Dissertations / Theses on the topic 'Holistic nursing care'

Spirituality and nursing have been intertwined from the beginning of the profession; however, there is little evidence that clearly defines spiritual nursing care and no standardized practices that can be included in the routine preoperative plan of care for patients undergoing invasive surgical procedures. The purpose of this project was to conduct a systematic review of the literature to define spiritual care and identify specific spiritual nursing care interventions. The biopsychosocial model, Narayanasamy's transcultural care practice model, and Watson's theory of human caring provided the theoretical framework for the project. MEDLINE, PubMed, Wiley online library, SCIENCE, WOS, Cochrane, and SciELO databases were searched for the literature review. Keywords and phrases used included spirituality, spiritual nursing care, holistic health practices, inpatient, hospital, and preoperative care. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) II tool was used for data analysis. Interventions found in the literature to be supportive of spirituality included healing presence; providing effective communication; praying with the patient and family or facilitating other religious rituals; using the therapeutic self to be with the patient; listening to and exploring the patients' spiritual perspectives; and showing support and empathy through patient-centered caring, nurturing spirituality, and creating a healing environment. Employing these nursing actions might promote positive social change by contributing to a sense of well-being as patients find meaning and purpose in their illness and life overall, which will promote improved surgical outcomes and better patient satisfaction with care.

Philosophiae Doctor - PhD (Nursing)
Man is a bio-psycho-social-spiritual being, and his needs are informed by all these elements. The need for spiritual care in nursing education and practice is no longer a new concept in developed countries, nor even in some developing countries. However, in Nigeria, there is no consistent evidence of how spirituality is taught within the nursing curriculum nor how it is practised. The literature review also confirms that no existing set of rules or models for integrating spiritual care into the curriculum of nursing exists in the country. If nursing care is to be holistic, concerted attention must be paid to spiritual care, and to the training of nurses so that they can provide spiritual care within the context of holistic care for patients in the healthcare system. The main purpose of this academic work was to develop a model for the integration of spiritual care-giving into the nursing curriculum. This cross-sectional study used adapted modified Intervention Mapping (IM) strategies with a mixed method approach, to collect in-depth information.

The U.S. Centers for Disease Control (CDC) (2016a) state that the misuse and illicit use of prescription analgesic drugs and use of heroin have skyrocketed to epidemic proportions. Former Surgeon General Vivek Murtha’s report, Facing Addiction in America (2016) notes that 12.5 million Americans use opioid pain relievers in ways other than those intended by prescription (USHHS, 2016). Notably, about 61% of the US drug overdose deaths in 2014 involved an opiate (Rudd, Seth, David, & Scholl, 2016). To address the opioid crisis requires the coordinated responses of all health care providers. Multiple disci- plines and professional nursing organizations have recommended strategies and published policy state- ments. Efforts to stem the opioid crisis include the development of provider education and dissemination of opioid prescribing guidelines, protocols for adher- ence to these guidelines, effective use of non-opioid treatment modalities for chronic pain, and initiatives to increase access to opioid addiction treatment. Nursing leadership in these initiatives must be broad based and unequivocal in order to engage all levels of the nursing workforce and to promote collaboration among organizations and agencies.

This thesis examines the management of multidisciplinary teams in a highly innovative environment through a study of multidisciplinary patient care teams in palliative care. It investigates management that enables spontaneous innovation where necessary, yet maintains discipline and compliance with legislation, regulation and policy. To assist the explanation a model of palliative care multidisciplinary team management and operation is developed, building on work described in the continuous innovation and organisational configuration literatures. This thesis describes innovative practices as focusing on changing the organisation’s social potential, when necessary, in order to match changes in an individual patient’s situation. A definition of innovation suitable to this environment is developed here, adapted from the innovation literature. A definition of social potential suitable to this environment is also developed, based primarily in the literature of the socialisation of organisations. In palliative care organisations, care is delivered to the patient and any group of people supporting the patient during the end of life process. Care provided to these supporters, referred to in this thesis as patient-based carers, can extend beyond the death of the patient. Palliative care is more than symptom management during the dying process and can involve an interaction lasting weeks or months between the organisation and patients and patient-based carers. A patient’s situation is described at many levels and involves a number of aspects of the patient’s condition and life; for example medical, social, psychosocial, spiritual and physical. In palliative care, patients and patient-based carers are the major sources of information about their situation and changes to it. This makes them active participants in the care team, although some patients and patient-based carers choose not to take this role. Every patient and every group of patient-based carers creates individualised situations when progressing through their end of life processes, requiring individualised care from teams that can change the membership mix to suit the situation. Palliative care professionals can be members of multiple individual patient care teams simultaneously and teams can include heads of discipline (managers). Multidisciplinary palliative care teams can be managed from inside or outside the team, as the situation requires. Uncertainty pervades this environment and the response is flexibility based in learning and understanding. From the model developed of the management of innovation in the palliative care environment implications for the management of multidisciplinary teams in a highly innovative environment are drawn.
Doctor of Philosophy (PhD)

This study adopted an ethnographic approach to examine the role of the Registered Nurse (RN) in the intellectual disability sector. The research setting (The Centre) is a residential facility for clients with intellectual disability in the northern suburbs of Adelaide that opened in 1971 and was similar to a hospital with the same hierarchy of nursing. Mental deficiency nurse training was conducted there until the 1990s but that qualification is no longer recognised. The Centre is under the umbrella of a large state disability organisation that is in the process of moving clients of the service from institutions (the Centre) to community living options such as group homes. The cessation of mental deficiency nurse training and the introduction of deinstitutionalisation were considered to impact on client health and in the late 1990s a 24 hour nursing service was commenced. There was strong anecdotal evidence the service should be evaluated. A review of the literature found some research had been conducted in overseas countries with a focus on deinstitutionalisation but with a paucity of interest in the role of the RN, particularly in Australia. Ethnography, first used in anthropology as a way of describing different cultures, was chosen as the research methodology because the researcher wanted to discover how the culture influenced the role of the RN. The researcher is an RN employed in the area. As an ethnographer and participant observer, the researcher became the data collection instrument. The entire culture is considered to be the sample in ethnography and data took the form of hundreds of hours of field note entries and interview transcripts. Following analysis, the findings were presented in themes answering the research question which was in two parts. The first ‘from the perspective of the nurse, client and other health care professionals, what constitutes intellectual disability nursing?’ and secondly ‘what are the every day rituals, norms and patterns within the disability culture that shape and influence disability nursing for the Registered Nurse?’. ‘Caring for the client who is institutionalised’, ‘The RN in the disability sector having certain qualities’, ‘Working within a different paradigm’, ‘Having to assume responsibility for large numbers of unregulated workers’, ‘Having to work alongside many professional groups’ and ‘Having different educational needs’ are themes which describe the role. Themes describe the diversity of the role and in describing the registered intellectual disability nurse as ‘different’ the role is compared with that of the nurse in other settings. The current research revealed there is a need for more health related education for unregulated workers and specific intellectual disability education for registered and enrolled nurses. Themes that answer the second part of the research question are ‘hierarchical structure’, ‘the Registered Nurse's position’ and ‘role confusion’. The non-nursing management at the top of the hierarchical ladder was found to significantly limit the role of the RN who was afforded no opportunity for leadership. Confusion over the RN's role and indeed individual workers' roles was observed at all levels. Findings suggest much stronger nursing leadership is required to provide advocacy and holistic care for the client and education for the carer. An outcome of the current research was the development of a model for intellectual disability nursing (see Table 8-1).

