Strategies for the Facilitation of Self-Leadership Among Ward Nurses in a Nurse-Led Critical Care Outreach Service.

Introduction: Nurses are responsible for monitoring and providing nursing care to patients. The early detection of a patient who is starting to deteriorate - and the activation of critical care outreach services (CCOS) - can improve patient outcomes. However, the literature indicates that CCOS are underutilised. Self-leadership is a process whereby persons influence their own behaviour. Objective: The purpose of this study was to develop strategies for the facilitation of self-leadership in ward nurses that will enable them to act proactively and promptly in utilising CCOS at a private hospital group in South Africa. Methods: A sequential exploratory mixed-method research approach was followed to develop strategies for the facilitation of self-leadership in nurses that will enable them to utilise CCOS proactively when a patient starts to deteriorate. An adapted version of Neck and Milliman's self-leadership strategic framework was used as the methodological steps of the study. Results: The quantitative analysis extracted eight factors, which were used as the departure point to develop strategies for the facilitation of self-leadership among nurses in a CCOS. Five strategies were developed that related to self-motivation, role models, patient outcome, assistance and guidance from CCOS, and the power of self-confirmation; these strategies aligned with the themes and categories extracted from the qualitative data analysis. Conclusion: There is a need for self-leadership among nurses in a CCOS.

Self-leadership of nurses in a critical care outreach service: The development of a conceptual framework.

Background: Globally, critical care outreach services (CCOS) were implemented in health care facilities; however, compliance with guidelines is poor. The authors have noticed that a gap exists in the literature on how self-leadership might influence nurses' implementation of CCOS. Self-leadership is about leadership applied to oneself. Critical care outreach services assist nurses with the nursing care of a patient whose health is declining. Leadership is needed for the successful implementation of CCOS. Aim: This article aims to outline the method the authors followed for developing the conceptual framework for how self-leadership amongst nurses influenced the functioning of CCOS. Setting: The research was conducted at a private hospital in Pretoria. Methods: A qualitative approach was followed to provide an accurate description of nurses' experiences on their self-leadership in a CCOS. The practice-oriented theory of Dickoff (1968) was the reasoning map for developing and constructing the conceptual framework. Results: Bedside nurses experienced the following self-leadership strategies: constructive thought patterns, natural rewards and behaviours focused on their implementation of CCOS. Conclusion: The conceptual framework was part of another study and provided the authors with a rationale that guided the authors with the development of self-leadership strategies in a CCOS. Contribution: The conceptual framework provided the authors with an understanding of how nurses' self-leadership influenced the implementation of CCOS. The conceptual framework can also assist in developing training programmes for nurses to improve their self-leadership and ultimately improve nurses' competence in providing quality nursing care to patients.

Experiences of nurses practising mindfulness during self-leadership in delivering a rapid response system for general wards in a private hospital in Gauteng.

BACKGROUND:  The increased complexity of the nursing care needs of patients and acuity in general wards present nursing care challenges for nurses. Self-led nurses are attentive, taking responsibility for activating the rapid response service when a patient is starting to deteriorate. OBJECTIVES:  The purpose of this article is to describe nurses' experiences practising mindfulness during self-leadership in delivering a rapid response system (RRS) in a private hospital in Gauteng. METHOD:  A qualitative, exploratory, descriptive and contextual design was followed. Homogenous purposive sampling was used and a total of eight focus groups were conducted. Focus groups durations were between 45 min and 60 min. The data analysis was carried out through open coding on Atlas.ti using the noticing things, collecting things and thinking about things (NCT) approach. An independent coder met with the researcher during a consensus meeting and finalised the analysis. RESULTS:  The findings indicated an underlying theme of nurses being mindful in their self-leadership through the development of self-motivation and self-direction in the RRS. Three categories with six subcategories emerged from the data analysis, namely self-motivation in an RRS by the team, self-direction through role-modelling to peers and training. CONCLUSION:  Nurses practised mindfulness during self-leadership, utilising behavioural and natural reward approaches and constructive thought patterns. These findings could assist management with developing training programmes for nurses.

Factors that guide nurse managers regarding the staffing of agency nurses in intensive care units at private hospitals in Pretoria.

Staffing needs affect the nursing department's budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse) perceive the staffing of agency nurses in intensive care units (ICUs). The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n=124). One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.