The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

Caring for cancer patients in acute cancer care settings: Voices of South African nurses

Little is known about the experience of nurses in Africa caring for cancer patients. This study was undertaken to provide a straightforward description of the experiences of South African nurses caring for patients in acute cancer care settings. Purposive sampling selected 20 nurses with whom there were in-depth interviews. Most of the participants were female registered oncology nurses with more than five years' experience. Three themes were identified: defining the cancer nursing experience, the challenges experienced in caring for cancer patients, and challenges imposed by the healthcare system. Most of the participants believed they were called by God to care for cancer patients. However, the challenges they experienced led to guilt feelings and believing the care they provided was insufficient. They were subjected to workplace violence, missed the support from senior nursing management, and displayed signs of burnout. Addressing these challenges could limit their emotional distress and prevent burnout.

S’occuper des patients atteints de cancer : l’expérience d’infirmières et d’infirmiers d’Afrique du Sud travaillant en soins aigus

On sait peu de choses de l’expérience des infirmières et infirmiers d’Afrique du Sud qui soignent les patients atteints de cancer. La présente étude avait pour but de décrire en termes simples l’expérience du personnel infirmier travaillant dans les milieux de soins aigus. Par échantillonnage dirigé, on a sélectionné 20 infirmières et infirmiers qui ont ensuite passé des entrevues détaillées. Il s’agissait pour la plupart de femmes, infirmières autorisées en oncologie, ayant plus de 5 ans d’expérience. Trois thèmes sont ressortis des discussions : la définition de l’expérience des soins infirmiers oncologiques, les difficultés de la prestation de soins aux patients atteints de cancer, et les problèmes attribuables au système de santé. Pour la plupart, les personnes ayant participé à l’étude croyaient que Dieu les avait appelées à travailler auprès des patients atteints de cancer. Toutefois, à cause des difficultés vécues, elles se sentaient coupables et n’avaient pas l’impression de donner des soins adéquats. En outre, elles étaient victimes de violence dans leur milieu de travail, ne bénéficiaient pas du soutien des cadres de gestion des soins infirmiers, et montraient des signes d’épuisement professionnel. Pour réduire la détresse émotionnelle et prévenir l’épuisement, il faudra trouver une solution à ces problèmes.

Psychometric testing of the Persian version of the Nursing Care Quality Scale: A methodological study

AIM

To evaluate the psychometric properties of the Persian version of the Cambodian Nursing Care Quality Scale.

DESIGN

Methodological design.

METHODS

This study was carried out in several steps: a forward-backward translation was done, face and construct validity was measured using exploratory and confirmatory factor analysis and the reliability was evaluated. A convenience sampling method was employed to recruit 350 nurses from May 2021 to March 2022.

RESULTS

The exploratory factor analysis extracted six factors that explained 60.76% of the total variance. The six-factor model is supported by confirmatory factor analysis. The Cronbach's alpha and the intra-class correlation coefficient were 0.94 and 0.85, respectively.

PATIENT OR PUBLIC CONTRIBUTION

Evaluation of the quality of care can lead to the enhancement of the quality of nursing services and patient safety. This will subsequently increase the patients' and community satisfaction.

The perceived effects of generational diversity on supervision of new professional nurses in public hospitals

Background

The current global nursing workforce is a combination of personnel from three different generation cohorts, which are the Baby Boomers, Generation X and Generation Y (Millennials). These generational cohorts work side by side to provide quality nursing care to the patients on a daily basis.

Aim

This article aims to report the effects of generational diversity on the supervision of new professional nurses in selected public hospitals in North West Province.

Setting

This study was conducted at seven public hospitals situated at three out of the four districts of North West Province, South Africa. These public hospitals classifications consist of six districts and one provincial hospitals.

Methods

The study followed an exploratory, descriptive and contextual qualitative research design underpinning the constructivist paradigm was followed to pave a way for this study. Operational managers were purposively sampled and data were collected using the focus group discussion as well as individual interviews. Data analysis followed the guideline of the thematic analysis.

Results

This article reports on three themes that emerged from data analysis, namely (1) generational differences, (2) insubordination and (3) impact on supervision.

