Hester C. Klopper

Practice environment, job satisfaction and burnout of critical care nurses in South Africa.

AIM To describe the practice environment, job satisfaction and burnout of critical-care nurses (CCNs) in South Africa (SA) and the relationship between these variables. BACKGROUND CCNs are more sensitive to job satisfaction and burnout, and several studies have been published on the relationship between these variables. However, the research that was undertaken did not focus exclusively on the practice environment of CCNs or the context of SA. METHOD The RN4CAST survey was used. A stratified sample of 55 private hospitals and seven national referral hospitals were included in the study. A total of 935 CCNs completed the survey. RESULTS The practice environment is positive, except for staffing and resource adequacy, and governance. The greatest job dissatisfaction is experienced with regard to wages, opportunities for advancement and study leave. CCNs have a high degree of burnout. CONCLUSION The high degree of burnout is related to dissatisfaction with wages, opportunities for advancement, study leave and a practice environment with inadequate staffing and resources, and lack of nurse participation in hospital affairs. IMPLICATIONS FOR NURSING MANAGEMENT Managers should ensure that adequate numbers of CCNs are on the staff allocation and provide opportunities for CCNS to participate in policy and governance of the hospital, while giving attention to good salaries and providing opportunities for advancement and study leave.

A tale of two systems—Nurses practice environment, well being, perceived quality of care and patient safety in private and public hospitals in South Africa: A questionnaire survey

OBJECTIVE To examine the practice environment, nurse reported quality of care and patient safety, and nurse workforce outcomes in medical and surgical units in private and public hospitals in South Africa (SA), and determine the association of modifiable features of the hospital such as the practice environment and patient to nurse workloads on these outcomes. DESIGN Cross-sectional survey of nurses. SETTING AND PARTICIPANTS Nurses were surveyed in medical and surgical units of 55 private hospitals and 7 public national referral hospitals in SA. A total of 1187 nurses completed the survey. MEASUREMENTS Practice environment, patient to nurse workloads, nurse reported quality of care and patient safety, and nurse workforce outcomes including burnout, job satisfaction and intention to leave. RESULTS On a national level, more than half, 54.4% (634/1166) of nurses intend to leave their hospital within the next year due to job dissatisfaction and 52.3% (600/1148) rate their practice environment as poor or fair, while almost half, 45.8% (538/1174) report high levels of burnout and 44.9% (517/1152) are not confident that management will resolve patient problems. Public hospital nurses report more negative outcomes than private hospital nurses. Some 71% (320/451) of public hospital nurses rate their practice environment as poor/fair, 62.9% (281/447) are not confident management will resolve patient problems, and 59% (272/461) intend to leave their hospital within the next year due to job dissatisfaction. On a national level, more favourable practice environments are significantly associated with more positive nurse reported quality of care, and nurse workforce outcomes. This is true for private and public hospitals. Patient to nurse workloads are also significantly associated with more positive nurse reported quality of care and patient safety, and nurse workforce outcomes, but primarily in public hospitals. CONCLUSIONS Improving the practice environment, including patient to nurse ratios holds promise for retaining a qualified and committed nurse workforce and may benefit patients in terms of better quality care.

Integrative literature review defining evidence-based neurodevelopmental supportive care of the preterm infant.

Neurodevelopmental supportive care (NDSC) is a well-researched topic and extensive evidence is available on its benefits in terms of the outcome for preterm infants. The programs, strategies, and individual elements of NDSC have been evaluated; however, knowledge and implementation of the developmental care approach is fragmented and the evidence base for elements of NDSC that make up the holistic model is not explicitly documented. The aim of this study was to identify and critically appraise the methodologic quality of relevant research studies and synthesize the current best available evidence of NDSC. A comprehensive investigation of NDSC including studies using research methods other than clinical trials may provide a combination of results from several primary studies, therefore an integrative literature review was utilized as the method of choice. Sixteen research articles were found to be of good methodologic quality and level and strength of evidence after critical appraisal. They described or defined the elements of NDSC explicitly. Extraction of data from these articles contributed to the formulation of 25 conclusion statements. Each of these statements could be grouped under 9 categories that resulted from a process of synthesis, and each of these categories could be substantiated from its literature support, clinical impact, and supporting evidence, including the specific literature references and volume and level of evidence associated with that element of NDSC, providing the evidence base for defining NDSC.

The nature of community health care centre practice environments in a province in South Africa

The practice environment plays an important role in nursing. Currently, limited information seems to exist on the nature of practice environments within the primary health care (PHC) context of the public health care sector of South Africa. This study describes the demographic profile of community health care centres (CHCs) and professional nurses (PNs) as well as the current status of the practice environment of nurses in the PHC context. A quantitative, descriptive cross-sectional survey design was used. Firstly, demographic data of the CHCs (N=41; n=26) was obtained. Secondly, PNs (N=291; n=195) were surveyed using the Practice Environment Scale of the Nursing Work Index (PESNWI) and questions focussing on their demographic profile. The demographic profile of CHCs and PNs was described and the confirmatory analysis of the PES-NWI showed that the survey was valid in the PHC context of South Africa. The Cronbach alpha ranged between 0.68 and 0.86. Nurses disagreed that the sub-scales named staffing and resource adequacy and nurse participation in PHC/CHC affairs were present in their practice environments. Development and implementation of a positive practice environment programme for the South African PHC context could improve the wellbeing of nurses and assist in the delivery of quality care to patients.

