Дисертації з теми "4205 Nursing"

Modern Matrons are at the vanguard of both care delivery and the NHS reforms and have an important role in the modernisation of, and future delivery of healthcare. An important contextual feature of their role and a concept that has been widely embraced by the National Health Service, is that of decentralized decision making. Unlike clinical decision making which has been extensively studied, there is little in the healthcare literature regarding leadership and management decision making or the concept of decentralised decision making. In order to maximise the effectiveness of the Modern Matron role, it is important that we gain a thorough understanding of how they make leadership and management decisions, the reality of the term decentralized decision making for them and an insight into their abilities and needs in regards to this essential skill.

Abstract The Mediating Effect of Distress Caused by Constipation on Predictors of Quality of Life of Hospice Patients with Cancer. Key positive outcomes for hospice patients include the prevention and alleviation of physical and psychological distress, maintenance of physical and mental functioning and all aspects of quality of life. This research used secondary analysis of previously gathered data to answer new research questions with alternative strategies to examine relationships not previously analyzed. The researchers collected data from 717 cancer patients who had been admitted to one of two private hospices. The aim of their experimental intervention was to define the effectiveness of using standardized assessment tools to provide systematic feedback to hospice staff about hospice patients and their caregivers. The aim of this secondary analysis was to assess the mediating effect of constipation distress on the relationship between constipation intensity and the hospice patients' QOL. Variables included in the analysis were: Quality of Life, Constipation Distress, Sociodemographic Characteristics (Age, gender, marital status, race/ culture, education, and socioeconomic status), Clinical Characteristics (Type of cancer, Co-morbidities, Functional/mental Health status), and Constipation Intensity. The data analyzed using descriptive statistics, including the frequency, percentage, means and standard deviation for quality of life. A relationship between quality of life and sociodemographic variables and between quality of life and clinical characteristics were evaluated with Pearson correlation coefficients. An exploratory mediation analysis was used to assess the mediation effect of the constipation distress. Results showed that age, ethnicity, constipation severity and functional status were predictors of QOL (P<0.0), and the bootstrapping showed that constipation distress has a mediation effect on the relationship between constipation severity and quality of life. The symptom intensity and distress as well as the relationship between constipation and quality of life need to be seen in a holistic approach to achieve the best symptom management for cancer patients.

After the 2001 attacks on the World Trade Center, public health garnered more attention. This event forced public health nurses to acquire new roles needed to respond to disasters. The purpose of this project was to synthesize the current evidence related to the role of nurses during disaster preparedness and apply that evidence to public health nurses. The practice question focused on the role of nurses during disasters which were not a part of their normal daily activity. The Fineout-Overholt, Melnyk, Stillwell, and Williamson hierarchy for grading evidence was the theoretical framework used. A systematic literature review was conducted to synthesize the current evidence and answer the proposed practice questions. After removing exclusion criteria, there were 3 articles evaluated and graded for levels of evidence. Much of the current literature offered recommendations for competencies, role identification for nurses during disaster preparedness by their employers, curriculum development, and training needed for nurses to identify their role during disasters. A suggested recommendation based on this project is to conduct a mixed methods study to help identify the specific role of the public health nurse during disasters. Obtaining a broader perspective of the role for the public health nurse during disasters can provide a better understanding of the new roles and duties they can assume. The social implication of these findings is that local health departments can identify the role of public health nurses during disaster preparedness and improve the nurse's response to disasters, thereby protecting the health of populations.