Conclusion

Understanding the generational diversity and its impact on the supervision of new professional nurses might assist in improving the leadership styles for operational managers and will promote collegiality among colleagues and positively influence the provision of quality care for patients.

Contribution

These results provide a framework for future research and provide the basis for understanding the impacts generational diversity has on supervision of new professional nurses.

Nurse leaders' experiences of professional responsibility towards developing nursing competence in general wards: A qualitative study

AIM

To explore nurse leaders' experiences of professional responsibility to facilitate nursing competence in general wards.

BACKGROUND

Nurse leaders are responsible for maintaining high levels of competence among nurses to improve patient safety.

METHODS

Qualitative analysis was conducted between February and April 2019 using semi-structured interview data from 12 nurse leaders in surgical and medical wards at three Norwegian hospitals.

RESULTS

Four main themes were identified: struggle to achieve nursing staff competence; focus on operational and budgetary requirements rather than professional development; demands to organize sick leaves and holiday periods; and challenges in facilitating professional development.

CONCLUSION

Nurse leaders felt that their responsibilities were overwhelming and challenging. They witnessed more support for current administrative tasks than for the implementation of professional development. Additionally, unclear work instructions from the employer provided few opportunities to facilitate professional development. Hospital management failed to ensure quality of care and patient safety in general wards by not supporting the strengthening of nurses' professional competence and preventing turnover.

IMPLICATIONS FOR NURSING MANAGEMENT

Management may integrate formal work instructions that clarify nurse leaders' responsibilities as professional developers, allowing nurse leaders to meet their obligation of maintaining adequate professional competence among nursing staff in general wards.

Nurse managers' learning facilitation practices: A philosophical hermeneutic study

AIM(S)

To understand how nurse managers facilitate learning in clinical workplaces.

BACKGROUND

Meeting staff learning needs in the complex workplaces of contemporary health care is paramount to the delivery of safe patient care. Hospitals employ a range of strategies to address these needs. However, nurse managers' contribution to staff learning at the unit level is underexplored in contemporary literature.

METHOD(S)

A Gadamerian philosophical hermeneutic framework guided data collection and analysis. Thirteen nurse managers from two Australian hospitals each participated in two interviews and a period of observation.

FINDINGS

Nurse managers' learning facilitation practices were enacted with staff individually, within teams, and through artefacts, and were shaped by their identities, perspectives on staff learning, knowledge of staff performance, and motivations. Power was revealed as a uniquely enacted driver of their learning facilitation practices.

CONCLUSION(S)

This paper illuminates an aspect of nurse managers' practice that has been poorly acknowledged in contemporary nursing literature. Nurse managers' learning facilitation practices were found to be complex, fluid, and embedded in their everyday work routines.

IMPLICATIONS FOR NURSING MANAGEMENT

Given current concerns about safety and quality in health care, this research opens up possibilities for definition and enrichment of nurse managers' practice as facilitators of learning.

Perceptions of nurses on access to structural empowerment in a hospital in the Western Cape

Background

Structural empowerment is an ever-evolving concept interpreted and applied in many different ways as it focuses on the structures in a healthcare organisation to allow competent nurses to manage empowering opportunities in a professional manner. At a public hospital in the Western Cape, nurses complained about a lack of access to structural empowerment in a hospital, including structures of power, such as clear information, to partake in important decisions.

Objectives

The purpose of this study was to describe how nurse managers could support nurses in accessing structural empowerment through power resources.

Method

A quantitative design was followed with a survey. The accessible population in this study was different categories of nurses of professional, enrolled and assistant nurses (N = 200), which were on duty at the time of data gathering. The sample was selected by means of probability sampling (n = 110). An existing instrument based on a five-point Likert scale was distributed that took 45 minutes to complete. Descriptive and inferential statistics were calculated, and the chi-square was used to indicate statistical significance differences among the nursing categories on the items (p < 0.05).

Results

The general results indicated that the majority of nurses had challenges to access structural empowerment through power sources (information, support and resources). Significant differences were found between nurse categories for having the necessary supplies for the job (p = 0.043) and rewards for unusual job performance (p = 0.023). Those aspects on which no significant differences were found are of utmost importance, as they indicate the urgency of addressing limitations in power sources for all categories of nurses.

