Strategies to address management challenges in larger intensive care units.

AIM: To illustrate the need for and suggest strategies that will enhance sustainable management of a large intensive care unit (ICU). BACKGROUND: The challenges faced by intensive care nursing in South Africa are well documented. However, there appear to be no strategies available to assist nurses to manage large ICUs or for ICU managers to deal with problems as they arise. METHODS: Data sources to illustrate the need for strategies were challenges described by ICU managers in the management of large ICUs. A purposive sample of managers was included in individual interviews during compilation of evidence regarding the challenges experienced in the management of large ICUs. The challenges were presented at the Critical Care Society of Southern Africa Congress held on 28 August to 2 September 2012 in Sun City North-West province, South Africa. RESULTS: Five strategies are suggested for the challenges identified: divide the units into sections; develop a highly skilled and effective nursing workforce to ensure delivery of quality nursing care; create a culture to retain an effective ICU nursing team; manage assets; and determine the needs of ICU nurses. CONCLUSION: ICUs need measures to drive the desired strategies into actions to continuously improve the management of the unit. Future research should be aimed at investigating the effectiveness of the strategies identified. IMPLICATIONS FOR NURSING MANAGEMENT: This research highlights issues relating to large ICUs and the strategies will assist ICU managers to deal with problems related to large unit sizes, shortage of trained ICU nurses, use of agency nurses, shortage of equipment and supplies and stressors in the ICU. The article will make a contribution to the body of nursing literature on management of ICUs.

Communication satisfaction of professional nurses working in public hospitals.

AIM: This study aimed to establish and describe the level of communication satisfaction that professional nurses experience in selected public hospitals in the City of Johannesburg, South Africa. BACKGROUND: The success of any organisation depends on the effectiveness of its communication systems and the interaction between staff members. METHOD: Data were collected by means of questionnaires, based on the Communication Satisfaction Questionnaire (CSQ), from a sample of 265 professional nurses from different categories, chosen using a disproportionate random stratified sampling method. RESULTS: The results indicated poor personal feedback between nurse managers (operational managers) and professional nurses, as well as dissatisfaction among nurse managers and professional nurses with regard to informal communication channels. A lack of information pertaining to policies, change, financial standing and achievements of hospitals was identified. CONCLUSION: Nurse managers should play a leadership role in bringing staff of different departments together by creating interactive communication forums for the sharing of ideas. IMPLICATIONS FOR NURSING MANAGEMENT: The results emphasise the need for nurse managers to improve communication satisfaction at all levels of the hospital services in order to enhance staff satisfaction and create a positive working environment for staff members.

Reasons for Doctor Migration from South Africa

Background: The migration of doctors from their home countries is not a new phenomenon. Apart from voluntary migration due to various reasons; medical professionals; often from sub-Saharan Africa; are actively recruited by developed countries. Doctors in South Africa are esteemed for the high standard of training they receive locally; a quality which renders them prime candidates for employment. Various factors are involved in the push-pull theory of migration. It has; however; been reported extensively that push factors usually play a much greater role in doctors' decision to leave their countries of origin; than the pull factors in the host or recipient country. Push factors motivating migration most frequently include dissatisfaction with remuneration packages and working conditions; high levels of crime and violence; political instability; lack of future prospects; HIV/AIDS; and a decline in education systems. In addition to a depletion of intellectual resources through losing highly qualified and skilled individuals; source countries also face substantial monetary implications caused by the migration of doctors. The cost of training medical students is subsidised by the government; and could be regarded as a lost investment when young graduates seek permanent employment abroad. The aim of the study was to investigate the profile of South African qualified physicians who emigrated from South Africa. Methods: The investigation was conducted in 2005 as a descriptive study where the participants were primarily found by the snowball sampling method. The initial group of participants were known to the researcher. Participants had to be graduates from South African medical schools/faculties; living abroad and in possession of a permanent work permit in the countries where they were employed. Short-term locum doctors were not included. Information; consent letters and questionnaires were either hand-delivered or e-mailed; and completed forms and questionnaires were returned via these routes. Participation was voluntary. Results: Twenty nine of 43 potential participants responded; of which 79.3were male and 20.7female between the ages of 28 and 64 years (median 47 years). The year of graduation ranged from 1964 to 2000 (median 1985); and the year of leaving the country ranged from 1993 to 2005 (median 2002). The majority (72.4) were in private practice before they left; 27.5had public service appointments and 17.3were employed by private hospitals. Seventy nine percent of respondents had postgraduate qualifications. Countries to which migration occurred included New Zealand; United Arab Emirates; Bahrain; United Kingdom; Canada; Yemen; and Australia. Forty one percent of respondents indicated that they would encourage South African young people to study medicine; although 75would recommend newly graduate doctors to leave the country. Financial factors were indicated as a reason for leaving by 86.2of the respondents; better job opportunities by 79.3; and the high crime rate in South Africa by 75.9. Only 50of the respondents said that better schooling opportunities for their children played a role in their decision to leave the country. Approximately one-fifth (17.9) of the respondents indicated that they already had family abroad by the time they decided to emigrate. Conclusions: Financial reasons were the most important motivating factor in this particular group of doctors who relocated to overseas destinations; followed by working conditions and the rate of crime and violence in the country. In comparison to other investigations published previously; the results presented here clearly indicate a tendency that more doctors offer financial and crime-related reasons for migration from South Africa than before. In order to prevent the loss of medical expertise from a society already in need of quality healthcare; issues compelling doctors to look for greener pastures should be addressed urgently and aggressively by stakeholders

