A comprehensive support programme for professional nurses performing HIV counselling and testing at primary health care clinics in the rural Eastern Cape
- Authors: Madolo, Agrinette Nomboniso
- Date: 2019
- Subjects: HIV-positive persons -- Counseling of , AIDS (Disease) -- Patients -- Counseling of , Primary health care -- South Africa -- Eastern Cape , Community health nursing -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/40746 , vital:36232
- Description: The increase in global rates of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) has had far reaching effects on healthcare services around the world. According to the 2017 statistics released by UNAIDS, South Africa has the largest HIV epidemic in the world. The South African Department of Health provides an HIV counselling and testing (HCT) service to patients in order that they may know their HIV status and endeavours to educate patients so that they may adapt their behaviours and lifestyles. The goal of this study is to develop a support programme for nurses to assist them in coping emotionally with their day-to-day activities when providing HCT services to patients attending primary healthcare clinics. The paradigm used as a lens to view the phenomenon is Kinlaw’s cyclical growth of empowerment theory. The researcher used a qualitative,explorative, descriptive and contextual design. The study involves three phases: (a) empirical research that explores nurses’ experiences of performing HCT in primary healthcare rural clinics, (b) the development of a conceptual framework for a support programme using the survey list of Dickoff et al. (1968:427). (c) the formalisation of the Comprehensive Support Programme to help nurses to cope emotionally with working with HCT on a long-term basis. Chinn and Kramer (2005118) were used to evaluate the programme. . The empirical findings revealed registered nurses experienced HCT both positively and negatively. They felt overwhelmed by the expectation that all patients attending primary healthcare clinics should be offered HCT routinely and the time constraints involved. They described how the emotional trauma attached to HCT affected their work patterns, leading to low productivity, and affected them outside work, leading to stress and sleep disturbances. They feltl disturbed that even when informed, people choose not to adopt safer sex practices and that how patients responded to a positive diagnosis cannot be predicted. Participants showed signs of stress, frustration, despair and sadness because most tested clients show positive test results and the number of clients testing positive is increasing. While participants felt helpless to improve the situation, at the same time, HCT was experienced as rewarding because it enabled diagnosis of medical conditions of which people weree not aware. The goal of the study was achieved with the development and formalisation of an extensive, relevant and applicable Comprehensive Support Programme for implementation for registered nurses to enable them cope emotionally when conducting HCT based on the empirical findings.
- Full Text:
- Date Issued: 2019
- Authors: Madolo, Agrinette Nomboniso
- Date: 2019
- Subjects: HIV-positive persons -- Counseling of , AIDS (Disease) -- Patients -- Counseling of , Primary health care -- South Africa -- Eastern Cape , Community health nursing -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/40746 , vital:36232
- Description: The increase in global rates of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) has had far reaching effects on healthcare services around the world. According to the 2017 statistics released by UNAIDS, South Africa has the largest HIV epidemic in the world. The South African Department of Health provides an HIV counselling and testing (HCT) service to patients in order that they may know their HIV status and endeavours to educate patients so that they may adapt their behaviours and lifestyles. The goal of this study is to develop a support programme for nurses to assist them in coping emotionally with their day-to-day activities when providing HCT services to patients attending primary healthcare clinics. The paradigm used as a lens to view the phenomenon is Kinlaw’s cyclical growth of empowerment theory. The researcher used a qualitative,explorative, descriptive and contextual design. The study involves three phases: (a) empirical research that explores nurses’ experiences of performing HCT in primary healthcare rural clinics, (b) the development of a conceptual framework for a support programme using the survey list of Dickoff et al. (1968:427). (c) the formalisation of the Comprehensive Support Programme to help nurses to cope emotionally with working with HCT on a long-term basis. Chinn and Kramer (2005118) were used to evaluate the programme. . The empirical findings revealed registered nurses experienced HCT both positively and negatively. They felt overwhelmed by the expectation that all patients attending primary healthcare clinics should be offered HCT routinely and the time constraints involved. They described how the emotional trauma attached to HCT affected their work patterns, leading to low productivity, and affected them outside work, leading to stress and sleep disturbances. They feltl disturbed that even when informed, people choose not to adopt safer sex practices and that how patients responded to a positive diagnosis cannot be predicted. Participants showed signs of stress, frustration, despair and sadness because most tested clients show positive test results and the number of clients testing positive is increasing. While participants felt helpless to improve the situation, at the same time, HCT was experienced as rewarding because it enabled diagnosis of medical conditions of which people weree not aware. The goal of the study was achieved with the development and formalisation of an extensive, relevant and applicable Comprehensive Support Programme for implementation for registered nurses to enable them cope emotionally when conducting HCT based on the empirical findings.
- Full Text:
- Date Issued: 2019
Perspectives of South African women and midwives on clinical practice in public maternity units: facilitating the scaling-up of such clinical practices
- Authors: Wibbelink, Margreet
- Date: 2019
- Subjects: Physician practice patterns , Midwives -- South Africa -- Attitudes Pregnant women -- South Africa -- Attitudes Midwifery -- South Africa
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/44422 , vital:37168
- Description: Despite a steady drop globally in maternal and newborn deaths since 1990, thousands of women and newborns still die each year during pregnancy and childbirth. South Africa, together with other countries, failed to achieve the Millennium Development Goal of reducing maternal mortality by three quarters by 2015. This is despite the positive efforts made in the country towards achieving these goals. However, much more still needs to be done. For that reason, proper and safe care of labouring women remains the identified major focus to prevent these deaths. The current study was the culmination of an investigation into the problem of poor performance regarding maternal and perinatal outcomes as identified by the researcher. The aim of this research study was to understand the experiences and perceptions of the women and the midwives regarding the clinical practices in public maternity units in South Africa in order to facilitate the scaling-up of the midwifery practice. A mixed-methods (sequential exploratory) design was used to answer the research question and objectives, and the study was conducted in three phases. In Phase One, a qualitative research design was implemented. The population were all the midwives in the Eastern Cape who had been working in public maternity units and women who had delivered in those settings. Non-probability purposive sampling with inclusion criteria assisted in selecting a suitable sample. Data collection was done using semi-structured audio-recorded interviews from eleven public sector midwives and eleven women receiving care from the midwives in the Eastern Cape, a province of South Africa. On data analysis, three themes emerged, namely participants had diverse experiences of the midwifery practice, midwives highlighted the burden with regard to the shortage of skilled midwives, and midwives identified managerial issues that affect their performance. Phase Two of the study comprised the quantitative research. The population was the midwives in South Africa who were working in public maternity units and nonprobability purposive sampling criteria were used to select participants. Data collection was done by means of a survey that used a tool adapted from the Hennessy-Hicks Training Needs Analysis Questionnaire. Questions for the survey tool were based on the results of Phase One. A total number of 314 questionnaires were completed, returned and analysed. Phase Three of the study comprised the integration of the results of the first two phases. The study found that midwives were committed to provide quality care but major factors needed to be addressed to facilitate scaling-up of clinical midwifery practices. The midwifery profession needed to be strengthened and an enabling working environment provided. Based on the results of the study as well as the theoretical, conceptual and contextual framework, two strategies were developed: Strategy 1: Empowering midwives to deliver woman-centred care in public sector maternity units Strategy 2: Creating an enabling work environment in order to deliver womancentred care in public sector maternity units.