SAMMANFATTNING Begrepp som patientcentrerad vård och helhetssyn i vården verkar användas av olika yrkeskategorier, inom hälso- och sjukvård, vilket kan ur kvalitetssynpunkt kan resultera i oklarheter inom den kliniska verksamheten. Syfte: Syftet med studien var att ta reda på vilka likheter och skillnader begreppen patientcentrerad vård och helhetssyn i vården har i den vetenskapliga litteraturen. Begreppen söktes i databaserna CINAHL och PubMed. Metod: Den metod som används för att jämföra begreppen byggde på Segestens begreppsanalysmodell. Resultat: Det som främst skiljer begreppet helhetssyn i vården från patientcentrerad vård är den andliga dimensionens centrala roll. Resultatet visar även att ett patientcentrerat arbetssätt förbättrar ekonomiska resultat. Det är främst sjuksköterskor som använder sig av helhetssyn i vården. Patientcentrerad vård verkar användas främst av läkare men begreppet förekommer även bland sjuksköterskor. Det gemensamma för begreppen då det gäller karaktäristika, förutsättningar och konsekvenser, är det som definieras i kraven på god vård enligt hälso- och sjukvårdslagen. Slutsats: sjukvårdspersonalens arbetssätt och syn på patienten utifrån patientcentrerad vård och helhetssyn i vården värnar om patientens bästa. Det som skiljer begreppen kan bero på vilken yrkesgrupp som undersökts i respektive studie. Studier av begreppet patientcentrerad vård uppfattas vara mer genomförda på läkargruppen samtidigt som helhetssyn i vården tycks vara mer förekommande då det gäller sjuksköterskegruppen. Fler studier behövs för att identifiera användningen av dessa begrepp och om deras betydelse i den kliniska verksamheten.
SUMMARY Concepts such as patient-centered care and holistic care seem to be used by different professions in healthcare. Looking upon these concepts from the aspect of quality, ambiguities can arise in clinical practice. Objective: The purpose of this study was to compare the similarities and differences between the concepts of patientcentered care and holistic care as they are presented in scientific literature. The terms were searched for in the databases CINAHL and PubMed. Method: The method used to compare the concepts was based on Segesten concept analysis model. Results: what differentiates the concept of holistic care of the patient-centered care is the central role of spiritual dimension. The results also show that a patient-centered care improves economic results. The term holistic health care seems to be used primarily by nurses, while patient-centered care seems to be used primarly by physicians, even though the term does occur among nurses. Conclusion: both patient-centered care and holistic care seem to have the same goal, that of preserving the patient`s best interests. What distinguishes the concepts may depend on the profession which was examined in each study. Research studies on patient-centered care have been carried out primarily on physicians, while studies on the holistic approach in health care have focused on nurses. More studies are needed to identify the use of these concepts and their importance in clinical practice. Nyckelord: Patient-centeredness, patient-centered care, holistic care, holistic nursing.

The purpose of holistic spiritual care is to assess and provide for the spiritual needs of patients. Current literature indicates that holistic spiritual care is important to the healthcare of patients. Researchers suggest that nurses who practice holistic spiritual care are more aware of the attributes of caring, respect, and emotional support. This project study addressed a problem at the research site reported by local community nurses and holistic spiritual care experts of nurses not practicing holistic spiritual care. Mezirow's transformational learning theory was used as the theoretical foundation for this qualitative study, which was designed to examine the attitudes and beliefs of nurses about practicing holistic spiritual care. The study's participants were comprised of a mixed-gender convenience sample of 21 local registered nurses, aged 22 to 64, who were retired or who worked for a registry, and were recruited on Facebook to participate in a qualitative online questionnaire. Hand and computerized open coding and thematic analysis were used to analyze the data. Participants indicated that they believed practicing spiritual care nursing was beneficial as it could improve patient outcomes. The themes that emerged from the data included personal insecurities of nurses, little support, and lack of training in practicing spiritual holistic care. These findings were used to develop a 3-day workshop series designed to increase awareness and improve understanding of the benefits of holistic spiritual care of nurses, nurse educators, nurse leaders, and administrators. This study promotes positive social change by providing healthcare stakeholders at the local site with better understandings of the benefits of holistic spiritual care programs.

Increasingly, experts recommend that military primary care clinics consider implementing delivery of care based on models of holistic wellness. Several wellness measurement tools exist, but none of these has been applied to a military primary care clinic. In this study, the psychometric testing of two holistic wellness measurement instruments was carried out for possible use with soldiers in primary care clinics. The instruments tested were the Perceived Wellness Model (Adams, Bezner, & Steinhardt, 1998) and the Optimal Living Profile (Renger et al., 2000). Both instruments appear suitable for use in future studies for measuring wellness in Cadet Soldiers. The measures provided by these instruments provide important data that professionals can use to assist young Soldiers in their multidimensional wellness development.

The health care environment is transforming with new demands and expectations to improve patient outcomes including patient satisfaction. Health care organizations expect front line nurse managers to improve patient quality and satisfaction without a clear direction or meaningful understanding of the holistic role, functions, and competencies required to achieve organizational goals. The purpose of the qualitative transcendental phenomenological study was to explore the lived experiences and perceptions of the holistic and changing nature of the projected contemporary nurse manager’s roles, skills, practices, and dimensions aligned with the expectations for improving patient satisfaction. The exploration of the lived experiences and perceptions among 21 study participants, and data analysis using the modified van Kaam approach, led to the formulation of eight major themes that explained the nature of the experience with the phenomenon. The eight essential themes that encompass the context of the new contemporary and holistic role of the nurse manager to improve patient satisfaction include the following; (a) new expectations, (b) building a patient caring culture, (c) leader rounding, (d) healthy working environment, (e) staff engagement and empowerment, (f) change agent for continuous quality improvement, (g) impact of organization focus and culture, (h) challenges: sustainability of initiatives; lack of interdepartmental and interdisciplinary teamwork. The new proposed nurse manager role in transformation conceptual model aligns nurse manager contemporary and holistic role with transforming cultures for improved patient outcomes. The study findings are significant to health care organization, leaders, policy makers, and educators, in creating new patient caring and healthy working cultures for improved patient satisfaction.

A desire to more fully understand the impact of altered states of spiritual health on the general health of patients has been a focus of recent research activity. Studies have explored the meaning of spirituality held by patients and nurses, the spiritual needs of patients, and methods of providing spiritual care in nursing. However, few studies have investigated nurses’ own spiritual health and the significance this may have on the provision of holistic nursing care. The aim of this study, therefore, was to inform nursing regarding the spiritual health of nurses and the influence that nurses’ own spiritual health has on their ability to provide holistic nursing care to their patients. The study was conducted in two phases using both quantitative and qualitative methodologies. Phase one consisted of a survey of Division 1 nurses currently employed in the Grampians region of Victoria to describe key dimensions of their spiritual health. This survey provided biographical data and, through the use of the “Shalom Measure of Spiritual Health”, discovered the ideal of spiritual health held by nurses as well as the nurses’ perception of patient needs pertaining to the achievement of spiritual health. Phase two utilised Naturalistic Inquiry to further explore the meaning of spirituality and spiritual health held by nurses, and the methods of achieving these for nurses and patients. The findings revealed that although nurses perceive the spiritual dimension of patient care to be important, they feel ill-equipped to provide this aspect of care. In addition, the major support for nurses, who themselves experience spiritual distress whilst at work, comes from colleagues. Further, prevailing health care systems in place do not always lend themselves to holistic approaches to care. This study identifies the need for nurse education to redress the clearly inadequate preparation nurses are given for this aspect of their role. Health care policy-makers and administrators also have a responsibility to consider all dimensions of care when designing and implementing health care guidelines and systems.
Master of Nursing

