Nursing

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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.
The assessment of the aggregate health status of an organisation.
(1993) Grainger, Linda Denise.; Uys, Leana Ria.; Kortenbout, Wilhelmina Petronella.
As adults spend the major portion of their lives at work, it is essential that the reciprocal relationship between their work and health be recognised. In this regard, occupational nurses have an important function, through the provision of effective occupational health programmes in the workplace, although this is a challenging task and programmes often bear little relevance to health needs. The process of identifying health needs involves the measurement of health status, requiring a clear understanding of the nature of health and how it is determined. However, conceptualisations of health in relation to work tend to be inadequate as they deal with it on an individualistic basis, often as a negative measure, do not include the various dimensions of health, and fail to take account of the influences of the wider community. This study sets out to overcome these problems. A model of aggregate (collective) health in the workplace was developed from a conceptual framework, to expain how influences inter-relate and contribute to health in this setting. Health is conceived in positive terms, with the individual represented as the core, passing through the organisation and community, thereby depicting the interrelationships between their health. At the aggregate level four sets of factors, human biology, environment, lifestyle and health care organisation, are shown to influence health. The subjective, objective, physical, psychological and social dimensions of health are incorporated, whilst the potential of work as a stressor or health strengthening influence on health is recognised. Concepts from the model have been operationalised into composites of variables, for the assessment of aggregate health status. A measurement strategy was then devised, involving the analysis of data collected by means of an examination of organisational records, interviews with key people, a survey of a random stratified sample of members, health hazard identification in the workplace and an assessment of the provision of health care in the wider community. The survey instrument, consisting of an interview and questionnaire, was developed and subjected to a field test. The model, strategy and instrument were revised according to the results.
Professional nurses knowledge and understanding of AIDS/HIV infection.
(1993) Chamane, Nomusa Joyce.; Kortenbout, Wilhelmina Petronella.
This study examines the Professional nurses' knowledge and understanding of AIDS/HIV infection. The Professional nurses that participated in the study, are those working in a specialised institution which caters for tuberculosis and psychiatric patients, and those suffering from oesophageal and lung cancer; and the patients with orthopaedic problems. Knowledge explored is specifically related to AIDS/HIV infection, which includes the causes, mode of spread of infection, symptoms, diagnostic tests available, prevention, complications and identification of high risk groups. The sample was formed by 53 Professional nurses; 27 being those that have done the AIDS counselling course, and 26 who have not done the course. To collect data, questionnaires were sent to the participants. Apart from the questionnaires, focus group interviews (21 participants) were done to elicit any information that may not be obtained through the use of a questionnaire. The theoritical framework used is a combination of two theories, Cognitive Dissonance Theory and Fear of Contagion Theory. Cognitive Dissonance Theory assumes that people want to maintain consistency with their beliefs, attitudes, values and behaviour. People confronted with examples of their own inconsistency in these areas, will experience psychological discomfort and be motivated to eliminate the inconsistency. Fear of Contagion Theory developed as a response to perceived threat of catching the disease/infection. Three behaviours characterise this fear:- avoidance, taking extreme precautions, and verbal expression of fear regarding the disease. As a result, apart from looking at factual knowledge, one had to identify the behaviors that relate to this theoretical framework. These included fear, avoidance, taking extreme precautions and dissonance/discomfort. These areas are covered in the questionnaire as well as in the interview with the focus group. The results show high knowledge of general information, including the mode of spread. Lack of knowledge in identification of high risk groups, symptoms, diagnostic tests and use of universal precautions in specific areas was identified. Fears and dissonance are found to be caused by lack of knowledge, aggravated by the fact that the disease is incurable, as it was expressed by the focus groups. Uncertanty was marked with regard to the use of protective clothing. Some participants responded in a manner that showed the use of extreme precautions, while others were unsure in such a way that in the end they indentified different protective clothing for the similar situations. In areas where knowledge deficit was identified, it was discovered that the Trained AIDS Counsellors had better knowledge than those that have not done the course except for universal precautions. On looking at the programme it was discovered that the use of universal precautions was not included in the programme and this might be the cause for the uncertainty. The difference between the two groups might have been in the understanding gained from knowledge acquired during the counselling course, since both groups were exposed to the same enviroment, policies and circulars regarding caring for HIV infected patients. Although the results showed the numerical differences, it was surprising that in certain sections when these differences were tested statistically, no statistical difference was shown between the two groups. This might have been due to the small sample used. There are respondents that showed a negative attitude towards caring for AIDS/HIV infected patients; unfortunately no further questions were asked to explore this aspect. This is a shortfall of this study. It is clear that AIDS/HIV infection is a challenge to all professionals, since it has become one of the leading causes of death. It is then believed that nurses should be equipped with adequate knowledge so as to be able to care for those suffering from AIDS/HIV infection. In conclusion it was clear that AIDS/HIV infection is a challenge for all professionals.
