Browsing by Author "Kortenbout, Wilhelmina Petronella."

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The assessment of the aggregate health status of an organisation.
(1993) Grainger, Linda Denise.; Uys, Leana Ria.; Kortenbout, Wilhelmina Petronella.
As adults spend the major portion of their lives at work, it is essential that the reciprocal relationship between their work and health be recognised. In this regard, occupational nurses have an important function, through the provision of effective occupational health programmes in the workplace, although this is a challenging task and programmes often bear little relevance to health needs. The process of identifying health needs involves the measurement of health status, requiring a clear understanding of the nature of health and how it is determined. However, conceptualisations of health in relation to work tend to be inadequate as they deal with it on an individualistic basis, often as a negative measure, do not include the various dimensions of health, and fail to take account of the influences of the wider community. This study sets out to overcome these problems. A model of aggregate (collective) health in the workplace was developed from a conceptual framework, to expain how influences inter-relate and contribute to health in this setting. Health is conceived in positive terms, with the individual represented as the core, passing through the organisation and community, thereby depicting the interrelationships between their health. At the aggregate level four sets of factors, human biology, environment, lifestyle and health care organisation, are shown to influence health. The subjective, objective, physical, psychological and social dimensions of health are incorporated, whilst the potential of work as a stressor or health strengthening influence on health is recognised. Concepts from the model have been operationalised into composites of variables, for the assessment of aggregate health status. A measurement strategy was then devised, involving the analysis of data collected by means of an examination of organisational records, interviews with key people, a survey of a random stratified sample of members, health hazard identification in the workplace and an assessment of the provision of health care in the wider community. The survey instrument, consisting of an interview and questionnaire, was developed and subjected to a field test. The model, strategy and instrument were revised according to the results.
An exploratory analysis of alternative approaches in distance learning programmes for nurses.
(1995) Kortenbout, Wilhelmina Petronella.; Uys, Leana Ria.
An exploratory retrospective study conducted on two differing educational programmes, both of which were for the diploma in community health nursing. The aims of the study were: i) To propose a conceptual framework in order to compare distance learning programmes in community health nursing. ii) To describe and compare two such programmes based on this framework: one content-based and the other community / problem based. The research design used case study methodology, after the development of a model for the education of professional nurses which was derived from literature. The constructs of the model were used as propositions in a case study protocol. The four constructs were each made up of two elements and each element consisted of the poles of a continuum by which that feature in a programme could be identified. The constructs were: a) The Conceptual Programme which included the elements of Base and Structure; Base being either institution or community and structure either content or process. b) The Student with elements of Professional or Personal attributes. Professional attributes were either empowered or disempowered and personal either self directing or passive. c) The Context which had Components and Relationships as elements. The former comprised either limited formal health services or all-embracing health related sectors, whilst the latter specified relationships would either be seen as linkages with unilateral formal communications or partnerships where collegial relations impacted on both parties involved. d) The Concrete Resources included both human and material resources. Human resources were either limited or additional and material either limited or varied. Application of the Conceptual Programme analysis demonstrated that programme A was institution and content based whilst programme B was community / problem (process) based. Programme documentation and student assignment and projects were analyzed in terms of the remaining three constructs. An interview with a tutor for each programme followed after they had read the case reports. A third interview was then held with a key person who had overseen both programmes and read case and interview reports in order to validate both content and the use of the model as framework for analysis. The following trends emerged: i) The content programme was associated with more disempowered and passive students as those were defined in this study. ii) The content programme also used more limited formal health sector settings for learning and in this linkage type relationships dominated although three instances of partnerships did occur, and some community based groups were used by students. iii) The content programme used one tutor per contact session for lectures with students and, cost, in 1991 currency, R150 per student to deliver. iv) The community / problem based programme showed a stronger trend to empowered and self directing students with several clear instances being documented. v) There was a greater variety of settings used for learning in this programme. vi) Several instances of partnership relationships occurred despite the limited contact time between students and communities or health settings. vii) The community / problem-based programme needed two facilitators per contact session at a cost of R1130 (1991) as small group discussions were the main strategy for learning. viii) Student evaluations of both programmes showed that students viewed them in much the same way despite the differences that were found. This indicates that student evaluations on their own provided insufficient evidence about the nature of a programme. ix) The community / problem based programme cost about 20% more to deliver than the content programme out of a total expenditure of R186 000 (1991 value). x) The model was revised to collapse professional and personal attributes into one element and to add another element 'metacognition' to the construct student. 'Access' was also recommended as an additional construct with elements of barriers and supports. This new model needs to be tested and reviewed by peers. The revised model for the education of professional nurses could be a useful yardstick for evaluating existing educational programmes, selecting newly proposed programmes and guiding policy formation.
