowledge to clinical practice, and that the student learning in the clinical nursing units are not up to the expected standard, hence the quality of clinical nursing education is questionable. The current education system in South Africa focuses on the provision of quality assurance in order to be in line with international standards. In accordance with the South African Qualifications Authority, the Constitution, South African Nursing Council, Batho-Pele principles, National Plan for Higher Education and outcomes-based education, there is a need to create a climate that is conducive to learning in the nursing units in order to develop the students' abilities regarding analytical, critical, evaluative and creative thinking. The nurse unit manager is experiencing problems with regard to clinical nursing education and the nursing students are also complaining that the clinical learning areas are not conducive to their learning. Therefore, the products that are produced by such an environment lack knowledge, skills, values and attitudes inherent in the nursing profession. Hence this study strives to describe empowerment strategies for the nurse unit manager to create a climate conducive to learning, based on their expert knowledge and experiences. The research questions arising from this problem are: What are the expectations and perceptions of the nursing students about the role of the nurse unit manager in creating a climate conducive to learning at the nursing college in the North-West Province? How can the nurse unit manager be empowered to create a climate conducive to clinical learning? The objectives are: Phase One: Stage one: To explore and describe the expectations of the nursing students regarding the role of the nurse unit manager in creating a climate conducive to learning. Stage two: To explore and describe the expectations and perceptions of the nurse unit manager regarding their role in creating a climate conducive to learning. Phase Two: To describe a conceptual framework. Phase Three: To describe empowerment strategies for the nurse unit manager to create a climate conducive to learning. The research design in this study was qualitative, descriptive, explorative and contextual in nature. In stage one of phase one, descriptive naïve sketches were used as a method of data gathering (Giorgi in Ornery, 1983:52) whereby 22 nursing students from the nursing college were selected for the research study. The following open-ended questions were written on the chalkboard, namely: "What are your expectations about the role of the nurse unit manager in creating the clinical nursing units as a climate conducive to learning?" The data was analysed according to Tesch's descriptive method (in Creswell, 1994:155). An independent coder who was purposively selected was used in the categorisation of data. The researcher held meetings with the independent coder for consensus discussions reached independently. Trustworthiness was ensured as described by Lincoln and Guba's (1985:290-326) model of trustworthiness. In order to ensure the credibility of the study, five nursing students who participated in the study were selected to participate in individual interviews to validate the categories and subcategories. In stage two of phase one, focus group interviews were conducted as a method of data gathering whereby 13 nurse unit managers from the clinical learning areas where the nursing students are placed for their clinical learning experiences were selected by the quota sampling technique. The interview was conducted by a nurse educator with a Master's degree, who is also a psychiatric nurse with expertise and experience in interviewing skills. A tape recorder was utilised with the nurse unit manager's permission to collect data. A follow-up interview with five nurse unit managers was conducted to validate the data gathered during the focus group interview. The following open-ended questions was used to obtain data from the nurse unit manager: "What are your perceptions regarding your role in creating an environment conducive to clinical learning?" "How can you be empowered as part of your role, to create clinical nursing units as climates conducive for clinical teaching and learning for nursing students?" Data was analysed according to Tesch's descriptive method (in Creswell, 1994:155). An independent coder was purposively selected in the categorisation ( iv ) of data. Categories were defined and arranged in table form for both participants in order to arrive at final categories. Trustworthiness was ensured as described by Lincoln and Guba's (1985:290-326) model of trustworthiness. Findings were conceptualised and conclusive statements made through logical deductive, inductive reasoning and inferences. A conceptual framework was developed within Muller's (1998) management process and the legal and professional frameworks. The integrated empowering process was adapted from Muller's management process, Vogt & Murrel's (1990) & Hokanson-Hawks' (1999) empowerment methods. This process comprises planning, organising (providing and structuring), directing (education, leading, mentoring and supporting), and control (actualising). Empowerment strategies for the nurse unit manager were described to create a climate conducive to learning, based on the results of phase one and phase two. Evaluation of the study was done, limitations, recommendations and conclusions were described with regard to nursing education, practice and nursing research.

