Doctoral Degrees (Nursing)

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The delivery of cultural care by health professionals among the hospitalized AmaXhosa male initiates of traditional circumcision in the Eastern Cape.
(2009) Ntsaba, Mohlomi Jafta.
Traditional male circumcision is a rite of passage among the AmaXhosa in South Africa. According to the custom of male traditional circumcision, initiates should remain in the bush for the entire seclusion period. The AmaXhosa male initiates encounter complications due to a ritual that has gone wrong. Common complications are penile sepsis, dehydration, penile amputations and septicaemia. As a last resort, when the AmaXhosa male initiates do not improve from complications associated with the custom they are referred to hospital for admission (Meintjes, 1998; Warren-Brown, 1998). The main purposes of this study were, first to explore and describe the delivery of care to the hospitalized AmaXhosa male initiates whilst in the hands of healthcare professionals and professional care system. Second, to describe what constitutes culturally appropriate care for hospitalized AmaXhosa male initiates. This study took place in three research sites, that included one rural hospital and two urban hospitals which admitted the AmaXhosa male initiates of traditional circumcision. A total of 13 hospitalized AmaXhosa male initiates and nine health professionals took part in this study. Leininger's ethnonursing qualitative research approach was used to guide this study. Data were collected, using purposive sampling, by means of unstructured interviews using guides, tape-recorder, and field notes. The study was first piloted at Umlamli Hospital using the same data collecting strategies as for the major study. Data from key and general informants were analysed separately using Leininger's (1991) four-phase method. This was carried out in order to answer the research questions and research purposes. Major themes and patterns emerged from this process.
The use of love medicine among black Africans in KwaZulu-Natal and risks of HIV transmission to both men and women in South Africa.
(2010) Kunene, Mirriam Busisiwe.; Mtshali, Ntombifikile Gloria.
No abstract available.
The development and implementation of policy guidelines for health promotion in the workplace.
(2007) Mchunu, Gugu Gladness.; Uys, Leana Ria.
The three phased study aimed to develop policy guidelines for workplace health promotion based on an exploration of the current status of health promotion in South African workplaces. In the first phase of the study a case study approach was used to analyse the current situation of health promotion in the workplace. For this phase of the study the particular aim was to determine to what extent the participating workplaces were involved in health promotion, or were salutogenic in nature. A total of 6 organizations participated in the first phase of the study, with a total of 258 participants. The second phase aimed at developing policy guidelines for health promotion in the workplace. The consensus method, using the Delphi technique, was used in this phase, involving seven participants who were experts in the field of occupational health and health promotion. The third phase was an observation of the implementation of the policy guidelines. Implementation analysis, which is part of evaluation research, was the methodology used. Two organizations from phase one participated in the implementation phase. In summarising the findings on the current situation of employee health promotion programs the study showed that none of the participating organizations emerged as health promoting workplaces. Organizations that offered employee health promotion/wellness programs mainly focused on individual health and on HIV/AIDS and none of them was found to provide comprehensive holistic programs that aimed at providing healthy work environments. In phase 2 of the study it emerged that there was a very strong concurrence between the findings from the experts and literature in terms of what needs to be included in health promotion policy guidelines. The key elements for health promotion policy documents were (1) organizational philosophy (2) stakeholder involvement and (3) the description of programs to be included in the policy. During the policy implementation process it emerged that different strategies were used in the policy development process. This process was largely influenced by such factors as organizational size, type and internal structures. Recommendations include an emphasis on more legislative support for health promotion in the workplace, and for more concrete aids such as policy guidelines and educational preparation of occupational health professionals for this component of their role.
A comparative analysis of adolescent sexual and reproductive health programmes in two African countries : Ghana and South Africa.
(2007) Shepherd, Joan Hannah Elizabeth Estella.; Adejumo, Oluyinka.
