THE CLINICAL RESOURCE NURSE'S PEER MENTORING ROLE IN SEHA FACILITIES IN ABU ...

131 Pages·2017·0.98 MB·English

THE CLINICAL RESOURCE NURSE’S PEER MENTORING ROLE IN SEHA
FACILITIES IN ABU DHABI, UNITED ARAB EMIRATES

By

AGNES NTLALETSE de LANGEN

Student Number: 672-420-5

Submitted in accordance with the requirements

For the degree of

DOCTOR OF LITERATURE AND PHILOSOPHY

In the subject

HEALTH STUDIES

At the

UNIVERSITY OF SOUTH AFRICA

PROMOTER: PROF ON MAKHUBELA-NKONDO

JOINT PROMOTER: DR EM MATLAKALA

DECEMBER 2016
DECLARATION
I, Agnes Ntlaletse de Langen, solemnly declare that:

THE ROLE OF A CLINICAL RESOURCE IN PEER MENTORING, is my own original
work; and to the best of my knowledge, it has not been previously submitted for
degree or examination purposes at any other institution of higher learning.
I declare further that all the sources that I have used or quoted have been duly
indicated and acknowledged by means of complete bibliographic references.

Signed: ______________________ ___________________
Agnes Ntlaletse de Langen Date

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DEDICATION
I dedicate this exegetic work posthumously to my parents, Mr Aaron and Mrs
Herminah Ramasehla, for instilling in me a culture of discipline and inculcating an
appreciation of the value of education. I greatly appreciate and admire their resolute
courage and determination.
Agee, Mokone ‘a Mabula le Kwena e kgolo ya ka meetseng!!!
To Leago Ramasehla, my recently born granddaughter, I communicate the same
lessons still etched in my mind from my parents’ teachings:
Kodumela moepa thutse, ga go lehumo le tšwago kgauswi”.
(Perseverance is the mother of success)!
I am now passing the baton on to you, Leago.

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ACKNOWLEDGEMENTS
I acknowledge the invaluable contributions made to this study by a host of individuals
and organizations whose names are mentioned below. That others are not
mentioned by name hereunder, does not in any way constitute a non-recognition or
diminishment of their immeasurable efforts and various other relevant contributions
expended. I have neither omitted their names condescendingly, nor attenuated their
indelible personal and professional insights. I take full responsibility for any omission
that may arise.
 I extend my most hearfelt gratitude to my Heavenly Father; for His numinous
guidance to first seek His kingdom and its righteousness, and that everything else
will be added unto me. My Creator enabled me to depend on Him for everything.
Without Him, I am nothing. He sent His holy angels to lift me up, lest I tread on
stones. Thank you Father God for good health and your numinous guidance
throughout this journey;
 My promoter, Professor ON Makhubela-Nkondo and joint promoter Dr EM Matlakala
of the Department of Health Studies at the University of South Africa; for their
insightful advice and guidance, as well as their tireless encouragement and support
throughout this research project;
 The University of South Africa (UNISA); for granting me a bursary to register for the
doctoral program in pursuit of my postgraduate studies in the College of Human
Sciences, Department of Health Studies, (UNISA);
 The Unisa Registration Officers: Ms Lindi Madiseng, Messrs Peter Phuthuyagae
and Thomas Moyo; for helping me with the application and registration procedures
at UNISA;
 Ms Talana Erasmus, UNISA Librarian; for his kindness and resolute patience in the
search and accumulation of relevant literature for this study;
 Dr ME Chauke, and Dr BT Mokoboto-Zwane; for providing innovative perspectives
in respect of various pertinent aspects of the study;
Le kamoso!!! (Be forever graceful and blessed!!!)
 SKMC (Sheikh Khalifa Medical City) and Mafraq Hospital IRBs for granting me
permission to conduct the study and using their facilities as the research site;
 Mr Abbas Hassan, Ms Hanan Taha, Ms Shorouq Al Khatib, Ms Hanan Taha, and
Ms Reema Al Mahdi; for their unqualified support and encouragement;
Shukran jazeelin!!! Allah yabarek fiek
 Ms Diana Basa Lim-Guadalupe, Ms Jennifer Williams, Mrs Linda Haskins, and
Karen McKenna; for believing in me. They have been my angels;
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 My late parents, Mr Aaron and Mrs H Ramasehla; for their monumental love and for
instilling the virtues of perseverance, discipline, and gratitude in me;
Phaahle le Hunadi! Morena a le segofatše a le boloke (God bless you)
 My daughter, Mangetane, and granddaughter Leago; for their love, support, and
encouragement, during the inordinate days of my solitary confinement to my
studies. I love them both without measure;
 My extended family and friends; for their unflinching support, encouragement, and
understanding the reasons for my absence during the many days of our gatherings.
 All the research participants; for sharing their time, efforts an views regarding the
study;
 The manuscript editor, Dr TJ Mkhonto; for his editorial support and contribution.

