School of Nursing & Public Health

Permanent URI for this communityhttps://hdl.handle.net/10413/6703

Browse

Now showing 1 - 20 of 510

An inquiry into student support mechanisms in postgraduate nursing programmes at the University of KwaZulu-Natal : a students' perspective.
(2010) Mugarura, John.; Mtshali, Ntombifikile Gloria.
Background: Literature on postgraduate student throughput and success suggests a mismatch between registration, throughput and success rates among postgraduate students. Purpose of the Study: This study aimed at exploring and describing mechanisms used to increase throughput and success rates in Postgraduate Nursing Programmes at the University of KwaZulu-Natal. Conceptual Framework: The theoretical framework used in this study was derived from Tinto's proposed Theory ofInstitutional Action (2005). This theory is based on the assumption that learners' behaviour which is manifested in persistence or departure is never fully understood because only the act of leaving or staying is observed, not the underlying intentions behind the action. Research Methodology: Using a mixed methods paradigm, the whole target population of 83 participants was sampled for the quantitative aspect and 2 focus groups each consisting about 12 participants for the qualitative aspect were used. Data were collected using a questionnaire and an interview guide. Descriptive statistics and were used for quantitative data, while thematic content analysis was used for qualitative data. Results: This study revealed that the support mechanisms for increasing student throughput and success rates are structured in three phases: the pre-enrolment phase, the integration phase, and the engagement phase. During the pre-enrolment phase, support is offered in form of information to help students understand what is expected of them, inform students about the programmes offered, the cost of the programmes, duration of the programs and the available support services. During the integration phase, the support provided includes guidance about the registration process, information about programmes and disciplines offered, counselling regarding curriculum design, modules to select and required credits for completion, orientation, and helping international students with visa extension with repatriation issues. During the engagement phase, the support provided includes academic, psychosocial and financial services. Facilitating factors reported include: student interaction with academic staff to monitor and provide feedback, a responsive curriculum to learning needs through the teaching and assessments methods utilised, active student involvement, personal effort, prior learning and working experience, and enough learning resources. Barriers reported were inadequate information, insufficiency of student-lecturer interaction time, unsuitable psychosocial support for adult learners, lack of mentorship and academic advising services, lack of time to participate in co-curricular activities, limited time for studying, ineffective use of learning resources, and language barrier. Recommendations: The study revealed a need to provide a balance mixture the available support mechanisms because academic support dominated the support services offered. Findings also showed the necessity to adapt the psychosocial support to the needs of all categories of students including adult postgraduate students.
Analysis of cognitive levels of examination questions set in the Bachelor of Nursing programme at the University of KwaZulu-Natal.
(2010) Garekwe, Masaitsiweng.; Mtshaji, N.G.
Background: 'The literature reveals that a large percentage of teachers ask questions aimed at lower cognitive levels irrespective of the underpinning philosophy. They fail to set challenging questions at higher order levels when setting examination papers. Purpose of the Study: This study is aimed at describing and analysing the examination questions set over a four year academic period, at the University of KwaZulu-Natal School of Nursing, in terms of Bloom's levels of cognitive domains. Research Methodology: A quantitative approach and content analysis was used. A total of 1319 questions were examined, SOUTCed from 39 examination papers, from 2003-2007. These questions were independently reviewed by two coders according to Bloom's taxonomy's template. Research Results: The findings revealed that all six categories of the cognitive domains in Bloom's taxonomy were used across the four levels in the Bachelor of Nursing (BN) programme. Overall about 57 % of the questions were aimed at lower level (knowledge, recall and comprehension) whilst only 43.4% were aimed at higher levels (application, analysis, synthesis and evaluation). In the first year lower order questions averaged at 62% with higher order questions at 51 %. In second year the lower order questions took up 51% of the paper \\~th higher order questions at 49%. During third year there was an equal (50/50) split between higher order and lower order questions. In fourth year there was the highest percentage of lower level questions (66%) was seen, with only 34% of questions being of the higher order. Regarding the increase in the complexity of questions within the programme, a change of 13% was seen between first and second year. Whilst there was an increase of 1% reported between second and third year. However, there was a significant drop (16%) in the complexity ofquestions in the fourth year, with lower order questions clearly dominating. Recommendations: The nursing education curriculum, and staff development progranune, should pay special attention towards developing educators in the setting of questions ensuring appropriate examination criteria are met. Exercises during the capacity building initiatives should cover aspects such as how to plan an assessment for the whole programme ensuring the appropriate increases in complexity as the programme progresses, as well as setting, or critiquing, of examination papers and coming up with recommendations to improve the quality of questions. Special attention should be given to how to align teaching and assessment in such a way that the level ofcomplexity increases as the students' progress through the programme. Lastly, further research should be conducted, using mixed methods, to explore the assessment of learning and in order to address certain questions which could not be answered quantitatively; for example questions regarding the construction of questions, because it impacts the nature of the question Also it should be noted that there was a disjuncture between the scenario and the questions in some cases.
An exploration of adolescents knowledge, perceptions and behaviors regarding sexual reproduction and sexual reproductive health services in Botswana.
(2009) Dingi, Keineetse.; Naidoo, Joanne K.