Sex and sexuality issues are still sensitive and controversial subjects despite the growing numbers of sexual and reproductive health (SRH) programmes for adolescents in subSaharan African countries (WHO, 2002; Department ofInternational Development (DFID), 2004). The purpose of this study was to examine and analyze the structure and procedural mechanisms adopted by adolescent sexual and reproductive health (SRH) programmes in two African countries. This study also explored the adolescents' perceived usefulness and relevance of these programmes in addressing their SRH needs. The study was conducted in Ghana (West Africa) and South Africa (Southern Africa) as a cross-national study in these two sub-Saharan African countries. A comparative case study design was adopted involving the use of both quantitative and qualitative approaches to data collection and analysis. Snowballing, critical case, and purposive sampling methods were used. A wide range of personnel from both countries including programme directors, managers, nurse/midwives, peer educators and youth counselors (n=48) were interviewed within the context of adolescent sexual and reproductive health (ASRH) programmes and adolescents (n=247) participated through client exit surveys and focus group discussions. Records review, document analysis and observation of the facilities were employed through a checklist. A Tri-dimensional conceptual framework adapted from Donabedian (1980) and WHO (2001) for: (1) Structure, (2) Process, and (3) Output of ASRH programmes, guided the study and served as the frame for analysis and comparison. Qualitative data were transcribed and analyzed using framework analysis and quantitative data through use of SPSS Version 13.0. Findings of the study revealed that both Ghana and South Africa have established ASRH structures through development of programmes and policies for young people. They also shared common features related to programme focus and philosophy on ASRH matters. Both countries face several challenges associated with sexuality issues, inadequate human and material resources. Religious, socio-cultural, logistical and structural factors were identified as barriers, which hindered access and use of the facilities. These barriers were found to have a profound influence on programme implementation, achievement of objectives and future development. Adolescents in the two countries are confronted with a range of issues affecting their sexual health and general well-being for which they seek services from ASRH programmes. These programmes in both countries were generally perceived as relevant and important by youth utilizing the facilities. The need for changes in the attitude of service providers, structural layout, logistical improvement and staffing composition was expressed. Despite efforts made, there are still programmatic issues needing attention, for which specific recommendations towards improvement were made on the basis of findings from both countries. Findings from this study have implications for nursing practice, management, education, research and relevant stakeholders involved with adolescent health, including policy makers. Recommendations are made that may contribute to the development of an effective model of "Adolescent-Friendly" programmes in the two countries.
A social constructionist analysis of talk in episodes of psychiatric student nurse-psychiatric client community clinic based interaction.
(2007) Middleton, Lyn Elizabeth.; Uys, Leana Ria.
The study seeks to explore and to offer a critical account for the 'discursive doings' of student psychiatric nmsing practice as they are jointly constructed in the episodes of conversation between the nmse and client-speakers within the context of the communitybased psychiatric clinic. The study is built around a social constructionist framework and is concerned with the analysis of the discursive activities present within seven (7) transttibed, audio-recordings of student nurse-psychiatric client interactions. A thick and sometimes critical description of three of the contextual forces back grounding/foregrounding the discursive processes of psychiatric nursing is given. These include the public health psychiatric care context, the problem-solving approach of the undergraduate psychiatric nursing curriculum and the assumption and effects of modem psychiatric nursing theory. The first level of analysis is an aspect of the methodology and offers a descriptive and interpretive analysis of the talk in the texts. Various conversational discourse analytic tools were used here to transform talk into text and to develop the starting point for the subsequent positioning theory analysis. The second level of analysis is a positioning theory analysis of happenings within these texts. Some of the textual descriptions generated in the first level of analysis are used to illuminate and to add substance to the accounts of these positioning theory happenings. The analysis has shown that from a social constructionist positioning perspective, the unfolding nurse-client dialogue in these texts operates in four potentially distinct ways - highlighting, herding, hectoring and heeding - with specific effects for their going on together in conditions of relationship. These ways of talking are shown to be contrary to the person-eentered rhetoric of modem psychiatric nursing and more aligned with the bio-medical format of talk in helping contexts. Can these activities be dismissed as non-nursing activities? The implications for a modem psychiatric nursing theory that holds the person-centred approach to be its quintessential essence are considered and a number of ideas for how client-authorised expressions may be jointly manifest in conversations situated in this practice context are offered.
Maternity care in KwaZulu-Natal : towards a grounded theory of adolescent-friendly maternity services.
(2005) Chetty, Ravani.; Adejumo, Oluyinka.
The issue of adolescent health has steadily grown momentum with people realizing the vulnerability ofthis sector ofthe world's population. Within the South African context, the tide had also turned. However, most initiatives aimed at the prevention of problems, one of which was adolescent pregnancy. Extant literature revealed that despite efforts to reduce adolescent pregnancy, adolescent fertility rate in SubSaharan Africa remained on the rise. As such, the need for appropriate maternity services for this group became a concern, as extant literature also revealed the costly long term effects to pregnant and parenting adolescents, as well as society as a whole. Within KwaZulu-Natal pregnant and parenting adolescents use the same maternity services as their adult counterparts. It was not clear if these services were appropriate to the needs of these clients. As such, a Glaser Grounded Theory approach was used to explore the maternity services from the points of view of the various stakeholder groups. Data was collected, using theoretical sampling, by means of semi-structured interviews and focus group interviews. Constructs of adolescent-friendly maternity care were identified from the findings. The components of the constructs included aspects of (1) Structures and Resources, (2) Attitudes to AMCs, and (3) Services. The resources or structures that either need to exist and/or be improved included policies, the quality and quantity of HCps, formalized support for AMCs, a sensitized administration, community involvement and the educational preparation of HCps. The attitudes that service providers were expected to demonstrate in their interaction with AMCs included those of equality, empathy and respect. They were also expected to show understanding towards AMCs and provide them with reassurance and support. The third component identified specific services to be provided to AMCs during the antenatal, labour and delivery, and postnatal period. These constructs can be used by health care planners and providers to strengthen and improve service provision to and utilization by pregnant and parenting adolescents and form the foundation on which a theory of adolescent-friendly maternity care can be based. Recommendations were made with regards to future service and research endeavours.