I THANK YOU ALL SO PROFUSELY!!!!

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LIST OF ACRONYMS USED IN THE STUDY
AADON Acting Assistant Director of Nursing
AAHSA American Association of Homes and Services for the Aging
ADDIE Analysis, Design, Development, Implementation, and Evaluation
ADON Assistant Director of Nursing
AED Arab Emirates Dirham
ANCC American Nurses Credentialing Center
BLS Basic Life Support
CAP College of American Pathologists
CNC Clinical Nurse Coordinator
CNEP Continuing Nursing Education Program
CRN Clinical Resource Nurse
DGN Diploma in General Nursing
DHA Dubai Health Authority
ED Emergency Department
ENTT Ear, Nose, Throat, and Thoracic
GNI Graduate Nurse Intern
GT Grounded Theory
HAAD Health Authority Abu Dhabi
HDU High Dependency Unit
HRM Human Resources Management
IFAS Institute for the Future Aging Services
IRB Internal Review Board
JCI Joint Commission International
MOH Ministry of Health
NMC Nursing and Midwifery Council
PALS Paediatric Advanced Life Support
PICU Pediatric Intensive Care Unit
REC Research Ethics Committee
RN Registered Nurse
SKMC Sheikh Khalifa Medical City
SEHA Abu Dhabi Health Service Company
UAE United Arab Emirates
UAENMC United Arab Emirates Nursing and Midwifery Council
UK United Kingdom
UMs Unit Managers
USA United States of America
WHO World Health Organisation
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ABSTRACT
The nursing profession is premised on the moral and ethical maxim: do unto others
as you would they do unto you. Advanced beginner nurses progress to become fully
fledged professional nurses as a result of the socialisation, support and nurturing by
the proficient and expert counterparts. Socialisation engenders a spirit of brotherhood
and sisterhood within the nursing profession. However, there is evidence to suggest
that nurses ‘eat their young’. In the event that advanced nurses consider themselves
as dinner for the expert nurses, they are inclined to leave the profession due to their
real or perceived unpalatable experiences of suffering under the tutelage of the
expert nurses.
Proceeding from the grounded theory paradigm, the purpose of the study is to
explore and describe the extent (if any) to which the role of the clinical resource
nurse affects staff retention. The study was conducted at two SEHA (Abu Dhabi
Health Service Company) facilities in Abu Dhabi. The study followed a qualitative
design that is explorative, descriptive and contextual in nature, with some quantitative
aspects developed by means of questionnaires. The purposive non-probability
sampling technique was employed in the study, with the sample size comprised of 1
Assistant Director of Nursing; 1 Acting Assistant Director of Nursing; 5 Unit
Managers; 3 Clinical Nurse Coordinators; 16 Clinical Resource Nurses; 11 Graduate
Nurse Interns; and 14 Registered Nurses. Quantitative data will be collected using
semi-structured interviews, as well as open-ended surveys. Data was analysed
qualitatively. Guba’s model in Polit & Beck (2012:582) was utilised to ensure
trustworthiness of the study. Ethical requirements were considered throughout the
study.
Findings showed that the responsibility of peer mentoring does not rest solely on the
shoulders of the CRN (Clinical Resource Nurse) but is a team effort is a team effort
between senior leadership unit managers, CNCs (Clinical Nurse Coordinators) and
external stakeholders such as HAAD (Health Authority Abu Dhabi), SEHA, NMC
(Nursing and Midwifery Council) and higher education.