An investigation of different approaches to the prevention of alcohol abuse among black adolescents : a community based partnership approach.
(1994) Nkonzo-Mtembu, Lulama Lorraine.; Uys, Leana Ria.
According to Amos (1989) the use of, and the attitudes towards alcohol amongst young people in Africa is an area about which little is known but which has potentially major health implications. Neither has much been done about primary prevention in this field. The case studies which included a participatory research was conducted among three groups of people in the Clermont Township near Durban in the Natal Region. The aim of the research was to describe alcohol abuse as a social problem among the black adolescents and to compare and contrast the implementation of alcohol abuse prevention strategies that were and are used by the different groups of people in their community. The case study approach documented the work of each community. All the three groups of people who participated in the research agreed that alcohol abuse was a problem in their community. They described factors in their township which were contributory to the alcohol problems in their community and described the various cycles of negative effects and consequences to the individual, family and to the community. They agreed that in the past alcohol was not a problem in the traditional African society because of cultural and economic factors. Most interesting was the serious effects all groups described alcohol abuse amongst both teachers and the pupils in the Black education system. Each group planned, implemented and evaluated a unique alcohol preventive strategy. While the youth group maintained a strong alcohol focus with an educational programme, both the adult groups moved into the more general issues of economic empowerment. All three groups also used the participation and capacity building. The willingness to get involved, and to address the problems of the groups were remarkable. The following were the research conclusions: * Material resources were relatively available in this community. * Health professionals were available in this community, but they did not follow the Comprehensive Primary Health Care approach and were not involved in community development. * Integrated drinking seemed to be in harmony with the values of these groups and could be used in the alcohol abuse prevention. An integrative, multi-faceted and comprehensive community based partnership approach was used to the multi-causal alcohol abuse prevention programmes and strategies. This strategy was successful in involving community partners and leading to the solving of the actual problems and the development of positive health behaviours. The research revealed that the development projects needed "seed money" to initiate and to maintain. Alcohol abuse prevention can be used as a vehicle to enter a community and to engage it in a health directed partnership.
The experiences of infertile African women in Durban.
(1994) Ndaba, Nelisiwe Dorcas.; Brookes, H. B.
The experiences of African women with primary infertility were explored. These women were from Durban and surrounding rural areas, in KwaZulu / Natal. The aims of the study were to describe their perception of infertility using King's (1981) Interacting Systems Model and to describe the actions they undertook in response to their problem of primary infertility. A purposive sample of the first ten consenting women with primary infertility, five from the academic hospital and five from a private gynaecological practice were selected on the day when they attended either health centre. Case studies were conducted using in-depth interviews. Women's personal, interpersonal and social systems were adversely affected by their problem of being unable to conceive. For example in the taped discussions, all ten participants had a low self-image in regard to their personal system which was reflected in all but four, when measured with Rosenberg's Self-Esteem Scale (Rosenberg, 1979). All women were found to be at various stages in the grief process, only one having attained acceptance (Kubler-Ross, 1969). Eight women were married and the remaining two were single. Four of the married participants had experienced problems with "in-laws", which has led to poor interpersonal relationships, unlike the other four married participants. Despite not being major decision-makers in the household, all the participants were allowed to make their own decisions about whom they saw in regard to infertility. All the women concerned made use of formal medical facilities but four participants made use of traditional and/or faith healers as well. Some of the problems identified were the lack of emotional support from nursing personnel as well as their own lack of understanding of causes, investigations and treatment of female infertility. Recommendations regarding effective nursing care of women with infertility and the possible formation of support groups, were made. As all the participants were literate, informative pamphlets could be developed. Areas of further research were identified.
