Positive practice environments in critical care units in South Africa


  • Ethical approval: Ethical approval was obtained from the North-West University Ethics Committee: NWU-0015–08-S1, the ethics committees of the private hospital groups that participated in the study and each of the individual participants.

  • Conflict of interest: This work is from a self-founded doctoral study. No existing or potential conflict of interest has been identified.

  • Funding: This doctoral study was funded in part by the North-West University (Potchefstroom Campus) and the Atlantic Philanthrophies (University-based Nursing Education SA (UNEDSA) programme).

Hester C. Klopper, School of Nursing Science, North-West University (Potchefstroom Campus), Private Bag X 6001, Potchefstroom, South Africa, 2250. Tel: +27 18 299 1830; Fax: +27 18 299 1715; E-mail: hester.klopper@nwu.ac.za.


PRETORIUS R. & KLOPPER H.C. (2011) Positive practice environments in critical care units in South Africa. International Nursing Review59, 66–72

Background:  The demanding nature of the critical care unit (CCU) presents a challenge to many nursing professionals and carries the risk of a high turnover rate. The critical care nurse (CCN) is responsible for caring for the most ill patients in hospitals, and the acute shortage of nurses contributes to the intensity and pressure of the environment. While the reasons for the nursing shortage are varied and complex; a key factor seems to be an unhealthy work environment. Little evidence exists of research conducted to investigate the practice environment of CCNs in South Africa (SA).

Purpose:  This study aimed to construct a grounded theory for positive practice environments (PPEs) in private CCUs in SA.

Methods:  Intensive interviews and a constant comparative approach to data collection and data analysis were used to explore the participants' (n = 6) perceptions of the elements of a PPE.

Findings:  A theory depicting the core conceptual category of being in control and its relation to the other six categories was constructed from the data to explain a PPE for private CCUs in SA.

Conclusions:  The study provides a robust overview of the elements of a PPE and contributes to the constructivist application of grounded theory.

Study limitations:  The study was conducted in the private healthcare sector in SA, thus limiting the findings to this context.