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciado em Enfermagem
As crianças com Síndrome de Down necessitam de todo um trabalho em equipa multidisciplinar, incluindo os pais, para que se possam desenvolver com maior estabilidade e harmonia. As crianças com Síndrome de Down apresentam, problemas derivados do seu problema genético que constituem um desafio para o seu desenvolvimento, tais como problemas anatómicos, cognitivos entre outros devem fazer com que os Enfermeiros tenham em especial atenção ao conhecimento sobre essa mesma patologia, para um melhor cuidar e um melhor tratar. O trabalho proposto pelo aluno consiste num estudo quantitativo, do tipo exploratório e tem como objectivo explorar os conhecimentos dos alunos do 4º ano do curso da Licenciatura de Enfermagem da U.F.P Foi colocado um questionário online através do Google drive para os alunos do 4ºano do curso da Licenciatura de Enfermagem da U.F.P., a amostra foi constituída por 22 alunos do 4º ano do mesmo curso referido. De acordo com os resultados considera-se que os alunos do 4ºano do curso da Licenciatura de Enfermagem demonstraram ter conhecimentos sobre a patologia em investigação. Children living with Down Syndrome need great teamwork from the entire multidisciplinary team, including the parents, so they can develop with greater stability and harmony. Children living with Down Syndrome exhibit problems resulting from their genetics that are a challenge for their own development, such as anatomic and cognitive challenges presented by these children should make Nurses fully aware of the need of obtaining greater knowledge of this pathology so they can provide better care. The project proposed by the student is based on a exploratory and quantitative study, that has the goal of assessing the knowledge of 4th grade students in Nursing Degree of U.F.P. It has been designed an online questionnaire through Google Drive to the 4th grade students of Nursing Degree of U.F.P., being that the sample was made up of 22 4th grade students of the referred course. According to the results we were able to reckon that the 4th grade students of Nursing Degree have demonstrated knowledge about this pathology.

Since the care for the elderly is a low priority there are shortcomings. One of these shortcomings are that the elderly living in nursing homes do not feel that they have a meaningful existence. The aim of this study was to identify which factors could give the elderly residing in nursing homes a meaningful existence. The study was conducted through a review of existing literature with a systematic literature study. Scientific articles were found, read, analyzed and condensed. The connotation of the term "meaningful existence" is individual and differs from person to person. This study has identified six categories that could lead to a meaningful existence for the elderly living in nursing homes. These were: to feel secure, maintaining integrity, maintaining relations, to feel inner harmony, to feel comfort and to be active. Four important findings derived from the categories and were discussed further. These were integrity, a meaningful activity, animals in the health facility environment and security. In conclusion it was found that a meaningful existence, what ever it may be to the single individual, is important to the quality of life for the elderly persons residing in nursing homes.

Bakgrund: Livsstilsrelaterad ohälsa är ett stort samhällsproblem både i Sverige och i övriga världen. Sjukvården står inför en stor utmaning att komma till rätta med de sjukdomar och det lidande som orsakas av en ohälsosam livsstil. Sjuksköterskor har en viktig roll i mötet och behandlingen av patienter som lider av livsstilsrelaterad ohälsa. Motiverande samtal är en klinisk praktiserad och erkänd metod för att hjälpa människor att ändra sitt beteende.   Syfte: Att belysa sjuksköterskans användning och erfarenhet av motiverande samtal i praktiken med patienter som är i behov av livsstilsförändring.    Metod: Metoden som använts är litteraturöversikt. Tio vetenskapliga artiklar har granskats och använts för att besvara syftet.   Resultat: I resultatet framkom två huvudteman. Det första temat, hur MI används, beskriver vikten av utbildning och hur utbildning i MI står i relation till det kliniska användandet samt i vilken utsträckning MI-metoden används. Det andra temat, erfarenheter, beskriver sjuksköterskors erfarenheter av att arbeta med MI.   Diskussion: Diskussionen fördes utifrån Rosemarie Rizzo Parses teori om Human becoming och relevant litteratur.