The development and testing of a multi-ethnic, low literacy, family support programme for the primary prevention of child abuse and neglect in the child under five years.
(1995) Lewis, Wendy May.; Uys, Leana Ria.
The main aim of this research was to identify a family support programme which could be used as a primary prevention strategy against child abuse as a first positive step within the family, the basic unit of society, towards reducing community violence. The central focus of this intervention was that it should be appropriate for use in a multi-ethnic South African context and implementable by community health nurses or related lay health personnel with minimal training. No such programme was identified. The researcher attempted to integrate the most appropriate and scientifically substantiated features of existing programmes and develop a unique South African programme. This programme was developed and tested in a participatory manner with multiethnic communities. Community health nurse facilitators were trained and evaluated and the developed programme was then implemented by these facilitators in several sites. The influences of the developed programme were extensively evaluated. Changes in attitudes, feelings and behaviour of the child, the mother, the maternal-child interaction and the family system were explored. A quasi-experimental design with pre and post testing of the experimental group and two control groups (control 1 received social support and control 2 receiving routine clinic nursing only) was utilized. Completed analysis has yielded some exciting and provocative results. There are clear differences in each of the groups attitudes to their children. On the Mother-Child Relationship Evaluation (MCRE) positive gains in maternal-child relationship were established for the experimental group and this was greater than that of both controls (t-test = 4.151 @ alpha = 0.0013; H=4.0734 @ alpha = 0.04 and F=7.031 @ alpha = 0.0004). On the Family Assessment Device (FAD) some limited changes were observed in the experimental group over the controls (F= 3 .33 @ alpha = 0.05). This is a positive outcome indicating that the family support programme evidenced significant changes in the participants relationships with their children and in their families and wider social life. Mothers and facilitators qualitative feedback reported positive interaction with young and older children and changed maternal and child attitude and behaviour. Despite the critical shortage of staff in community health settings facilitators continue to implement the programme voluntarily in their service settings.
An exploratory analysis of differently focused women's organizations in community development and health.
(1996) Mogotlane, Sophie Mataniele.; Uys, Leana Ria.
Two research methods, a correlational survey and a case study method were used to explore the impact of health focused and economic focused women's organizations on community development and health. Through the study the following questions were answered: (i) Is there a difference in the health and development indicators of the households of Elim Care Group Project members, Akanani members and members of the community who do not belong to any of the organizations? (ii) What contribution have these organizations made to individuals' and/or communities' way of life? (iii) What aspects of these organizations' structure and/or function strengthen or weaken the organization? For the correlational survey, quantitative data were collected from three categories of thirty households each that belonged to Care Group members, Akanani members and community members who did not belong to any organization. The analysis of the data showed that both the health focused and economic focused organizations kept their focus even though their functioning tended to overlap. The health focused group had a greater impact on health indicators e.g. number of diarrhoea episodes, respiratory tract infection episodes, nutritional state, while the economic focused group had greater impact on development indicators e.g. housing, income and education. The improvement in the development indicators did not influence the health indicators directly. The qualitative data collected for the case study provided an indepth information about the case studied. The health focused organization demonstrated stability in its management. This was composed of health personnel under the employment of the Department of Health Managing the Care Group was a paid job for them. The organization was established and supported by the community and therefore expressed the community's concerns. The economic focused organization provided opportunities for the rural people to establish money making enterprises. Some of the problems shown in this study in this regard relate to poor managerial and business skills that resulted in the production of products that were not readily marketable in the locality. This caused a lot of anxiety amongst members as earnings were irregular. The differences in the structure and functioning of the groups were analysed. These influenced the effectiveness and continued viability of the organizations.
