THE ROLE OF THE ENROLLED NURSING AUXILIARY IN A SELECTED HEALTH CARE ADMINISTRATION. by EDITH TIYA NI MABUNDA submitted in fulfilment of the requirements for the degree of MASTER OF ARTS IN NURSING SCIENCE at the UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROF S.W. BOOYENS JOINT SUPERVISOR: DR S KOCH JANUARY 1995 Student number: 415-205-0 DECLARATION I declare that THE ROLE OF THE ENROLLED NURSING AUXILIARY IN A SELECTED HEALT H CARE ADMINISTRATION is my own work and that all the sources that I have used or quoted have been indicated and acknowledged by means of complete references. 1995'- 01- ~4 SIGNATURE DATE (MISS E.T. MABUNDA) (i) SUMMARY The purpose of this study was to determine the contribution of nursing auxiliaries towards health care services against their scope of practice. Nursing auxiliaries practising within the Elim, Letaba, Malamulele, Nkhensani, Shiluvana and Tintswalo hospitals in the Gazankulu Health Administration, in the Northern Transvaal Province, constituted the target population. The findings revealed that nursing auxiliaries are not functioning strictly according to their scope of practice. They are an essential component of nursing services in Gazankulu by rendering a major contribution towards health care services in fulfilling their scope of practice-role. Apart from their prescribed practice-role, they are also engaged in activities that should be performed by enrolled and professional nurses as well as doctors and general assistants. There appears to be a need for education for all categories of nursing staff regarding the scope of practice of nursing auxiliaries for improving the effective utilisation of this category of nursing personnel. KEY TERMS Enrolled nursing auxiliary, Gazankulu area, health assistant, nurse aide, nursing assistant, nursing duties, orderly, role, scope of practice, selected health care administration, ward attendant. (ii) ACKNOWLEDGEMENTS. Firstly I want to thank God who made it possible for me to complete my dissertation. To my parents, thank you for your motivation, support, love and encouragement throughout my studies. To my children, to whom this book is dedicated, thank you for your patience. You frequently missed my attention and presence which you so rightfully deserved. So many people were helpful to me in the writing process of this dissertation . In particular I wish to acknowledge the contributions made by the following people: Professor S.W. Booyens and Dr S. Koch for their patience, encouragement and guidance. Their insight and suggestions were of invaluable assistance in preparing this dissertation. Mrs Nxalati Mawila who took ti.me from her busy schedule to read and critique this dissertation. Mr Alex Mbhombi for typing the measuring instrument Mr X.M. Maluleke and K.J. Baloyi for typing this dissertation. My friend Lunic Lowane in whose house I have spent long, uninterrupted hours of study. Thank you for your friendship. Uncle H.W. Nukeri and O.C. Mavanyisi who allowed me to use their houses as "hotels" and "study rooms". The Gazankulu Department of Health and Social Welfare for allowing me to conduct this research in its health services. The nursing auxiliaries in the Elim, Letaba, Malamulele, Nkhensani, Shiluvana and Tintswalo hospitals for willingly sharing their professional experiences with me. The Nursing Service Managers of the various institutions for their cooperation in the distribution of questionnaires and for checking the instrument for face and content validity. All my relatives, family and friends for their continued encouragement and support. (iii) THE ROLE OF THE ENROLLED NURSING AUXILIARY IN A SELECTED HEALTH CARE ADMINSTRA TION. TABLE OF CONTENTS. PAGE CHAPER 1 ORIENTATION TO THE STUDY. 1.1. Introduction...................................................................................................... 1 1.2. Statement of the problem.................................................................................. 3 1.3. Historical background of the nursing auxiliary................................................. 4 1.4. Theoretical framework....................................................................................... 5 1.5. Research questions............................................................................................ 6 1.6. The purpose of the study................................................................................... 7 1.7. Significance of the study.................................................................................... 8 1.8. Delimitation of the study.................................................................................... 9 1.9. Limitations of the study....................................................................................... 10 1.10. Definition of terms.............................................................................................. 10 1.11. Outlay of the research report.............................................................................. 11 1.12. Summary............................................................................................................. 11 CHAPTER 2 LITERATURE REVIEW 2.1. Introduction........................................................................................................ 12 2.2. Definitions of the nursing auxiliary................................................................... 12 2.3. Title/designation of the nursing auxiliary.......................................................... 15 2.4. Training of the nursing auxiliary....................................................................... 16 . 2.5.. Viewpoints regarding the practice of the nursing auxiliary............................. 21 2.6. Role and function of the nursing auxiliary........................................................ 29 2.7. Summary.............................................................................................................. 36 (iv) CHAPTER 3 METHODOLOGY. 3.1. Introduction................................................................................................ 37 3.2. Study design .............................................................................................. _,_ 37 3.3. The population............................................................................................. 37 3.3.1. Characteristics of the population................................................................ 39 3.4. The research instrument............................................................................... 40 3.4.1. The questionnaire........................................................................................ 