The study aimed to explore adolescents knowledge, perceptions and behaviors regarding sexual reproduction and sexual reproductive health services in community junior school in Tutume Botswana. A descriptive exploratory design using both the qualitative and quantitative approach was used to guide the research process. Data was collected by means of a self administered questionnaire and two focus group discussions. A total of 76 participants answered the questionnaire and 2 focus group discussions one consisting of the 15 to 17 year olds and the other one consisting of 12 to 15 year olds were conducted. The results of the survey highlighted adequate levels of knowledge regarding sexual matters among adolescents in the school with the bulk of the information being provided by the teacher. Parents, nurses, siblings, peers and the media played a low key role in providing adolescents with information regarding sexual reproduction and sexual reproductive health services. The results of the focus group discussion showed marked underutilization of the local clinic for curative, preventive and promotive services by adolescents. The poor utilization resulting mainly from perceived barriers such as provider attitudes, subjective norms, cultural taboos, inadequacy of the clinic, judgmental attitudes from provider and parents as well as lack of encouragement from authority figures like parents and teachers. Adolescents in the focus group discussion perceive themselves as being susceptible to HIV but did not appreciate the benefits of using preventive measures even though the survey group showed sound knowledge on contraception. Improving the services to align them to adolescent friendly services, improving the delivery of information through other means apart from the teacher and reducing the barriers that discourage adolescents from reaching the reproductive health services will go a long way in improving the utilization of the services by adolescents.
An exploration of the nurses perception on causes of and management of in-patient aggression in a psychiatric institution in Botswana.
(2009) Kealeboga, Kebope Mongie.; Middleton, Lyn Elizabeth.
Inpatient aggression in mental health settings is a significant concern because it compromises the quality of care provided by health care workers. Nurses are one of the groups most affected by inpatient aggression because they are usually the client's first contact on admission. A number of studies have found that nurses are the most frequently assaulted professional group both inside and outside of the hospital setting, are more frequently assaulted than doctors and most are likely to experience some form of aggression in their career. The causes of inpatient aggression are frequently conceptualised as multidimensional and involving factors internal to the client e.g. age, factors relating to the environment such as inflexible ward routines and factors relating to the quality of the interaction between nursing staff and clients. Research studies suggest that nurses generally respond reactively and rely heavily on physical control strategies rather than on interpersonal strategies in managing inpatient aggression. Contemporary literature suggests that the perceptions nurses hold about aggression and its causes influences their management of the event and that this process is mediated by a number of client, environment and nurse-related variables including age, education, gender, nursing experience, perceptions of aggression and its causes. Although the causes and management of inpatient aggression in nursing is well documented in the United Kingdom and some other West European countries, this is not the case for Africa and in the case of this study, for Botswana. No studies have attempted to find the nurses' perception, perception on the cause, and management of inpatient aggression in Africa and more so in Botswana. Aim: The purpose of the study was to explore how nurses' demographic characteristics, their perceptions of aggression and its causes, influence the management of inpatient aggression by nurses in the main psychiatric institution in Botswana. Method: A descriptive, exploratory non-experimental design was used. Perception of inpatient aggression was captured by a Perception of Aggression Scale (POAS) and the perception on the cause and management of inpatient aggression was collected with Management of Aggression and Violence Attitude Scale (MAVAS).The sample comprised of 71 nurses, 48 of whom were females and 23 males. The mean age of the nurse respondents was 36 years. Of the 71 respondents 50 were registered nurses only while 20 were psychiatric registered nurses. More than two thirds of the respondents had a diploma in nursing, one had a masters degree and the remainder, a degree in nursing. The average nursing and psychiatric nursing experience of the respondents were 12.1 and 6.87 years respectively. ANNOVA test and t-tests were done to find the associations between the nurses' demographic variables, their perception, perception on the cause and management of inpatient aggression. Findings: The respondents In this study perceived inpatient aggression as both negative and positive. There was an overall agreement with the perception of aggression as always negative and as an action of physical violence against a nurse (81.73%). Nurses saw the cause of inpatient aggression as emanating from the internal, external and situational/interactional factors. The use of traditional methods of aggression dominated as shown by a high mean score of 80.5 as compared to interpersonal management with a mean score of 60.5. A statistical difference was found between gender, perception of aggression and perception of aggression and the traditional management of aggression while age, nursing and psychiatric nursing experience were statistically associated with the use of interpersonal management of aggression. Conclusion: The study provided insight into the nurses' perceptions, perceptions on the cause and management of inpatient aggression in a mental institution in Botswana. Nurses in this study hold predominantly negative perceptions of aggression and generally favour traditional management strategies. However, older, more experienced nurses tended to favour interpersonal techniques. Recommendations for nursing practice, education and research to address this issue centre around further and targeted education and training in mental health and specifically, in the comprehensive management of aggression which includes communication skills, use of de-escalation, use of medication and cautious physical restraint.
Analyzing the relationship between leadership style, organisational factors and retention of professional nurses in public health care facilities in KwaZulu-Natal.
(2009) Nkosi, Zethu Zerish.