Planning and implementing distance learning in Rwanda.
(2005) Mukamusoni, Dariya Mahuku.; Gwele, Nomthandazo S.
Distance Learning (DL) is recognized to be a contemporary mode of education delivery. It is used to respond to the need of human resource development in developing countries. The evolution of Information Communication Technology (ICT) is seen as an opportunity for the development of DL. DL through ICT is perceived as an opportunity for meeting most of the challenges of higher education systems in Sub-Sahara Africa in general, and in Rwanda in particular. Planning and implementing DL as an innovation in the education system of Rwanda are processes which need to be understood if DL is to expand and contribute to human resource development in different sectors. The aim of this study was to analyze the process of planning and implementing DL in tertiary health professional education in the Kigali Health Institute and in tertiary teacher education in the Kigali Institute of Education, in order to understand the dynamics of planning and implementing DL, and to suggest the way forward for the success of those two programs. Concepts taken from innovation Havelock's problem solving strategy (1982) and social system theories in particular Owens's open sociotechnical systems for schools (1998) were combined to form the framework which guided this study. A qualitative case study, using a comparative descriptive approach, was the research design. The participants were drawn from (a) policy makers in the ministry of education, ministry of health, ministry of public services and the Rwanda Information Technology Authority (RITA); (b) management in the participating institutions; (c) the teaching staff, especially those who were involved and/or are still involved in the process; (d) students; (e) and members of professional regulatory bodies. Purposive and theoretical sampling was used to select the participants. Twenty one informants were interviewed. Three focus group discussions of six, four and eight participants respectively were conducted. In addition document review and analysis, and physical artefacts served also as means of data collection. The results showed that systematic planning with a comprehensive document and strategic plan as outcome of the planning process are essential for the successful implementation of distance learning in Rwanda. Supportive and responsive institutions and suprasystems are indispensable to a conducive environment for planning and implementing DL in Rwanda. From the results, recommendations for the progress of the two programs that were part of this study were put forward. A framework of planning and implementing DL in Rwanda was developed based on these results. This framework may be used by policy makers, educators and other parties interested in the development of DL in Rwanda.
Process of change in nursing education in the Arab Gulf region.
(2005) Mustapha, Najah.; Gwele, Nomthandazo S.
A three-phased, cross-sectional study was conducted in the nursing schools in two Arab Gulf countries (the UAE and Bahrain) to assess the process of change in Nursing education. The illuminative approach to evaluation using a case study design was used. Different methods were utilized to collect data, namely interviews, documentary analysis and self-administered questionnaires. In the initial phase of the study, the directors of the Schools of Nursing were involved. A theoretical sample of a wide range of tutors, students and counselors was included. The interviews were conducted using a semi-structured interview format. Seventeen faculty members from Bahrain, and seventeen from two institutes of nursing in the UAE, namely Abu Dhabi and Sharjah, were interviewed. Students were interviewed from three academic levels of the program. Thirteen students in Bahrain and nineteen in the UAE participated in the interviews. The N-Vivo qualitative program was used to analyze the qualitative interviews. In the second phase of the study, all faculty who taught case-based courses in Bahrain and the UAE were asked to participate in the study; 24 from the UAE and 30 from Bahrain. A 20% random sample of students from the three academic levels in the UAE and 25% from the two academic levels in Bahrain was used. Sixty-four students from the UAE and forty-six from Bahrain answered the self-administered questionnaire. The questionnaire used data extrapolated from the qualitative interviews. The SPSS (version 11) was used to analyze the self-administered questionnaire. T-test and correlation tests were employed at this stage to analyze data. In both countries, innovation attributes, especially complexity and incompatibility with the students' and the faculty's background, were perceived by both faculty and students as hindering the dissemination of innovation. In both countries a strong training program that tackled concerns of both old and new faculty members was lacking. Planning for a sustainable system and team approach to change was lacking in both countries to varying degrees. Differences were noted between the UAE and Bahrain in the introduction and implementation of change. The UAE faculty perceived their involvement in the choice of a case-based curriculum as a major facilitating factor. Other factors perceived by the UAE faculty as facilitating the process of change were the planned series of workshops, involvement of the faculty in decision-making and the secondment of an external expert during the implementation of the innovation. The Bahrain faculty perceived the leadership style of forcing change as deterring the process of change. The institutional context, the lack of planning, the lack of a common meaning of change among faculty and other stakeholders, and the lack of structured professional development program were other factors perceived as hindering change. The study led to the development of a framework for introducing educational change in the Arab Gulf region. It is hoped that the framework would help decision-makers and leaders of educational institutions understand change better and be able to introduce and monitor change effectively. The major recommendations tackled developing a continuing staff development program, building multidisciplinary teams, planning and monitoring the change process and establishing a common meaning of change from the beginning of any change. Conducting further research on the perceptions of key political stakeholder towards change and researching the managerial practices of nursing leaders could serve as an initial step towards the validation of the suggested framework.