An epistemological study of the power of women as nurses : a phenomenological approach.
(1996) Van der Merwe, Anita Serdyn.; Uys, Leana Ria.
Aim: The aim of the study was to do an epistemological analysis of the power of women as nurses working in one of the larger and more deprived regions of South Africa, namely KwaZulu-Natal. This research was based on the premises of the Standpoint theory. Concurrent to the collection of data, a literature review and a concept analysis of power, powerfulness, powerlessness and empowerment were done and incorporated where applicable in the final theoretical framework. Methodology: A phenomenological approach was used. This incorporated two to three in depth interviews with each participant, lasting an average of thirty minutes each, was used. Women, relating to the gender factor, as nurses were also marginalised in terms of class, as they belonged to the enrolled category of nurses, and race, being African. A fourth selection criterium was added to analyse the reality of locality, called rurality. The researcher applied the principle of theoretical saturation and a total number of nine women, who belonged to the enrolled category of nurses and who worked in a distinct rural health care setting, were interviewed. A second group consisting of five women enrolled nurses and working in an urban setting were interviewed, as were a third relatively contrasting group of four women registered nurses. All forty four interviews were audio taped and transcribed, and a qualitative software package called NUD*IST was used to identify and refine experiential themes. Findings: The relationship between power and rights was often layered in contradiction during the interviews and the participants portrayed a picture of being oppressed or marginalised and powerless. The women as nurses belonging to the enrolled category were alienated as women and as nurses in terms of being severed from the nursing profession and from the ruling gender of men, of being lost in an ever present routinization of activities, of being misused, maternalised and domesticated at home and at work. These phenomena were quantitatively more voiced by the rural group of women and these participants strongly emphasized the limiting influence of their prescribed scope of practice, the approach of the senior category of nurses and they conveyed a traditionalist and altruistic view of nursing and nurses. The women as registered nurses created their own freedom often away from their men as in divorce. They also sought for solutions concerning powerlessness in more global and distant terms, for example in relation to cultural practices. They communicated a sense of empowerment in terms of for example education, personal qualities and increased job satisfaction. Culture rather than race was emphasized as an essence of womens' oppression. An epistemological framework of the power of women as nurses developed by the researcher constructed the totality of empowerment in terms of fifteen transformational and hierarchial actions incorporating and adapting Dooyeweerd's theory of modalities and the surfaces of class (categorial divide), gender (the eternal carer), race (culture) and locality (rurality). These actions and reformulated concepts could be used for the development of specific strategies to facilitate the empowerment of individuals, groups and communities of women as nurses and nurses as women. Further collaborative research into the phenomenon of power, a reconceptualization of nursing education and levels of expertise and hierarchies within nursing were some of the suggestions for the way forward.
The integration of diagnosis, treatment and rehabilitation of psychiatric patients into primary health care in the Eastern Cape.
(1996) Sokhela, Effie Nobesuthu.
The purpose of this study was to design and implement the two phases of a three-phased approach to the integration of the psychiatric component into the PHC system in the Eastern Cape. The study included an educational approach in which the PHC nurses were trained to diagnose, treat and rehabilitate psychiatric patients. Case studies and surveys were used to collect data. A sample of six clinics in which twenty registered nurses were trained was conveniently selected. Nurses had to volunteer so that 50% of the registered nurses would take part in the study. Each clinic was seen as a case in which a record review and questionnaires were used to collect data. The data revealed that, given the training in the diagnosis, treatment and rehabilitation, nurses could provide the first line of psychiatric care efficiently if there is a backup support from a team of consultants at the secondary health services and a support and supervision from an advanced psychiatric nurse.
An analysis of the influence of multilevel leadership on the effectiveness of provincial hospitals in the Kwazulu/Natal Province.
(1998) Mabaso, Mokgadi Susan.; Uys, Leana Ria.