Bakgrund: Vacciner har under många år varit en av de största bidragande faktorerna till en god folkhälsa. När många invånare vaccinerar sig skyddas fler mot smittsamma virussjukdomar i samhället. En tveksamhet till vacciner finns trots det hos många människor. Syfte: Syftet var att undersöka orsaker till vaccinationstveksamhet hos vuxna. Metod: En allmän litteraturstudie genomfördes för att besvara syftet. Tre databaser användes för informationssökning. Innehållet i artiklarna granskades med stöd av kategorisering av åsikter i en tabell. Resultat: Resultatet för litteraturstudien består av fyra kvantitativa artiklar, fem kvalitativa samt en med mixad metod. Fyra kategorier påvisades: brist på kunskap, oro, rädsla och brist på tillit, brist på stöd och attityder och kulturella aspekter. I resultatet framkom ett flertal anledningar till att individer erhöll en tveksamhet till vaccin däribland bristande kunskap och rädsla. Slutsats: Mer forskning krävs för att identifiera åtgärder som sjuksköterskan kan använda sig av i mötet med patienter som är tveksamma till vaccin.
Background: For many years, vaccines have been one of the major contributing factors to good public health. The fact that many people vaccinate provides protection against several viral diseases in society. Nevertheless, there are many people that have doubts about vaccines. Objective: The aim of the literature study was to investigate the causes of vaccination hesitancy with adults. Methods: A general literature study was conducted to answer the purpose. Three databases where used for information retrieval. The content of the articles was examined with the aid off categorization of opinions in a table. Results: The result of the literature study consists of four quantitative articles, five qualitative articles and one with a mixed method. The content of the articles was reviewed, and four categories were identified: lack of knowledge, concerns, fears and lack of trust, lack of support and attitudes and cultural aspects. In the results, there were a number of reasons why individuals hold a doubt towards vaccine, including lack of knowledge and fear. Conclusion: More research is needed to identify actions that the nurse can use when meeting patients with vaccine hesitancy.

Barn runt om i världen far illa och utsätts för fysiskt-, psykisk- och sexuellt våld samt vanvård och försummelse. Sjuksköterskor möter barn och vuxna i sitt omvårdnadsarbete, där barn har farit illa eller riskerar att fara illa. Sjuksköterskor har anmälningsplikt vid misstanke om att barn far illa. Dock finns olika omständigheter som påverkar sjuksköterskor att inte göra en orosanmälan vid misstanke att barn far illa, trots att anmälningsskyldighet och etiska koder finns. Syftet med litteraturstudien var att undersöka vilket stöd sjuksköterskor behöver för att göra en orosanmälan vid misstanke om att barn far illa. I litteraturstudien framkom det att sjuksköterskor behöver stöd i form av emotionellt-, informativt- och instrumentellt stöd för att göra en orosanmälan. Sjuksköterskor efterfrågar stöd genom kunskap vilket kan erhållas via utbildning, för att kunna identifiera barn som far illa. Ett organisatoriskt stöd och en god sammanhållning inom teamet är av stor vikt för att främja sjuksköterskors hantering av orosanmälan, där alla inom hälso- och sjukvård får reflektera och dela kunskaper med varandra. Sjuksköterskors individuella förutsättningar gällande normer och värderingar av en vuxen- och barnrelation har en inverkan på anmälningsprocessen. Därmed behöver sjuksköterskor stöd för att samtliga sjuksköterskor utgår från samma värderingar och plikter mot barnet och förövaren.
Children around the world suffer from abuse such as physical, psychological and sexual violence and neglect. Nurses meet children and adults in families in their work where children have been harmed or are at risk of harm. Nurses have an ethical responsibility and duty to report when children are at risk of harm in a report of concern. Although there are ethical codes and an obligation to report, there are circumstances that affect nurses to not always make a report when a child is at risk. The aim of this literature study was to investigate what support nurses need to make a proper report of concern, when there is a suspicion of a child at risk. The study revealed that nurses need emotional, informative and instrumental support to make a complaint. Nurses demand support through knowledge, which can be obtained through education, in order to identify children who are at risk of harm. In addition, organizational support and a good cohesion within a multidisciplinary team is of great importance in promoting nurses' handling of a report of concern, where everyone in healthcare can reflect and share knowledge with each other. Nurses' own upbringing and individual judgement of norms and values have an impact in their decision of what is acceptable in an adult / child relationship, which affect the application process. As a result, nurses need support so that they share the same base of values and duties towards the child and the offender.