The development of an HIV/AIDS counselling approach for Africans.
(2004) Pienaar, Abel Jacobus.; Uys, Leana Ria.
HIV/AIDS care needs to be comprehensive and holistic (UNAIDS, 2002). Counselling has proved to be one of the most effective behavioral tools in the global anti-HIV/AIDS fight by equipping people mentally, emotionally, psychologically and socially for the disease (Anon, 2000). Over the past two decades researchers identified cultural factors, race, gender and class as leading inequitable treatments in general counselling situations (Coleman, 1995). This challenge happened to be the same in HIV/AIDS counselling, especially because the counselor work with sensitive information. Nurses who forms the back-bone of HIV/AIDS counselling, are all trained on a Western model of HIV/AIDS counselling. Herbst (1990) also pointed out that knowledge concerning cultures and subcultures and its implications has become a major issue for the nurse to deliver health care in South Africa. Faced with the history of South Africa and the diverse cultures it was my personal experience as a professional nurse, counselor and researcher while I was working on the *Ufe health train, that the knowledge of culture is one of the most important factors of HIV/AIDS counselling. This motivated me to embark on this research. This research aims at providing an analytical description of the experience of counselling for African (Batswana) counselees and their counselors with specific reference to HIV/AIDS counselling with view to improve this interaction. The objectives of this research was to: a) analyse the counselling done by Western and African counsellors in the health system, with a particular focus on HIV/AIDS counselling, b) establish how acceptance and decision-making is promoted, understanding of the counselee is established and psychosocial support is given, and c) develop a middle -range theory that describes appropriate HIV/AIDS counselling for African counselees. Glaser's (1965; 1967; 1992) grounded theory approach was used to guide this research. Multiple data collection methods were used, which took place concurrently with the descriptive analysis. Glaser's conceptual analysis paradigm for qualitative data analysis was utilised. Based on the results of this research the importance of an HIV/AIDS counselling approach for Africans is emphasised.
The conceptions of sexual relationships among the Yoruba people in Nigeria.
(2005) Irinoye, Omolola Oladunni.; Uys, Leana Ria.
The study explored the cultural dynamics of construction of sexual intercourse within gender constructions of masculinity and femininity among the Yoruba people of South western Nigeria. The Explanatory Model Interview Catalogue (EMIC/ETIC) framework, a cultural explanatory social analytic framework with guides to looking at the insiders' perspectives, was used as the theoretical base to the study. The study was conducted to broaden understanding of sexual relationships in order to generate culturally relevant programmes that can promote sexual health, control sexual coercion, sexual violence and reduce the transmission and spread of HIV. It explored information about the conceptions of sexual relationships, social dynamics of sexual negotiations in marital and non-marital relationships, the expressions and process of knowledge acquisition as such translates to sexual behaviour by men and women. The prevalence of consensus, coercive and forced sexual intercourse and sexual morbidity were determined. Perceived link of sexual coercion and sexual violence to HIV transmission was also explored. Traditional practices, including regulatory mechanisms for the control of sexual behaviour of men and women in the culture were also explored. Equally focused in the study were differences in the conceptions of sexual relationships among the study population as moderated by sex, age, educational background and marital status, along with experiences of sexual coercion, forced sex, and sexual intercourse related morbidity. Adopting the ethnographic method, qualitative data from historical review of existing information about the Yoruba people, focus group discussions, in-depth individual interviews and observations were complemented by quantitative data generated through a survey in a sample Yoruba community of lIe-Ife. Findings showed the conception of sexual relationships and sexual intercourse built around the conception and social constructions of active masculinity and passive femininity. Conceptions of sexual relationship evolved as a transitional phenomenon that individuals were expected to learn informally instinctually and as they attain sexual biological maturity through language use and observations of practices among older people. Two typologies of masculinity and femininity were discernible in the study population that also give specifications to social and sexual behaviour of men and women. There appeared a changing conception of femininity especially among young people below 30 years, which is also informing sexual behaviour of young women. Relationships were moderated by age, economic status and marriage, which invariably put women in subordinate position to men either in social or sexual relationships. Behaviour of men and women were dictated by social role assignment of leadership through economic provisions for family and control of sexual act by the man. This was within a contractual relationship of older men with younger women with the primary motive of procreation in traditional orientation. Sexual intercourse was seen as a compulsory act for both men and women especially as it results to procreation though the initiation and control were part of the social responsibility of the man. It was socially approved within marriage but pre-marital and extra marital relationships were tolerated more for men. The act was also used "as a prove of self", for economic gains, to demonstrate love, for enjoyment and as a tool of punishment of women by some men. Knowledge acquisition about sexual relationships and sexual intercourse tended to be inadequate throughout the life span. There was never a time when individuals, even after marriage, have access to correct information about sexual intercourse. There was gross assumption of what sexual partners know about sexual intercourse in the population. Within the context of 13 identifiable topical knowledge areas desirable for sexual health, more than 50% of males and females expressed lack of knowledge. There were significant differences in expressed knowledge by male and female respondents of what sexual intercourse is and the motives of sexual intercourse
Development and implementation of a staff development plan for nurses in one district in Zambia based on a learning organization approach.