Professional nurses knowledge and understanding of AIDS/HIV infection.
(1993) Chamane, Nomusa Joyce.; Kortenbout, Wilhelmina Petronella.
This study examines the Professional nurses' knowledge and understanding of AIDS/HIV infection. The Professional nurses that participated in the study, are those working in a specialised institution which caters for tuberculosis and psychiatric patients, and those suffering from oesophageal and lung cancer; and the patients with orthopaedic problems. Knowledge explored is specifically related to AIDS/HIV infection, which includes the causes, mode of spread of infection, symptoms, diagnostic tests available, prevention, complications and identification of high risk groups. The sample was formed by 53 Professional nurses; 27 being those that have done the AIDS counselling course, and 26 who have not done the course. To collect data, questionnaires were sent to the participants. Apart from the questionnaires, focus group interviews (21 participants) were done to elicit any information that may not be obtained through the use of a questionnaire. The theoritical framework used is a combination of two theories, Cognitive Dissonance Theory and Fear of Contagion Theory. Cognitive Dissonance Theory assumes that people want to maintain consistency with their beliefs, attitudes, values and behaviour. People confronted with examples of their own inconsistency in these areas, will experience psychological discomfort and be motivated to eliminate the inconsistency. Fear of Contagion Theory developed as a response to perceived threat of catching the disease/infection. Three behaviours characterise this fear:- avoidance, taking extreme precautions, and verbal expression of fear regarding the disease. As a result, apart from looking at factual knowledge, one had to identify the behaviors that relate to this theoretical framework. These included fear, avoidance, taking extreme precautions and dissonance/discomfort. These areas are covered in the questionnaire as well as in the interview with the focus group. The results show high knowledge of general information, including the mode of spread. Lack of knowledge in identification of high risk groups, symptoms, diagnostic tests and use of universal precautions in specific areas was identified. Fears and dissonance are found to be caused by lack of knowledge, aggravated by the fact that the disease is incurable, as it was expressed by the focus groups. Uncertanty was marked with regard to the use of protective clothing. Some participants responded in a manner that showed the use of extreme precautions, while others were unsure in such a way that in the end they indentified different protective clothing for the similar situations. In areas where knowledge deficit was identified, it was discovered that the Trained AIDS Counsellors had better knowledge than those that have not done the course except for universal precautions. On looking at the programme it was discovered that the use of universal precautions was not included in the programme and this might be the cause for the uncertainty. The difference between the two groups might have been in the understanding gained from knowledge acquired during the counselling course, since both groups were exposed to the same enviroment, policies and circulars regarding caring for HIV infected patients. Although the results showed the numerical differences, it was surprising that in certain sections when these differences were tested statistically, no statistical difference was shown between the two groups. This might have been due to the small sample used. There are respondents that showed a negative attitude towards caring for AIDS/HIV infected patients; unfortunately no further questions were asked to explore this aspect. This is a shortfall of this study. It is clear that AIDS/HIV infection is a challenge to all professionals, since it has become one of the leading causes of death. It is then believed that nurses should be equipped with adequate knowledge so as to be able to care for those suffering from AIDS/HIV infection. In conclusion it was clear that AIDS/HIV infection is a challenge for all professionals.