Amyotrofisk Lateral Skleros, ALS, är en neurologisk sjukdom vilken leder till att samtliga kroppens muskler förtvinas och dör. Då sjukdomen saknar bot blir all behandling symptomatisk och individuellt anpassad för varje enskild persons behov. I denna systematiska litteraturstudie har det sökts efter olika sätt att stötta denna patientgrupp då syftet att belysa hur vi som personal kan hjälpa och stötta personer med ALS relaterad dysfagi och andningsproblem till en så bra tillvaro som möjligt skulle belysas.Författarna har funnit att omvårdnaden sällan sätts i fokus. Det är istället de lösningar som tar bort symtomet som fått fokus i flertalet av de artiklar som granskats. Att hjälpa dessa personer till trygga och oberoende människor som kan fortsätta att leva istället för som många av artiklarna visade då det gjordes insatser som ledde till att personerna blev mer bundna till sina anhöriga och sina vårdare.

Bakgrund: Den ökande migrationen i världen leder till att större krav ställs på sjuksköterskor i vårdandet av immigrerade patienter. Sjuksköterskors vårdande av immigrerade patienter innebär att de kommer i kontakt med olika språk och kulturer. I mötet med dessa patienter uppstår språkbarriärer och kulturskillnader, vilket innebär att sjuksköterskan behöver ha en förmåga att ge en transkulturell omvårdnad. Sjuksköterskans upplevelser av att vårda dessa patienter är ett angeläget område att undersöka. Syfte: Syftet var att beskriva sjuksköterskors upplevelser av att vårda immigrerade patienter. Metod: En systematisk litteraturstudie med beskrivande syntes, som baserades på tolv kvalitativa vetenskapliga artiklar. Resultat: I resultatet framkom det två teman: utmaningar i kommunikationen och kulturens inflytande i vårdandet. Sjuksköterskorna upplevde utmaningar i vårdandet av immigrerade patienter som innebar kommunikationssvårigheter och kulturella skillnader. Det framkom även att sjuksköterskorna beskrev behov av mer kunskap och erfarenhet i transkulturell omvårdnad. Slutsatser: Kommunikationssvårigheter och kulturrelaterade företeelser upplevdes av sjuksköterskorna som hinder i vårdandet av immigrerade patienter. Sjuksköterskorna uttryckte behov av mer kunskap och erfarenhet som en grund för ökad kompetens och färdighet i att vårda immigrerade patienter.

