Cognitive biases regarding utilization of emergency severity index among emergency nurses.

AIM: The study aimed to measure emergency nurses' prevalence of cognitive biases when utilizing Emergency Severity Index (ESI). Moreover, the study aimed to measure the differences between cognitive biases and demographic variables. BACKGROUND: Nurses use Emergency Severity Index (ESI) to prioritize the patients. Cognitive biases could compromise the clinical decisions of nurses in triage. Consequently, this hinders the delivery of safe and quality patient care. METHODS: A cross-sectional analytical approach invited 208 emergency nurses from four tertiary care hospitals. Institutional review board approval and permission from institutional heads were obtained. Informed consent was attained before data collection. Data was collected through a structured scenario-based questionnaire to measure cognitive biases at five levels of ESI. Descriptive and inferential statistics were obtained through v25.0 of SPSS. RESULTS: Among the 86.6% response rate, 56.2% of nurses were male. 62.90% had nursing diplomas. Cognitive biases were present at all ESI levels one to five, in order 51%, 45%, 90%, 89%, and 91% among nurses. Premature closure 22%, tolerance to risk 12%, satisfying bias 25%, framing effect 22%, and blind obedience 34% from level one to five consecutively. Demographic variables, including males, experience between 2 and 5 years, general nursing as qualification, and without emergency severity index certification, were identified to encounter more cognitive biases when making triage decisions. CONCLUSION: Numerous cognitive biases are considerably existing among emergency nurses when prioritizing patients. Cognitive de-biasing measures can improve triage decisions among nurses that could enhance quality care and patient safety.

Experiences of student nurses on role modelling of a therapeutic approach by registered nurses: Recommendations for improvement.

BACKGROUND: A therapeutic approach involves portraying the attributes of being polite towards fellow human beings and patients, respecting them irrespective of their circumstances and having sympathy and compassion for them. Knowledge of therapeutic approach is the initial step towards gaining patients' trust and developing student nurses' communication with patients; however, theoretical knowledge alone may not increase application in practice. Role modelling of a therapeutic approach increases patient care satisfaction and enables student nurses to therapeutically communicate with patients, colleagues and all other staff members. The most appropriate way for student nurses to learn what it means to portray therapeutic approach is seeing registered nurses' role modelling it. OBJECTIVES: To make recommendations for the enhancement of role modelling of therapeutic approach by registered nurses for student nurses at a regional public hospital. METHOD: A qualitative, exploratory, descriptive, phenomenological and contextual design was used. Three focus group interviews were conducted. Data were analysed using Giorgi's descriptive phenomenological method. Measures to ensure trustworthiness and ethical principles were applied throughout the research. RESULTS: One central theme with three main themes and related sub-themes indicated that student nurses had negative experiences on role modelling of therapeutic approach owing to registered nurses' non-therapeutic communication, lack of professionalism and ethical conduct as well as poor quality patient care. However, only the recommendations seeking to address the experiences of non-therapeutic communication which included negative attitudes of registered nurses towards patients, lack of provision of patient information, poor handling of patients' complaints as well as racial discrimination re-handling of patients' complaints will be highlighted. CONCLUSION: The majority of student nurses had negative experiences on role modelling of therapeutic approach by registered nurses. They needed registered nurses to improve their approach towards patients. It is expected that the implementation of the recommendations will enhance therapeutic approach to patients.

Nurse managers experiences of their leadership roles in a specific mining primary healthcare service in the West Rand.