(2006) Libetwa, Miriam Chilembwe.; Adejumo, Oluyinka.
This study explored the existing planning systems that nurse managers in health institutions in the Lusaka district in Zambia used to plan staff development activities, with a view to developing a model suitable for a staff development plan for all nurses in Zambia. The learning organization and transformational learning theory frameworks were used to guide the study. The learning organization framework was based on Senge (1990), The Fifth Discipline, which addressed five components, namely, systems thinking, personal mastery, mental models, building shared vision and team learning. The transformational learning theory framework was based on (Gravette 2000), which addressed the reflective and constructive processes that employees go through during their learning. A survey and action research methods were used to explore the planning systems which nursing managers in the Lusaka district used to plan staff development activities. The total population of nurses designated as nursing managers, registered nurses and enrolled nurses working in the central hospital (734 nurses), in the specialized hospital (128 nurses), and in 31 health centres (980 nurses) in the Lusaka district constituted the target population. Systematic sampling was used to select a total of 614 participants; only 368 nurses returned completely filled questionnaires. A staff development tool jointly developed with the participants also served as a means of generating data for the study. The quantitative data were analyzed according to the Statistical Package of Social Sciences (SPSS) 11.5 version, using frequencies and percentage distributions. Framework analysis was used to analyze the collected qualitative data. The major findings of the study revealed that nursing staff in the urban district of Lusaka were not using systematic methods based on any known approach in planning staff development activities. Using a learning organization framework, a model of staff development was jointly developed with the participants, as well as a checklist for assessing staff when utilizing the model in a Zambian setting. The study concluded that the developed learning organization model was capable of facilitating the development of culture of lifelong learning among nurses and midwives in Zambia.
The development of an intervention model for managing abrupt death trajectories in KwaZulu-Natal level 1 emergency departments.
(2004) Brysiewicz, Petra.; Uys, Leana Ria.
AIM: The aim of this research was to describe how the health professionals manage sudden/abrupt deaths in the ED and to foster change in current practice by involving the clients (dead or dying clients and their families) and the health professionals. METHOD: Action research was the approach used in this four year research project, and co-researchers (nurses) from three Level I ED's in KwaZulu-Natal were actively involved in shaping and guiding the project. The participants involved in the research were health professionals, bereaved families and mortuary staff members. FINDINGS: An intervention model, the Dealing with Sudden Death Model, was developed in order to guide the therapeutic management of sudden/abrupt deaths in ED's. Along with this was the development of the family pamphlet, the Preparation Checklist and the Incident Evaluation Checklist. Following the implementation of this model the health professionals emphasized the fact that this model provided guidance and meaning to the care rendered to the dead or dying client, the bereaved families and fellow colleagues. The Dealing with Sudden Death Model had resulted in a production of knowledge and planned changes in the management of sudden/abrupt deaths in the ED's.
The analysis of knowledge construction in community based service-learning programmes for basic nursing education at two selected nursing schools in South Africa.
(2011) Mthembu, Sindisiwe Zamandosi.; Mtshali, Ntombifikile Gloria.
Community based service-learning is one of the fastest growing reforms in higher education, especially in the field of health care. The increased interest in this phenomenon is based on the demands by government and society that higher education institutions should be more responsive to the needs of the community. Literature, however, reflects that service learning lacks a sound theoretical base to guide teaching and learning due to limited research in this area. This study was, therefore, aimed at exploring the phenomenon knowledge construction in basic nursing programmes in selected South African nursing schools with the intention to generate a middle range theory that may be used to guide the process of knowledge construction in community-based service-learning programmes. This study adopted a qualitative approach and a grounded theory research design by Strauss and Corbin. Two university-based schools of nursing were purposively selected to participate in the study. There were a total number of 16 participants. The collection of data was intensified by the use of multiple sources of data (participant observation, documents analysis and in-depth structured interviews). The data analysis process entailed three phases; open, axial and selective coding. The results of the study revealed that the phenomenon “knowledge construction” is conceptualised as having specific core characteristics, which include the use of authentic health-related problems, academic coaching through scaffolding, academic discourse-dialogue and communities of learners. The findings showed that there are a number of antecedent conditions and contextual circumstances contributing to how knowledge is constructed in a community based service learning programme. The process of knowledge construction emerged as cyclical in nature, with students, facilitators and community members having specific roles to play in the process. A number of intervening variables were identified that had an influence on the expected outcomes on knowledge construction in community based service learning programmes. These findings led to the generation of a conceptual model. Knowledge construction according to this model takes place in an environment which is characterised by interactive learning, collaborative learning, actively learning and inquiry-based learning through continuous reflective learning processes. The main concepts in this conceptual model include concrete learning experiences, continuous reflection, problem posing, problem analysis, knowledge deconstruction and knowledge generation, knowledge verification, knowledge generation, testing of generated knowledge and evaluation of generated knowledge. The sub-concepts include learning through senses, an initial situation, health-related triggers, social interaction, reflection-in action, reflection-on action, hypotheses generation, conceptualisation of learning experiences, information validation and community interventions. Recommendations were categorised into education and training of academic staff, application of the model and further research with regard to quality assurance in CBSL programmes as well as the use of other research designs for similar studies.