BACKGROUND : Many professional nurses have left the employment to work in developed countries. Quality patient care is declining because the few PNs that are rendering care have limited expertise. Literature review showed that nurse managers have a role to play in retention of staff. PURPOSE : The study aims to analyze the leadership styles and organizational factors toward the retention of professional nurses working in public health facilities. POPULATION : Professional nurses in four public hospitals, four union managers, twelve professional nurses working abroad and representative from SANe. A total of 188 participated in the study which formed part of the 70% of the sample. DESIGN : A Case study design which included both quantitative and qualitative approaches. Observations in the wards and document analysis were done guided by a case protocol. INSTRUMENTS : Revised Nursing Work Index and Revised Conditions of work effectiveness was administered among the professional nurse and chief professional nurses. Chief nursing service managers and union managers were interviewed using interview guides. Focus groups among professional nurses who had overseas experiences were conducted. Reliability was maintained by having a Cronbachs alpha of above 0.70 in all variables except leadership. RESULTS : Cases presented differently in all aspects, except Case C who was consistent in all the variables. The professional nurses in Case C viewed their CNSM as being visible and accessible. Case A and B were similar in terms of the organizational factors. All CNSM verbalized that they were willing to send PNs for educational programmes but the DOH policy was allowing nurses to work anywhere in the province. PNs had little access to resources on time to do tasks and paperwork as compared to access to support and opportunity.CONCLUSION : PNs are willing to stay in their organizations provided they will be given educational and promotional opportunities. There was a relationship between organizational factors and retention. Leadership factors showed a weak negative relationship with other variables.
A comparison of particulate matter (PM101) in industrially exposed and non exposed communities.
(2008) Moodley, Gonasagren.; Naidoo, Rajen.
BACKGROUND For many years, the Durban south community has raised concerns about ambient air pollution including particulate matter. The Durban South Industrial Basin (DSIB) may be high risk for exposure to significant levels ofPMI0 due to its geographic relationship with two major petroleum refineries, together with a pulp and paper manufacturing facility. While potential sources of elevated levels of PMlOin the south are industrial, the north is likely to be exposed to controlled burning of vacant fields and use ofbiomass fuels, particularly in informal settlements. Adverse health effects from particulate matter (PM) were well documented by extensive epidemiological observations by animal and human studies, following laboratory exposures. Studies across a variety of environmental settings have demonstrated a strong association between ambient air particulate matter (PMlO) and cardiopulmonary morbidity and mortality. Studies have reported that particulate matter is associated with adverse health effects resulting from inflammatory responses in the lower respiratory tract. Exposure to particulate matter may increase the risk of lung cancer. Some studies suggested that small temporal increases in ambient particulate matter are sufficient to cause health impacts. Other studies attributed strong seasonality to temperature inversions associated with temperature changes. Studies also illustrated the impact of temporal variation on PMl 0 levels across regions. OBJECTIVES The main objectives of this study were to determine and compare the levels of ambient PMIO in industry exposed and non-industry exposed communities, to determine temporal variation and to make recommendations. METHODS This study focused on determining the 24-hour ambient PMI0 levels in the Durban south community. The PMIO levels in Durban south (industry exposed) were compared with the PM10 levels in an area north of Durban (non-industry exposed). Relevant data obtained from the monitoring program of the South Durban Health Study (SDHS) was reviewed for the purposes of this study. The different techniques used to measure PMI0 are gravimetric sampling and tapered elemental oscillating microbalance (TEaM). Both methods were used to collect PMI0 data. The data comprised of quantitative and categorical variables. The dependent variable was the PM10 values and the independent variable was the sampling sites. Non-parametric tests were used to analyse the data. RESULTS PMI0 was recorded in all sites in north and south areas. The levels varied across all sites. Both the north and south areas recorded high PMI0 values at regular intervals. No particular trend was observed when the 24 hour PM10 concentration was compared against the standard. All sites recorded medians that were generally in the region of 40-S0,ug/m3. The site with the highest median (SIA,ug/m3 ) was Assegai. Briardale recorded the lowest median (34.9,ug/m3 ). Exceedances of the South African National Standard code 1929 maximum 24-hour concentrations of7S,ug/m3 were observed across all sites. Overall there were 163 (16.7 % of all samples) exceedances, and these ranged widely between the various sites, with no particular regional trend. Overall .June experienced the highest PMl 0 values. No differences in seasonal trends were observed in north and south. CONCLUSION On average the levels ofPMI0 do not exceed national or international standards. The findings did not reveal any statistical difference in exposure levels between the industry exposed and non-industry exposed areas.
A descriptive study of the structure and process standards in the intensive care unit (ICU) at the University Central Hospital of Kigali (CHUK) in Rwanda.
(2009) Twahirwa, Timothee Shahidi.