The purpose of this study was to determine the contribution of unit managers towards the training of student nurses coming to their units for clinical practica. The sample consisted of students training in the four nursing colleges in the Cape Peninsula, and unit managers working in health services accommodating students for clinical practica in the same area. The findings revealed that the majority of unit managers were teaching students whenever they had the opportunity. Generally unit managers were prepared for their teaching function, but many students were not satisfied with some clinical learning opportunities presented to them, for example drawing up patients' care plans, discussing patients' treatment plans when handing over report, giving assistance regarding patient care decisions and lending support when students are confronted with patient care problems. There appears to be a need to educate unit managers regarding these and other aspects of the students' training programme.
Health Studies
M.A. (Nursing Science)

This study investigated the leadership challenges encountered by nurse unit managers and factors enhancing leadership in their units. Currently in South Africa’s private hospitals, nurse unit managers face challenges such as financial management, cultural diversity, new roles and technology. The aim of the study was to develop a support strategy for unit managers to achieve success in their leadership role. This study was conducted at a private hospital in Gauteng Province, South Africa. A qualitative research approach was followed. Data were gathered using semi structured individual interviews with a purposive sample of six operational unit managers with one and more years working experience as unit managers. Qualitative open coding for data analysis methods and presentation were employed. Three themes emerged from the findings namely, factors influencing the leadership role of the unit manager, the challenges encountered by unit managers in their leadership role and the needs of unit managers. The factors influencing the leadership and management roles were related to the challenges encountered by nurse unit managers in running their units. The findings indicate that a key need required of the unit manager is support and direction from executive management. From the needs expressed by the nurse unit managers, ideas were formulated by the researcher to support the development of a strategy to support the unit managers in their leadership role. The strategy includes eight key elements and is presented in the section that follows.
Health Studies
M.A. (Nursing Science)

The theoretical part of the thesis introduces the current state of the issue. The fundamentals of management, the three basic lines of health managers and their functions and roles are described first. Another section is devoted to the specifics of nursing care in the intensive care unit. The second part is focused on qualified nurses, their qualification, duties and the role, factors of satisfaction and difficulties of the care for patients in the intensive care unit. The last part deals with problems occurring in exercise of the nursing profession and with the assistance of a manager in dealing with these problems. Five objectives were established. Objective 1: To identify what nurses working in intensive care units need to be satisfied in their work. Objective 2: To map the form of support to the nursing team in the ICU from the perspective of managers. Objective 3: To point out possibilities of increase in job satisfaction of nurses working in intensive care units. Objective 4: To identify motivational factors for nurses working in intensive care units. Objective 5: To determine if there are obstacles preventing managers from supporting the nursing team. Qualitative research was selected to collect the data and 6 research questions were established. Research question No.1: What do nurses working in ICU need to be satisfied in their profession? Research question No.2: Do nurses working in ICU perceive any difference in position of a nurse working in an ICU and a nurse working in a standard unit? Another question No.3: What are the means used by the management to support the nursing team in ICU? Question No. 4: What are the possibilities of increasing work satisfaction of nurses working in ICU? Question No. 5: Which specific motivational factors are involved in satisfaction of nurses working in ICU? Research question No. 6: Which obstacles prevent managers from supporting the nursing team? Non-standardized interviews were conducted with 8 ward nurses and 12 nurses working in shifts who were employed in intensive care units of surgical or internal departments. Answers to the established research questions were formed based on analysis of the results. Results can be provided to managers in health care facilities and to nurses working in intensive care units.

This study investigated the attitudes and perceptions of nurse managers regarding cost containment issues in selected public hospitals in the Port Elizabeth metropole of the Eastern Cape. Four hospitals participated in the study, and 211 nurse managers completed questionnaires. The results obtained from the participants’ responses indicated that: ✦ Nurse managers are ill-prepared for many responsibilities regarding cost containment, and need appropriate orientation and preparation both during their initial formal, and during their nurse management and in service training in order to fulfil their “financial” or cost containment role more effectively. ✦ Nurse managers perceived the relationship between the productivity of staff and cost containment positively, but were reportedly unable to • prevent nurses from leaving their points of duty • curb the rate of absenteeism among nurses • reduce the number of resignations ✦ Nurse managers suggested that more effective hospital cost containment efforts should ensure that • effective security checks are performed to curb losses of stock and equipment • more public telephones are installed in hospitals • stricter controls regarding wheelchairs are implemented The rationalisation of staff and services, as well as specialised equipment among the four public hospitals could enhance these hospitals’ cost containment results. However, this would necessitate reorganising these hospitals’ services at provincial level. The nurse managers required more knowledge about hospitals’ financial management and cost containment issues. Guidelines for such a course were developed addressing: analysis of monthly variance reports; budgeting for manpower; balance statement; calculations for the supplies and expenses budget; income statements; the hospital’s budgetary cycle; break-even analysis; analysis of cost-effectiveness and cost-benefit analysis.
ADVANCED NURSING SCIENCES
D.Litt. et Phil.