A desire to more fully understand the impact of altered states of spiritual health on the general health of patients has been a focus of recent research activity. Studies have explored the meaning of spirituality held by patients and nurses, the spiritual needs of patients, and methods of providing spiritual care in nursing. However, few studies have investigated nurses’ own spiritual health and the significance this may have on the provision of holistic nursing care. The aim of this study, therefore, was to inform nursing regarding the spiritual health of nurses and the influence that nurses’ own spiritual health has on their ability to provide holistic nursing care to their patients. The study was conducted in two phases using both quantitative and qualitative methodologies. Phase one consisted of a survey of Division 1 nurses currently employed in the Grampians region of Victoria to describe key dimensions of their spiritual health. This survey provided biographical data and, through the use of the “Shalom Measure of Spiritual Health”, discovered the ideal of spiritual health held by nurses as well as the nurses’ perception of patient needs pertaining to the achievement of spiritual health. Phase two utilised Naturalistic Inquiry to further explore the meaning of spirituality and spiritual health held by nurses, and the methods of achieving these for nurses and patients. The findings revealed that although nurses perceive the spiritual dimension of patient care to be important, they feel ill-equipped to provide this aspect of care. In addition, the major support for nurses, who themselves experience spiritual distress whilst at work, comes from colleagues. Further, prevailing health care systems in place do not always lend themselves to holistic approaches to care. This study identifies the need for nurse education to redress the clearly inadequate preparation nurses are given for this aspect of their role. Health care policy-makers and administrators also have a responsibility to consider all dimensions of care when designing and implementing health care guidelines and systems.
Master of Nursing

Bakgrund: Att vårdas hemma vid livets slut blir allt vanligare. De senaste 10-15 åren har behovet av avancerade vårdinsatser i hemmet alltjämt ökat och möjligheterna att vårda patienter med komplicerade sjukdomstillstånd har blivit mer möjliga. Detta har medfört att kraven på de såväl medicinska som de specifikt omvårdnadsmässiga åtgärderna har växt. Syfte: Syftet med denna studie var att belysa ASIH- sjuksköterskors upplevelse av att vårda patienter i hemmet vid livets slut. Metod: Studien har en kvalitativ och deskriptiv ansats. Två sjuksköterskor från en ASIH:enhet i Stockholm intervjuades. En innehållsanalys gjordes sedan för att analysera det insamlade materialet. Resultat: Tretton subkategorier kunde urskiljas ur dessa bildades fem kategorier. Kunskap och erfarenhet grund till god omvårdnad, Närståendes betydelse i vården, Kommunikation och förståelse mellan patient och sjuksköterska, Ta seden dit man kommer och Personal cost of caring. Slutsats: Sjuksköterskan inom ASIH bär ett stort ansvar då det gäller symtomlindring. Det kan gälla smärta såväl som oro och ångest. Vikten av att ha en helhetssyn som innefattar både patient och närstående beskrevs som viktiga. Ett fungerande samspel mellan sjuksköterska, patient och närstående är en förutsättning för god omvårdnad.
Background: To be cared for at home at the end of life is becoming more common. The last 10-15 years, the need for advanced care in the home has increased and the possibility to treat patients with complex medical conditions has become more possible. This has led to higher medical demands and to higher demands concerning specific nursing activities. Aim/Objective: The purpose of this study was to illuminate the ASIH-nurses' experience of treating patients at home at the end of life. Design: The study has a qualitative and descriptive approach. Two nurses from one ASIH unit in Stockholm were interviewed. A content analysis was then used to analyze the material. Result: Thirteen subcategories could be distinguished those formed five categories. Knowledge and experience due to good care, Significant others and their part in the caringprocess, Communication and understanding between patient and nurse, To adapt to customs and Personal cost of caring. Findings: The nurse within the advanced homecare facility bears a great responsibility when it comes to symptom relief. It may be relief of pain as well as anxiety. The importance of having a holistic approach that includes both patient and relatives were described as important. A good interaction between nurses, patients and relatives is a prerequisite for good care.

Background: Person-centred care is a care model that favors the whole person to be seen, not only the disease. Caring person-centred means giving time and listening the patient about their health problems. This promotes the patients’ involvement in their care and that the care is based on the patients’ story. Patients and relatives experience that receiving insufficient time and information about the patient’s state of health makes person-centred care downgraded. Aim: To describe nurses' experiences of providing person-centred care. Method: Qualitative literature study with descriptive synthesis where eleven caring science articles used for result analysis. Results: Nurses experienced that the relationship with patients and the right conditions for person-centred care were basics for caring person-centred. Seeing the person behind the patient and motivating patients’ participation enabled a person-centred approach. Collaborating with colleagues, devoting more time to patients and personal conditions were both an opportunity and an obstacle to provide a person-centred caring. Conclusion: Seeing the person behind the patient and making patients involved is central in caring person-centred. It also requires the right conditions such as extra time, knowledge and functional cooperation for providing appropriate person-centred care.
Bakgrund: Personcentrerad vård är en vård som möjliggör att hela personen ses, inte bara sjukdomen. Att vårda personcentrerat innebär att ge tid till och lyssna på patienter om sitt hälsoproblem. Detta leder till patientdelaktighet och till att vården utgår från patientensberättelsen. Patienter och anhöriga upplever att de inte får tillräcklig med tid och information om patientens hälsotillstånd, vilket gör att personcentrerad vård kan bli nedprioriterad. Syfte: Att beskriva sjuksköterskors erfarenheter av att ge personcentrerad vård. Metod: En kvalitativ litteraturstudie med beskrivande syntes där elva vårdvetenskapliga artiklar användes till resultatanalys. Resultat: Sjuksköterskor erfor att relationen till patienter och rätt förutsättningar för personcentrerad vård var grunden till att kunna ge personcentrerad vård. Att se personen bakom patienten och motivera patientdeltagande i sin egen vård möjliggjorde personcentrerat arbetssätt. Att samarbeta med kollegor, ägna mer tid till patienter och personliga förutsättningar var både möjlighet och hinder för att vårda utifrån personcentrerat arbetssätt. Slutsats: Att se personen bakom patienten och göra patienter delaktiga i sin vård är centralt för att kunna vårda personcentrerat. Det krävs även rätt förutsättningar så som mer tid, kunskap och fungerande samarbete för att kunna ge adekvat personcentrerad vård.

Bakgrund: Att ge andlig omvårdnad ligger i sjuksköterskans ansvar. Trots alltmer forskning som visar att en tillfredställande andlig omvårdnad har positiv inverkan på hälsa, har detta dock ofta försummats inom vården. Begreppet andlighet kan ha olika betydelser och behöver därför uppfattas i sin bredd. Syfte: Beskriva vuxna patienters (18+) upplevelse av andlig omvårdnad inom somatisk slutenvård. Metod: En integrativ översikt bestående av nio kvalitativa originalartiklar från USA, Singapore, Kanada, Nederländerna, Iran och Australien. Data samlades genom CINAHL, Medline och manuell sökning. Analys gjordes efter inspiration av Friberg och Whittemore och Knafl analysmodeller. Resultat: Andlig omvårdnad kunde av patienterna upplevas positiv, negativ eller obefintlig beroende på olika faktorer. Patienterna i studien upplevde andlig omvårdnad genom att få möjlighet till uttryck av sin andlighet, genom att få möjlighet till relationer, genom att få ha sin värdighet i behåll och genom sjuksköterskans närvaro. Andlig omvårdnad ska utföras utifrån en personcentrerad vård eftersom uttryck av andlighet kan variera mellan individer. Slutsats: För att kunna prata om andlig omvårdnad behöver både personalen och patienter ha förståelse för vad andlighet kan innebära. Sjuksköterskan behöver få kunskap och verktyg för att lätt kunna införa andlig omvårdnad i sitt arbete och känna sig trygg med att utföra en holistisk vård dvs att se hela människan. Detta skulle resulterar i mer tillfreställda patienter.