Introduction Patient safety IS fundamental to quality health and nursmg care and the ongomg improvement of patient safety is one of the most urgent issues facing health care today. Quality health and nursing care is a process which can be monitored, but which requires ongoing evaluation and change. The poor quality of patient care is a major problem of many hospitals in Rwanda and the University Central Hospital of Kigali, (CHUK), is no exception, especially in the Intensive Care Unit, (ICU). (Rwanda Ministry of Health Report, 2005). Pmpose of study The purpose of this study was to describe and explore the structure and processes of quality patient care at CHUK Intensive Care Unit, using the JFICM minimum standards, in order to improve the current quality of patient care and to further highlight gaps that might exist in this care for further research. Methodology The research was conducted in the Intensive Care Unit at CHUK. A checklist and self-reporting questionnaires, which were developed by the researcher, guided by the Joint Faculty ofIntensive Care Medicine (2003), constituted the instrument for this study. The sample consisted of 41 participants who were health care workers in the ICU and 20 of the patient's files. These files were used for researcher's observations during the period of data collection being 20thJune to 20th July 2008. A descriptive quantitative design was used. Results Design: While the ICU was in a self contained area with easy access to other departments the actual work environment did not comply with the recommendations of the JFICM (2003) minimum standards ofICU. ICU staffing: The staff consisted of only 1 medical doctor consultant and three specialist anesthetists. There were 11 Registered nurses (RNs) and 16 Enrolled nurses (ENs). A physiotherapist and dietician were available, but there was no biomedical engineer. The quantity of equipment was not adequate for the workload in the unit. There were no guidelines or protocols for nursing care and the unit had neither in-service training programmes nor research programmes available to the medical and nursing staff. While vital signs, ECG and oxygen were well monitored by using the nursing file (Appendix 10), the monitoring of patients was done without any guidelines or written procedures. The nursing reports, also, did not follow any guideline or procedure. Communications were generally poor because of the lack of equipment. The phone was not working for most of the time and there was no biotechnical engineer available to monitor the material and equipment. Conclusion According to the analysis of the structure and process standard based on JFICM (2003), the minimum standard of quality of ICU patient care at CHUK needs to be improved because the unit does not comply with an appropriate design, fulfil the staffing and operational requirements, or have the necessary equipment. Due to the shortage of qualified staff, plus the unavailability of protocols or guidelines, the processes of quality patient care were inadequate and need to be improved.
Experiences of social support among volunteer caregivers of people with AIDS living in the Kwangcolosi community, KwaZulu-Natal.
(2009) Fynn, Sharl.
HIV/AIDS is a significant social problem impacting on families, communities, the public health sector and greater society. This qualitative study looked at the experiences of social support among volunteer caregivers of people living with AIDS and relationships of trust and solidarity between caregivers and members of the community. KwaZulu-Natal has the highest HIV infection rate in South Africa. This further compounds the burden of care and stigma surrounding caring for people living with HIV/AIDS .This study draws on aspects of social support theory, social capital framework and the theoretical resources of socio-ecological theory more broadly. Methodologically, in-depth interviews were conducted with 10 female volunteer caregivers with a minimum of three months care work experience and Ulin’s thematic analysis was utilized to highlight the salient themes around their experiences of social support. The findings of this study revealed that the burden of care, stigma experienced by the volunteer caregivers and the relationships between the volunteers and community members as well as social networks all played a significant role in the need for the provision of social support to the volunteers. Furthermore, the findings of the study highlighted the social consequences of care work and the need for support in this ambit. The study concluded that social support for the volunteers is severely lacking for the following reasons; there was a complete breakdown of social cohesion between the volunteers and their community; the relationships between the volunteer and surrounding social networks were under strain and as a result had a negative impact on the accessing of social support. Factors such as social trust, social bonding, social bridging and social linking were lacking between the volunteers and the community therefore accessing social support becomes problematic. Poverty is a factor that had a ripple effect on the volunteer and resulted in the urgent need for support in the form of tangible and emotional resources. Volunteerism is an undeniable necessity in the treatment or care of HIV/AIDS patients. The issues around social trust and social networks played a key role in the accessing of social support which ultimately impacted on the efficacy of care provided by the volunteer. The findings highlighted that there was a dire need to mobilize social capital within the KwaNgcolosi community in order to create relationships that would facilitate the social support needed by the volunteer.
A cost analysis of a stepdown antiretroviral programme at the KwaDukuza District Municipality Clinic in the Ilembe District in KwaZulu-Natal for the period 1st April 2005 to 31st March 2006.
(2008) Kista, Yogendiran.; Moodley, Indres.
Introduction: While the antiretroviral (ARV) coverage has been scaled- up in the last 3 years in South Africa, there is limited data on the operating costs and financial sustainabihty of an anti- retroviral programme. Study Aim: To conduct a cost analysis of the stepdown ARV programme at the Kwadukuza Municipality Clinic (KMC) in the Ilembe district from a healthcare providers' perspective for the period 1st April 2005 to 31st March2006. Study Objectives: To determine the total costs and cost per patient per visit for outpatients attending the ARV, Wellness and VCT clinics respectively at KMC. Study Methods: Study location: This study was conducted at the Kwadukuza Municipality Clinic located in the Ilembe district in Kwazulu- Natal, South Africa. Study population: The population that is included in this study for the purposes of costing comprised: all the patients who received ARVs for the period under study; all the patients who attended the Wellness and VCT clinics and all the staff attached to the ARV programme at the KMC clinic Study design: This is a retrospective and cross- sectional study with both a descriptive and analytical component. Results: Seventy- one percent of the patients on ARVs were female with 50% of the patients being between 31 and 40 years of age. The total operating costs of running the ARV programme was R2 439 940- 90. The total cost accrued to the ARV clinic was R 1 698 003- 60. The Wellness clinic had a total cost of R 460 279- 68 and the VCT clinic accounted for the least total operating cost of R 281 657-77. The cost per patient visit was R440- 13 for the ARV clinic; R133- 05 for the VCT clinic and an amount of R61- 71 for the Wellness clinic. Conclusion This study provides the basis for determining the three cardinal cost components of the ARV programme, namely human resources, the cost of ARVs and the costs of viral load testing for the purposes of future planning and sustainability. The cost- effectiveness of ARV drugs can be improved if the healthcare providers negotiate a lower price for these drugs. The high cost due to monitoring tests can be lowered by decreasing the frequency of these tests but this may allow ARV drug resistance to be undetected.