- Full Text:
- Date Issued: 2019
- Authors: Wibbelink, Margreet
- Date: 2019
- Subjects: Physician practice patterns , Midwives -- South Africa -- Attitudes Pregnant women -- South Africa -- Attitudes Midwifery -- South Africa
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/44422 , vital:37168
- Description: Despite a steady drop globally in maternal and newborn deaths since 1990, thousands of women and newborns still die each year during pregnancy and childbirth. South Africa, together with other countries, failed to achieve the Millennium Development Goal of reducing maternal mortality by three quarters by 2015. This is despite the positive efforts made in the country towards achieving these goals. However, much more still needs to be done. For that reason, proper and safe care of labouring women remains the identified major focus to prevent these deaths. The current study was the culmination of an investigation into the problem of poor performance regarding maternal and perinatal outcomes as identified by the researcher. The aim of this research study was to understand the experiences and perceptions of the women and the midwives regarding the clinical practices in public maternity units in South Africa in order to facilitate the scaling-up of the midwifery practice. A mixed-methods (sequential exploratory) design was used to answer the research question and objectives, and the study was conducted in three phases. In Phase One, a qualitative research design was implemented. The population were all the midwives in the Eastern Cape who had been working in public maternity units and women who had delivered in those settings. Non-probability purposive sampling with inclusion criteria assisted in selecting a suitable sample. Data collection was done using semi-structured audio-recorded interviews from eleven public sector midwives and eleven women receiving care from the midwives in the Eastern Cape, a province of South Africa. On data analysis, three themes emerged, namely participants had diverse experiences of the midwifery practice, midwives highlighted the burden with regard to the shortage of skilled midwives, and midwives identified managerial issues that affect their performance. Phase Two of the study comprised the quantitative research. The population was the midwives in South Africa who were working in public maternity units and nonprobability purposive sampling criteria were used to select participants. Data collection was done by means of a survey that used a tool adapted from the Hennessy-Hicks Training Needs Analysis Questionnaire. Questions for the survey tool were based on the results of Phase One. A total number of 314 questionnaires were completed, returned and analysed. Phase Three of the study comprised the integration of the results of the first two phases. The study found that midwives were committed to provide quality care but major factors needed to be addressed to facilitate scaling-up of clinical midwifery practices. The midwifery profession needed to be strengthened and an enabling working environment provided. Based on the results of the study as well as the theoretical, conceptual and contextual framework, two strategies were developed: Strategy 1: Empowering midwives to deliver woman-centred care in public sector maternity units Strategy 2: Creating an enabling work environment in order to deliver womancentred care in public sector maternity units.
- Full Text:
- Date Issued: 2019
A best practice guideline for a healthy work environment for professional nurses working in the South African Military Health Service
- Authors: Mabona, Jean Fezeka Madi
- Date: 2018
- Subjects: Nurses -- Employment -- South Africa , Medicine, Military -- South Africa South Africa -- National Defence Force -- Medical care , Work environment -- National Defence Force -- Medical care
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/30811 , vital:31146
- Description: Governments, internationally and nationally, are becoming aware of the importance of healthy work environments within their health departments, environments that are caring and supportive to health professionals. This awareness is brought about by the mounting evidence that healthy work environments are critical to recruiting and retaining health professionals. On the other hand, unhealthy work environments can contribute to medical errors, ineffective delivery of care, and conflict and stress among health professionals in the clinical setting and faculty shortage that can compromise academic excellence in the academic setting. The professional nurses working in the South African Military Health Service (SAMHS), a branch of the South African National Defence Force (SANDF) could experience the military environment as unhealthy because it is rigid and controlled. The hierarchical rank structure could deprive them of their autonomy as the decision-making powers are directly proportional to the rank. Stressful conditions could be experienced when these professional nurses are taken away from the well equipped hospital environment to the deployment areas away from home. There was, however, no evidence found on the work environment of professional nurses in the SAMHS during literature review. The aim of the study is therefore to explore and describe the experiences of professional nurses working in the SAMHS and their understanding of a healthy work environment and the scope and nature of a best practice guideline, then to integrate the evidence generated to the evidence emanating from the critical appraisal of the existing best practice guidelines from other health settings in order to develop a best practice guideline for a healthy work environment for nurses in the SAMHS. The study adopted a qualitative, exploratory, descriptive and contextual research design. The research study was made up of three phases. In Phase 1, semi-structured interviews were conducted with professional nurses to collect information on their experiences of working in the SAMHS and their understanding of evidence-based best practice guidelines. The interviews were transcribed by an independent transcriptionist and data analyzed using the eight steps of data analysis as suggested by Tesch. Themes were identified and grouped together to form new categories. The process of coding was supported by an independent coder. Lincoln and Guba’s model of Page | vii trustworthiness consisting of credibility, transferability, dependability and confirmability was used to ensure the validity of the study. An integrative literature review was conducted where the existing evidence-based best practice guidelines for healthy work environment for nurses were searched for, appraised, had data extracted and were synthesized in Phase 2. In Phase 3, evidence generated in Phase 1 and Phase 2 was triangulated, forming recommendations that were utilized to develop a best practice draft guideline for a healthy work environment for professional nurses working in the SAMHS. The draft guideline was sent to five expert reviewers for their comments and recommendations. These were considered in the development of the final guideline. The final guideline consists of several recommendations in four themes: the need for effective leadership to create an empowering environment; effective communication amongst members of the health team; a culture that supports team work, and; the need for an environment that promotes professional autonomy. Further recommendations were made to address factors that impact negatively on enhancement of a healthy work environment. The guideline is intended for use by SAMHS’ leadership, at Levels 2, the strategic level, Level 3, the formation level and Level 4, the unit level (hospitals, sickbays and clinics and nursing college) and all professional nurses working in all the military health institutions of the SAMHS, including the military clinics, sickbays and hospitals irrespective of positions. However, the guideline may also be adapted by nursing institutions outside the military such as public and private hospitals and clinics where they find it applicable. Results
- Full Text:
- Date Issued: 2018
- Authors: Mabona, Jean Fezeka Madi
- Date: 2018
- Subjects: Nurses -- Employment -- South Africa , Medicine, Military -- South Africa South Africa -- National Defence Force -- Medical care , Work environment -- National Defence Force -- Medical care
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/30811 , vital:31146