The development of an intervention model to manage secondary traumatic stress in mental health workers in Rwanda.
(2010) Iyamuremye, Jean Damascene.; Brysiewicz, Petra.
Introduction: It was previously established that mental health workers in Rwanda experience secondary traumatic stress when working with trauma survivors. The effects of secondary traumatic stress can be serious and permanent in mental health workers when working with traumatized clients. It interferes with mental health worker’s ability to do their work effectively. Aim: This study aimed to explore STS and to develop an intervention model to manage secondary traumatic stress in mental health workers in Kigali, Rwanda. Methodology: This study was carried out into five cycles using action research approach. In the first cycles of the study a quantitative design was used to explore secondary traumatic stress in mental health workers in Rwanda. For this cycle, the particular aim was to determine the extent of the secondary traumatic stress in mental health workers in Rwanda. A total of 180 participants were selected using convenience sampling to be part of the quantitative study. In the second cycle of the study a qualitative design was used to explore mental health workers’ experiences of secondary traumatic stress. For this cycle 30 unstructured interviews were conducted. The third cycle aimed at developing the model to manage secondary traumatic stress. Action research approach was used in this phase. Experts from mental health services involved in the study were asked to participate in the study based on their availability as research team members. The fourth cycle of the study consisted of implementing the model in one mental health service and the fifth cycle consisted evaluation of the implementation of the model after six weeks period. The main aim of this cycle was an observation of the model implantation. Results: A diagrammatical model to manage secondary traumatic stress was developed by mental health professionals. In the model development cycle of the study, it emerged that there are very strong concurrence between the findings from experts in mental health care system and literature in terms of what needs to be included in the intervention model to manage secondary traumatic stress in mental health workers in Rwanda. The key elements to include in the model were based on preventive, evaluative and curative strategies to manage secondary traumatic stress in mental health workers in Rwanda. During the evaluation of the implementation, it emerged that participant noticed a change in coping strategies when facing the stressful incident in the practice. Recommendations: include an emphasis on more psychological support for mental health professional in their workplace and for more concrete aids such as supervision, guidelines on stress management on workplace, education on secondary traumatic stress management and implementation of counseling service for mental health workers. Conclusion: The model developed in the present study outlined different ways to manage STS at the individual, social and organizational levels. There is a need to translate the interventions to manage STS into active ongoing coping activities to be conducted at the individual, group and organizational levels. Organizational responses, such as creating a supportive organizational culture that acknowledges the potential for secondary traumatic stress, may help mental health workers to deal with workplace related secondary traumatic stress.
An analysis of the current basic nursing education systems of francophone African countries of the World Health Organization Afro region.
(2001) Ganga-Limando, Richard Makombo.; Gwele, Nomthandazo S.
It is against the background of new developments and initiates taking place in various countries to make basic nursing education systems more responsive and relevant to the ever-changing nature of society that a cross-national study of the current systems of basic nursing education of francophone African countries of WHO Afro Region was undertaken. The aim of the study was to describe and analyze the current systems of basic nursing education in Francophone African countries of WHO Afro Region with 'a view to providing guidelines for change toward a basic nursing educatian system that is in line with the recommendations of WHO (1994, 1985, 1984, 1966) and the various countries' health care delivery systems' policies. In the first phase, data was generated by means of a self-completion mailed questionnaire, administered to the members of the national regulatory bodies of nursing and nursing education from eighteen countries. The design of the above named questionnaire was based on the WHO (1994, 1985, 1984, and 1966) recommendations pertaining to basic nursing education systems. The main results of the findings of this phase showed two major trends. Firstly, more differences than similarities existed between the WHO (1994, 1985, 1984, and 1966) recommendations and the current basic nursing education systems of the countries under study. Secondly, discrepancies existed between the various countries' health care delivery systems' policies and the existing systems of basic nursing education. Finally, all the respondents expressed the views that the current basic nursing education systems are faced with educational and organizational changes and they agreed that there is a need to change the current basic nursing education systems. In the second phase, data was generated by means of three rounds Delphi questionnaires, administered to the national members of the regulatory bodies of nursing and nursing education as well as the members of national nursing associations from eighteen countries. The design of the first round Delphi questionnaire was based on the results of the first phase of this study, while the preceding round informed the design of the questionnaire of the next round. The main results of the findings showed similarities between the future orientation of the basic nursing education systems and the recommendations of the WHO as well as the global trends in the development of the basic nursing education. The stakeholders expressed the view that the national governments, the National Associations of Nurses and the Regional Office of WHO Afro Region need to play an active role in the transformation and the development of the basic nursing education systems in the Region. They suggested that the systems of educating nurses should move toward meeting the demands of the health care services and the global trends in the development of nursing and nursing education.