Organisational climate as a cause of job dissatisfaction among nursing staff in selected hospitals within the Mpumalanga Province.

This article focuses on a study conducted with the purpose of exploring and describing the organisational climate as a cause of job dissatisfaction among nursing staff in selected hospitals within the Mpumalanga Province. The major objectives were to determine what organisational climate encompasses; ascertain which factors related to organisational climate can cause dissatisfaction among nurses; determine whether there is a difference in the way nursing management and the nursing staff perceive the existing organisational climate; and make recommendations for health service managers to improve the organisational climate in order to facilitate greater job satisfaction among the nursing staff. A quantitative approach with an exploratory and descriptive design encompassing the survey method was used. A questionnaire was applied as the data collection instrument and was distributed to 140 respondents. The results indicated that the nursing management and the nursing staff were content with the intrinsic factors of their jobs, but were dissatisfied with the extrinsic factors of the organisational climate. The outcome of this research affirms that there are extrinsic factors within the organisational climate that affect the nursing management and the nursing staff adversely. Recommendations were made to promote job satisfaction in selected public hospitals within the Mpumalanga province.

Factors influencing post abortion outcomes among high-risk patients in Zimbabwe.

Post abortion complications remain one of the major causes of mortality among women of child bearing age in Zimbabwe. Based on this problem, factors associated with mortalities due to abortion were investigated with the aim of improving post abortion outcomes for Zimbabwe's women, and possibly also for women of other African countries. Cases and controls were selected from 4895 post abortion records to conduct a retrospective case-control study. Significant risk factors identified for reducing mortalities due to post abortion complications included the administration of oxytocic drugs and evacuation of the uterus whilst anaemia and sepsis apparently reduced these women's chances of survival. Women who died (cases) from post abortion complications apparently received better reported quantitative care than controls. Recommendations based on this research report include improved education of health care workers and enhanced in-service training, regular audits of patients' records and changed policies for managing these conditions more effectively in Zimbabwe.

Primary Care as a Means of Decreasing Health Care costs

The study was focussed at furthering the health objectives of the Government's Reconstruction and Development Programme in the area of primary care. The purpose of the study was to examine the possible reduction of medical scheme claims for cardiovascular disease by means of primary care; so that medical scheme benefits do not become exhausted so rapidly. A quantitative approach; using an explorative and descriptive design was used. A survey was done by means of a questionnaire which was distributed to 250 principle members of the medical scheme in four selected divisions of a private organisation. Thereafter; a limited clinical assessment was done on the participants. In addition; case studies were used to illustrate the cost savings that could be obtained by the delivery of managed primary care of cardiovascular (CVD) conditions. Twenty-seven percent of the participants had current; or a history of cardio-related conditions; and 32.15 percent of the participants were identified as having an overall high risk for CVD. Contributing circumstances aggravating these conditions were life style-related issues. Nurse-based primary care should focus on primary prevention; for example; taking personal responsibility weight management; sufficient exercise; discontinuing smoking habits; stress management; and secondary prevention which involves annual medicals; and a focussed approach of specific screening protocols

The role of the ward manager in creating a conducive clinical learning environment for nursing students.