- Description: Governments, internationally and nationally, are becoming aware of the importance of healthy work environments within their health departments, environments that are caring and supportive to health professionals. This awareness is brought about by the mounting evidence that healthy work environments are critical to recruiting and retaining health professionals. On the other hand, unhealthy work environments can contribute to medical errors, ineffective delivery of care, and conflict and stress among health professionals in the clinical setting and faculty shortage that can compromise academic excellence in the academic setting. The professional nurses working in the South African Military Health Service (SAMHS), a branch of the South African National Defence Force (SANDF) could experience the military environment as unhealthy because it is rigid and controlled. The hierarchical rank structure could deprive them of their autonomy as the decision-making powers are directly proportional to the rank. Stressful conditions could be experienced when these professional nurses are taken away from the well equipped hospital environment to the deployment areas away from home. There was, however, no evidence found on the work environment of professional nurses in the SAMHS during literature review. The aim of the study is therefore to explore and describe the experiences of professional nurses working in the SAMHS and their understanding of a healthy work environment and the scope and nature of a best practice guideline, then to integrate the evidence generated to the evidence emanating from the critical appraisal of the existing best practice guidelines from other health settings in order to develop a best practice guideline for a healthy work environment for nurses in the SAMHS. The study adopted a qualitative, exploratory, descriptive and contextual research design. The research study was made up of three phases. In Phase 1, semi-structured interviews were conducted with professional nurses to collect information on their experiences of working in the SAMHS and their understanding of evidence-based best practice guidelines. The interviews were transcribed by an independent transcriptionist and data analyzed using the eight steps of data analysis as suggested by Tesch. Themes were identified and grouped together to form new categories. The process of coding was supported by an independent coder. Lincoln and Guba’s model of Page | vii trustworthiness consisting of credibility, transferability, dependability and confirmability was used to ensure the validity of the study. An integrative literature review was conducted where the existing evidence-based best practice guidelines for healthy work environment for nurses were searched for, appraised, had data extracted and were synthesized in Phase 2. In Phase 3, evidence generated in Phase 1 and Phase 2 was triangulated, forming recommendations that were utilized to develop a best practice draft guideline for a healthy work environment for professional nurses working in the SAMHS. The draft guideline was sent to five expert reviewers for their comments and recommendations. These were considered in the development of the final guideline. The final guideline consists of several recommendations in four themes: the need for effective leadership to create an empowering environment; effective communication amongst members of the health team; a culture that supports team work, and; the need for an environment that promotes professional autonomy. Further recommendations were made to address factors that impact negatively on enhancement of a healthy work environment. The guideline is intended for use by SAMHS’ leadership, at Levels 2, the strategic level, Level 3, the formation level and Level 4, the unit level (hospitals, sickbays and clinics and nursing college) and all professional nurses working in all the military health institutions of the SAMHS, including the military clinics, sickbays and hospitals irrespective of positions. However, the guideline may also be adapted by nursing institutions outside the military such as public and private hospitals and clinics where they find it applicable. Results
- Full Text:
- Date Issued: 2018
A best practice guideline for clinical teaching at a public college of nursing
- Authors: Gcawu, Sybil Nyameka
- Date: 2018
- Subjects: Nursing -- Study and teaching , Clinical medicine Medicine -- Study and teaching
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/30194 , vital:30860
- Description: Clinical teaching is a critical component of the education and training of undergraduate nursing students. It determines the level of clinical competence that nursing students achieve during their studies. It should be informed by current best practice evidence available in the nursing care literature (Emanuel, Day, Diegnan & Prys-Muller, 2011:21-22). Clinical teaching is centred around provision of patient care in clinical practice. It takes place through an interaction between the nurse educator and the nursing students. During this process nursing students are moulded so they can demonstrate minimum competency in order to be registered by the regulatory body. Nursing students learn to become competent nurses in the clinical learning environment (Baxter 2006; Nash, 2007 in Franklin, 2013:35). In South Africa nurse educators are required to be fully responsible for clinical teaching through the use of appropriate teaching approaches and learning facilitation techniques (RSA DoH, 2013:91). The overall purpose of the current research study was to explore and describe the current clinical teaching practices of nurse educators; to search, appraise, extract and synthesise literature related to clinical teaching in nursing; and to develop A Best Practice Guideline for Clinical Teaching at a Public College of Nursing in the Eastern Cape Province. This had to be realized in three phases. In Phase One a quantitative, exploratory, descriptive and contextual study was conducted. A structured questionnaire was used to collect data from the nurse educators involved in clinical teaching within the Diploma in Nursing (General, Community, Psychiatric) and Midwifery programme. The data analysed was used as the basis of Phase Two—namely, an integrative literature review of evidence pertaining to the clinical teaching practices of nurse educators doing clinical teaching within the undergraduate programmes. The evidence from Phases One and Two was used to develop a draft Best Practice Guideline. The draft guideline was reviewed by a group of expert reviewers and their suggestions were incorporated in the final guideline. Ethical considerations were maintained throughout the research study. The rigour of the research process was ensured by cognitive testing of the questionnaire, and by critical appraisal of the literature accessed from an integrative literature review. The v authenticity of critical appraisal was ensured by having the critical appraisal done by the researcher and an independent reviewer.
- Full Text:
- Date Issued: 2018
- Authors: Gcawu, Sybil Nyameka
- Date: 2018
- Subjects: Nursing -- Study and teaching , Clinical medicine Medicine -- Study and teaching
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/30194 , vital:30860
- Description: Clinical teaching is a critical component of the education and training of undergraduate nursing students. It determines the level of clinical competence that nursing students achieve during their studies. It should be informed by current best practice evidence available in the nursing care literature (Emanuel, Day, Diegnan & Prys-Muller, 2011:21-22). Clinical teaching is centred around provision of patient care in clinical practice. It takes place through an interaction between the nurse educator and the nursing students. During this process nursing students are moulded so they can demonstrate minimum competency in order to be registered by the regulatory body. Nursing students learn to become competent nurses in the clinical learning environment (Baxter 2006; Nash, 2007 in Franklin, 2013:35). In South Africa nurse educators are required to be fully responsible for clinical teaching through the use of appropriate teaching approaches and learning facilitation techniques (RSA DoH, 2013:91). The overall purpose of the current research study was to explore and describe the current clinical teaching practices of nurse educators; to search, appraise, extract and synthesise literature related to clinical teaching in nursing; and to develop A Best Practice Guideline for Clinical Teaching at a Public College of Nursing in the Eastern Cape Province. This had to be realized in three phases. In Phase One a quantitative, exploratory, descriptive and contextual study was conducted. A structured questionnaire was used to collect data from the nurse educators involved in clinical teaching within the Diploma in Nursing (General, Community, Psychiatric) and Midwifery programme. The data analysed was used as the basis of Phase Two—namely, an integrative literature review of evidence pertaining to the clinical teaching practices of nurse educators doing clinical teaching within the undergraduate programmes. The evidence from Phases One and Two was used to develop a draft Best Practice Guideline. The draft guideline was reviewed by a group of expert reviewers and their suggestions were incorporated in the final guideline. Ethical considerations were maintained throughout the research study. The rigour of the research process was ensured by cognitive testing of the questionnaire, and by critical appraisal of the literature accessed from an integrative literature review. The v authenticity of critical appraisal was ensured by having the critical appraisal done by the researcher and an independent reviewer.