Investigating the quality of referral and support systems between fixed clinics and district hospitals in area 3 of KwaZulu-Natal Provincial Department of Health.
(2010) Hombakazi, Nkosi Phumla.; Reid, Stephen John Young.
Introduction A well-functioning primary health care system depends on all three levels of healthcare, that is, the primary, secondary and tertiary levels of care. District hospitals have a major role to play in the development of a strong referral system. This study was undertaken to evaluate whether the primary health care clinics in Area 3 possess all the key essential components for a strong referral system. Area 3 comprises 3 districts in northern KwaZulu-Natal, i.e. the Umkhanyakude, Uthungulu and Zululand districts. Aim The aim of the study was to evaluate referral support systems between fixed clinics and district hospitals in the three districts of Area 3 in KwaZulu-Natal province. Methods A descriptive study was undertaken in 58 randomly selected clinics in Area 3. Data was collected between July and August 2007, on availability of: communication technology, transport for patients being referred to the district hospital, and guidelines. Referral letters were reviewed to determine if they contained adequate information. Professional nurses were interviewed to determine the training they had attended. Results A third (34%) of clinic nurses on duty had been trained in Primary Health Care; 57% of clinics had at least one professional nurse on duty with a PHC diploma. The proportion of nurses trained in short courses ranged between 4% and 47%. Fifty-six out of fifty-eight (97%) of clinics had telephones; 57% reported problems with telephones. Eighty-eight out of one hundred and seven (88%) of selected referral letters did not have adequate information. Only 32% of urgently referred patients were collected by an ambulance within 1 hour. All 58 clinics had the Essential Drug List (EDL) available; availability of the other guidelines ranged between 29% and 79%. Discussion The percentage of clinic nurses with a PHC diploma or trained on short courses indicates that most clinic nurses render health services without or with inadequate knowledge and skills. Poor quality of referral letters and inefficient transportation of referred patients, especially emergencies, confirm a weak referral support system. User perceptions of the referral system have not been explored. Recommendations Training and support of clinic nurses needs to be prioritised to improve patient assessment and management, as well as the quality of referral letters. District management should advocate for improvement of patient transportation. Future studies should explore the use of referral letters by and training of, clinic nurses; as well as determine user perceptions.
Description of health seeking behaviours and experiences of homeless people in South Central Durban, South Africa.
(2009) Wentzel, Dorien Lesley.; Voce, Anna Silvia.
The study aimed to describe the health seeking behaviours and experiences of homeless people in South Central Durban. Homelessness is a broad and complex term that affects many people in South Africa. Homelessness inevitably causes serious health problems, conditions that are closely associated with poverty. Health problems experienced by homeless people are numerous and multifaceted. Homelessness is a complex issue that not only damages both physical and mental health, but also contributes to the spread of disease to the non-homeless (National Health Care for the Homeless Council, 2008:1). Drawing on interviews with homeless participants and healthcare workers, this study depicted the experiences, and the observed, felt and perceived needs of homeless people in accessing healthcare. The study reveals why, when and where homeless people access healthcare and the factors facilitating and hindering their access to healthcare. The researcher primarily used a qualitative methodology with a small quantitative component. The qualitative component comprised one on one in-depth interview. The quantitative component comprised a record review showing frequency distribution of health problems experienced by homeless people presenting at the Kathleen Voysey clinic. The findings highlight the unique lived experiences which include health problems, basic needs, accommodation, safety and security, community networks, access to pensions and grants. Findings show that homeless people are accessing healthcare facilities however there are mixed responses as to the service that they have received. A number of recommendations were suggested by both homeless participants and healthcare workers for policy makers, healthcare services, and homeless people and for future research regarding the care of homeless people.
Perceptions around managed health care service delivery in private medical care in the Republic of South Africa.
(2008) Scott, Mitchell Robert.; Chetty, Morgan.; Naidoo, S. S.