Bakgrund: Under ett kirurgiskt ingrepp är patienten många gånger sövd och täckt av draperingsmaterial. Operationssjuksköterskan har spetskompetens gällande omvårdnaden kring patienten i samband med kirurgiska ingrepp. I den högteknologiska operationsmiljön blir operationssjuksköterskans arbete fokuserat till det kirurgiska såret under operationen. I denna situation riskerar patienten att uppfattas som ett objekt och inte som en unik människa. Syfte: Studiens syfte var att undersöka operationssjuksköterskans förhållningssätt till hela människan under arbetet i operationssåret. Metod: Studien genomfördes som en kvalitativ intervjustudie med induktiv ansats och elva operationssjuksköterskor från två olika sjukhus i södra Sverige intervjuades med semistrukturerade intervjufrågor. Datamaterialet analyserades med latent innehållsanalys i enlighet med Erlingsson och Brysiewicz (2017). Resultat: Det genomgående temat i resultatet var Se människan under draperingen.Operationssjuksköterskorna beskrev att noggrant förarbete och förtroendefullt samarbete med kollegor var en förutsättning för att utföra sitt arbete i operationssåret. De var ständigt vaksamma på förändringar kring patienten och försvarade patienten och den utsatta kroppen under operationen. Även under arbetet i operationssåret var operationssjuksköterskorna medvetna om hela människan som låg under draperingen och operationssjuksköterskans fokus i operationssåret tar avstamp i intresse för patienten och det bästa operationsresultatet. Slutsats: Operationssjuksköterskorna är ständigt medvetna om hela patienten under arbetet i operationssåret. Deras patientfokus och drivkraft att göra det bästa för patienten, även i situationer då de måste ägna operationssåret all uppmärksamhet, genererar en god vård för patienten i samband med operation och ger en positiv bild av operationssjuksköterskans yrke.
Background: During a surgical procedure, the patient is often anesthetized and covered with draping material. The operating theatre nurse has expertise regarding the care of the patient in connection to surgical procedures. In the technological environment, the operating theatre nurse's work is focused on the surgical wound, during the operation. In this situation, there is a risk that the view of the patient will change from being a person into an object, and will not be seen as a human being. Objective:This study aims to investigate the operating theatre nurse’s attitude towards the whole picture of the human being during the work in the surgical wound. Method: The study was conducted with a qualitative interview method with an inductive approach, and eleven operating theatre nurses from two different hospitals in southern Sweden were interviewed with semi-structured interview questions. The data material was analyzed with latent content analysis in accordance with Erlingsson and Brysiewicz (2017). Result: The recurring theme in the result was See the human being beneath the draping. The operating theatre nurses described that careful preparation and trust in colleagues were a prerequisite in performing their work in the surgical wound. They were constantly alert to changes around the patient, and guarded the patient and the exposed body during the operation. Even during the work in the surgical wound, the operating theatre nurses were aware of the patient who was beneath the draping and the focus in the surgical wound was due to the concern of the patient, and the best surgical result. Conclusion: The operating theatre nurses are constantly aware of the whole person when they focus during the work in the surgical wound. Their patient focus is to do what is best for the patient. Even in situations when attention must be paid to the work in the wound, it is always due to the concern of the patient and gives a positive image of the profession of the operating theatre nurse.

Bakgrund: Venösa bensår är ingen sjukdom utan ett symtom som orsakas av bakomliggande faktorer. Det är framförallt äldre personer som har en ökad risk för sårbildning. Sjuksköterskan är ansvarig för att utföra en bedömning av såret inför val av behandling. Syfte: Att beskriva sjuksköterskors bedömning av venösa bensår hos patienter inom hemsjukvården. Metod: Studien är en kvalitativ intervjustudie med induktiv ansats. Data samlades in genom sex semistrukturerade intervjuer. Materialet analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre kategorier: Sjuksköterskans tillvägagångssätt vid bedömning, sjuksköterskan och patienten tillsammans i en bedömning, sjuksköterskans behov av erfarenhet, stöd och utveckling i bedömning. Sårets egenskaper och fastställande av bakomliggande orsak var av stor betydelse. Likaså poängterades vikten av att göra en helhetsbedömning av patienten, vilket visade sig både ha positiva och negativa sidor relaterat till patientens hemmiljö. Kontinuerlig utbildning och stöd från kollegor ansågs vara till stor hjälp vid bedömning av patienter med venösa bensår. Slutsats: Det konstaterades att bedömningen av venösa bensår upplevs svår, innehåller flera moment samt att praktiken inte alltid stämmer överens med teorin. För att försäkra att patienten får de bästa förutsättningarna till en god sårläkning bör sjuksköterskan se till hela människan och varje patients enskilda behov.
Titel: Nurse's assessment of venous leg ulcers in home based care Background: Venous leg ulcers is not an illness, but a symptom caused by underlying factors. It is mostly elderly people which have an increased risk for ulceration. The nurse is responsible for making the assessment of the ulcer, before choice of treatment. Aim: To describe nurse's assessment of venous leg ulcers in patients within home based care. Method: The study is qualitative interview study with an inductive approach. Data was collected through six semi- structured interviews. The material was analysed with qualitative content analysis. Results: The analysis resulted in three categories: Nurses approach to assessment, the nurse and the patient together in an assessment, nurses needs for experience, support and development in assessment. The ulcer's characteristics and determination of underlying cause were of great importance. Similarly, the importance of making a comprehensive assessment of the patient was emphasized, which proved to have both positive and negative sides related to the patient's home environment. Continuous education and support from colleagues were of great help in assessing patients with venous ulcers. Conclusion: It was confirmed that the assessment of venous leg ulcers is experienced complex, containing several moments, and that practice and theory are not always consistent. To ensure that the patient gets the best prerequisites for good wound healing, the nurse should look after the entire person and patient's individual needs.

The emerging health care culture of accountability for patient outcomes compounds problems for already overwhelmed clinicians struggling to fit everything entailed in complicated office visits into 15-minute appointments. Unprocessed frustrations tempt clinicians to use ineffective and outdated methods for trying to get their patients to comply or adhere to their care plans, undermining effective health care management. The intention of this project was to evaluate whether educating medical assistants in the health coaching method of motivational interviewing can improve the patient care approach while simultaneously assisting clinicians struggling with insufficient time. Several individual scheduling conflicts limited the target population into two primary care medical assistants and two auxiliary primary care office staff who voluntarily chose to learn the new approach. Guided by the adult learning theory, an educational lecture project was designed to capture the spirit of motivational interviewing through basic descriptions and strategies that will assist learners to focus on person-centered conversation skills, helping to balance both the needs of the patient and clinician. Following the education, participants filled out an anonymous post-lecture evaluation questionnaire to provide immediate feedback about learner understanding. Responses indicated the project met its stated objectives, and results showed the versatility of the motivational interviewing method which can be learned and effectively applied by health care workers from a wide range of professional backgrounds. Motivational interviewing is an innovative approach that utilizes therapeutic communication to promote behavior changes that lead to improved health of our communities and country.