- Full Text:
- Date Issued: 2018
Strategies to facilitate the use of birth care provided by skilled birth attendants in the rural areas of Ghana
- Authors: Adatara, Peter
- Date: 2018
- Subjects: Maternity nursing -- Ghana , Neonatal nursing -- methods Delivery (Obstetrics) Midwifery -- Ghana
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/23415 , vital:30541
- Description: Increasing skilled attendance during childbirth is well established in literature to play a significant role in averting the many preventable maternal deaths that occur in developing countries such as Ghana.Inadequate utilisation of skilled birth care services in Sub-Saharan Africa is believed to be a major hindrance to efforts aimed at improving the health of women, especially during delivery. There is low utilisation of birth care services provided by skilled birth attendants in the rural areas in Ghana. The purpose of this study was to develop strategies that could facilitate the utilisation of skilled birth care provided by skilled birth attendants in the rural areas of Ghana. The study adopted a qualitative, explorative, descriptive and contextual method to explore and describe women’s experiences regarding the utilisation or non-utilisation of skilled birth care services provided by skilled birth attendants in the rural areas in Ghana. The study was conducted in three phases: Phase One of this study described the research population, sampling method, data collection and analysis to obtain women’s experiences regarding the utilisation or non-utilisation of skilled birth care services. In this study, data were collected and analysed from the research population. The research population consisted of women who utilised skilled birth care attendants or unskilled care attendants during child birth. The data collection method used was individual interviews. Data collected from the interviews were transcribed verbatim and analysed according to the steps suggested by Tesch to identify themes and sub-themes. The study identified three themes and sub-themes: Theme 1: Experiences of participants related to the use of skilled birth care attendants; Theme 2: Participants expressed their reasons for choosing a home birth; Theme 3: Participants offered suggestions to improve skilled birth care at healthcare facilities. The findings in Phase one of this study formed the basis for the development of the strategies in Phase three. Phase Two of the research design focused on the development of a conceptual framework based on the research findings and utilized to develop strategies which skilled birth attendant may use to facilitate the use of skilled birth care services by women in the rural areas of Ghana where there is low utilisation of birth services provided by skilled birth attendants. The conceptual framework of Dickoff, James and Wiedenbach was used to provide a guide and a link between the different concepts in the research study. Phase Three of this study focused on the development of strategies that will facilitate an increased in the labouring women utilisation of the services provided by skilled birth attendants. The data obtained was used to developed three strategies such as collaboration, education and training, supportive supervision as well as community mobilisation and participation to guide skilled birth attendants to facilitate the utilisation of skilled birth care services during childbirth. The WHO Health for All model, the theoretical model underpinning this study, also guided the development of the strategies to facilitate labouring women utilisation of the services provided by skilled birth attendants. Recommendations regarding the implementation of a national collaborative, education and supportive supervision policies on a macro level are made, as well as recommendations for nursing practice, education and research. It is therefore concluded that the researcher succeeded in achieving the purpose for this study because the strategies which are understandable, clear, simple, applicable and significant to skilled birth care in rural areas has been developed for use by skilled birth attendants to facilitate the utilisation of skilled birth care provided by skilled birth attendants in the rural areas of Ghana.
- Full Text:
- Date Issued: 2018
- Authors: Adatara, Peter
- Date: 2018
- Subjects: Maternity nursing -- Ghana , Neonatal nursing -- methods Delivery (Obstetrics) Midwifery -- Ghana
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/23415 , vital:30541
- Description: Increasing skilled attendance during childbirth is well established in literature to play a significant role in averting the many preventable maternal deaths that occur in developing countries such as Ghana.Inadequate utilisation of skilled birth care services in Sub-Saharan Africa is believed to be a major hindrance to efforts aimed at improving the health of women, especially during delivery. There is low utilisation of birth care services provided by skilled birth attendants in the rural areas in Ghana. The purpose of this study was to develop strategies that could facilitate the utilisation of skilled birth care provided by skilled birth attendants in the rural areas of Ghana. The study adopted a qualitative, explorative, descriptive and contextual method to explore and describe women’s experiences regarding the utilisation or non-utilisation of skilled birth care services provided by skilled birth attendants in the rural areas in Ghana. The study was conducted in three phases: Phase One of this study described the research population, sampling method, data collection and analysis to obtain women’s experiences regarding the utilisation or non-utilisation of skilled birth care services. In this study, data were collected and analysed from the research population. The research population consisted of women who utilised skilled birth care attendants or unskilled care attendants during child birth. The data collection method used was individual interviews. Data collected from the interviews were transcribed verbatim and analysed according to the steps suggested by Tesch to identify themes and sub-themes. The study identified three themes and sub-themes: Theme 1: Experiences of participants related to the use of skilled birth care attendants; Theme 2: Participants expressed their reasons for choosing a home birth; Theme 3: Participants offered suggestions to improve skilled birth care at healthcare facilities. The findings in Phase one of this study formed the basis for the development of the strategies in Phase three. Phase Two of the research design focused on the development of a conceptual framework based on the research findings and utilized to develop strategies which skilled birth attendant may use to facilitate the use of skilled birth care services by women in the rural areas of Ghana where there is low utilisation of birth services provided by skilled birth attendants. The conceptual framework of Dickoff, James and Wiedenbach was used to provide a guide and a link between the different concepts in the research study. Phase Three of this study focused on the development of strategies that will facilitate an increased in the labouring women utilisation of the services provided by skilled birth attendants. The data obtained was used to developed three strategies such as collaboration, education and training, supportive supervision as well as community mobilisation and participation to guide skilled birth attendants to facilitate the utilisation of skilled birth care services during childbirth. The WHO Health for All model, the theoretical model underpinning this study, also guided the development of the strategies to facilitate labouring women utilisation of the services provided by skilled birth attendants. Recommendations regarding the implementation of a national collaborative, education and supportive supervision policies on a macro level are made, as well as recommendations for nursing practice, education and research. It is therefore concluded that the researcher succeeded in achieving the purpose for this study because the strategies which are understandable, clear, simple, applicable and significant to skilled birth care in rural areas has been developed for use by skilled birth attendants to facilitate the utilisation of skilled birth care provided by skilled birth attendants in the rural areas of Ghana.