The purpose of this study was to describe and identify the leadership style that prevails in health care institutions, in order to establish the influence of multilevelleadershipon the effeciveness of hospitals in KwaZulu-Natal. Hunt's extended multilevel leadership Model was used as a conceptual framework. Six institutions were selected by random sampling, categorised into three sizes i.e. large institutions with number of beds above 400, midddle sized between 200-400 and smaller institutions with a bed state below 200. Three categories of leaders were as top, middle and operational leadership. The 8 leaders included the chief medical superintendent, the hospital secretary, the chief nurse manager, two area nurse managers and the three operational nurse managers in each of the six institutions. A total of 48 MLQ instruments designed by Bass and Avolio (1989) focused on leadership style was used to identify transformational, transactional and nonleadership styles. 121 Questionnaires were distributed to staff and community to measure hospital effectiveness. Interviews were carried out on patients and visitors to establish patients' satisfaction. The effectiveness of health care services was described by goal attainment, level of support and system's achievement. The instruments to measure goal attainment and level of support were designed by the researcher. The 6 institutions were measured for system's achievement by using the instrument designed by Beattie, Rispel and Cabral (1995). The criteria used to assess infrastructure, access to the institution, management of personnel, management of resources, patient satisfaction, community outreach programmes and the process of care, was based on the criteria developed by Beattie, Rispel, and Cabral (1995). A correlation was done to establish the relationship between leadership style and hospital effectiveness. Findings; the area manager exhibited the leadership style that is predominantly Transformational, the other four categories identified in the study, revealed a leadership style that was predominently Transactional. Of the six institutions two revealed a transfomational leadership style and three revealed a transactional leadership style. One institution reflected a Laissez-Faire leadership style. The overall leadership style was transactional. On comparing the three effectiveness criteria goal attainment was identified as the most effective area of achievement followed by system's achievement and the least being level of support. A MANOVA multivarate analysis of variance revealed that the relationship between leadership style and goal attainment was not significant. The relationship between leadership style and level of support was significant. On further analysis using the Shetre test, it was found that the level of support was significantly related to transformational leadership. The relationship between leadership style and stystem's achievement was not established, because the sample size of six institutions was too small. The overall relationships between leadership style and hospital effectiveness was significant at p-< 0.01 level. Recommendations; included that all all categoties of leadership at institutions are to increase their diagnostic level of awareness of their leadership styles. Rigorous education and training on leadership and support were essential. A further recommendation was that the methodology used in this study to measure hospital effectiveness be used more widely as a management tool. A common instrument used to evaluate acceptable standards of health care assessment should be used to ensure comparison between and within institutions in KwaZulu- Natal There was a need for further research to establish the influence of leadership style on hospital effectiveness in order to ensure quality care by health care providers and to increase professional efficiency and effectiveness in the hospitals of KwaZulu-Natal.
An investigation into the needs assessment phase of the health education process for school children.
(1998) Tanga, Tobeka Thelma.; Uys, Leana Ria.
This study investigated the needs assessment phase of the health education process for school children. The objectives of the study were to identify health education needs of school children using three approaches, namely, the epidemiological, consumer and social science approaches. In the social science approach, a PRECEDE model has been used. Time taken in using each approach and the skills of PHC nurses necessary to use each, were investigated in order to determine the most effective and efficient approach. A comparative case study design has been used, whereby each approach was considered as a case, hence, an embedded case study. One rural administrative area in the district of Umtata, which has a health centre in its catchment area, was selected. The population for the sudy were school children aged 12 to 16 years doing standard five. Four out of ten Junior Secondary schools in the area were randomly selected. In the epidemiological approach, records from the health centre and three of the four selected schools were analysed. In the consumer approach, focus group interviews (two groups of boys and two groups of girls) were conducted. In the social science approach, focus group interviews of school children(four groups) from the other two remaining schools, focus group interviews of mothers as carers( four groups), and in-depth interviews of standard five teachers from each of the four schools were conducted. Data analysis was done using Tesch's method of qualitative data analysis.A time activity sheet was used to estimate time used in each approach. A questionnaire was distributed among PHC nurses to determine their skills in relation to the approaches used. Results showed that the social science approach was the most comrehensive approach but used the longest time. The consumer was balanced and efficient though the least time was used. The epidemiological was found to have identified physical problems to the exclusion of the social and psychological problems.