Quality of nursing doctoral education in seven countries: survey of faculty and students/graduates

AIMS This study aimed to compare the findings of the quality of nursing doctoral education survey across seven countries and discuss the strategic directions for improving quality. BACKGROUND No comparative evaluation of global quality of nursing doctoral education has been reported to date despite the rapid increase in the number of nursing doctoral programmes. DESIGN A descriptive, cross-country, comparative design was employed. METHODS Data were collected from 2007-2010 from nursing schools in seven countries: Australia, Japan, Korea, South Africa, Thailand, UK and USA. An online questionnaire was used to evaluate quality of nursing doctoral education except for Japan, where a paper version was used. Korea and South Africa used e-mails quality of nursing doctoral education was evaluated using four domains: Programme, Faculty (referring to academic staff), Resource and Evaluation. Descriptive statistics, correlational and ordinal logistic regression were employed. RESULTS A total of 105 deans/schools, 414 faculty and 1149 students/graduates participated. The perceptions of faculty and students/graduates about the quality of nursing doctoral education across the seven countries were mostly favourable on all four domains. The faculty domain score had the largest estimated coefficient for relative importance. As the overall quality level of doctoral education rose from fair to good, the resource domain showed an increased effect. CONCLUSIONS Both faculty and students/graduates groups rated the overall quality of nursing doctoral education favourably. The faculty domain had the greatest importance for quality, followed by the programme domain. However, the importance of the resource domain gained significance as the overall quality of nursing doctoral education increased, indicating the needs for more attention to resources if the quality of nursing doctoral education is to improve.

Leadership, job satisfaction and intention to leave among registered nurses in the North West and Free State provinces of South Africa.

BACKGROUND The nurse leadership of a hospital is identified as the single most important aspect of the practice environment that impacts nurse outcomes. When nurses are satisfied with their jobs, they tend to remain with their employers and become more productive in their workplaces. OBJECTIVES This study aimed to investigate the relationship between leadership, job satisfaction and intentions to leave among registered nurses (RNs) working in hospitals in the North West and Free State provinces of South Africa. METHODS A cross-sectional survey design was adopted. The population (N = 680) with the sample (n = 204) included RNs in medical-surgical units in both private and public hospitals in the two provinces. Data were collected using the RN4CAST questionnaire. RESULTS RNs were satisfied with the items pertaining to leadership except for praise and recognition (55.7%). They also indicated high levels of overall job satisfaction (70.5%) but were dissatisfied with wages (50%), study leave (40.9%) and opportunities for advancement (40.1%). Furthermore, 46.1% of the RNs intended to leave their current hospitals. The results indicated a relationship between leadership and job satisfaction (r = 0.47; p = 0.00) and between intention to leave and job satisfaction (d = 0.50). CONCLUSION The nurse managers played a significant role influencing RNs level of job satisfaction, while job satisfaction was highly correlated with intention to leave. The nurse leadership can improve job satisfaction by giving praise and recognition to the RNs for jobs well done, and RNs should be afforded the opportunity to advance their careers through further studies.

Community-Based Collaboration in Support of Older Persons

This study describes the processes for community-based collaboration in support of the older person living in the world of HIV/AIDS in South Africa. Secondary data from study from 333 older persons (> 60 years) and 28 leaders of community agencies of and for health and wellbeing were thematically analyzed. Findings suggest that older persons are resources in community partnership for ameliorating the impact of HIV and AIDS. This would be the case even as the older people may be living with HIV or AIDS.

Educational background of nurses and their perceptions of the quality and safety of patient care

Background International health systems research confirms the critical role that nurses play in ensuring the delivery of high quality patient care and subsequent patient safety. It is therefore important that the education of nurses should prepare them for the provision of safe care of a high quality. The South African healthcare system is made up of public and private hospitals that employ various categories of nurses. The perceptions of the various categories of nurses with reference to quality of care and patient safety are unknown in South Africa (SA). Objective To determine the relationship between the educational background of nurses and their perceptions of quality of care and patient safety in private surgical units in SA. Methods A descriptive correlational design was used. A questionnaire was used for data collection, after which hierarchical linear modelling was utilised to determine the relationships amongst the variables. Results Both the registered- and enrolled nurses seemed satisfied with the quality of care and patient safety in the units were they work. Enrolled nurses (ENs) indicated that current efforts to prevent errors are adequate, whilst the registered nurses (RNs) obtained high scores in reporting incidents in surgical wards. Conclusion From the results it was evident that perceptions of RNs and ENs related to the quality of care and patient safety differed. There seemed to be a statistically-significant difference between RNs and ENs perceptions of the prevention of errors in the unit, losing patient information between shifts and patient incidents related to medication errors, pressure ulcers and falls with injury.

The quality of doctoral nursing education in South Africa.

Background The number of doctoral programmes in nursing has multiplied rapidly throughout the world. This has led to widespread concern about nursing doctoral education, specifically with regard to the quality of curricula and faculty, as well as to the availability of appropriate institutional resources. In South Africa, no study of these issues has been conducted at a national level. Objective To explore and describe the quality of nursing doctoral education in South Africa from the perspectives of deans, faculty, doctoral graduates and students. Method A cross-sectional survey design was used. All deans (N = 15; n = 12), faculty (N = 50; n = 26), doctoral graduates (N = 43; n = 26) and students (N = 106; n = 63) at South African nursing schools that offer a nursing doctoral programme (N = 16; n = 15) were invited to participate. Data were collected by means of structured email-mediated Quality of Nursing Doctoral Education surveys. Results Overall, the graduate participants scored their programme quality most positively of all the groups and faculty scored it most negatively. All of the groups rated the quality of their doctoral programmes as good, but certain problems related to the quality of resources, students and faculty were identified. Conclusion These evaluations, by the people directly involved in the programmes, demonstrated significant differences amongst the groups and thus provide valuable baseline data for building strategies to improve the quality of doctoral nursing education in South Africa.