- Full Text:
- Date Issued: 2018
Guidelines for the management of patients with diabetes mellitus at health care clinics in the Cacadu region of the Eastern Cape Province of South Africa
- De Mendonça, Hester Magdalena
- Authors: De Mendonça, Hester Magdalena
- Date: 2009
- Subjects: Diabetics -- Treatment -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: vital:10011 , http://hdl.handle.net/10948/1017 , Diabetics -- Treatment -- South Africa -- Eastern Cape
- Description: Diabetes Mellitus (DM) is the new epidemic in the world with 246 million people suffering from the disease at the moment and a projected increase to 380 million in 2025 (IDF, 2007b:36). The developing countries are the most vulnerable. Statistics state that SA and Egypt have the most diabetics on the continent. Globally, each year 3,8 million deaths are attributable to DM (IDF, 2007a). The Department of Health (DOH) and the Cacadu District Municipality (Eastern Cape) are serving a population of 102 721 in the Kouga and Koukamma areas, which covers an area of 5 992 km², with health care. There are 22 clinics with 28 registered nurses for all the clinics and between 3 and 9 lay health workers (LHWs) per clinic. For the purpose of this research study, the persons suffering from DM (±3550) in this area were taken into consideration (Strydom, 2005). DM is a chronic disorder and therefore patients should be able to manage their disease pattern for the rest of their lives (Healthline, 2008, Mbanya, 2006:12). In order to achieve this, continuous and effective patient education by health care providers are necessary. This disease affects more and more people each passing day, because of the rapid westernisation of the South African population, leading to more people attending clinics in the public health sector (Bonnici, 2002:32). There are specific guidelines laid down by the Department of Health (DOH) pertaining to the control and management of DM. Guidelines include the early diagnosis, treatment and patient education regarding DM (Department of Health, 1997, [revised 2004]). Evidence from previous research studies showed that not all registered nurses are aware of these guidelines and most have not been educated regarding the utilisation of these guidelines (O’Brien, van Rooyen & Carlson, 2006:36-40). In the clinics, the health care givers are confronted with a number of difficulties, such as a lack of funds to enable them to order adequate equipment and medicine. Another problem is the migration of registered nurses out of the country thus; there is also a shortage of staff to operate these clinics (Mkhize, 2004). The organisational structure in the clinics does not function optimally and there is a lack of communication between provincial, district and clinic level. Due to the above-mentioned challenges there is also a lack of efficient auditing systems to ensure quality assurance. Furthermore, a knowledge deficit pertaining to DM and the management thereof in all the groups participating in this study, namely the registered nurses, the lay health workers (LHWs) and the diabetic patients was found. The empowerment process of the LHW is not explored fully and therefore not executed to its full potential. To be able to improve the management of DM in this region, it is important to know what the difficulties are that the health care givers as well as the patients experience in relation to this issue. This study therefore explored and described these difficulties. The research was based on a qualitative, quantitative, explorative, descriptive and contextual research design. Health care givers as well as diabetic patients attending clinics in the Cacadu region of the Eastern Cape have been requested to complete questionnaires pertaining to their knowledge of Diabetes Mellitus. The current organisational structure of the provincial department of health was explored and findings analysed using the activities of the management process (Muller, 2006:106). The SA Government is committed to combining the national human resource development strategy with the rapid upgrading of service delivery to all of the nation’s communities. Stemming from this undertaking, suitable members of the community are to be trained as LHWs. LHWs are to play an integral role in strengthening the abilities of the community to empower themselves to participate and take responsibility for their own health and wellness (Department of Health, 2001a:4). From the research, it was found that the above-mentioned national plan had been implemented, but is not functioning at optimum level due to several shortcomings/deficits. Proposed guidelines were therefore designed to address the shortcomings and fragmentation of the plan. As specific knowledge deficits in DM were identified during this research study, general educational guidelines were included for the registered nurses and the diabetic patients. The LHW was identified as an indispensable link in the chain of efficient health care and therefore, specific educational guidelines on DM were generated to prepare her for the role. With her knowledge, insight into DM and the management thereof and newly required skills in educating and supporting of the patient, she could be an asset in the road to optimum self-care for the diabetic patient.
- Full Text:
- Date Issued: 2009
- Authors: De Mendonça, Hester Magdalena
- Date: 2009
- Subjects: Diabetics -- Treatment -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: vital:10011 , http://hdl.handle.net/10948/1017 , Diabetics -- Treatment -- South Africa -- Eastern Cape
- Description: Diabetes Mellitus (DM) is the new epidemic in the world with 246 million people suffering from the disease at the moment and a projected increase to 380 million in 2025 (IDF, 2007b:36). The developing countries are the most vulnerable. Statistics state that SA and Egypt have the most diabetics on the continent. Globally, each year 3,8 million deaths are attributable to DM (IDF, 2007a). The Department of Health (DOH) and the Cacadu District Municipality (Eastern Cape) are serving a population of 102 721 in the Kouga and Koukamma areas, which covers an area of 5 992 km², with health care. There are 22 clinics with 28 registered nurses for all the clinics and between 3 and 9 lay health workers (LHWs) per clinic. For the purpose of this research study, the persons suffering from DM (±3550) in this area were taken into consideration (Strydom, 2005). DM is a chronic disorder and therefore patients should be able to manage their disease pattern for the rest of their lives (Healthline, 2008, Mbanya, 2006:12). In order to achieve this, continuous and effective patient education by health care providers are necessary. This disease affects more and more people each passing day, because of the rapid westernisation of the South African population, leading to more people attending clinics in the public health sector (Bonnici, 2002:32). There are specific guidelines laid down by the Department of Health (DOH) pertaining to the control and management of DM. Guidelines include the early diagnosis, treatment and patient education regarding DM (Department of Health, 1997, [revised 2004]). Evidence from previous research studies showed that not all registered nurses are aware of these guidelines and most have not been educated regarding the utilisation of these guidelines (O’Brien, van Rooyen & Carlson, 2006:36-40). In the clinics, the health care givers are confronted with a number of difficulties, such as a lack of funds to enable them to order adequate equipment and medicine. Another problem is the migration of registered nurses out of the country thus; there is also a shortage of staff to operate these clinics (Mkhize, 2004). The organisational structure in the clinics does not function optimally and there is a lack of communication between provincial, district and clinic level. Due to the above-mentioned challenges there is also a lack of efficient auditing systems to ensure quality assurance. Furthermore, a knowledge deficit pertaining to DM and the management thereof in all the groups participating in this study, namely the registered nurses, the lay health workers (LHWs) and the diabetic patients was found. The empowerment process of the LHW is not explored fully and therefore not executed to its full potential. To be able to improve the management of DM in this region, it is important to know what the difficulties are that the health care givers as well as the patients experience in relation to this issue. This study therefore explored and described these difficulties. The research was based on a qualitative, quantitative, explorative, descriptive and contextual research design. Health care givers as well as diabetic patients attending clinics in the Cacadu region of the Eastern Cape have been requested to complete questionnaires pertaining to their knowledge of Diabetes Mellitus. The current organisational structure of the provincial department of health was explored and findings analysed using the activities of the management process (Muller, 2006:106). The SA Government is committed to combining the national human resource development strategy with the rapid upgrading of service delivery to all of the nation’s communities. Stemming from this undertaking, suitable members of the community are to be trained as LHWs. LHWs are to play an integral role in strengthening the abilities of the community to empower themselves to participate and take responsibility for their own health and wellness (Department of Health, 2001a:4). From the research, it was found that the above-mentioned national plan had been implemented, but is not functioning at optimum level due to several shortcomings/deficits. Proposed guidelines were therefore designed to address the shortcomings and fragmentation of the plan. As specific knowledge deficits in DM were identified during this research study, general educational guidelines were included for the registered nurses and the diabetic patients. The LHW was identified as an indispensable link in the chain of efficient health care and therefore, specific educational guidelines on DM were generated to prepare her for the role. With her knowledge, insight into DM and the management thereof and newly required skills in educating and supporting of the patient, she could be an asset in the road to optimum self-care for the diabetic patient.