Gender conflict amongst adolescents at the Rossburgh High School, Durban.
(2000) Chetty, Ravani.; Uys, Leana Ria.
In 1998 the Faculty of Community and Development Disciplines (CADD) embarked on a project to prevent and reduce crime involving school children. A needs assessment was conducted in the three schools where the project was to have its main focus. One of the problems that came out of the Rossburgh High School was the conflict that appeared to exist between male and female learners at the school. Male learners were observed to 'bully' their female counterparts. Given the high statistic of violence against women in South Africa, this seemingly 'small' problem could have relevance later on in the lives of these adolescents. In order to intervene successfully it was first necessary to understand the problem that existed. By means of focus groups male and female adolescents provided information around the phenomenon. From data obtained, it appeared that fighting was predominantly due to boyfriend/girlfriend relationships. The problem was explored in depth and recommendations were made with regards to intervention programmes and future research.
Mental health care provided by nurses in the primary health care clinics in Swaziland.
(2000) Hlatshwayo, Makhosazana Zanele.; Ganga-Limando, Richard Makombo.
The study was designed to examine and describe mental health care provided by the nurses in the primary health care settings of Swaziland. The study sought to answer one main questions namely: • what was the nature of mental health care provided by nurses in the primary health care clinics? A sample of 31 primary health care clinic nurses was used to generate data for the study. The sample consisted of registered nurses with only one having a mental health qualification. The study used both qualitative and quantitative methods for data collection. Data analysis involved simple frequency and percentage counts using SPSSmanual as well as descriptive narratives using NVIVO computer analysis methods. Findings revealed that mental health care in the primary health care clinics was mainly traditional involving immunizations, family planning and antenatal services, Limited mental health care was provided by the only mental health nurse involved in the study, Nurses stated that the care they provided was in line with their job descriptions, The study concluded that the mental health care provided at the primary health care clinics was based on the traditional approach that did no encompass mental health care, Recommendations made were related to the promotion of the integration of mental health care into the services provided in the primary health care scttings with nurses being prepared for the role.
Exploring the extent of cultural sensitivity among the nursing students doing the four year diploma at Addington hospital in KwaZulu-Natal province.
(2000) Mafanya, Busisiwe Benedicta.; Khanyile, Thembisile.; Moletsane, Relebohile.
This study was undertaken to explore the extent of cultural sensitivity among the nursing students of Kwa Zulu - Natal Province. A qualitative. ethnographic, explorative design was utilized. A quantitative approach was also used. Subjects were second, third and fourth year students registered for the four year Comprehensive Diploma in Nursing leading to registration as a Nurse (General, Psychiatry, Community Health) and Midwife. To ensure measures of trustworthiness, Guba's model in (Krefting 1991) was implemented. Narrative statements in the form of scenarios and questionnaires were employed to explore, to examine and to describe the extent to which the nursing students are sensitive towards cultures of groups that are different from theirs. The data was analyzed based on the developmental stages of cultural sensitivity by (Bennett 1986). Tesch's method was used to analyze the qualitative data and the Statistical Analysis System (SAS) was used to analyze the quantitative data. Based on the findings. the following conclusions were drawn:- Some students were unable to acknowledge variations that exist among cultures. Problems emanating from cultural differences still exist between nurses and patients due to the ethnocentric views held by some nurses. The study revealed that the students were at varying stages of levels of development of cul tural sensitivity, which means that they ranged from lack of cultural sensitivity to cultural sensitivity. Nursing students, therefore. need more preparation by their program in order to provide culturally congruent nursing care to all.
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.
Critical thinking skills development among the diploma nursing students in a case-based curriculum.