40 3.4.2. Development of the instrument.................................................................... 40 3.5. Validity and reliability................................................................................. 41 3.5.1. Validity......................................................................................................... 41 3.5.2. Reliability...................................................................................................... 43 3.6. Pilot study...................................................................................................... 43 3.7. Ethical aspects................................................................................................ 45 3.8. Collection of data........................................................................................... 46 3.9. Response to questionna:rres............................................................................ 46 3.10. Data analysis.................................................................................................. 48 3.11. Summary........................................................................................................ 48 CHAPTER4 DATA ANALYSIS AND DISCUSSION OF THE FINDINGS. 4.1. Introduction.................................................................................................. 49 4.2. Discussion of fmdings................................................................................. 49 4.3. Conclusion.................................................................................................... 122 \ / (v) CHAPTER 5 COMMENTS, CONCLUSIONS, RECOMMENDATIONS AND IMPLICATIONS FOR THE NURSING PRACTICE. 5.1. Introduction.................................................................................................... 123 5.2. Summary......................................................................................................... 123 5.3. Profile of respondents..................................................................................... 124 5.4. Conclusions...................................................................................................... 126 5.5. Limitations....................................................................................................... 138 5.6. Implications of the findings............................................................................. 139 5.7. Recommendations............................................................................................. 140 5.8. Recommendations for further research............................................................ 142 5.9. Final comments................................................................................................. 142 6. BIBLIOGRAPHY.............................................................................................. 144 (vi) LIST OF TABLES PAGE TABLE 2.1.: Number of persons registered and enrolled in the Republic of South Africa as at 93-12-31.. ............... . 17 TABLE 3.1.: Gazank:ulu hospitals with their health centres, c1 r. m.c s and v1.s.1 t in.g po1•n t s .................................................. . 38 TABLE 3.2.: Indication of the total population according to hospital ..... 39 TABKE 3.3.: Return of questionnaires. .................................................. . 47 TABLE 4.1.: Experience of respondents ................................................... . 68 TABLE 4.2.: Comparison of experienced to inexperienced nursing auxiliaries regarding the extent to which activities for promotion and maintenance of health are performed .. .. .. .. 68 TABLE 4.3.: Comparison of experienced to inexperienced nursing auxiliaries regarding the extent to which activities for the provision of health and family planning information are performed........................................ 72 TABLE 4.4.: Comparison of experienced to inexperienced nursing auxiliaries regarding the extent to which activities for admission procedures are performed................................. 7 4 TABLE 4.5.: Comparison of experienced to inexperienced nursing auxiliaries regarding the extent to which activities for routine nursing procedures are performed.................................................... 77 (vii) TABLE 4.6.: Comparison of experienced to inexperienced nursing auxiliaries regarding the extent to which activities for advanced nursing procedures are performed ....................................................... . 79 TABLE 4.7.: Comparison of experienced to inexperienced nursing auxiliaries regarding the extent to which activities for recording and reporting are performed ...................................................................... . 84 TABLE 4.8.: Comparison of experienced to inexperienced nursing auxiliaries regarding the extent to which activities for the discharge procedures are performed .................................................................... . 85 TABLE 4.9.: Comparison of experienced to inexperienced nursing auxiliaries regarding the extent to which activities for the promotion and main tenance of the patients hygiene are performed .......................................................................... . 86 TABLE 4.10: Comparison of experienced to inexperienced nursing auxiliaries regarding the extent to which activities for the promotion and maintenance of the physical comfort of a patient are performed. ........................................................... . 88 (viii) TABLE 4.11: Comparison of experienced to inexperienced nursing auxiliaries regarding the extent to which activities for the prevention of physical deformity and other complications in a patient are performed ........................................................................... . 89 TABLE 4.12: Comparison of experienced to inexperienced nursing auxiliaries regarding the extent to which actitives for the supervision over and maintenance of a supply of oxygen to a patient are performed ........................................................................... . 91 TABLE 4.13: Comparison of experienced to inexperienced nursing auxiliaries regarding the extent to which activities for the taking of the vital signs of a patient are performed ............................................... .. 93 TABLE 4.14: Comparison of experienced to inexperienced nursing auxiliaries regarding the extent to which activities for the maintenance of intake in a patient are performed. .................................................... .. 95 TABLE 4.15: Comparison of experienced to inexperienced nursing auxiliaries regarding the extent to which activities for the maintenance of elimination in a patient are performed ...................................... . 98