- Full Text:
- Date Issued: 2009
Strategies to facilitate collaboration between allopathic and traditional health practitioners
- Authors: Tembani, Nomazwi Maudline
- Date: 2009
- Subjects: Alternative medicine -- South Africa , Healers -- South Africa , Physicians -- South Africa
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: vital:10012 , http://hdl.handle.net/10948/1283 , Alternative medicine -- South Africa , Healers -- South Africa , Physicians -- South Africa
- Description: The formal recognition of traditional healing has been controversial for some time with traditional healers being labelled by those of conventional medical orientation as a medical hazard and purveyors of superstition. The support for the development of traditional medicine and establishment of co-operation between traditional healers and allopathic heath practitioners was first promoted in the international health arena by the World Health Organisation. Estimating that 80% of the population living in rural areas of many developing countries was using traditional medicine for the primary healthcare needs, this organisation advocated for the establishment of mechanisms that would facilitate strong cooperation between traditional healers, scientists and clinicians. The study was undertaken in the Amathole District Municipality, Province of the Eastern Cape based on Chapter 2, Section 6(2) (a) of the Traditional Health Practitioners Bill 2003, which required regulation and promotion of liaison between traditional health practitioners and other health professionals registered under any law. The purpose of the study was to develop and propose strategies to facilitate collaboration between traditional and allopathic health practitioners to optimise and complement healthcare delivery. The conceptual framework guiding the study was derived from Leininger’s theory of Cultural Care Diversity and Universality chosen because of its appropriateness. The terms used throughout the study were defined to facilitate the reader’s understanding. Ethical principles were adhered to throughout the research process. To ensure trustworthiness of the study, Guba’s model (in Krefting,1991:214-215) was used where the four aspects of trustworthiness namely, truth value, applicability, consistency and neutrality were considered. A qualitative, exploratory, descriptive and contextual research design was used which assisted in articulating the appropriate strategies to develop to facilitate v collaboration between allopathic and traditional health practitioners. The study was done in two phases. Phase one entailed data collection using unstructured interviews, a focus group interview, literature control and modified participant observation. In Phase two strategies to facilitate collaboration between allopathic and traditional health practitioners were developed. The population in this study comprised three groups of participants. Group 1 consisted of allopathic health practitioners, Group 2 comprised traditional healers and Group 3 was composed of participants who were trained as both traditional healers and allopathic health practitioners. All participants had to respond to three research questions which aimed at: exploring and describing the nature of the relationship between allopathic and traditional health practitioners before legalisation of traditional healing and their experience as role-players in the healthcare delivery landscape in the Amathole District Municipality. eliciting the viewpoints of allopathic and traditional health practitioners regarding the impact on their practices of legalisation of traditional healing and developing strategies to facilitate collaboration between allopathic and traditional health practitioners. Data obtained from each group was analysed using Tesch’s method as described by Creswell (2003:192). Themes emerging from data and the corresponding strategies to address the themes were identified for each group. The participants’ responses to the three research questions revealed areas of convergence and divergence. Of significance was the reflection by the participants on their negative attitude towards each other. They also highlighted that there was no formal interaction between traditional and allopathic health practitioners in the Amathole District Municipality. Their working relationship was characterised by a one-sided referral system with traditional healers referring patients to allopathic health practitioners but this seemed not to be reciprocated vi by the latter group. The exception was the case of traditional surgeons whose working relationship with allopathic health practitioners was formally outlined in the Application of Health Standards in the Traditional Circumcision Act, Act No.6 of 2001. Allopathic health practitioners attributed their negative attitude as emanating from the unscientific methods used by traditional healers in treating patients, interference of traditional healers with the efficacy of hospital treatments and delays by traditional healers in referring patients to the hospitals and clinics. Traditional healers stated that they were concerned about failure of allopathic health practitioners to refer patients who talked about “thikoloshe” and “mafufunyana” to the traditional healers. Consequently, these patients presented themselves to the traditional healers when the illness was at an advanced stage. A reciprocal referral system was perceived by the traditional healers as the core element or crux of collaboration. There were ambivalent views regarding the impact of legalisation of traditional healing on the practices of both traditional and allopathic health practitioners. Elimination of unscrupulous healers, economic benefits, and occupational protection were benefits anticipated by traditional healers from the implementation of the Act. The possibility of having to divulge information regarding their traditional medicines, monitoring of their practice resulting in arrests should errors occur were however, cited by traditional healers as threatening elements of the Act. A lack of understanding the activities of each group with an inherent element of mistrust became evident from the participants’ responses. Ways of fostering mutual understanding between them were suggested which included holding meetings together to discuss issues relating to healing of patients, exposing both groups of health practitioners to research, as well as training and development activities. The participants also highlighted areas of collaboration as sharing resources namely, budget, physical facilities, equipment and information and role clarification especially pertaining to disease management. The participants vii strongly suggested that there should be clarity on the type of diseases to be handled by each group. The need for capacity building of traditional and allopathic health practitioners in preparation for facilitating collaboration was advocated by all and the relevant activities to engage into were suggested. Analysis, synthesis and cross referencing of the themes that emerged from the data culminated in the identification of three strategies that were applicable to all groups of participants and which would assist in facilitating collaboration between allopathic and traditional health practitioners. The researcher coined the three strategies “Triple C” strategies abbreviated as the TRIC strategies. The first “C” of the three “Cs” stands for “change attitude”, the second “C” for “communication” and the third “C” for “capacity building.” Each of the proposed three strategies is discussed under the following headings:- Summary of findings informing the strategy Theory articulating the strategy Aim of the strategy Suggested implementation mechanism As the strategies had to be grounded in a theory which would serve as a reference point, the researcher used the Survey List by Dickoff, James and Wiedenbach (1968:423) as a conceptual framework on which to base the proposed three strategies. The results of this study and recommendations that have been made will be disseminated in professional journals, research conferences and seminars.