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Mestrado Acadêmico em Ciências do Cuidado em Saúde
Este estudo tem como objeto: as relações interpessoais entre os trabalhadores de enfermagem em um hospital pediátrico. As relações interpessoais no trabalho de enfermagem constituem um aspecto importante para o desenvolvimento do processo do cuidar na qual se destaca como uma das formas de comunicação/expressão entre seres humanos visto que inclui os sujeitos no grupo, favorecendo para além de uma realização de vida no trabalho a melhoria da qualidade da assistência prestada. Objetivo geral: compreender como se estabelecem as relações interpessoais entre os profissionais de enfermagem para o desenvolvimento do cuidar da criança e sua família no contexto da emergência pediátrica e como objetivos específicos: descrever os elementos que configuram as relações interpessoais dos profissionais de enfermagem no trabalho em pediatria na perspectiva do profissional e analisar as possibilidades e limites nas relações interpessoais dos profissionais de enfermagem para o desenvolvimento do cuidar da criança e sua família. Cenário: o estudo foi realizado na unidade de emergência (UE) de um hospital universitário federal pediátrico no estado do Rio de Janeiro. Participaram do estudo 19 profissionais de enfermagem sendo seis enfermeiros e 13 técnicos de enfermagem. Resultados: os dados foram analisados baseados na análise temática de conteúdo e emergiram duas categorias temáticas: 1. As relações humanas interpessoais no trabalho da enfermagem e sua implicação na produção de cuidado da criança, O profissional de enfermagem na relação com a criança e sua família no contexto hospitalar durante o desenvolvimento do cuidado. A categoria 1 não apresentou sub temas, enquanto a categoria 2, expressou dois sub temas: 2.1 As possibilidades nas relações humanas interpessoais dos profissionais de enfermagem com a criança e sua família no desenvolvimento do cuidado; 2.2 Os limites nas relações humanas interpessoais no desenvolvimento do cuidado à criança e sua família. Os temas acolhimento, confiança; diálogo, relações profissionais e pessoais no ambiente de trabalho, amizade e união foram apontados pelos profissionais de enfermagem como elementos que configuram as relações interpessoais entre os profissionais para o desenvolvimento do trabalho. Os profissionais apresentaram o diálogo, respeito, confiança, gostar de cuidar da criança e relacionarem-se bem com a criança como possibilidades no relacionamento interpessoal no desenvolvimento do cuidar da criança. Foram apontados como limites no relacionamento dos profissionais de enfermagem as dificuldades na relação com o familiar que acompanha a criança internada e também o sofrimento relacionado ao envolvimento afetivo durante o cuidado da criança. Conclusão: olhar as relações humanas interpessoais sob a luz da complexidade permitiu compreender o sujeito humano em processo relacional no ambiente de trabalho. Neste estudo cuidar em pediatria pressupões saberes além do saber técnico. O profissional de enfermagem ao entrar em contato com os clientes precisam considerar que o cuidado é relacional e envolver-se na interação eu-tu proporciona vivenciar experiências com próprios sentimentos. Entender o ser humano na perspectiva da complexidade é considerar que as limitações fazem parte da condição humana entendendo que o que aparentemente pode parecer como uma limitação, também torna-se possibilidade quando compreendida como um modo diferente de ver e lidar com o fenômeno. A relações humanas interpessoais devem ser priorizadas uma vez que foi sinalizado que a forma como as pessoas se relacionam interferem no produto final do trabalho, no caso o cuidado a criança e sua família
This study aims at the interpersonal relationships among nurses in a pediatric hospital. The interpersonal relationships on nursing work are an important aspect for developing the process of caring in which it detaches as being one of the communication/expression ways among human beings since it includes the subjects of the group, facilitating, beyond a work lifetime achievement, the improvement of the quality of the assistance offered. General goal: to understand how interpersonal relationships are set among nurses for developing the care of children and their family on the context of pediatric emergency and as specific goals: to describe the elements that configure the interpersonal relationships of nurses working on Pediatricsin the perspective of the professional and to analyze the possibilities and limits on interpersonal relationships of nurses for developing care of children and their family. Scenario: the study was carried out on an emergency unit (EU) of a Federal University Pediatric Hospitalat Rio de Janeiro. Nineteen nursing professionals have participated: 6 nurses and 13 nursing technicians. Results: the data were analyzed based on content thematic analysis and two categories emerged: 1. Human interpersonal relationships on nursing work and its implication on the production of childcare, The nursing professional on the relationship with the child and his family in the hospital context during care development. The category 1 did not present subthemes, however the category 2 presented two subthemes: 2.1 The possibilities on interpersonal human relationships of nursing professionals with the child and his family on development of care; 2.2 The limits on interpersonal human relationships on development of care concerning the child and his family. The subjects: reception, confidence; dialog, professional and personal relationships on work environment, friendship and union were pointed out by the nursing professionals as elements configuring interpersonal relationships among the professionals for work development. The professionals presented dialog, respect, confidence, liking taking care of the child and having a good relationship with the child as possibilities of interpersonal relationship of childcare. As limits on nursing professionals relationship there were pointed out the difficulties on the relationship with the family member accompanying the hospitalized child and also the suffering concerning affective involvement during childcare. Conclusion: looking at interpersonal human relationships under the light of the complexity allowed understanding the human subject on relational process on work environment. In this study, care in Pediatrics requires knowledge beyond the technical know-how. The nursing professional, when he gets in touch with the clients, needs to consider that the care is relational and engaging in the interaction me-you allows living experiences with the own feelings. Understanding the human being on the perspective of the complexity is to consider that the limitations are part of human condition, understanding that what may look a limitation, becomes a possibility when it is understood as a different way of seeing and dealing with the phenomenon. Interpersonal human relationships must be prioritized once it was shown that the way people relate interferes on the work final product, in this case the care of the child and his family