(2001) de El-Kantar, Lina Abi Faker.; Adejumo, Oluyinka.
Faculty members in many schools of nursing have been urged to include critical thinking in all aspects of the nursing curriculum. The faculty at the Institutes of Nursing in the United Arab Emirates, have adopted in the academic year I998 a case-based curriculum that teaches nursing courses by using case studies, which represent a terrific and non-threatening method to use to teach and learn either critical thinking skills or clinical decision-making (Robinson, 1998; Glendon and Ulrich, 1992, 1997). The development of critical thinking skills in a case-based curriculum was investigated. A randomly selected, cross-sectional sample of nursing students at the Abu Dhabi Institute of Nursing (N= 88) was studied. Three groups (n=30) from each level of a three-level-diploma nursing program were measured for development of critical thinking skills using the Test of Everyday Reasoning (TER). Relationships were investigated between TER scores, the level of the program and other socio-demographic and academic achievement determinants. Critical thinking ability did not change significantly among the three levels during the educational experience in a case-based curriculum; however, the participants in the highest level of the program were able to get a higher mean TER scores from the other two levels. One of the conclusions that could be drawn from this study was that critical thinking might not change as an associated factor with a case-based curriculum at this premature phase of its implementation until some time after the graduates of this program become practicing nurses where clinical decision-making would be in action. The other conclusions focused on the necessity of unfolding the utilized cases in the curriculum and on determining whether the construct of critical thinking has been incorporated in them.
Facilitating collaboration between traditional healers and western health practitioners in the management of chronic illnesses in Swaziland.
(2001) Dlamini, Priscilla Sibongile.; Uys, Leana Ria.
The purpose of the study was to analyze the process of facilitating collaboration between traditional healers and western trained health care workers in the management of chronic illnesses, hypertension and diabetes. This process was facilitated through qualitative participatory action research which utilized the principles of Action Science Enquiry. This was a qualitative research. Two phases were as followed: phase one was the analysis of the problem of collaboration while phase two was the implementation of strategy one and two. Strategy one was the development of the constitution of traditional healers towards the establishment of the Swaziland traditional Healers' Council and a traditional healers' department within the Ministry of Health and Social Welfare. Strategy two was a small comparative survey into the safety and efficacy of traditional medicine. The survey compared clients who utilized only traditional medicines and those who utilized only western medicines to control their hypertension. Data was collected through interviews, meetings, observations and clinical measurements. Audio-taped and field notes were transcribed, carefully studied and analyzed. The editing analysis described by Crabtree and Williams (1992) was utilized in the analysis of data. The results of phase one was a descriptive profile of traditional healers and the way hypertension and diabetes were managed by the traditional healers and the western trained health care workers, with the aim of finding out how they could collaborate. A number of barriers for collaboration were identified such as the lack of a legal body of traditional healers, negative attitudes of western trained health care workers towards clients and traditional healers, ethical issues, perceptions of illnesses and payments as well as the lack of transparency. Enhancers for collaboration were also identified. Consequences of a successful collaborative process were established by the participants. Strategies to solving the problems of collaboration were identified and two of the strategies were implemented. A traditional collaborative model was identified and compared to an existing modem collaborative model. Phase two, strategy one, the legalizing of traditional healers in Swaziland, was decided upon during one of the meetings held between traditional healers, clients and western trained health care workers. Barriers to successfully organize this strategy were also identified, such as organization and exclusion, leadership style, traditional and cultural structures, lack of resources, poor communication and different traditional healers' categories. Action plans to solve those problems were developed and progress was made. The end result was that a draft of the traditional healers' constitution content was developed. Stakeholders who would be part of the development of the constitution were contacted. The stakeholders included the Ministry of Health and Social Welfare, the Ministry of Natural Resources and Agriculture, the Swaziland World Health Organization, the Ministry of Justice and the University of Swaziland. The traditional healers managed to form an interim committee called the Traditional Healers' Constitution Development Committee. This committee was still in a process of involving all traditional healers in Swaziland to furnish their views and opinions to the committee concerning the constitution. The target date for the constitution to be completed was set to be around April, 2001. The researcher will still be working with the committee until the legalizing process is completed. This would take another one year to complete. Phase two : strategy two, establishing the efficacy of traditional healers' medicines to control hypertension was established to enhance trust between the traditional healers and the western trained health care personnel. From the small sample, it would seem that fluctuations of blood pressure levels were similar between the two groups. This showed that traditional healers medicines to control hypertension in Swaziland is effective. Though it was difficult to establish the safety of those clients who utilized only the traditional medicines, there were no abnormalities discovered to be associated with the use of the traditional medicines.