Introduction: This study aimed to explore private General Practitioners' perceptions of Managed Health Care CMHC) for health service delivery in the Republic of South Africa (RSA). The specific objectives were to review perceptions regarding issues in MHC including ethics of care, quality of care, design ofMHC programmes and regulation and monitoring ofMHC. The study also reviewed demographic profile of respondents and associations between demographic profile and perceptions. A literature survey indicates that MHC was introduced in a Western context as a means ofregulating cost of healthcare. Models ofMHC generally involve a need to obtain authorization and a restriction of services available. There are ongoing debates about MBC and in particular the potential conflict between managing healthcare provision using business and profit principles and the principles of other stakeholders in health care. Providers, such as General Practitioners, are concerned that their autonomy and their ability to offer best possible care for their patients may be compromised. Patients feel that their ability to access optimal care is not a primary consideration in a model of MBe. The popularity ofMBC in the United States of America is declining and MBC companies have been making financial losses on the Stock Market. MBC has been introduced in South Africa and there has not been any recent assessment of healthcare provider perceptions of the model. This study aimed to address this gap in literature. Methods: The study design was mixed with quantitative and qualitative components. The study population was all private General Practitioners in RSA as this population would have most experience of MBC. The data collection tool was designed by the researcher and comprised closed-ended questions and one open-ended question around perceptions of MBe. Demographic data, and other data relating to experience of MBC, was collected on a separate questionnaire. Questionnaires were posted to a representative sample of private General Practitioners; this constituted 30% of all active private General Practitioners. Results and discussion: The response rate was poor at 13.6%. Respondents generally had negative perceptions of MHe. They cited problems with ethics ofMBC, quality of service and felt that it affected their ability to act independently. They felt that MHC should be monitored by an independent regulatory body and that there should be more teaching around differing models of healthcare. There were no significant associations between gender, place of work, experience oftvtHC and perceptions. However, there was a significant correlation between doctors employed by Iv1HC companies and perceptions. A major limitation of this study was the predominant use of quantitative methodology. A qualitative methodology, using focus group discussion, may have highlighted major issues and following initial qualitative methods a quantitative tool could have been developed. The low response rate is of concern. Respondents may be biased and may have only responded if they felt strongly about the subject. However, respondents did raise some important issues, especially with regards to ethics which must be explored further. There should be ongoing research into differing models of healthcare provision (for example private-public partnerships). Medical school curricula should include training around models of healthcare. Consideration should be given to monitoring MBC using an independent monitoring authority.
Impact of delayed introduction of sulphadoxine-pyrimethamine and artemether-lumefantrine on malaria epidemiology in KwaZulu-Natal, South Africa.
(2007) Junior, Anyachebelu Emmanuel.
Background The years 1985 to 1988 and 1997 to 2001, were periods of high morbidity and mortality due to malaria in KwaZulu-Natal, South Africa. One reason for the increased burden of disease was the emergence of drug resistant Plasmodium falciparum. The parasite was resistant initially to chloroquine and then to sulphadoxine-pyramethamine, the medication of choice for the treatment and prevention of malaria in different periods of time. The changing epidemiology of malaria in Mrica was exacerbated by policy makers not making timely and rational change to the failing malaria drug regimens to newer and effective ones. Purpose ofthe study This study was conducted to determine the impact of delayed introduction of sulphadoxine-pyramethamine (Fansidar®) and artemether-lumefantrine (Coartem®) as a first-line drugs for malaria in KwaZulu-Natal from 1985 to 1988 and 1997 to 2001 respectivel y, Study Design Observational, Analytic, Ecological Method The incidence of malaria in KwaZulu-Natal was compared during different phases of the period when chloroquine was the first line treatment. The baseline phase (1982 to 1984) was taken when chloroquine correctly should have been used and this was compared with the delayed phase (1985 to 1988), when it should have been replaced by of sulphadoxinepyramethamine. During the second period sulphadoxine-pyramethamine was the first line treatment of malaria, the baseline phase (1993 to 1996) when it correctly should have been used was compared to the delayed phase (1997 to 2001) of introduction of the alternate treatment of malaria with artemether-Iumefantrine. Ethical approval for this study was obtained from the Biomedical Research Ethics Committee, of the University of KwaZulu-Natal. Statistical Methods The relative association of malaria infection during the chloroquine baseline and change phases and the sulphadoxine-pyrametharnine baseline and change phases were compared with statistical significance at 0.05. Results The risk of malaria infection was 4.5 times (Incidence Risk Ratio = 4.5; 95% Confidence Interval: 4.1 to 5.0; P < 0.0001) higher in chloroquine change phase relative to the baseline phase. During the sulphadoxine-pyrametharnine period, the malaria risk was 3.5 times greater (Incidence Risk Ratio = 3.50; 95% Confidence Interval: 3.40- 3.60; p < 0.0001) in the change phase. In the chloroquine period, the malaria mortality risk was 9.1 times higher (95% Confidence Interval: 2.1 to 38.5; p=0.0003) and the case fatality rate was increased 1.3 times more (95% Confidence Interval: 1.0 to 1.7; p< 0.001) in the change period. The risk of death during the sulphadoxine-pyramethamine change phase was 4.8 times (95% Confidence Interval: 3.3 to 7.0; p
Perceptions of and attitudes to the compulsory community service programme for therapists in KwaZulu-Natal, 2005.
(2009) Khan, Nasim Banu.