Bakgrund: Sjuksköterskorna är till stor del ansvarig för läkemedelshantering i vården, således är även patientsäkerheten en viktig faktor som sjuksköterskorna behöver förhålla sig till i relation till läkemedelshantering för att upprätthålla säkerheten. Syftet var att identifiera faktorer som riskerade patientsäkerheten i sjuksköterskornas läkemedelshantering. Metoden som användes var en litteraturstudie. Studien genomfördes i form av en kritisk granskning av relevant litteratur och vetenskaplig forskning. Resultatet beskrev faktorer som orsakade, riskerade eller bidrog till osäker läkemedelshantering. Enligt 11 vetenskapliga artiklar utformades följande teman: Sjuksköterskornas handhavande, Arbetsmiljöns inverkan och Bidragande organisatoriska faktorer. Det framkom att sjuksköterskornas ogynnsamma arbetsmiljö, ett inadekvat antal patienter per sjuksköterska relaterat till sjuksköterskornas kompetens och erfarenhet samt långa arbetspass och åtskilliga pass i månaden var faktorer som bidrog till osäker läkemedelshantering. Sjuksköterskorna borde besitta förmågan att hantera stressiga situationer och kunna tyda oklara ordinationer. Det framkom att avbrott under iordningsställande av läkemedel var ett hinder för säkerheten i läkemedelshantering. Konklusion: Faktorerna som kunde identifieras i litteraturstudien påträffades i olika skikt av hälso- och sjukvårdsorganisationen. De identifierade faktorerna visar på förbättringsområden på individ och organisationsnivå för att kunna upprätthålla patientsäkerheten.
Background: The nurse is largely responsible of drug management, thus one important factor that the nurse should consider within the drug management should be the patient safety aspect. The aim was to identify factors risking the patient safety in the nurse’s drug management. The method used was a literature study. The study was conducted by a critical review of relevant literature and scientific research. The results describe factors that cause, risk or contribute to unsafe drug management. From 11 scientific articles the following theme was designed: Nurse’s handling, Impact of the work environment and Contributing organizational factors. The nurse’s unfavorable work environment, an inadequate number of patients per nurse, as well as long work sessions and several shifts per month are factors that cause unsafe drug management. Nurses should possess the ability to handle stressful situations and be able to interpret unclear prescriptions. Interruptions during the preparation of medicines is an obstacle to the safety during drug handling. Conclusion: Factors that was identified in the literature study were found in different layers by the healthcare organization. The identified factors show improvement areas in individual and organizational levels in order to maintain patient safety.

The experience of patients living with chronic obstructive pulmonary disease (COPD) and their views on the quality of healthcare they receive is not currently captured in patient reported measures. Aim: To develop and validate a patient reported experience measure to assess experiences of living with COPD and perceived quality of healthcare provision. Method: Previous work with 83 COPD patients identified 38 items for inclusion in a patient reported experience measure. These, together with the COPD Assessment Test and Hospital Anxiety and Depression Scale were administered to patients with COPD. Items demonstrating significant gender or age bias (p<0.05), floor or ceiling effects (set at 40%), missing data >15%, or high item to item correlations (r>0.8) were removed. Rasch analysis was applied to the remaining items. Results: 174 patients (Mean age 71 years, SD 9; 91 female; Mean Forced Expiratory Volume1 59%, SD 21.9) were studied. 29 items were removed, providing a 9-item unidimensional scale (chi-square p=0.33) with a wide scaling range (logits from -0.1 to +0.2). These cover experiences of living with COPD (e.g. I feel that I am in control of my condition) and health care (e.g. I am concerned that my GP won't listen to my point of view). Internal consistency was good (PSI= 0.77) and correlations between the COPD PREM-9, COPD Assessment Test and Hospital Anxiety and Depression Scale were moderate (r=0.42 and r=0.30, respectively). Conclusions: The COPD PREM-9 demonstrated good internal reliability and showed a wide scaling range suggesting, regardless of severity, people with COPD can have good or bad experiences. There were low to moderate correlations with the COPD Assessment Test and Hospital Anxiety and Depression Scale, which suggests the PREM COPD-9 is measuring a different concept. The COPD PREM-9 may be a useful measure of quality of care that complements measures of health status and mood.