Development and testing of a model for implementation of recognition of prior learning.
(2001) Khanyile, Thembisile.; Uys, Leana Ria.
The Minister of Education's public statement In August 1999, that South African citizens should mobilize and build an education and training system for the 21'st century . among other things emphasized the application of procedures for recognition of prior learning as part of the restructuring process. On the other hand the resolution taken by the South African nursing Council at the beginning of 2000. that enrolled nurses should be upgraded through the process of recognition of prior learning further increased the urgency for nursing education institutions to develop and implement RPL policies In South Africa, Recognition of Prior learning (RPL)is seen as an appropriate approach to offer equity and redress of past imbalances in the education and training system. The purpose of the study was to develop and test an appropriate model that could be used for Recognition of Prior Learning for nurses. To test the model, it was implemented in a form of pilot projects by three institutions. It was important for the model development to identify and involve all the stakeholders of the nursing education system. An appropriate design for the study was a multiphase decision oriented evaluation research . Stuffelbeam's Context. Input, Process and Product evaluation model was used to guide the research process. The first phase was the development of the model which involved the Context evaluation. During the context evaluation phase, the Education Committee of the South African Nursing Council and the evaluative researcher developed the guidelines for the RPL process. These were refined by the stakeholders during the regional workshops. The results of this phase was the RPL guidelines. The second phase was the Input and the Process evaluations. Each institution had to make planning decisions for Implementation. The result was RPL policies for each institution Thereafter. the three institutions Implemented the RPL guidelines to specific target groups of nurses that were identified for the purpose of the pilot project. Data collection instruments varied according to the phase of the model development. Checklists were used to measure the extent to which each Institution had followed the RPL guidelines Dunng the Product (evaluation) phase. candidates' scores were compared with those of other candidates who accessed the specific programs through the traditional entry routes. According to the results all RPL candidates were successful In the programs they aimed at accessing DUring the testing phase after access, the RPL candidates compared favourably with other the other candidates who accessed the programs through traditional routes . The result indicate that the self- directed approach used during RPL helped the candidates in the actual programs. A process onented and competency- focused model was developed through an inclusive process. Nursing education Institutions and policy makers can use the model to structure and evaluate RPL implementation in nursing education institutions in South Africa.
Spiritual care in nursing : a grounded theory analysis.
(2001) Mahlungulu, Sarah Nomalizo.; Uys, Leana Ria.
There is scientific evidence that the spiritual well-being of a person can influence the quality of life lived and the general responses to life's crises of illness, pain, suffering and even death (Ross, 1994). The problem that was identified in this study was the absence of an explicit description or the phenomena of spirituality and spiritual care in nursing within a South African context. Concept clarification was imperative ifnurses, patients/clients in South Africa were to realize spirituality and spiritual care within a broader context of holistic nursing. The purpose of the study was to conceptualize the phenomena of spirituality and spiritual care from the perspectives of nurses and patients/clients with an aim of generating a middle range theory of spiritual care in nursing that explained the phenomena by utilizing data that were grounded in the participants' experiences. A qualitative mode of inquiry using a grounded theory method was applied. A sample of 56 participants composed of 40 nurses, 14 patients and 2 relatives of patients was recruited by theoretical sampling procedure from two hospitals, and one hospice settings. Data were collected by utilizing focus groups interviews followed by one to one in depth interviews and observations. An audio tape recorder was used to record the conversation, field notes and memos were also kept to strengthen the data, and to ensure trustworthiness. Data were collected and analyzed simultaneously. A software called Nvivo was used to code data into different levels of coding. The results were rich descriptions of the phenomena in question and a development of a theoretical model for spiritual care. The concept of spirituality was described as a unique individual quest for a transcendent relationship by establishing and maintaining a dynamic relationship with self, others and with God as understood by the person. The ability to establish and maintain a meaningful transcendent relationship seemed to be related to the person's beliefs, faith or trust. 99% of the participants expressed their quest for a transcendent relationship through organized religion while I % claimed to have their spiritual fulfilment outside an organized religion. The phenomena of spirituality and spiritual care were conceptualized as occurring in phases which begin with a comfortable zone, trigge r-response and spiritual caring. The nurses role in spiritual care was perceived as based upon the principles of ubuntu. compassion for human suffering and pain and acceptance of a patient/client as a unique being. Nurses carried their spiritual care roles by accompanying, helping, presencing, valuing and intercessory roles. The outcomes of spiritual care were cited as hope, inner peace, finding meaning and purpose in life, illness, and in death.