Key words: clinical resource nurse, peer mentoring, staff retention

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TABLE OF CONTENTS
CHAPTER 1: OVERVIEW OF THE STUDY 1
1.1 INTRODUCTION 1
1.2 BACKGROUND OF THE RESEARCH PROBLEM 2
1.2.1 Existing Peer Mentoring and Staff Retention Approach 2
1.3 STATEMENT AND CONTEXT OF THE RESEARCH PROBLEM 3
1.4 AIM/ PURPOSE OF THE STUDY 5
1.4.1 Study Objectives 5
1.5 THE RESEARCH QUESTIONS 6
1.6 SIGNIFICANCE AND RELEVANCE OF THE STUDY 6
1.6.1 Disciplinary/ Epistemological Significance 6
1.6.1.1 Significance to peer mentors 7
1.6.1.2 Significance to nurses in general 7
1.6.2 Institutional/ Organisational Significance 8
1.7 CONCEPTUAL AND THEORETICAL FRAMEWORK OF THE STUDY 8
1.7.1 Definition of Key Concepts 8
1.7.1.1 Clinical Resource Nurse (CRN) 9
1.7.1.2 Graduate Nurse Intern (GNI) 9
1.7.1.3 Mentoring 9
1.7.1.4 Peer 9
1.7.1.5 Peer Mentoring 9
1.7.1.6 Registered Nurse 9
1.7.1.7 Role in Peer Mentoring 10
1.7.1.8 Staff Shortage 10
1.7.1.9 Staff Turnover 10
1.7.2 Assumptions of the Study 10
1.7.2.1 Ontological Assumptions 10
1.7.2.2 Epistemological Assumptions 11
1.7.2.3 Methodological Assumptions 11
1.7.3 Theoretical/Meta-theoretical Grounding 11
1.8 RESEARCH DESIGN AND METHODS 12
1.9 LIMITATIONS OF THE STUDY 12
1.10 ORGANISATION OF CHAPTERS IN THE STUDY 12
1.11 CONCLUSION 13
CHAPTER 2: LITERATURE REVIEW 14
2.1 INTRODUCTION 14
2.2 NURSING DYNAMICS IN THE UAE 14
2.2.1 The Cultural Dimension 14
2.2.1.1 Perceived Low Status of the Nursing Profession in the UAE 15
2.2.2 The Organisational/Institutional Environment 16
2.2.2.1 Discrepant Uniformity in Licensing and Regulations 16
2.2.2.2 Limited Career Opportunities 16
2.2.2.3 Nursing Turnover and Nursing Staff Shortages 16
2.2.3 The Individual Psychological Domain 19
2.2.3.1 The Transition Stage 19
2.2.3.2 Interpersonal Relationships Building 20
2.3 PEER MENTORING 21
2.3.1 Seminal Studies in Support of Peer Mentoring 22
2.3.1.1 A Peer Mentoring Model 24
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2.3.2 Peer Mentoring Styles 24
2.3.3 The Phases of a Peer Mentoring Relationship 26
2.3.3.1 The Orientation Phase 26
2.3.3.2 The Working Phase 27
2.3.3.3 The Termination Phase 27
2.3.4 Peer Mentor Matching 28
2.3.4.1 Peer Mentor Matching Criteria 29
2.3.4.1.1 Seeking Pair Input During the Matching Process 29
2.3.4.1.2 Compatibility 30
2.3.4.1.3 Variation of Speed Dating 30
2.3.4.1.4 Maximising Social Exchange 31
2.3.5 Peer Mentoring Strategies Impacting on Staff Retention: A
Comparative Review 31
2.3.5.1 Agency Preparation for Effective Employee Recruitment and
Selection 32
2.3.5.2 Staffing Needs Assessment 32
2.3.5.3 Designing and Implementing Effective Recruitment Strategies 33
2.3.5.4 Designing and Implementing Successful Selection Processes 33
2.3.5.5 Management Capacity Building to Support Staff Retention 33
2.3.5.6 Early Employee Orientation and Induction 33
2.3.5.7 Providing Employee Support to Address Life Changes 33
2.3.5.8 Establishing a Peer Mentorship Programme 33