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Empresa de Ônibus e Turismo Pedro Antônio LTDA
Mestrado Profissional em Enfermagem Assistencial
O processo de trabalho do (a) enfermeiro(a) é construído por saberes originários de diferentes matrizes científicas e configuram uma atividade centrada no cuidado com articulação no campo da administração. No exercício da função, o (a) enfermeiro (a) utiliza uma série de saberes que podemos chamar de tecnologias. Tecnologias que são empregadas no trabalho do enfermeiro nos diferentes momentos da produção. Este estudo tem como objetivo, analisar o processo de trabalho do (a) enfermeiro (a), buscando identificar o uso das tecnologias no gerenciamento e no cuidado em saúde. Trata-se de um estudo descritivo com abordagem qualitativa. Como campo de estudo foi escolhido o Hospital Universitário Sul Fluminense, no Município de Vassouras. Os dados foram coletados através de entrevista temática com enfermeiros do hospital e observação participante. A análise dos dados se deu por meio da triangulação associada ao método hermenêutico dialético. Os resultados mostraram a utilização de diferentes ferramentas tecnológicas no gerenciamento do cuidado em que a fusão da função gerencial com a assistencial é uma constante. Nesse processo, destacamos o saber da teoria clássica da administração, como elemento presente em grande parte da produção naquele hospital. Apontamos, como conclusão, a importância de novos dispositivos para a descentralização do trabalho e a recuperação da centralidade no usuário
The working process of the nurse is constituted by facts derived from different scientific matrixes and configures an activity centered in the care, with an articulation in the administration field. In the realization of his function, the nurse uses a series of knowledge that we can call technologies. Technologies that are used in the work of the nurse on the different moments of the production. This study has as objective analyze the working process of the nurse, trying to identify the use of the technologies in the management and in the care in health. It‟s a descriptive study with qualitative approach. The Hospital Universitário Sul Fluminense, in Vassouras, was selected as the study field. The data were collected through a theme interview with the nurses of the hospital and participated observation. The analysis of the data was done by triangulation combined with the Hermeneutic-Dialectical Method. The results showed the utilization of different technological tools in the management of the care, in which the fusion of the management and care functions is a constant. In this process, we give emphasis to the knowledge of the administration classic theory, as an element present in a great part of the production in that hospital. We point out as a conclusion, the importance of new ways to the decentralization of work and the re-acquire of the users‟ centrality

Bakgrund: Utifrån erfarenheter och teoretisk kunskap har sjuksköterskestudenter uppmärksammat hur stereotyper kring kön finns starkt närvarande i sjukvården. Vården är dominerad av kvinnor men styrs av maktstrukturer utifrån patriarkala hierarkier. Problem: Kan förutfattade meningar om vad som är manligt och kvinnligt bli ett hinder för personcentrerad vård? Förminskas patienten från att vara en individ till att bli en generalisering utifrån genusnormer? Kan sjukvården bortse från fördomsfulla vårdkulturer gällande könsstereotyper i mötet med patienten? Syfte: Att beskriva hur sjuksköterskor upplever att genus påverkar den personcentrerade vården. Metod: Examensarbetet är en empirisk intervjustudie som använder en kvalitativ manifest innehållsanalys av obearbetat material. Urvalet består av sjuksköterskor inom svensk somatisk vård. Resultat: Vårdares och patienters kön har stark inverkan på vårdens utformning samtidigt som det florerar uppfattningar hos sjuksköterskor att en förutsättningslös attityd kan överbrygga könets betydelse. Slutsats: Genus måste belysas starkare, både i forskning och klinisk praxis då genus har en direkt och indirekt inverkan på den personcentrerade vårdens kvalitet. Sjukvården måste bli bättre på att medvetandegöra genus då rådande genusnormer ofta är osynliga och måste belysas kontinuerligt för att inte åter bli osynliga och genom detta orsaka diskriminering och vårdlidande.
Background: Experience and theoretical knowledge made nursing students aware that gender stereotypes are present in health care. Health care is dominated by women but controlled by patriarchal hierarchies. Problem: Can prejudice on masculinity and femininity hinder person-centered care? Is the patient being reduced from being an individual to becoming a generalization of gender norms? Is it possible for health care systems to ignore the impact of prejudiced gender cultures and still give patients qualitative treatment? Aim: To describe registered nurses experiences of how gender affects person-centered care. Method: An empirical interview study with a qualitative manifest content analysis of unprocessed data. The selection comprises registered nurses in Swedish somatic health care. Result: The gender of health care personnel and patients strongly affects the formation of health care relationships. Simultaneously there is preconception among nurses that an unbiased attitude can overlap the consequences of gender. Conclusion: Gender needs to be illuminated, in scientific research but also in practice. The health care system needs to develop its awareness of gender because prevailing gender norms are often invisible and need to be continuously illuminated in order to prevent gender bias, discrimination and care suffering.

Résumé exécutif

Introduction.

La prise en charge (PEC) des malades de tuberculose a été confiée à des institutions spécialisées et réduite aux seuls aspects biomédicaux du problème. En associant une revue de littérature sur les dimensions du problème posé par la tuberculose et un état des lieux sur la prise de charge de la tuberculose, les besoins non couverts par les centres de diagnostic et de traitement (CDTs) ont été identifiés dans trois districts sanitaires (DS) ruraux du Burkina Faso. Le recueil des évidences sur les interventions à même de corriger ces insuffisances (dans la littérature), associé à l’expérience des acteurs sur le terrain ont conduit à la mise en place d’un dispositif de soins. Ce dispositif intègre i) la décentralisation de la prise en charge des malades des CDTs vers les centres de santé de 1er échelon (CS), ii) l’organisation d’un soutien psychosocial au profit des malades en traitement et iii) la mise en contribution de personnes ressources pour offrir un soutien socioéconomique aux malades. Le présent travail s’intéresse à la conception et le test du dispositif au cours d’une phase pilote.

La question générale de recherche était de savoir si un tel dispositif pouvait améliorer significativement non seulement les résultats biomédicaux, mais aussi le confort physique, psychologique et matériel des malades pendant leur traitement. Trois hypothèses, faisant référence aux interventions clé du dispositif de soins, ont guidé l’investigation de cette question :

i) Une décentralisation du diagnostic, de l’administration des médicaments et du suivi du traitement de la tuberculose, des CDT vers les CS va contribuer à réduire pour les malades la distance à parcourir et accroitre de ce fait le taux de dépistage.

ii) Un soutien psychosocial va renforcer l’estime de soi des patients tuberculeux et réduire la stigmatisation ressentie par eux. Elle contribuera à améliorer le confort psychologique des malades ainsi que les résultats de traitement.

iii) Un soutien socioéconomique bien coordonné va résoudre les besoins de base des patients tuberculeux (transport, nourriture, habillement, etc.). Il va contribuer à améliorer les conditions de vie des malades ainsi que les résultats de traitement.

Le contenu du présent document comprend cinq parties. La première propose une introduction, la démarche générale et le contexte où le test du dispositif a été mis en place. La seconde présente les dimensions du problème posé par la tuberculose, un état des lieux sur l’offre actuelle de soins et les interventions potentiellement efficaces pour combler les besoins non couverts. La troisième partie décrit comment le dispositif de soin a été conçu et modélisé. La quatrième partie décrit le processus d’implantation et le fonctionnement du dispositif. Enfin, la dernière partie propose une discussion générale et quelques leçons apprises.