Conclusion

Empowerment can be achieved by enabling access to structural empowerment through power sources (i.e. opportunities, information, resources and support) at different levels for all categories of nurses.

The Influence of Nursing Work Environment on Patient Safety

Background: Patient safety has been a concern over the past two decades. The value of nurses and their work environment in relation to patient safety has been acknowledged by studies and international organizations. This study aimed to examine the relationship between patient safety practices and the nursing work environment. Methods: In total, 570 registered nurses were invited from the inpatient units in public and private hospitals. Perceived patient safety was evaluated using the Overall Perceptions of Patient Safety subscale from the Hospital Survey of Patient Safety Culture (HSPSC). The nursing work environment was assessed using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Findings: Of the 350 of 570 (64.6%) nurses surveyed, 35.2% (125) reported positive levels of perceived patient safety. Staffing and resource adequacy, professional communication style, and nurses’ participation in hospital quality improvement activities were associated with higher levels of perceived patient safety. Conclusion/Application to Practice: This study provided empirical results about perceived patient safety culture in relation to nursing work environment. It is paramount to focus on specific dimensions of the nursing work environment, such as staffing and resource adequacy, nurses’ participation and advancement, and communication style to improve the quality of care provided to patients. Hospitals are considered one of the most hazardous places compared with industries. Policy makers would help reduce injuries, save resources, and build a culture of safety when taking into consideration the importance of the nursing work environment in relation to patient safety.

Impact of having a certified nurse specialist in critical care nursing as head nurse on ICU patient outcomes

Objectives

This study evaluated the impact of the presence of a certified nurse specialist in critical care (CNS) as ICU head nurse in an open ICU on clinical outcomes.

Methods

The presence of a CNS as ICU head nurse was implemented in practice in April 2017. To evaluate the impact on patient outcomes before and after the implementation, patients were divided into two groups: before (April 2014 to March 2017; 1988 patients) and after (April 2017 to March 2019; 1664 patients). Patients’ demographic data were collected from the ICU database.

Results

Multivariable logistic regression analysis revealed that the presence of a CNS as ICU head nurse was associated with lower ICU mortality (odds ratio (OR): 0.52, 95% CI: 0.36–0.73, p < .001) and fewer patients receiving mechanical ventilation in the ICU (OR: 0.20, 95% CI: 0.15–0.26, p < .001).

Conclusion

CNSs are defined as one type of advanced practice nurses. Having a CNS as a head nurse in the ICU may have helped improve patient outcomes by leveraging these practical skills in nursing management.

'We are the advocates for the babies' - understanding interactions between patients and health care providers during the prevention of mother-to-child transmission of HIV in South Africa: a qualitative study

Background: HIV/AIDS has had a significant impact on maternal and child health in South Africa. It is thus of vital importance to implement interventions to prevent mother-to-child transmission of HIV (PMTCT) as early as possible during pregnancy. Negative interactions between patients and health care providers (HCPs) can be an important barrier to antenatal care, PMTCT use and PMTCT adherence. Research about respectful maternity care has focused more on the patient perspective. We therefore compared the patient and HCP perspectives and reflected on how interactions between HCPs and patients can be improved. Objective: To obtain insights into the attitudes of HCPs in the context of HIV and PMTCT-related care, by studying patient and HCP perceptions of their interactions, in a peri-urban hospital setting in Gauteng province, South Africa. Methods: A qualitative study was conducted in a public tertiary-level hospital. Fourteen semi-structured in-depth interviews were conducted with nurses and doctors in the antenatal clinic and postnatal ward. Thirty-one semi-structured in-depth interviews and two focus group discussions were conducted with HIV positive and negative women on the postnatal ward. Results: HCPs experienced a difficult work environment due to a high workload. This was combined with frustrations when they felt that patients did not take responsibility for their own or their child's health. They were motivated by the need to help the child. Patients experienced judging comments by HCPs especially towards younger, older and foreign women. They expressed fear to ask questions and self-blame, which in some cases delayed health care seeking. No discrimination or isolation of HIV infected patients was reported by patients and HCPs. Conclusion: We hypothesize that more humane working conditions for obstetric HCPs and a caring, personalised approach to patient management can improve patient-provider interactions and access to respectful care. These are critical to preventing mother-to-child transmission of HIV.