Compulsory community service programmes have been initiated in many countries to recruit health care professionals to provide services in rural and under-served areas. However, the success or failure of the Community Service Programme depends largely on the attitudes of the professionals, their understanding of the programme's objectives, their preparedness for working in these areas and their ability to adapt to a new and challenging experience. Aim The aim ofthis study was to assess therapist's perceptions and attitudes about the compulsory Community Service Programme in KwaZulu-Natal in 2005 and to assess whether these changed during the year. Methods An observational cross sectional study with a descriptive and analytic component was conducted on commencement and after completion of community service. The therapists completed a self-administered questionnaire before and after their community service. Results A total of 126 (89% of 142) therapists responded to the initial questionnaire, 59 (42%) completed the exit questionnaire of which 47 (33%) completed both the questionnaire at commencement and completion of community service. Despite the poor response rate, similarities in perceptions and attitudes were noted with other studies conducted nationally and internationally. At onset 50% indicated that they would work in the public sector in the future and this proportion declined to 35% by exit. Even fewer (24%) said they would work in a rural area in the future. Only 16% reported that they would stay on at the same institution the year after community service. There was also no significant association between therapists collecting a rural allowance and expressing an interest to work in a rural area in the future (p=0.78) or staying at the same institution in the years after community service (p=0.32). However, therapists working in urban areas were more likely to say they would work in a rural area in the future (p=0.018). The comparisons between the occupational catergories showed that for support and supervision, the Speech Therapy and Audiology Forum was considered significantly (p=O.OOI) supportive compared to the Physiotherapy Forum. There was no significant difference within the occupational catergories in their perceptions of support, mentoring and supervision, attitude, psychological coping, personal and professional gains, safety issues and the amount of community outreach conducted. All groups were similarly resource constrained. Language was a barrier for 50% of all community service therapists and impeded their professional functioning. Discussion Despite the challenges experienced by community service therapists the majority felt that they had made a difference in the community in which they have been placed. The obligation to work in rural and under-served areas was personally and professionally rewarding. Particular concerns centred on support, supervision, training, resources and language barriers in providing better service delivery. Recommendations To achieve its objectives in relation to compulsory community service, which is to ensure an improved provision of health services to all citizens ofthe country, the Department ofHealth should consider multiple strategies including financial incentives such as rural allowances and non-financial incentives to retain health care personnel in rural and under-served areas. A long-term strategy that addresses human resources in a comprehensive manner needs to be developed to improve staffing and quality health services in these areas.
Exploring the factors that contribute to job satisfaction among registered nurses at King Faisal Hospital, Kigali, Rwanda.
(2008) Nkomeje, Aurelie.
AIM: The aim of the study is to explore the factors that contribute to job satisfaction among registered nurses at KFH and to determine factors associated with job dissatisfaction among registered nurses at KFH. METHODOLOGY: A quantitative, descriptive, exploratory study was conducted to explore the factors that contribute to job satisfaction among Registered nurses at King Faisal Hospital. A non probability convenience sampling technique was used to include all the available registered nurses doing bedside nursing in the study. A criterion for inclusion into the study was to be a registered nurse working in the area for at least 6 months full time employment. Data was obtained through a questionnaire survey using Job Satisfaction Survey (JSS), to assess factors influencing job satisfaction among nurses at KFH, Kigali-Rwanda. Data were analysed by SPSS 15.0 for Windows. FINDINGS: The findings of this investigation was that the factors, namely; supervIsIOn, coworkers, nature of work and communication were factors that contributed to a greater job satisfaction of registered nurses (45.5%); while factors such as pay, promotion, fringe benefit, contingent reward and operation procedures, were factors that caused moderate job satisfaction (55.5%). Simultaneously, the research found that these results also indicated, to some degree, that these factors are contributing to job dissatisfaction, albeit small. The study recommends strategies that management can utilise by improving income (salary, benefits and rewards), job promotion and working conditions may increase RNs' job satisfaction and therefore improve the overall well being of nursing personnel and quality of health services. These strategies may be used as a tool to keep employees satisfied and motivated in their jobs. It also recommends ways by which management can reduce job dissatisfaction amongst employees by improving and simplifying the hospital policy and administrative matters. CONCLUSION: The results of this study revealed that registered nurses are moderately satisfied with their job. The nurse administrators will know that they need to do more to improve nurses' job satisfaction since registered nurses are only moderately satisfied.
Exploration of factors that influence the utilisation of HIV/AIDS prevention mehtods among University of KwaZulu-Natal students residing in a selected campus.
(2009) Ndabarora, Eleazar.
In this study, the researcher is interested in the utilization of HIV/AIDS prevention methods among university students. The purpose of this study was to explore factors that influence the utilization of existing HIV/AIDS prevention methods amongst students at the University of KwaZulu-Natal residing in a selected campus. Four residences within the selected campus were randomly selected and participants were conveniently selected from each of sampled residences. There was a total of 335 respondents and 261 (78%) completed the manual questionnaires while 74 (22%) completed online questionnaires. The study used quantitative approach and was descriptive-exploratory in nature. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 15. The majority of respondents were young people with the mean age of 22.9 years. The sample comprised 278 (78%) undergraduate and 57 (17%) post graduate students. Study findings showed that the factors which influenced the utilization of HIV/AIDS prevention methods varied and that they were mainly influenced by the awareness of the existing university-based HIV/AIDS prevention strategies. It also emerged that the mostly utilized HIV prevention methods were VCT services and free condoms. Perceived susceptibility and the perceived threat of HIV/AIDS score was also found to be correlated with HIV Risk Index score. Furthermore, there was Correlation between perceived susceptibility and perceived threat of HIV/AIDS and self-efficacy on condoms and their utilization. However, there seemed to be no relationship between utilization of HIV/AIDS prevention methods and these variables. In conclusion, the findings of this study suggest that most of Health Beliefs Model (HBM) variables were not predictors of the utilization of HIV/AIDS prevention methods among students. Intervention aiming to improve the utilization of HIV/AIDS prevention methods among students at the UKZN should focus on removing identified barriers, promoting HIV/AIDS prevention services and providing correct knowledge on HIV for behavioral change.