Première partie :Introduction, contexte et approche méthodologique générale.

Dans un chapitre introductif, nous mettons en exergue les défis que représente la promotion de la santé, le centre d’intérêt de la thèse, l’énoncé de la question de recherche et le cheminement méthodologique. Le cheminement utilisé est emprunté au modèle proposé par Campbell et Loeb pour la mise en œuvre et l’évaluation des interventions complexes. Il comporte quatre phases :i) la phase de modélisation, ii) la phase pilote, iii) la phase d’expérimentation définitive et iv) la phase d’implantation à long terme. La conception-modélisation et le test du dispositif de soins au cours d’une phase pilote ont fait l’objet du présent travail.

Le second chapitre présente le site de l’expérience. Six districts sanitaires ruraux sont répartis en un site d’intervention (3 districts couvrant un total de 8 453 km2 avec une population de 726 651 habitants en 2005) et en un site contrôle (3 autres districts couvrant un total de 9636 km2 avec une population de 719946). Les 2 sites partagent les mêmes réalités concernant l’organisation des soins en deux échelons (centres de santé de 1er échelon et hôpitaux de référence), la couverture en infrastructures (avec un rayon moyen de couverture par CS d’environ 6 kilomètres), l’organisation de la prise en charge de la tuberculose et les résultats du contrôle de cette maladie. La fréquentation des services de soins curatifs est considérée faible dans les 2 sites, comme dans les autres DS ruraux du pays. Elle se justifierait par les barrières financières, les pesanteurs socioculturelles, les perceptions négatives des populations vis à vis des services de santé et l’absence de système performant pour la prise en charge des urgences et des indigents.

Dans le troisième chapitre, un cadre général d’analyse de l’implantation du dispositif et de l’évaluation de son efficacité est proposé. Des précisions sont données à propos des centres d’intérêt, du but final de l’expérience et des méthodes utilisées pour vérifier les hypothèses de recherche. Une étude du processus d’implantation sert à analyser les interactions entre les acteurs et à identifier les obstacles rencontrés de même que les insuffisances du dispositif. Une étude quasi expérimentale sert à évaluer l’efficacité du dispositif.

Deuxième partie :Phase théorique.

Dans le quatrième chapitre, les insuffisances de l’offre de soins par les CDTs sont décrites et une revue de littérature sur les dimensions du problème posé par la tuberculose est présentée. Les 3 interventions susceptibles de couvrir les lacunes de l’offre actuelle de soins sont alors identifiées.

Troisième partie :Phase de modélisation du dispositif de soins.

Dans un cinquième chapitre, le processus de modélisation du dispositif est décrit. Une simulation du fonctionnement du dispositif permet de prévoir les effets directs et indirects. Les outils de documentation et d’évaluation du dispositif sont présentés.

Quatrième partie :Développement de la phase pilote.

Cette partie se compose de 4 chapitres qui sont: la présentation des interventions, des résultats intermédiaires, des interactions entre ces interventions et le système de santé. L’évaluation des effets observés termine cette partie.

Le sixième chapitre présente la manière dont le dispositif a été mis en place et son fonctionnement. En partant d’une démarche standardisée, obtenue après une concertation entre les différents acteurs (professionnels de santé et personnes issues du milieu de vie des malades), trois interventions ont été implantées dans les districts d’intervention. Il s’agit de la décentralisation du diagnostic et du traitement de la tuberculose dans 24 CS (8 / district), la mise en place de sessions de groupes de parole dans chaque CDT au profit des malades et la mise en place d’un comité de soutien dont les membres sont issus de l’environnement socioculturel des malades.

Le septième chapitre présente les résultats intermédiaires de chaque intervention.

Le huitième chapitre an\
Doctorat en Sciences médicales
info:eu-repo/semantics/nonPublished

ABSTRACT Emphasis on humanistic values and personal experience in nursing has led to the popularisation of holistic nursing approach to nursing care. Although holistic nursing care as a construct is widely discussed in nursing literature. Contextual clinical application has been difficult, in the absence of guiding conceptual framework and guidelines that directs nursing practice. In this study, the purpose was to examine the meaning of holistic nursing care and develop a framework for holistic nursing care, which can be utilised in nurse education settings and in clinical nursing practice in the context of paediatric nursing in academic hospitals. To achieve this aim, qualitative methodological perspectives were employed based on careful selection of the population, sampling, collection and analysis of data and trustworthiness. To enable the accomplishment of the purpose, the study objectives were formulated into two phases. Phase one objective enabled the identification of the characteristics of the concept holistic nursing care through concept analysis and by obtaining the emic viewpoints of the paediatric nurses working in academic hospitals. A philosophical inquiry was employed using Rodgers’ evolutionary method of concept analysis. To elucidate the concept holistic nursing care a qualitative, interpretive, explorative and contextual research design was employed. Holistic nursing care was interpreted as whole care fostering person-centred and family-centred care. The results confirm the current discourse in nursing literature with respect to “person-centred”, “family-centred care” as opposed to “patient-centred care”. The emphasis is on recognition of the need to transform current linguistic ontology from “patient care” towards the provision of “whole-person” care. Participants’ interpreted v holistic nursing care as whole care directed towards a unique and complex human being. The dynamic, which is the driving force for the achievement of whole care, is established through enabling goal-directed nurse-family relationships. One of the key finding is the prominence of spirituality and the inclusion of spirituality in different aspects of child nursing. The dependency of individual nurses to spiritual sources for personal strength and support was recognised and acknowledged. Knowledge of disease, person and “know how” are necessary for the acomplishment of ethically, safe person-centred whole care. Attributes of holistic nursing care yielded two dimensions; whole person and mind-body-spirit dimension. The decriptors of whole person include physical, mental, emotional, spirit and spitual being. Spirituality is the predominant antecedent. Holistic nursing care is initiated by the recognition of the individual, in need of health care, as a spiritual being with mind-body-spirit dimension. Spirituaity is an ever-present force pervading all human experience. Complimentary alternative medicine (CAM) was identified as a surrogate term. The connection of CAM with holistic nursing care is the focus of therapetic interventions that are directed to the mind-body-spirit domain. The emphasis is on health rather than curing. Preventative therapeutic interventions are desingned to meet the needs of the whole-person. Caution is advocated in the use of CAM therapies in child nursing, as CAM efficacy has not been sufficiently investigated in child health care. The conceptual framework is presented as unique contribution to nursing. The framework may be introduced at undergraduate teaching of child and family nursing care and in specialists’ paediatric nurse education. Recognition of the human being as a whole person with mind-body-spirit dimension is not restricted to a child or family care. Therefore, the vi framework is presented as a fundamental structure that can be used generally to all intervention activities in relation to human–human interactions. Its use may be broadened to any therapeutic environments. The framework may be tested in adult nursing in variety of settings in health care. There is a potential to expand and transfer certain elements of the framework to other discipline beyond nursing: in doctor-patient relationships, manager-employee relationships, and person-to-person interactions. Perhaps the South African Nursing Council, as the regulating body responsible for developing the educational framework of nursing education in this country may adopt this framework in line with their philosophy of nursing to articulate with their intended goal of providing holistic nursing care for the people of this nation. Adoption of the framework may require a shift from the current “patient-centred care” towards “person-centred care”.