BACKGROUND: Nurse managers are leaders in mining primary healthcare. Their leadership roles include inspiring and empowering operational managers and nursing personnel, by leading with competence developing them to become followers with insight and direction. However, these leadership roles are not clearly defined, and are negatively influenced by the traditional mining leadership style. OBJECTIVES: The aim of this study was to explore and describe the nurse managers' experiences of their leadership roles in a specific mining primary healthcare service on the West Rand, to develop recommendations to enhance these roles. METHOD: A qualitative, exploratory, descriptive and contextual research design was used in this study, following a phenomenological approach as a research method. A non-probability purposive sampling method was used. Nurse managers described experiences of their leadership roles during individual phenomenological interviews. Data saturation was reached on participant number 7. To analyse data, four stages of Giorgi's descriptive phenomenological data analysis was used. An independent coder coded the data and a consensus meeting was held. The study was guided by the theoretical framework of Winkler's role theory. RESULTS: The following subthemes emanated from data analysis: (1) leadership role ambiguity, (2) leadership roles experienced and (3) challenges experienced in leadership roles. CONCLUSION: This study revealed that the leadership roles for nurse managers in a specific mining primary healthcare service are not clearly defined. Hence enhancements and expansions of these leadership roles remained stagnant. A clearly defined policy on leadership roles for nurse managers should be developed.

Reasons for non-compliance with quality standards at primary healthcare clinics in Ekurhuleni, South Africa.

BACKGROUND: The South African Minister of Health stated that compliance with quality standards in health services is non-negotiable as it is fundamental in improving South Africa's current poor health outcomes, restoring patient and staff confidence in the public healthcare system, achieving widespread sustainable development and providing basic quality healthcare in South Africa. Non-compliance with quality standards, as evidenced by increased quality-related queries from the community, prompted the researcher to explore and describe the reasons for such at primary healthcare clinics in Ekurhuleni. AIM: This study sought to explore and describe the reasons for non-compliance with quality standards at the primary healthcare in Ekurhuleni in order to propose recommendations to facilitate compliance with quality standards. SETTING: The study was conducted at primary healthcare clinics in Ekurhuleni, one of the metropolitan districts, situated in an area east of the Gauteng province. METHODS: A qualitative, exploratory, descriptive and contextual research design was used for this study. Participants were purposefully selected from the population and consisted of individuals who willingly consented to participate. Twelve semi-structured individual interviews were conducted. RESULTS: The study findings revealed challenges with management practices, for example, non-involvement in decision-making, lack of support and poor internal communication practices. In addition, challenges with human, material and financial resources were stated as reasons for non-compliance with quality standards. CONCLUSION: Recommendations to facilitate compliance with quality standards were described, which included implementation of effective management practices and allocation of adequate healthcare resources required to facilitate such compliance.

Factors influencing motivation of nurse leaders in a private hospital group in Gauteng, South Africa: A quantitative study.

BACKGROUND: Nurse leadership is about aligning employees to a vision. This happens with buy-in, motivation and communication. When conducive environments are created by organisations, the motivation of nurse leaders will be enhanced, which will have a positive outcome on the organisation. Highly motivated nurse leaders accomplish more and are more productive. Nurse leadership is an essential source of support, mentorship and role modelling. These attributes tend to be more evident when nurse leaders are motivated. OBJECTIVES: The objective of this study was to determine the factors that influence the motivation of nurse leaders. METHOD: A quantitative, descriptive design and stratified sampling was used. Participants comprised unit managers (n = 49) from five hospitals in a private hospital group in South Africa. A self-administered questionnaire, namely, the Multidimensional Work Motivation Scale, was used to collect the data. Data were analysed using the IBM SPSS 22.0 program. RESULTS: The results indicated that the nurse leaders in this study were intrinsically motivated. Their motivation was influenced by support, relatedness, autonomy and competence. No relationships were found between motivation and age, years in a management position, gender, qualifications and staff-reporting structure. CONCLUSION: By implication, to understand what motivates nurse leaders and to keep them motivated, recommendations were proposed to nursing and human resources management. It is expected that the implementation of the recommendations will have a positive influence on patient outcomes, organisational success and the motivation and satisfaction of nurse leaders.

Student nurses' experiences regarding their clinical learning opportunities in a public academic hospital in Gauteng province, South Africa.