- Full Text:
- Date Issued: 2009
- Authors: Tembani, Nomazwi Maudline
- Date: 2009
- Subjects: Alternative medicine -- South Africa , Healers -- South Africa , Physicians -- South Africa
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: vital:10012 , http://hdl.handle.net/10948/1283 , Alternative medicine -- South Africa , Healers -- South Africa , Physicians -- South Africa
- Description: The formal recognition of traditional healing has been controversial for some time with traditional healers being labelled by those of conventional medical orientation as a medical hazard and purveyors of superstition. The support for the development of traditional medicine and establishment of co-operation between traditional healers and allopathic heath practitioners was first promoted in the international health arena by the World Health Organisation. Estimating that 80% of the population living in rural areas of many developing countries was using traditional medicine for the primary healthcare needs, this organisation advocated for the establishment of mechanisms that would facilitate strong cooperation between traditional healers, scientists and clinicians. The study was undertaken in the Amathole District Municipality, Province of the Eastern Cape based on Chapter 2, Section 6(2) (a) of the Traditional Health Practitioners Bill 2003, which required regulation and promotion of liaison between traditional health practitioners and other health professionals registered under any law. The purpose of the study was to develop and propose strategies to facilitate collaboration between traditional and allopathic health practitioners to optimise and complement healthcare delivery. The conceptual framework guiding the study was derived from Leininger’s theory of Cultural Care Diversity and Universality chosen because of its appropriateness. The terms used throughout the study were defined to facilitate the reader’s understanding. Ethical principles were adhered to throughout the research process. To ensure trustworthiness of the study, Guba’s model (in Krefting,1991:214-215) was used where the four aspects of trustworthiness namely, truth value, applicability, consistency and neutrality were considered. A qualitative, exploratory, descriptive and contextual research design was used which assisted in articulating the appropriate strategies to develop to facilitate v collaboration between allopathic and traditional health practitioners. The study was done in two phases. Phase one entailed data collection using unstructured interviews, a focus group interview, literature control and modified participant observation. In Phase two strategies to facilitate collaboration between allopathic and traditional health practitioners were developed. The population in this study comprised three groups of participants. Group 1 consisted of allopathic health practitioners, Group 2 comprised traditional healers and Group 3 was composed of participants who were trained as both traditional healers and allopathic health practitioners. All participants had to respond to three research questions which aimed at: exploring and describing the nature of the relationship between allopathic and traditional health practitioners before legalisation of traditional healing and their experience as role-players in the healthcare delivery landscape in the Amathole District Municipality. eliciting the viewpoints of allopathic and traditional health practitioners regarding the impact on their practices of legalisation of traditional healing and developing strategies to facilitate collaboration between allopathic and traditional health practitioners. Data obtained from each group was analysed using Tesch’s method as described by Creswell (2003:192). Themes emerging from data and the corresponding strategies to address the themes were identified for each group. The participants’ responses to the three research questions revealed areas of convergence and divergence. Of significance was the reflection by the participants on their negative attitude towards each other. They also highlighted that there was no formal interaction between traditional and allopathic health practitioners in the Amathole District Municipality. Their working relationship was characterised by a one-sided referral system with traditional healers referring patients to allopathic health practitioners but this seemed not to be reciprocated vi by the latter group. The exception was the case of traditional surgeons whose working relationship with allopathic health practitioners was formally outlined in the Application of Health Standards in the Traditional Circumcision Act, Act No.6 of 2001. Allopathic health practitioners attributed their negative attitude as emanating from the unscientific methods used by traditional healers in treating patients, interference of traditional healers with the efficacy of hospital treatments and delays by traditional healers in referring patients to the hospitals and clinics. Traditional healers stated that they were concerned about failure of allopathic health practitioners to refer patients who talked about “thikoloshe” and “mafufunyana” to the traditional healers. Consequently, these patients presented themselves to the traditional healers when the illness was at an advanced stage. A reciprocal referral system was perceived by the traditional healers as the core element or crux of collaboration. There were ambivalent views regarding the impact of legalisation of traditional healing on the practices of both traditional and allopathic health practitioners. Elimination of unscrupulous healers, economic benefits, and occupational protection were benefits anticipated by traditional healers from the implementation of the Act. The possibility of having to divulge information regarding their traditional medicines, monitoring of their practice resulting in arrests should errors occur were however, cited by traditional healers as threatening elements of the Act. A lack of understanding the activities of each group with an inherent element of mistrust became evident from the participants’ responses. Ways of fostering mutual understanding between them were suggested which included holding meetings together to discuss issues relating to healing of patients, exposing both groups of health practitioners to research, as well as training and development activities. The participants also highlighted areas of collaboration as sharing resources namely, budget, physical facilities, equipment and information and role clarification especially pertaining to disease management. The participants vii strongly suggested that there should be clarity on the type of diseases to be handled by each group. The need for capacity building of traditional and allopathic health practitioners in preparation for facilitating collaboration was advocated by all and the relevant activities to engage into were suggested. Analysis, synthesis and cross referencing of the themes that emerged from the data culminated in the identification of three strategies that were applicable to all groups of participants and which would assist in facilitating collaboration between allopathic and traditional health practitioners. The researcher coined the three strategies “Triple C” strategies abbreviated as the TRIC strategies. The first “C” of the three “Cs” stands for “change attitude”, the second “C” for “communication” and the third “C” for “capacity building.” Each of the proposed three strategies is discussed under the following headings:- Summary of findings informing the strategy Theory articulating the strategy Aim of the strategy Suggested implementation mechanism As the strategies had to be grounded in a theory which would serve as a reference point, the researcher used the Survey List by Dickoff, James and Wiedenbach (1968:423) as a conceptual framework on which to base the proposed three strategies. The results of this study and recommendations that have been made will be disseminated in professional journals, research conferences and seminars.
- Full Text:
- Date Issued: 2009
A holistic healthcare model for higher education campus health services
- Authors: Ricks, Esmeralda Jennifer
- Date: 2008
- Subjects: College students -- Health and hygiene -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: vital:10038 , http://hdl.handle.net/10948/666 , College students -- Health and hygiene -- South Africa -- Eastern Cape
- Description: Most students are adolescents and young adults, a group characterized by a new-found sense of independence, experimentation with sex and sometimes drugs and a feeling of invincibility (Gayle, Richard, Keeling, Garcia-Tunon, Kilbourne, Narkunas, Ingram, rogers and Curran, 1990:1538). These behavioural, developmental and environmental issues may contribute to premature morbidity, mortality and reduced quality of life for university students (Patrick et al., 1992:260). The ages of staff on the other hand range from young adults to retirement age. The types of health problems that exist among staff who use the campus health service include First Aid treatment on site for injuries on duty and more chronic health problems such as, for example, hypertension and diabetes mellitus. To date there is very little evidence as to whether or not the healthcare needs of students and staff are being met comprehensively or whether the practitioners rendering the service are knowledgeable and complying with the PHC norms and standards developed by the department of Health’s Quality Assurance Directorate. The lack of such empirical data can contribute to misconceptions and hamper the management of public health problems experienced in SA, for example sexually transmitted infections and the transmission of HIV. Thus the purpose of this research was to develop a model that would assist registered nurses employed at a higher education campus health service in the Western Region of the Eastern Cape Province to render a healthcare service relevant to the healthcare needs of the students and staff on campus.
- Full Text:
- Date Issued: 2008
- Authors: Ricks, Esmeralda Jennifer
- Date: 2008
- Subjects: College students -- Health and hygiene -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: vital:10038 , http://hdl.handle.net/10948/666 , College students -- Health and hygiene -- South Africa -- Eastern Cape
- Description: Most students are adolescents and young adults, a group characterized by a new-found sense of independence, experimentation with sex and sometimes drugs and a feeling of invincibility (Gayle, Richard, Keeling, Garcia-Tunon, Kilbourne, Narkunas, Ingram, rogers and Curran, 1990:1538). These behavioural, developmental and environmental issues may contribute to premature morbidity, mortality and reduced quality of life for university students (Patrick et al., 1992:260). The ages of staff on the other hand range from young adults to retirement age. The types of health problems that exist among staff who use the campus health service include First Aid treatment on site for injuries on duty and more chronic health problems such as, for example, hypertension and diabetes mellitus. To date there is very little evidence as to whether or not the healthcare needs of students and staff are being met comprehensively or whether the practitioners rendering the service are knowledgeable and complying with the PHC norms and standards developed by the department of Health’s Quality Assurance Directorate. The lack of such empirical data can contribute to misconceptions and hamper the management of public health problems experienced in SA, for example sexually transmitted infections and the transmission of HIV. Thus the purpose of this research was to develop a model that would assist registered nurses employed at a higher education campus health service in the Western Region of the Eastern Cape Province to render a healthcare service relevant to the healthcare needs of the students and staff on campus.