Spirituality is an integral part of a persons wholeness and therefore has an effect on and plays an important role in health and illness. Nurses are required by national and international nursing bodies as well as hospital accreditation agencies, to identify patients spiritual needs and intervene by integrating spiritual care into their nursing care. However, to date, no nursing studies have described Tanzanian nurses experiences of spirituality and spiritual care. The qualitative method of interpretive description was used. A purposive sample of fifteen registered nurses who were engaged in direct clinical practice at one of the private not-for-profit hospitals in Dar es Salaam, Tanzania was drawn. In-depth interviews using open-ended questions were carried out, tape-recorded, and transcribed verbatim. The data collection and analysis occurred concurrently. The transcripts were coded using inductive analysis. Themes related to spirituality and spiritual care that emerged from data were: meaning of spirituality, meaning of spiritual care, recognition of spiritual needs, interventions to respond to spiritual needs, challenges addressing spiritual care, and factors positively influencing the provision of spiritual care. Several recommendations for enhancing spiritual caregiving practices were given by participants. The findings from this study offer a basis for assessment, planning, and intervention strategies that nurses can apply in integrating spiritual care in clinical practice.

碩士
美和技術學院
健康照護研究所
97
Holistic nursing care model was the most common and effective model in nursing care. The Ministry of Health of Vietnam has promulgated the regulations on holistic nursing care as a part of hospitals’ regulation in 1997. This study is a description – survey oriented research. It investigates the current status on holistic nursing care and explores perception on holistic nursing care between nurses and patients. The aim of the study was to identify (1) the relationship between holistic nursing care and nurses characteristics; (2) the relationship between holistic nursing care and patients characteristics; and (3) the perception on holistic nursing care between the nurses and patients. The study adopted questionnaire in data collection. A convenience sample was 238 nurses, who are nurses taking care of patients at medical departments and 420 patients with level II patients who are being treated at medical departments. The Statistical Package for Social Sciences (SPSS) for Windows (version 13) was used to analyze the data. The results indicated that there were significant differences in perceptions on holistic nursing care between nurses and patients. The mean score of nurses’ perception was higher than patients’ perception. The results suggested that the patient was unsatisfied with nursing care on holistic nursing care. The main reasons were lacking medical equipment and devices; lacking beds for the patient to lie down; lacking facilities serving for the patient’s daily living activities; and lacking a board of indicating hospital policies, regulations, and health information for patients and their families; limiting health education for patients and referring to social organizations to support the patient care. In addition, nurses need to explain procedures clearly and frequently monitor the patient.

This qualitative study sought to explore the Hong Kong Chinese patient's perceptions of an Intensive Care experience and their views on the introduction of feng shui principles focussing on sleep orientations, dietary management and exercise regimes. The study explored the background of feng shui as an authentic traditional Chinese belief. It also explores if incorporating these feng shui principles into the health care setting would provide a positive effect for open-heart patients in an Intensive Care Unit at the Hong Kong Adventist Hospital in Hong Kong. The major inference drawn from this study is that Chinese patients seek culturally related experiences from the health care setting. The Chinese informants showed strong belief patterns in traditional practices of feng shui, however, practiced these within the confines of their homes as these experiences were denied to them in the hospital setting.
Health Studies
M.A. (Nursing Science)

Introduction. The use of Highly Active Antiretroviral Therapy (HAART) has shown to reduce the morbidity and mortality and prolongs survival, improving quality of life restoring and preserving immunologic function, maximizing antiretroviral activity and durably suppressing viral load and further preventing vertical HIV transmission. However, their use in Critical Care Units CCU is still controversial as there are still no set standards for how HAART should be applied in these settings (Anderson, 2009). This study was aimed at exploring the perceptions of critical care nurses towards their educational preparedness in managing HIV/AIDS patients admitted to CCU in KwaZulu-Natal. Methodology. Quantitative descriptive research design was used and data collection included a structured questionnaire and open ended questions. Results. The findings of this study indicate that of the critical care nurses who were sampled for this study and had undergone training in HIV/AIDS management, 45% and 25% respectively perceived that they were not educationally prepared to provide services for people living with HIV/AIDS admitted to CCUs. Almost all N=50 (94%) critical care nurses reported that HIV/AIDS management should be incorporated into the critical care nursing programme. Their universal perception N=42 (75%) is that this will improve the standards of nursing care in the critical care field. Over and above lack of training and updated information reported by the respondents, they are still challenged by factors such as advanced level of HIV disease, confidentiality about the disease, knowledge about a HIV/AIDS treatment regimen and emotional challenges. However, there are guiding policies within critical care settings for nurses to utilise in the management of HIV/AIDS and in the care of people who have already been infected. Conclusion and recommendations. In conclusion, more research with a larger scale sample is required to provide appropriate generalisation of the findings of the study. Alternatively a qualitative research study which may provide richer data on the lived experiences of the critical care nurses regarding care of people living with HIV/AIDS is suggested.
Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

In the midst of hope and suffering due to the challenges posed by HIV and AIDS in South Africa, communities have literally witnessed a glimmer of hope in women volunteers who have readily and willingly provided care and support to people living with HIV and AIDS (PLWHA) and their families. Policy-makers have maintained that if the care of sick people is to be both comprehensive and cost-effective, it must be conducted as much as possible in the community, with hospitalization only when it is necessary. However, the strains on those caring for people with HIV and AIDS are enormous. This paper argues that neo-liberal policies are reinforcing the divide between the 'haves' and the 'have-nots', by placing strain on women volunteers in the field of community home-based care. The study was conducted in the area of Mpophomeni Township, in KwaZulu-Natal province. The research participants consisted of 10 community home-based care (CHBC) volunteers and their supervisor, 3 CHBC trainers, and 1 counselling trainer. Using a qualitative design, this study examines a specific CHBC training course and how effectively it prepares voluntary caregivers for the challenges experienced in individual homes. Ascertaining how the training helped caregivers to confront their own fears and problems before dealing with those of others, and exploring how community caregivers coped with the stress inherent in their jobs was the primary focus of this study. For these purposes, a qualitative methodology was deemed most appropriate for it allowed me to gain in-depth information through observations, semistructured interviews, a review of relevant documents, and training materials. Inspired by feminist perspectives, the findings revealed that already overburdened and poor people provide the bulk of voluntary services in the area of CHBC. Consequently, they are unable to provide quality care for people living with HIV and AIDS without external support from the government. The findings further established a mismatch between the training content and the reality of work of caregivers. The training puts more emphasis on practical aspects, by providing basic nursing care, often only relevant in helping a bedridden patient. However, many voluntary caregivers reported that the demands placed on them do not end with the death of the patient. This poses a challenge for those in the CHBC training environment as they need to offer relevant and well-researched information linked to the reality of voluntary caregivers' work. The study also highlighted a need to consider the personal long-term goals of volunteer caregivers and begin to realize the importance of using the training to put them on a career path. I therefore argue that the burden of care for people living with HIV and dying from AIDS in resource-poor settings cannot be shifted entirely to communities with the false assumption that they are able to cope. As we continue to grapple with moral and ethical issues in the context of HIV and AIDS, we also need to be concerned about moving women volunteers' efforts from invisibility to visibility through a social transformation agenda.
Thesis (M.Ed.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.