An exploration of the presence and enactment of caring in the human resource management of nurses in KwaZulu-Natal hospitals.
(2000) Minnaar, Ansie.; Uys, Leana Ria.
The aim of the study was to explore the practice of caring in human resource management of nurses. Both the qualitative and quantitative research approaches were used to ensure that the richness and the complexities of caring is reflected in the study. A qualitative analysis of the interviews vvth nurse managers and nurses indicated that they saw caring as an important part of their task. They saw caring in human resource management of nurses mainly as dealing with the interpersonal aspects- personal problem-solving-, development and growth-, welfare needs-, and HIV/AIDS issues related to nurses. A quantitative survey of nurses from different levels was done to explore the presence and enactment of caring in the formulating strategies, structuring the work, workforce planning, staffing process and in the utilising and maintaining of nurses. It was found, according to respondents that caring was not present to satisfactory levels in the human resource management process of nurses, although caring concepts, as well as Christian principles, were present and clearly described in the mission, philosophies and goals and objectives of the hospitals. The fact that nurse managers are not solely responsible for the experiences of nurses and the way nurses expressed themselves on the caring issues in human resource management in the study should be emphasised. Organisational factors such as salaries and benefits of nurses, shortage of nurses at national and international levels, organisational structures and other financial ccnstrains in hospitals, contribute to the experiences of nurses in this study. Health service administrators, nurse managers and nurses should all take the responsibility to find means to improve and instil caring in hospitals. Therefore the decision to train nurse managers and to upgrade the management knowledge and the implementation of caring concepts in nursing management with relevant care and support to HIV/AIDS nurses, is of the utmost importance to equip nurse managers to survive in these demanding circumstances in the hospitals.
A grounded theory analysis of the meaning of community-based education in basic nursing education in South Africa.
(2003) Mtshali, Ntombifikile Gloria.; Gwele, Nomthandazo S.
An extensive review of literature revealed that although CBE was a familiar concept and a national policy for health professionals' education in South Africa, there was, however, limited understanding of this phenomenon. Most of the existing CBE programmes were a reaction to the inadequacy of traditional nursing education and had emerged without any intellectual discourse on the phenomenon CBE. The aim of this study was to analyse the phenomenon CBE in basic nursing education and the meaning attached to it. Furthermore, the researcher aimed at developing a middle-range theory of CBE. Strauss and Corbin's (1990) grounded theory approach was used to guide the research process. The South African Nursing Council's (SANC) education committee and seven nursing education institutions with CBE programmes were included for participation in the study. Data were collected by means of observation, interviews and document analysis. Purposive and theoretical sampling was used for selecting interviewees, resulting in a total of 41 interviewees. Data collection and initial analysis took place concurrently. Descriptive analysis followed by conceptual analysis was performed using Strauss and Corbin's paradigm for qualitative data analysis. The primacy of the community as a learning environment, timing of first exposure, duration, frequency and sequencing of community-based learning experiences, as well as service provision, emerged as discriminatory core characteristics of CBE in basic nursing education. Irrelevance of traditional nursing education and political change emerged as antecedents of CBE. The need to respond to national health policies and community health needs was seen as conditions under which CBE had to operate in South Africa. The nature of the CBE educative process, which placed emphasis on active learning and curriculum relevance, emerged as essential for the realization of expected outcomes of CBE in basic nursing education. Based on these results, it was concluded that CBE in basic nursing education in South Africa is (a) relevant education, (b) responsive education, (c) education for social justice, (d) a conscious and deliberate PHC socialisation process and (e) a process and outcomes education. As this was a ground breaking study on the meaning of CBE in basic nursing education in South Africa, a number of further research studies are recommended.
The experiences of death and dying of Zulu patients, their families and caregivers.
(1989) Mtalane, Lissah Joyce Themba.
This thesis studies the impact of the terminal illness and awareness of undergoing the dying process and inevitable death, at the KwaZulu Government hospital Ngwelezana, at Empangeni in the Lower Umfolozi District. A case study, drawing both upon nursing and social anthropology, was conducted to establish the experiences of death and dying of Zulu patients, their families and caregivers. The basic trend reflected in the findings is the need to discuss dying with patients, the lack of skills and knowledge on the part of caregivers, lack of recognition of patients' cultural beliefs. The study does not claim to deal with a complete spectrum of the experiences of death and dying of all Zulus but is a meaningful and significant innovation into an unresearched area of patient care.

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