Exploring how psychiatric nurses working with psychiatric clients in the eThekwini district understand the spiritual dimension of holistic psychiatric nursing practice : a descriptive phenomenological study.
(2010) Tokpah, Mulbah Massaquoi.
The purpose of this qualitative study was to explore how psychiatric nurses working with psychiatric clients in the EThekwini District understand the spiritual dimension of holistic psychiatric nursing practice. Descriptive phenomenology informed the study design, data collection and analysis. Integrating spiritual and psychiatric care is an important contemporary issue for psychiatric nursing if the profession is to continue to define itself as a holistic and client-centered activity and to provide socially responsive care (Greasley et al 2001; Mohr, 2006). Local data about how nurses understand and practice spirituality in their working encounters with clients would be an important first step in enhancing holistic, patient-centered psychiatric nursing care in the South African context. Purposeful sampling was used to select the seven psychiatric nurses working in psychiatric settings in the EThekwini District. These participants were selected from the advanced psychiatric nursing classes of the School of Nursing of the University of KwaZulu-Natal for 2008/2009 and 2009/2010. Data were collected through in-depth interviews lasting for 45minutes to lhour and were audio-taped and later transcribed to facilitate easy analysis. The Colaizzi Method of data analysis and representation was utilized. The following four themes emerged during the analysis of the data. Each theme had between three and twenty one associated significant statements. Theme 1 revolved around the higher power of spirituality, religion and their relationship. The participants conceptualized spirituality in a variety of ways, linking spirituality to religion and to cultural values, daily moral and interpersonal experiences with self and others that provide direction and meaning in life. Spirituality was conceived of as "the glue that brings people together" and as a primary source of meaning making in daily life that provides people, nurses and patients with a sense of belonging and of joy, hope, and comfort in both difficult and happy times. The second theme "Central to but forgotten in psychiatric nursing practice" concurs with the literature view that spirituality and psychiatric nursing care are related, although spirituality is often forgotten in psychiatric nursing practice. Participants linked spirituality specifically to Maslow's Hierarchy of needs. The third theme entitled "Psychiatric nursing for the spirit: Enabling and limiting factors identifies a number of factors which influence how psychiatric nurses engage with this dimension of holistic psychiatric nursing practice. This theme focuses on factors which influence psychiatric nurses in providing spiritual care for their patients. Enabling factors include psychiatric' nurses own spiritual orientation and knowledge about spiritual care enables them to provide spiritual care whereas limiting factors include the lack of spiritual education and spiritual knowledge in providing this care. The final theme highlights what these nurses see as important for developing their ability to provide spiritual assistance and includes education in method of spiritual assessment and intervention as the basis for providing holistic psychiatric nursing practice. A number of recommendations for psychiatric nursing practice, education, research and policy-making based on the data from the study were made to relevant stakeholders. If accepted and implemented will go a long way in augmenting psychiatric nursing intervention to be holistic wherein psychiatric nursing care will include not only the biological, psychological and social care but also the spiritual care.
The epidemiology of motor vehicle collisions involving pedestrians in eThekwini Municipality, 2001-2006.
(2009) Hobday, Michelle Bridget.
Introduction Road traffic collisions in developing countries contribute towards the greatest burden of disabilities and fatalities globally. Concern has arisen about the high proportion of pedestrians involved in collisions in South Africa. Aim This study describes the epidemiology of motor vehicle collisions involving pedestrians in eThekwini Municipality from 2001 to 2006, aiming to identify opportunities for prevention and informing policy. Methods An analytic cross-sectional study design was used. Data was obtained from the eThekwini Transport Authority database (police accident reports), and the Nationallnjury Mortality Surveillance System (mortuary reports). Exposure variables included pedestrian and drivers' demographics and collision environment. Death and injury were the outcome variables measured. Population data was obtained from Statistics South Africa. Results Pedestrians' injuries decreased from 7 445 to 6 288 (incidence risk: 241 to 193 per 100 000) from 200 I to 2006. Annual case fatality rose from 4.9% (366 deaths in 200 I) to 6.8% (430 deaths in 2006). Child pedestrians aged 5 to 9 years had a 77% increased risk of injury relative to other children. The fatality risk ratio of male to female pedestrians was 3.8 (95% Confidence Interval: 1.7 to 9.3). Male drivers aged 30 to 34 years had a 68% increased collision risk relative to all other male drivers and eight times (Incidence risk ratio: 8.0; 95% Confidence Interval: 6.2 to 10.3) the risk of female drivers. Only 3.4% of collisions occurred on freeways but accounted for 19.6% of pedestrian fatalities. Few (1.5%) collisions involving pedestrians occurred at night in unlit conditions but constituted more than four times the number of fatalities as number of collisions in these conditions.
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.

Browse

Browsing School of Nursing & Public Health by Date Accessioned