The incidence of falls and serious injuries related to patient falls in hospitals is on the rise. This situation could potentially result in serious injuries and even death for the patient, as well as financial burden for acute care hospitals and increased workloads and stress for nursing staff. The incidence of falls in the metropolitan acute care hospital medical ward where this study was conducted continues to be problematic. This research study investigates the factors that cause patient falls in order to maintain and enhance sustainable falls prevention management. The falls risk assessment tool used in the hospital was part of the 6-PACK Falls prevention program for patients that was developed in 2002. A mixed method case study was employed for the research. Data was collected from a medical ward in two phases: Phase 1 analysed the quantitative falls data from the hospital RiskMan software tool and Patient Centred Care Plan (PCCP). This analysis informed the development of the qualitative research in Phase 2 which included the nurse questionnaire and nurse focus group discussions, as well as patient interviews to examine the complexities involved in falls management prevention. The triangulation of nurse and patient viewpoints of the falls prevention program, together with the administrative (RiskMan, PCCP) data, provides a fuller exploration of the contributing factors and adds to the body of knowledge in this important area. The Donabedian model of structure, process and outcome (SPO) was adapted to form an Inpatient Falls Prevention model that could be effective in the analysis of all aspects of patient care. The data collected in the quantitative and qualitative phases was analysed using this Inpatient Falls Prevention model. The case study identified that there were a significant number of patients whose falls risk assessment was not documented as part of their daily care plan. This resulted in high-risk patients not having falls prevention strategies implemented in their nursing care. For cognitively impaired patients falls were much higher for several reasons, including patient-nurse ratios, time challenges and issues surrounding the management of patients with dementia, delirium, and behavioural issues. The ward and bed layout, equipment malfunction, lack of patient education, and engagement in their falls prevention plan were also identified as contributing factors to inpatient falls. This study found that nurses failed to properly implement falls prevention strategies and management in the medical ward, and makes a number of recommendations for the benefit to all stakeholders - the healthcare system, hospitals, nurses, and most importantly, the patients. There is an increased need for professional development of nursing staff to identify and document patients at risk of falls and to modify the falls risk assessment tool. Patients need to be more actively engaged in their falls prevention plan and there needs to be better stakeholder communication: nurse to nurse, nurse to patient and nurse to allied health professionals. In addition, there is a need for more frequent PCCP auditing and immediate feedback to nursing staff. In this way, nurse knowledge of patient assessment, falls documentation and implementation strategies would assist in increasing patient safety and enhancing their hospital experience.

AIM: The aim of this research was to describe how the health professionals manage sudden/abrupt deaths in the ED and to foster change in current practice by involving the clients (dead or dying clients and their families) and the health professionals. METHOD: Action research was the approach used in this four year research project, and co-researchers (nurses) from three Level I ED's in KwaZulu-Natal were actively involved in shaping and guiding the project. The participants involved in the research were health professionals, bereaved families and mortuary staff members. FINDINGS: An intervention model, the Dealing with Sudden Death Model, was developed in order to guide the therapeutic management of sudden/abrupt deaths in ED's. Along with this was the development of the family pamphlet, the Preparation Checklist and the Incident Evaluation Checklist. Following the implementation of this model the health professionals emphasized the fact that this model provided guidance and meaning to the care rendered to the dead or dying client, the bereaved families and fellow colleagues. The Dealing with Sudden Death Model had resulted in a production of knowledge and planned changes in the management of sudden/abrupt deaths in the ED's.
Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2004.