Clinical learning experiences form an integral part of the student nurse's training, for it is in the clinical setting that students acquire the knowledge, skills and values necessary for professional practice. The purpose of this research was to explore student nurses experiences during clinical practice. A qualitative, exploratory, descriptive and contextual design was utilised, employing the phenomenological method. Unstructured interviews were conducted with student nurses in their final year of the four year nursing programme at a nursing college campus in the Limpopo Province. Tesch's method of data analysis was used. The findings indicate that there are aspects which impact negatively on student nurses' clinical learning experiences, such as lack of teaching and learning support, lack of opportunities for learning, poor theory-practice integration, and poor interpersonal relationships between the students, college tutors and ward staff. Recommendations to enhance the clinical learning experiences of student nurses were made.
Health Studies
M.A. (Health Studies)

The recruitment of a nurse champion and a physician champion is described in detail. At in-person meetings and via online presentations, team members familiarize themselves with current catheter practices and absorb the new protocols. They decide which medical floor unit will be the first target and pilot project for the initiative. Their criteria: a unit with a track record for cooperating with interventions and that also has a sizable number of Foleys and catheter-associated urinary tract infection cases. The project manager, champions, and other team members work out implementation details—promoting the project’s goals throughout the hospital, coordinating with other ongoing quality initiatives in the hospital, and identifying those people who will need special convincing. The changes will drive staff from their comfort zones, add to their workload, and challenge traditional relationships between nurses and doctors.

The implementation of a Hospital-in-the-Home Unit (HHU) involves the application of technologies adapted to improve quality of care. The aim of this chapter is to develop a model based on the Technology Acceptance Model, which identifies key success factors for the acceptance of technology systems in HHUs. Qualitative research was carried out in the HHU of a Spanish hospital. Interviews were conducted with the HHU team, the hospital nurse manager, and the medical manager. An extended technology acceptance model is derived from the interviews. While organisational triggers such as accessibility, collaboration, confidentiality, training, and security are the main drivers for perceived usefulness and ease of use; individual processes such as unlearning and openness to address the needs of patients are the main enablers for the participation of practitioners. The results shed light on a possible way for healthcare managers to enhance their subordinates’ acceptance of technologies for HHUs.

The aim of this chapter is to provide nurses with the knowledge to be able to assess, manage, and care for people with bone conditions in an evidence-based and person-centred way. Bone conditions (a major category of musculoskeletal conditions) cover a wide spectrum of diseases, some of which may be considered mild and self-limiting, while others may have a significant impact upon the individual’s quality of life and ability to function. It is estimated that up to 30% of all GP consultations are about musculoskeletal complaints; many are age-associated, and population ageing will continue to increase this demand (Oliver, 2009). The chapter will focus on osteoporosis, hip fracture (perhaps the most serious and costly consequence of osteoporosis or osteopaenia), Paget’s disease, and osteoarthritis, respectively. The chapter will provide a broad overview of these common conditions, enabling a proactive approach to patient care within a multidisciplinary context, whether in the primary or secondary care setting. The nursing management of the symptoms and common health problems associated with bone conditions can be found in several Part 2 chapters, and these are highlighted throughout the chapter. Osteoporosis has been defined as:...A progressive systemic skeletal disease characterised by low bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. (WHO, 1994)…The World Health Organization (WHO) has recommended a clinical definition of osteoporosis based on a bone mineral density (BMD) measurement of the spine or hip, expressed in standard deviation (SD) units called T scores. Using this definition, an individual is classified as having osteoporosis if his or her T score is ≤–2.5 SD at the spine or hip (WHO, 1994). It is estimated that osteoporosis occurs in approximately 3 million people in the UK, resulting in more than 230,000 fractures per annum, the most frequent being hip, vertebral body, and forearm fractures. In total, 75,000 hip fractures occur annually (British Orthopaedic Association, 2007), with the average age of incidence being 84 and 83 in men and women, respectively (National Hip Fracture Database, 2010).

The aim of this two-year intervention study was to provide information on the work-related physical demands and risks among nurses working in elderly 24-hour care units and to determine what kind of measures and management means can reduce physical strain on nurses. A variety of measures were used. This paper presents the key findings of nurses' physical load and risks associated with nursing care (The Care Thermometer method) and perceived workload of nurses (job strain and satisfaction questionnaire).The level of working safety increased from 56% to 71.5%. High-risk tasks have been reduced from 22.5% to 13.9%.There were significant differences (p-value < .001) in perceived stress between physical and psychological stress and by activities (long term care; homes for elderly; service homes) and by professions (nurses; practical nurses; nursing aids; first-line managers). Both physical stress and psychological stress increased, but physical stress increased less than psychological stress. It can be assumed that the interventions in this study had a positive impact on physical stress. Additional tests are needed to explain the differences between physical and psychological stress and the measures and management means that can best reduce physical strain on nurses.