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.
Pathways to mental health care in Kwazulu-Natal province South Africa.
(2001) Mkize, Lungiswa Patience.; Uys, Leana Ria.
The understanding of the pathways that clients take prior to admission to a mental health institution, is a vital factor in planning to reduce delays in seeking treatment. Studying the pathways may also help in the identification of sources of delays in the receiving of care and suggest possible improvements. Although western medicine plays an important role in the control of disease, traditional medicine continues to play an important role in the health care of black African communities. They, therefore possess unique attitudes, values and beliefs, about health and illness, which integrally infiuence their health behaviour. This study aims to increase the understanding by health professionals of pathways to care taken by clients before they are admitted to a mental health institution, so as to enhance heath service planning. It also aims to determine the socio-cultural and economic factors, as well as satisfaction with different service providers. The sample in this study consisted of 15 clients, who were between the ages of ten and fifty-nine years. These clients were males and females who were admitted for the first time in a mental health institution (MHI) (TownHill Hospital, Pietermaritzburg). The interview questionnaire, was administered, by the researcher.This study has demonstrated that, Africans still believe in traditional and faith healers as their first port of call when they are mentally ill. Their help seeking behaviour is determined by their cultural beliefs and values. The study also demonstrated the high involvement of the South African Police Services (SAPS) in the pathway to mental health institution by intervening to protect family or public and also transporting the client to a mental health institution. The Primary Health Care (PHC) is very seldom used Economic factors like unemployment strongly infiuence the mental health of people and also affect their social functioning, as it is shown by the high levels of unemployment in the sample. Some of these clients resort to living on the streets, because they cannot find employment and are homeless. The study has also shown the importance of education and training of health professionals in PHC, in identifying the first signs of mental illness when clients present themselves and making available the psychotropic drugs at the PHCC as this is the first port of call for clients. Psycho education of traditional healers, spiritual healers, SAPS and community should be implemented on when and how to refer clients, how to handle mentally ill clients.
An exploratory study of suicide amongst adolescents in Umzimkulu district high schools.
(2001) Jozana, Noluthando Edith.; Uys, Leana Ria.
High school adolescent's suicidal behaviour caused a concern to the Umzimkulu community and the multi - disciplinary team in the local Psychiatric institution during the years 1997 - 1999 . The purpose the study was to identify and describe the charactics of adolescents who committed suicide. Rutter's (1995) model of risk. resilience and recovery has been used as a theoretical frame work for the study. A descriptive, exploratory case study design is most suitable for the incidence of suicide at Umzimkulu District .The case study approach was best suited as it assists in an indepth study focussing on contemporary phenomena with sum real life contexts . The distinctive need for the case study design arises out the desire to understand complex psycho-social phenomena of adolescent suicide (Yin, 1989).Each adolescent who committed suicide over the last two years in Umzimkulu District will form a case . All data about the particular person will be the case description Adolescents who committed suicide were identified from the records at the police intelligence office of Umzimkulu Police Station. Parents, identified friends, teachers and health workers who had known the adolescents. Semi structured interviews with open ended questions were used. Interview schedules for teachers, parents and close friends differed slightly. A tape recorder for later transcription was utilised. To analyse the data, Ruttter's model was utilised to do cross case analysis. Results according to Rutter's model, were that, due to inconstant support received by the adolescents, high levels of stress in early child hood, had left them insuffiently resilient to with stand the problems they encountered during adolescence.

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