Ward sisters/managers are without doubt the professional gate keepers of the ward environment yet there are activities in that environment for which they do not seem to take full responsibility, namely that of the clinical learning of nursing students. The aim of this study was to investigate the role of the ward manager in creating a conducive clinical learning environment for nursing students. An explorative descriptive research method was employed. Findings reveal that the ward managers are generally satisfied with the way in which they handle the important role they play in facilitating teaching and learning for nursing students. They feel strongly, however, that the nursing students themselves need to be active in the learning process. While acknowledging the efforts of the ward managers in creating and maintaining the learning environment, nursing students were dissatisfied about several aspects that appeared to be lacking in the clinical environment, such as good interpersonal relations, support, exposure to practice administrative skills (for example, problem-solving and decision-making) and lack of feedback about their performance. There appears to be a need to develop more effective support structures within the learning environment so that nursing students can obtain sufficient exposure to learning opportunities.

[The teaching function of the registered nurse--I]. / Die opleidingsfunksie van die geregistreerde verpleegkundige--deel I.

A descriptive exploratory survey was undertaken by means of a questionnaire submitted to student nurses and registered nurses of hospitals affiliated with a nursing college in the Transvaal. The aim of the study was to establish whether, and to what extent, the training function of the ward sister is realised in practice. Analysis of the data showed the ward sister to be aware of her training function and her responsibility towards the student nurse as learner. It appears that the ward sister believes herself to be adequately involved with the basic care of patients and making a significant contribution to the training of student nurses. However, the observations and the experience of the student nurse differ from this point of view. She is of the opinion that more can be done in the ward to help her achieve her training needs. The fact that in many cases she is primarily considered as a worker, comes as a great disappointment.

[A scoring system for the evaluation of prenatal cardiotocograms: a study on normal patients]. / 'n Telsisteem vir die evaluering van voorgeboortelike kardiotokogramme: 'n studie van normale pasiënte.

A 10-point scoring system based on the basal heart rate, amplitude and frequency of variation, accelerations and decelerations was developed to assess antenatal fetal heart rate patterns in 47 patients with uncomplicated pregnancies and deliveries. From a gestational age of 28 weeks the fetal heart rate was monitored every 2 weeks until 36 weeks and then every week until delivery, usually by ultrasound. Every 4-minute period of the cardiotocogram was scored and then the mean score was calculated for every test. The mean score for all the tests was 6,9 with a standard deviation of 1,8. In 1 patient a basal bradycardia was responsible for the low score. At the end of the pregnancy, the fetal heart rate in this patient fluctuated between 90 and 110/min. A heart rate above 180/min was seen on three occasions in 3 different patients. Tests before or after these episodes of tachycardia were all normal. Severe variable decelerations and non-reactive heart rate pattern in 1 patient were responsible for the lowest score seen in this study. This patient developed severe variable decelerations during labour; at caesarean section, the umbilical cord was tightly around the neck twice. The difference between the lowest and highest 4-minute scores was called the fluctuation of the score. Between 28 and 36 weeks the mean fluctuation of the score varied between 0,6 and 1,2. After 36 weeks however, the mean fluctuation suddenly increased to 1,67 at 37 weeks and to 1,9 at 38 weeks. After 38 weeks the score fluctuation gradually declined again. The mean score was not influenced by the duration of pregnancy.

The importance of a scoring system for positive contraction stress tests.

A scoring system based on the basal fetal heart rate (FHR), accelerations, decelerations, and amplitude and frequency of variation was developed to evaluate positive contraction stress tests more accurately. Retrospective analysis and scoring was carried out on 149 patients who had had positive contraction stress tests (repeated late decelerations during spontaneous or induced uterine contractions). Five-minute Apgar scores were low in 35% of patients with low FHR scores but in only 18% when the FHR score was not low (P less than 0,05). When the FHR score was low 66% of neonates were growth-retarded, as opposed to 38% when the score was not low (P less than 0,01). The prevalence of intra-uterine growth retardation decreased as the FHR score improved. A wider fluctuation of subscores for each 5-minute period was associated with better fetal outcome than in patients who had fixed subscores. FHR scores below 4 were associated with high fetal mortality and prevalence of growth retardation.