A qualitative, non-experimental, explorative and descriptive research design based on the phenomenological philosophical tradition by Heidegger to broaden hermeneutics was conducted. The study was conducted at Umkhanyakude District to investigate the perspectives of eligible nursing students relating to the provision of spiritual care to patients. A purposive sample of 9 participants was recruited and consent form obtained. An unstructured interview guide, with a grand tour question, was used to conduct face to face individual interviews. The Thematic analysis and interpretative phenomenological method of analysis were employed until three themes, six categories and eleven subcategories emerged from the data. Data analysis revealed that nurses had difficulty to differentiate spiritual care from religious care. Commonly cited methods of providing spiritual care were prayer, reading sacred text and singing spiritual songs. Nurses still felt inadequately prepared educationally on how to provide spiritual care in nursing practice. Most of the participants provided spiritual care out of their own interest and not as part of their professional responsibility. Recommendations proposed that the matter be taken up by nurse managers to conduct related in-service education and mentoring programs and nurse educators to guide curriculum planning which evidently include spiritual care.
Health Studies
M.A. (Health Studies)

Aim: The aim of this study was to investigate the educational shortcomings as evident in the literature reviewed with the intention of developing intervention/s thus contributing to practice, management, research and education. Background: Literature identifies many limitations in psychosocial support to families of patients in ICU. Little is known about the continued educational support the ICU nurses receive, formally and informally, to empower them to provide psychosocial support to the families of ICU patients. Methodology: The mixed method (concurrent triangulation design), was adopted using the survey for both the quantitative and qualitative approach. In-depth interviews, conversations, participative observation and the review of documents were used to collect data. Collection of data occurred simultaneously. A research instrument and guide were used to obtain quantitative and qualitative data respectively. Setting: Purposive sampling was used for the selection of hospitals within which the chosen ICUs were located and the educational institutions which provided the formal education and training to ICU nurses who worked in these hospitals. Participants: The qualitative arm involved interviews with a purposively selected sample of critical care nurses. Saturation was reached after nine interviews. A sample size of 34 (n=34) was used in the quantitative arm of the study. Convenience sample was used. Data Analysis: A mixed method approach was adopted. The study applied a thematic analysis according to the qualitative analysis described by Creswell 2007. Descriptive statistics were used to summarize data and findings were presented in tables and graphs. The SPSS version 15.0 and STATA statistical package calculate non – parametric tests between selected study variables. Findings: The main themes derived from the qualitative analysis and confirmed by the statistical data demonstrated the manner in which continued education preparation was inadequate, the lack of specific clinical accompaniment, the lack of direction in terms of the philosophy of the units, ICU nurses being left on their own to obtain educational preparation. The results indicated that the lack of continued informal education at the unit and hospital level influenced the ICU nurses’ lack of implementation of psychosocial support to families of ICU patients. Statistical results and qualitative themes were converged and integrated during data analysis. Jamerson et al.’s (1996) model of family experience was used to contextualise the findings. Recommendations: Recommendations arising from the study were made for improvements in nursing practice, nursing management, nursing education and future nursing research. A practice checklist was formulated and expert opinion was sought using the Nominal Group Technique.
Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

The theme was chosen on the basis of their own experience, when new treatments, tools and nurses appear in the workplace, which are also required to constantly improve the quality of nursing care. The state approach to the patient forms the philosophical basis of nursing care. To give nurses of quality pastry about the bio-psycho-social and spiritual needs of the patient, it is necessary to have the knowledge, conditions and personal relationship to provide holistic care. At present, it is not possible that these are health and safety risk factors. Aims, research questions and hypotheses: The subject of the research is to find out the interest of nurses to apply a holistic approach in practice considering the current situation in nursing. Three objectives were set based on the subject of the research. Goal 1: Find out, if nurses are interested in providing modern nursing care based on patient needs. Goal 2: Identify nurses' personal views on providing holistic care. Goal 3: Determine the satisfaction level among nurses about the nursing care provided with regard to the current situation in practice. Methods and research file: Quantitative data collection method was used for the research. Anonymous questionnaire was distributed to nurses in selected healthcare facilities (Liberec Hospital, Turnov Hospital, Jablonec nad Nisou Hospital). The survey sample size is 180 respondents. Findings and conclusion: It follows from the research, that more than half of the respondents have already encountered the concept of holistic nursing care and they also understand what needs should be met by patients/clients and how to satisfy them. Some of them have already used the help of a social service or psychologist. However, it has turned out, that more than half of the responding nurses are not interested in spiritual needs. It has not been confirmed, that nurses' interest in providing this modern nursing care based on patient needs would depend on capacity of staff. The survey also shows, that the holistic care is provided in their hospitals according to one third of responding nurses. Nevertheless, the respondents think, that a holistic approach cannot be applied in their workplace because of lack of time, lack of staff and time consuming administration. Based on the results of Hypothesis 2, we can confirm, that nurses' opinion on the implementation of noursing care provided is influenced by the workload of nurses. The holistic approach moderately affects the job satisfaction level of nurses according to the survey. However, more than half of the responding nurses are satisfied with care they provide at their workplace, because they can see satisfied patients/clients. Hypothesis 3 has not proved any relationship between the satisfaction level of nurses and current situation in health care, where a holistic approach can be effectively applied. There will be a seminar for general nurses within the lifelong learning of nurses focusing on holistic care as an outcome of this diploma thesis.

The purpose of this study was to describe and compare the perceptions of the registered nurses and the nurse managers regarding the role of the registered nurse in integrated primary health care. Quantitative, descriptive research was conducted to determine if there were any discrepancies between role perceptions and role expectations. Data collection was done using structured questionnaires. Two groups of respondents participated in the study. The registered nurse group (n=40) provided direct clinical care in integrated primary health care settings. The second group was composed of nurse managers (n=20) managing integrated primary health care services. The findings revealed that there are some areas where there is lack of congruence between the perceptions of registered nurses and nurse managers regarding the functions that registered nurses perform. These differences may result in confusion and role conflict among registered nurses, which can ultimately impede the attainment of integrated primary health care goals.
Advanced Nursing Sciences
M.A.(Nursing Science)

Holistic nursing care requires body and psyche orientation. That means it stresses both, body and psychosocial human needs. It is necessary for nurses to understand the principle of psychosocial interaction and care of the whole person including his/her dearest in health and illness. The aim of the thesis ?Holistic approach in providing nursing care to handicapped children in health & social facilities? was to find out how the needs of handicapped children are satisfied in health & social facilities from the point of view of holistic approach. The work involved both, qualitative and quantitative research. 104 nurses filled in a questionnaire and 10 respondents were observed within the quantitative research. Two hypotheses were set. The first hypothesis was focused on handicapped children in health & social facilities and on satisfaction of their needs from the point of view of holistic theory. Most of the nurses are convinced that they are providing holistic care. However on the other hand a lot of nurses answered that they preferred provision of physiological needs to psychosocial needs. This finding does not fully confirm the holistic approach in providing nursing care. The second hypothesis says that nurses provide more holistic care in non-profit making facilities than in those operated by regional authorities. Non-profit making facilities could not be included in the research as nurses are not employed there and those who work there work at the positions of social workers and caregivers, not at the positions of nurses. Comparison was only performed at facilities operated by private limited companies and the regional authority. The research also compared the approach to holistic nursing care between head nurses and ward sisters and nurses working on shifts. The nurse managers answered more positively than the nurses working on shifts. A nurse providing holistic care sees a human as a unique complex being, not as its single parts. Such a nurse is ready to help people achieve and maintain optimal health, helps in prevention and reduction of diseases and provides support to those incurably ill. It is important to realize that body and psyche are closely linked, not separated. This thesis may be used by nurses working with handicapped children in health & social facilities. Elaboration of a standard for holistic nursing care for handicapped children in health & social facilities is the practical output of the thesis.