BACKGROUND: During the training of student nurses, clinical placement is a compulsory requirement, as it exposes them to learning opportunities for the acquisition of clinical skills. This prepares them to become safe and competent professional nurses. However, the increased intake of student nurses in the Gauteng nursing colleges led to overcrowding in a public academic hospital, thus negatively influencing their learning experiences and availability of clinical learning opportunities. AIM: The purpose was to explore and describe the student nurses' experiences regarding their clinical learning opportunities to make recommendations to enhance their clinical learning opportunities in order to address the optimisation of their learning experiences. METHODOLOGY: A qualitative, exploratory, descriptive and contextual research design was used. A purposive sampling method was used to select second-year student nurses registered in the Regulation (R425) programme for qualifying as a nurse (general, psychiatry and community) and midwife, as they would have acquired at least 1 year of clinical experience. Four focus groups, which comprised six to eight participants, were constituted, and research was conducted until data were saturated. Field notes were simultaneously taken to enrich the data collected. Thematic coding of qualitative data was used. Principles of trustworthiness and ethical principles were adhered to. RESULTS: The study revealed four themes. Three were negative experiences that included overcrowding, negative emotional experiences of student nurses and challenges of professional nurses. A theme concerning positive experience entailed knowledge-sharing amongst various health care disciplines. CONCLUSION: It was evident that student nurses had more negative emotional experiences than positive experiences. Therefore, the need to enhance their clinical learning opportunities in order to address the optimisation of learning experiences is eminent.

Reasons for non-compliance with quality standards at primary healthcare clinics in Ekurhuleni, South Africa

Background: The South African Minister of Health stated that compliance with quality standards in health services is non-negotiable as it is fundamental in improving South Africa's current poor health outcomes, restoring patient and staff confidence in the public healthcare system, achieving widespread sustainable development and providing basic quality healthcare in South Africa. Non-compliance with quality standards, as evidenced by increased quality-related queries from the community, prompted the researcher to explore and describe the reasons for such at primary healthcare clinics in Ekurhuleni. Aim: This study sought to explore and describe the reasons for non-compliance with quality standards at the primary healthcare in Ekurhuleni in order to propose recommendations to facilitate compliance with quality standards. Setting: The study was conducted at primary healthcare clinics in Ekurhuleni, one of the metropolitan districts, situated in an area east of the Gauteng province. Methods: A qualitative, exploratory, descriptive and contextual research design was used for this study. Participants were purposefully selected from the population and consisted of individuals who willingly consented to participate. Twelve semi-structured individual interviews were conducted. Results: The study findings revealed challenges with management practices, for example, non-involvement in decision-making, lack of support and poor internal communication practices. In addition, challenges with human, material and financial resources were stated as reasons for non-compliance with quality standards. Conclusion: Recommendations to facilitate compliance with quality standards were described, which included implementation of effective management practices and allocation of adequate healthcare resources required to facilitate such compliance

Recommendations to facilitate managers' compliance with quality standards at primary health care clinics.

BACKGROUND:  The Republic of South Africa (RSA) is shifting towards universal health coverage and a unified health system. This milestone can be achieved through the implementation of National Health Insurance (NHI). To employ NHI, health establishments in the country are compelled to comply with quality standards. The non-compliance with quality standards at primary health care (PHC) clinics within a district in Gauteng, which was verified by quality standards' audit reports, prompted an intervention. No prior research aimed at facilitating managers' compliance with quality standards has been conducted within the context under study. This research gap necessitated an exploration on how managers' compliance to quality standards at PHC clinics within a district in Gauteng could best be facilitated. OBJECTIVES:  To describe recommendations to facilitate managers' compliance with quality standards at PHC clinics within a district in Gauteng. METHOD:  A qualitative, exploratory, descriptive and contextual research design was used in this study. Semi-structured, individual interviews were conducted. RESULTS:  The recommendations to facilitate managers' compliance with quality standards at PHC clinics within a district in Gauteng were described. However, for the purpose of this article, only the recommendations seeking to address challenges with management practices as a reason for non-compliance with quality standards at PHC clinics will be discussed. These recommendations include involvement of PHC clinic managers in decision-making, adequate support from senior management and improvement of internal communication practices. CONCLUSION:  The researcher concludes that the senior management team in the district under study should strive to embrace the described recommendations as a strategy to facilitate managers' compliance to quality standards at PHC clinics.