M.Cur.
The researcher's occupation as medical services manager at a packaging company regularly brings her into contact with the occupational health nurses employed at the factories. She has become aware that the occupational health nurses often become involved in ethical dilemmas with regards to the handling of HIV -positive people at the workplace in that the interests of the HIV -positive conflict with the interests of the employer. The occupational health nurse finds him/herself acting as intermediary and advocate between the two parties, namely the employer and the HIV -positive person. In spite of the provision of legal norms and ethical standards to regulate the interests of the HN -positive person in the workplace, no guidelines exist as to how these norms and standards should be operasionalised during interaction between the HIV -positive person, the occupational health nurse and the employer. The occupational health nurse is therefore uncertain how to act professionally within laid-down ethical standards with the HIV -positive person at the workplace. The purpose of this study is to describe guidelines and criteria for the operasionalisation of ethical standards for the occupational health nurse regarding the HIV -positive person in the workplace. This objective is obtained through the following aims: • Researching and describing literature with specific reference to current legal and ethical frameworks within the occupational health context regarding interaction with the HNpositive person in the workplace in order to formulate these ethical standards; • Researching and describing problems and solutions for the following target groups regarding the ethical aspects regarding the HN -positive person in the workplace: Occupational health nurses The HN -positive person in the workplace. The design of the research is qualitative, explorative and descriptive. The research was carried out by studying the occupational health nurses and HN -positive people employed by the packaging company countrywide. The occupational health nurses who were involved were obtained from a purposive test sample. The HN -positive people were chosen by making use of a quota test sample. Data obtained from the occupational health nurses was gathered by means of a workshop, and the data from the HN -positive people was obtained through personal interviews. The results of the research identified certain problems and solutions which were experienced by both target groups. These problems and solutions are divided into four sub-categories to illustrate how individual, organisational, health and family-systems are influenced. In order to assist the occupational health nurses to ethically handle the HIV -positive person in the workplace, guidelines and criteria were drawn up for the operasionalisation of the ethical standards. Additional research themes were identified through the study, the goal being to further improve the ethical handling of the HIV-positive person in the workplace, and to give better support to the HIV positive person.

This study investigated the preventive and promotive health care in the practice of indigenous healers. It focussed on specific aspects of primary health care. The objectives of the study were to describe the current practice of indigenous healers with regard to preventive and promotive health care. The study also identified specific areas in which indigenous healers practices with regard to preventive and promotive health care can be enhanced. It also intended to describe the effect of a short training course for indigenous healers based on the assessment, with regard to their knowledge, beliefs and practice. The study was a qualitative multi-phased research project which ircluded three phases. The researcher's target population ccnsisted of indigenous healers in Region D of KwaZulu-Natal. The researcher targeted indigenous healers living at Vryheid District Under Hlahlindlela tribal Authority. Sisters at the clinics in Vryheid and Pietermaritzburg participated in the present study as well as western medical practitioners and nurses at Edendale hospital. Focus group discussions and individual interviews were conducted. A template method of data analysis was used. Results revealed that indigenous healers practices were claracterized by preventive and promotive health measures which were, to a greater extent African -culture related. Areas of concern where indigenous healers practices would be enhanced were intensified by the formal health care workers. A short training course was designed and implemented by the researcher. Evaluation of the training course revealed that it was to a greater extent effective.
Thesis (M.N.)-University of Natal, Durban, 2003.

This institutional ethnography relies on observations, interviews, and textual analyses to explore the experiences of mothers and children who attend a women-centered agency in Vancouver, Canada where a hot lunch, child care in the emergency daycare, and participation in group activities are vital forms of support. Mothers who come to the centre have many concerns related to their need for safe housing, a sustainable income, adequate food, child care, and support. And like mothers anywhere, they have concerns about their children. While many of the children, the majority of them First Nations, have never had a diagnostic assessment for fetal alcohol syndrome (FAS) or for the relatively new umbrella category, ‘fetal alcohol spectrum disorder’ (FASD), a number of the mothers were concerned or even knew that their children had FAS. This thesis asks – how does it happen that mothers have come to know their children in this way? The study critically examines how FASD knowledge and practices actually work in the setting and what they accomplish. My analysis traces how ruling practices for constructing and managing ‘problem’ mothers and children coordinate work activities for identifying children deemed to be ‘at risk’ for FASD. In their efforts to help their children and improve their opportunities for a better life, mothers become willing participants in group activities where they learn how to attach the relevancies of the FASD discourse to their children’s bodies or behaviours. They also gain instruction which helps them to confess their responsibility for children’s problems. While maternal alcohol use as the cause of FASD is contested in literature and in some work sites it is, in this setting, taken as a fact. This study discovers how institutional work processes involving government, medicine, and education actually shape and re-write women’s and children’s experiences into forms of knowledge that make mothers and children institutionally actionable. It is only by exposing the relations of power organizing mothers’ work that it may be possible to re-direct attention to mothers’ and children’s embodied concerns and relieve mothers of the overwhelming responsibility for which they are held and hold themselves to be accountable.
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