2.3.5.9 Ensuring Constructive and Effective Coach Supervision 33
2.3.5.10 Offering on-the-job learning for Career Development and
and Advancement 34
2.3.5.11 Establishing Worker Participation Infrastructure 34
2.3.5.12 Establishing Worker-Management Oversight Teams 34
2.3.6 Strengths and Weaknesses of Peer Mentoring 34
2.3.6.1 Strengths of Peer Mentoring 34
2.3.6.1.1 Increased Self-confidence 34
2.3.6.1.2 Positive Preceptor Experience 34
2.3.6.1.3 Enhanced Leadership Skills 35
2.3.6.1.4 Reduced Stress 35
2.3.6.1.5 Professional Socialisation 35
2.3.6.2 Weaknesses of Peer Mentoring 35
2.3.6.2.1 Potential Ineffective Pairing Strategies 35
2.3.6.2.2 Inadequate Commitment Levels 35
2.3.6.2.3 Negative Mentor Attitude 35
2.4 CONCLUSION 36
CHAPTER 3: THEORETICAL FRAMEWORK 37
3.1 INTRODUCTION 37
3.2 THEORETICAL FRAMEWORK 37
3.3 APPLICABLE NURSING THEORIES 38
3.3.1 The ADDIE Model 38
3.3.1.1 The Analysis Phase 38
3.3.1.2 The Design Phase 38
3.3.1.3 The Development Phase 38
3.3.1.4 The Implementation Phase 39
3.3.1.5 The Evaluation Phase 39
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3.3.2 Benner’s Skill Acquisition Model 39
3.3.2.1 The Novice Stage 39
3.3.2.2 The Advanced Beginner Stage 39
3.3.2.3 The Competent Nurse Stage 40
3.3.2.4 The Proficient Nurse Stage 40
3.3.2.5 The Expert Nurse Stage 40
3.3.3 Peplau’s Interpersonal Relations in Nursing 40
3.3.3.1 The Orientation Phase 40
3.3.3.2 The Work (Contract-Contact) Phase 41
3.3.3.3 The Termination Phase 42
3.3.4 Mulaudzi’s Philosophy of Ubuntu, Cultural Diplomacy, and Mentoring 43
3.3.4.1 Philosophy of Ubuntu 43
3.3.4.2 Cultural Diplomacy 43
3.3.4.3 Mentoring 44
3.4 CONCLUSION 46
CHAPTER 4: RESEARCH DESIGN AND METHODOLOGY 47
4.1 INTRODUCTION 47
4.1.1 Key Aspects of Grounded Theory 48
4.2 RESEARCH DESIGN 48
4.2.1 The Qualitative Research Approach 49
4.2.2 Justification for the Qualitative Research Approach 49
4.2.3 Stages in the Qualitative Research Design 49
4.2.3.1 The Conceptual Stage 50
4.2.3.2 The Exploratory Stage 50
4.2.3.3 The Participatory/Consultative Stage 51
4.2.3.4 The Narrative Stage 51
4.2.3.5 The Descriptive and Interpretative Stage 52
4.3 SAMPLING AND SAMPLING PROCEDURES 53
4.3.1 Study Population and Sample Size 53
4.3.1.1 Sample Size 54
4.3.2 The Research Site and Negotiated Entry 54
4.3.3 Sampling Techniques/Methods 55
4.3.4 Sampling Criteria 56
4.3.4.1 Inclusion Criteria 56
4.3.4.2 Exclusion Criteria 56
4.3.5 Some Remarks Concerning Sampling Rationale 57
4.4 DATA COLLECTION 57
4.4.1 Qualitative Data Collection 58
4.4.1.1 Semi-structured Interviews 58
4.4.1.2 Informal Observation of Research Participants 60
4.4.2 Quantitative Data Collection 61
4.4.2.1 Questionnaire Development and Administration 61
4.5 DATA ANALYSIS 63
4.5.1 Open Coding 63
4.5.2 Axial Coding 64
4.5.3 Selective Coding 64
4.5.4 Memos 64
4.6 MEASURES TO ENSURE TRUSTWORTHINESS 64
4.6.1 Credibility 64
4.6.1.1 Prolonged Engagement 65
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