Nurse managers' work content: development of the questionnaire and results of the pilot study

AIM

To develop the Nurse Managers' Work Content Questionnaire (NMWCQ) and to describe nurse managers' work content.

BACKGROUND

Restructuring within health care has expanded the nurse manager's role to include organisational, patient and staff demands.

METHODS

The pilot study employed a cross-sectional study design. Based on a literature review, the NMWCQ with 102 items was developed and pretested for this study. Data were collected in 2017 from three Finnish acute care central hospitals that provide specialised health care. A total of 61 nurse managers participated, which represents a response rate of 59%. Principal component analysis was used to test the construct validity of the instrument. Cronbach's alpha values were used to analyse the internal consistency of the instrument. In addition, descriptive and nonparametric analysis was used.

RESULTS

Ultimately, 13 components with 87 items were identified in the questionnaire. The construct validity and internal consistency of the questionnaire were at acceptable levels. Cronbach's alpha rates of the components were 0.554 - 0.890. The most frequently performed daily work of nurse managers was in the component of organising, and the most infrequently performed daily work was in the component of clinical nursing.

CONCLUSIONS

The study shows that the Nurse Managers' Work Content Questionnaire (NMWCQ) is suitable for measuring the current content of nurse managers' work. However, the questionnaire is new and needs additional testing such as confirmatory factor analysis with larger amounts of data.

Socio-economic characteristics and career intentions of the WiSDOM health professional cohort in South Africa

Background

The human resources for health (HRH) crisis and dearth of research on the health labour market in South Africa informed the WiSDOM (Wits longitudinal Study to Determine the Operation of the labour Market among its health professional graduates) cohort study. The study aims to generate new knowledge on the career choices and job location decisions of health professionals in South Africa.

Methods

WiSDOM is a prospective longitudinal cohort study. During 2017, the first cohort for each of eight professional groups was established: clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists and physiotherapists. These cohorts will be followed up for 15 years. For the baseline data collection, each final year health professional student completed an electronic self-administered questionnaire (SAQ), after providing informed consent. The SAQ included information on: demographic characteristics; financing of training; reasons for choosing their profession; and their career intentions. We used STATA^® 14 to analyse the data.

Results

We obtained an 89.5% response rate and 511 final year health professional students completed the baseline survey. The mean age of all participants was 24.1 years; 13.1% were born in a rural area; 11.9% and 8.0% completed their primary and secondary schooling in a rural area respectively. The health professional students came from relatively privileged backgrounds: 45.0% had attended a private school, the majority of their fathers (77.1%) had completed tertiary education, and 69.1% of their mothers had completed tertiary education. Students with higher socio-economic status (SES Quintiles 3–5) made up a larger proportion of the occupational therapists (77.8%), physiotherapists (71.7%), doctors (66.7%), and dentists (64.7%). In contrast, individuals from SES Quintiles 1 and 2 were over-represented among the clinical associates (75.0%), oral hygienists (71.4%), nurses (61.9%), and pharmacists (56.9%). Almost one quarter (24.9%) of cohort members indicated that they had partly financed their studies through loans. Although 86.3% of all cohort members indicated that they plan to stay in their chosen profession, this ranged from 43.2% for clinical associates to 100% for dentists.

Conclusions

WiSDOM has generated new knowledge on health professional graduates of a leading South African University. The results have implications for university selection criteria and national health workforce planning.

Difficulties of unit managers in selected district hospitals in Cameroon

BACKGROUND

Being appointed to a managerial position because of one's clinical skills seems to be prestigious, even powerful. However, being a unit manager in a resource-constrained district hospital can be a daunting task. Also, managing a ward unit with no previous training in leadership and management can be very challenging.

OBJECTIVES

The purpose of this study was to describe the difficulties, in the day-to-day activities, of unit managers in selected Cameroonian district hospitals.

METHOD

A constructionist, descriptive Husserlian phenomenological inquiry was conducted to describe the difficulties of unit managers in two district hospitals. Ten unit managers were selected through a purposive sampling scheme, and then interviewed using semi-structured interviews. Coliazzi's qualitative data analysis method was used for analysis.

RESULTS

This study revealed that unit managers looked for assistance because it is not easy to be in their position. Their role implied facing difficulties and making sacrifices for something that is not even worth the trouble. Therefore, as a way to overcome their difficulties, they asked for assistance from the organisation, from their families and from God as strategies to face their difficulties.

CONCLUSION

The difficulties faced by unit managers in the selected district hospitals revealed the need to prepare nurses for managerial positions by ensuring they are trained as managers before commencing employment as a manager.

Enablers and barriers to clinical leadership in the labour ward of district hospitals in KwaZulu-Natal, South Africa

Introduction and background

Like many health systems in low-income and middle-income countries, the South African health system has failed to decrease both maternal and perinatal mortality significantly, especially in district hospitals. Inappropriately trained healthcare providers and poor clinical leadership are repeatedly linked to healthcare providers’ preventable factors contributing to most maternal and perinatal deaths. Clinical skills of healthcare providers have been largely addressed, while clinical leadership remained neglected. One strategy implemented recently to support clinical leadership is the introduction of District Clinical Specialist Teams (DCSTs). Clinical leadership in the labour ward of district hospitals in KwaZulu-Natal (KZN) is conceptualised as an emergent phenomenon arising from dynamic interactions in the labour ward and the broader health system, converging to attain optimal patient care.

Aim

To evaluate the enablers and barriers to clinical leadership in the labour ward of district hospitals.

Method

Iterative data collection and analysis, following the Corbin and Strauss grounded theory approach, was applied. In-depth interviews were carried out with the midwifery members of the DCSTs in KZN. The emergent enablers and barriers to clinical leadership were presented and discussed at a workshop with broader midwifery representation, leading to a final classification of enablers and barriers to clinical leadership.

Results and conclusion

Enablers and barriers to clinical leadership arise as a result of emergent dynamic interactions within the labour ward and the broader health system, located at policy, organisational, team and individual healthcare provider levels, with the policy context as the overriding factor framing the implementation of clinical leadership.

Using scenarios to explore conflict management practices of nurse unit managers in public hospitals

Background

Workplace conflict is common among nurses globally. Learning how to manage it may reduce related adverse consequences. Inappropriate management of conflict is attributed to decreased productivity, poor morale and financial loss for organisations. Nurse unit managers can play a key role by effectively managing workplace conflict in the units.

Objectives

To explore how nurse unit managers manage conflict in public hospitals and subsequently to make recommendations on how to optimise conflict management skills of nurse unit managers.

Method

A qualitative, explorative, descriptive and contextual study was conducted to explore how nurse unit managers managed conflict based on a scenario provided to them. Purposive sampling was used to select nurse unit managers working in three public hospitals. Eleven nurse unit managers participated in the study. Data were collected in two phases. In phase 1, a conflict scenario was developed in consultation with experienced nurse managers. The conflict scenario was used during phase 2, which involved individual face-to-face semi-structured interviews with nurse unit managers until data saturation. Tesch’s method of thematic synthesis was used to analyse the data. Literature review was undertaken to ascertain what is considered as an appropriate intervention in conflict management.

Results

Three themes emanated from data analysis: nurse unit managers managed conflict appropriately, nurse unit managers avoided the conflict and nurse unit managers managed conflict inappropriately.

Conclusion

While some of the nurse unit managers managed conflict appropriately, additional and continuous education and training is required to optimise the capacity and develop their conflict management competency. The findings could be integrated into orientation, training and preparation of nurse managers by health care organisations and educational institutions.

Challenges of being a hospital nurse manager in the Volta region of Ghana: a qualitative study

AIM

To explore the challenges facing hospital nurse managers (HNMs) in selected hospitals in the Volta region of Ghana.

METHOD

The study, which had an exploratory qualitative design, involved the recruitment of 12 HNMs from six public hospitals in the Volta region of Ghana. Purposive sampling was used and data were collected through semi-structured interviews. The conventional content analysis approach was adopted for data analysis.

FINDINGS

The study revealed several managerial challenges of being HNMs in performing their roles. These include: a lack of managerial preparedness, clear job descriptions and support; interference by other managers; and inadequate nursing staff and material resources. All these compromised the quality of nursing care. Participants found their role tedious and stressful, but also regard it as an opportunity to learn new ideas.

CONCLUSION

HNMs face several challenges that negatively affect their performance. There is a need for succession planning, career development and mentoring programmes to strengthen HNMs' leadership and management skills to help them provide high-quality nursing care.

The content of nurse unit managers' work: a descriptive study using daily activity diaries

BACKGROUND

NUMs' job description in Icelandic hospitals has been revised and now also includes managerial and financial responsibilities.

AIM

To describe the actual work activities of nurse unit managers (NUMs) in surgical and internal medicine services as self-documented and reflected in their job description.

DESIGN

Prospective exploratory study.

METHOD

The study's setting was the largest hospital in Iceland. Data were collected over 7 days from NUMs working on surgical and medical units with an activity diary listing five domains and 41 activities: 'management and planning' (seven activities), 'staff responsibility (seven activities), 'direct clinical work' (five activities), 'service' (12 activities) and 'other' (nine activities).

RESULTS

The managers' spent most of their time within the 'other' domain (32% of their time), then the next significant amount of time on 'management and planning' and 'clinical nursing' (19%), and the least amount of time on 'service' (14%). All reported working on two or more activities simultaneously. NUMs made erroneous estimations approximately half of the time about the domain they spent most of their time in and their satisfaction with their work each day varied greatly.

CONCLUSION

The work of NUMs is highly diverse, including undefined miscellaneous tasks and clinical work beyond their job description.

An evaluation of the competencies of primary health care clinic nursing managers in two South African provinces

Background

Managerial competencies to enhance individual and organisational performance have gained currency in global efforts to strengthen health systems. Competent managers are essential in the implementation of primary health care (PHC) reforms that aim to achieve universal health coverage.

Objective

To evaluate the competencies of PHC clinic nursing managers in two South African provinces.

Design

A cross-sectional study was conducted in two South African provinces. Using stratified random sampling, 111 PHC clinic nursing managers were selected. All supervisors (n=104) and subordinate nurses (n=383) were invited to participate in the survey on the day of data collection. Following informed consent, the nursing managers, their supervisors, and subordinate nurses completed a 40-item, 360-degree competency assessment questionnaire, with six domains: communication, leadership and management, staff management, financial management, planning and priority setting, and problem-solving. Standard deviations, medians, and inter-quartile ranges (IQRs) were computed separately for PHC nursing managers, supervisors, and subordinate nurses for competencies in the six domains. The Tinsley and Weiss index was used to assess agreement between each of the three possible pairs of raters.

Results

A 95.4% response rate was obtained, with 105 nursing managers in Gauteng and Free State completing the questionnaires. There was a lack of agreement about nursing managers’ competencies among the three groups of raters. Overall, clinic nursing managers rated themselves high on the five domains of communication (8.6), leadership and management (8.67), staff management (8.75), planning and priority setting (8.6), and problem-solving (8.83). The exception was financial management with a median score of 7.94 (IQR 6.33–9.11). Compared to the PHC clinic managers, the supervisors and subordinate nurses gave PHC nursing managers lower ratings on all six competency domains, with the lowest rating for financial management (supervisor median rating 6.56; subordinate median rating 7.31).

Conclusion

The financial management competencies of PHC clinic nursing managers need to be prioritised in continuing professional development programmes.

"Mindless Medicals"

This article explores stakeholders' perceptions of the quality of occupational health service (OHS) delivery in South Africa. Using a purposive sampling technique, 11 focus group discussions (FGDs) were conducted in three provinces. Focus group participants ( n = 69) were recruited through professional organizations of occupational physicians and occupational health nurses as well as employer representatives of major industries in South Africa. Transcriptions of FGDs were analyzed using thematic content analysis. South Africa has diverse models of OHS delivery with varying quality. Focus group participants criticized the outsourced model of service delivery and the excessive focus on physical examinations to achieve legal compliance. These problems are exacerbated by a perceived lack of employer emphasis on occupational health, insufficient human and financial resources, and lack of specific quality of care standards for occupational health. Improvement in the quality of OHS delivery is essential to realize South Africa's quest for universal health coverage.