- Full Text:
- Date Issued: 2008
Inter-level health service referral of women in labour
- Authors: Jantjes, Louisa
- Date: 2008
- Subjects: Childbirth -- South Africa , Medical referrals -- South Africa , Midwives -- South Africa , Labor (Obstetrics) -- Complications
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: vital:10010 , http://hdl.handle.net/10948/986 , Childbirth -- South Africa , Medical referrals -- South Africa , Midwives -- South Africa , Labor (Obstetrics) -- Complications
- Description: Although it is considered an everyday occurrence, childbirth is nonetheless an important and dramatic experience in the life of every woman. Childbirth, a normal physiological state in the life of a woman, can be an awe-inspiring and exciting experience, but sometimes disconcerting experiences may also occur. Women sometimes see labour as the end to a long drawn out process following pregnancy and therefore attribute great significance to all occurrences during labour. When complications occur in a usually uncomplicated process of labour, the health care provider must be able to make quick and effective management decisions and implement appropriate interventions. This may include the referral of women in labour to a level of care where complications can be dealt with more effectively, thereby ensuring the best maternal and neonatal outcomes. Patient referral is regarded as a fundamental component of the health care system therefore a well functioning system should ensure that patients are treated in the appropriate manner at the appropriate place at the lowest possible cost to the health system. The goal of this research study was to explore and describe the inter-level health service referral of women in labour by midwives, in order to design guidelines for midwives and other relevant health care providers involved in inter-level health service referral of women in labour in the South African public health care sector. The research design used for this study is a combination of qualitative and quantitative approaches. The paradigmatic perspective of this study was based on the World Health Organization’s Health for All Model. Appropriate data collection and analysis strategies were used for the different stages of the study. Data collection commenced only after permission to conduct the research had been obtained from relevant authorities and University of Port Elizabeth and the Nelson Mandela Metropolitan University structures. Informed consent was obtained from participants included in the study. In stage 1 of this research project, a profile of midwives at lower level maternity care centres was compiled and the perceptions and experiences of midwives working at lower level maternity services, who are responsible for inter-level health referrals of women in labour, were described. Stage 2 described, by means of analysis of maternity case records, aspects of the inter-level referral of women in labour including the profiles of women admitted to midwife obstetric units (MOUs) who are v referred to higher levels of care. Of significance in this study is the appropriateness of midwifery referrals and the maternity care implemented by health care providers during inter-level health service referral of women in labour. In stage 3 clinical guidelines for midwives and other relevant maternity care providers, to assist them in the inter-level health service referral of women in labour, were developed. Findings from stage 1 of this research study revealed that midwives were generally well qualified and sufficiently experienced in the management of women in labour who need referral. Disconcerting findings relating to human and material resource shortages were discovered; these included major problems with patient transportation and difficulties with communication relating to inter-level health service referral of women. These shortages adversely affected midwives’ ability to efficiently care for women during the inter-level health service referral of women in labour in the research area. Stage 2 of the study yielded results of questionable standards of care to women and infants included in the study. A further disturbing finding from the study is the poor state of record keeping. The development of the provisional guidelines in stage 3 of the study was informed by the four main themes identified from the research findings. Before embarking on guideline development, the researcher familiarized herself with theory related to the clinical guidelines. These included clarifying the concept ‘clinical guidelines’, justifying the need for developing clinical guidelines as well as giving consideration to concerns about clinical guidelines. The research findings as well as literature related to these findings informed the researcher on the development of the guidelines. Provisional guidelines were therefore developed on responsibilities of role players in inter-level health service referral of women in labour at first level of referral, namely the midwife obstetric units, transport personnel and maternity care providers at the referral hospital. Steps were taken throughout the study to adhere to ethical standards of research. The researcher will ensure that the research report is available to all health authorities involved, the participants included in the study and the health care providers who may benefit from the research findings.
- Full Text:
- Date Issued: 2008
- Authors: Jantjes, Louisa
- Date: 2008
- Subjects: Childbirth -- South Africa , Medical referrals -- South Africa , Midwives -- South Africa , Labor (Obstetrics) -- Complications
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: vital:10010 , http://hdl.handle.net/10948/986 , Childbirth -- South Africa , Medical referrals -- South Africa , Midwives -- South Africa , Labor (Obstetrics) -- Complications
- Description: Although it is considered an everyday occurrence, childbirth is nonetheless an important and dramatic experience in the life of every woman. Childbirth, a normal physiological state in the life of a woman, can be an awe-inspiring and exciting experience, but sometimes disconcerting experiences may also occur. Women sometimes see labour as the end to a long drawn out process following pregnancy and therefore attribute great significance to all occurrences during labour. When complications occur in a usually uncomplicated process of labour, the health care provider must be able to make quick and effective management decisions and implement appropriate interventions. This may include the referral of women in labour to a level of care where complications can be dealt with more effectively, thereby ensuring the best maternal and neonatal outcomes. Patient referral is regarded as a fundamental component of the health care system therefore a well functioning system should ensure that patients are treated in the appropriate manner at the appropriate place at the lowest possible cost to the health system. The goal of this research study was to explore and describe the inter-level health service referral of women in labour by midwives, in order to design guidelines for midwives and other relevant health care providers involved in inter-level health service referral of women in labour in the South African public health care sector. The research design used for this study is a combination of qualitative and quantitative approaches. The paradigmatic perspective of this study was based on the World Health Organization’s Health for All Model. Appropriate data collection and analysis strategies were used for the different stages of the study. Data collection commenced only after permission to conduct the research had been obtained from relevant authorities and University of Port Elizabeth and the Nelson Mandela Metropolitan University structures. Informed consent was obtained from participants included in the study. In stage 1 of this research project, a profile of midwives at lower level maternity care centres was compiled and the perceptions and experiences of midwives working at lower level maternity services, who are responsible for inter-level health referrals of women in labour, were described. Stage 2 described, by means of analysis of maternity case records, aspects of the inter-level referral of women in labour including the profiles of women admitted to midwife obstetric units (MOUs) who are v referred to higher levels of care. Of significance in this study is the appropriateness of midwifery referrals and the maternity care implemented by health care providers during inter-level health service referral of women in labour. In stage 3 clinical guidelines for midwives and other relevant maternity care providers, to assist them in the inter-level health service referral of women in labour, were developed. Findings from stage 1 of this research study revealed that midwives were generally well qualified and sufficiently experienced in the management of women in labour who need referral. Disconcerting findings relating to human and material resource shortages were discovered; these included major problems with patient transportation and difficulties with communication relating to inter-level health service referral of women. These shortages adversely affected midwives’ ability to efficiently care for women during the inter-level health service referral of women in labour in the research area. Stage 2 of the study yielded results of questionable standards of care to women and infants included in the study. A further disturbing finding from the study is the poor state of record keeping. The development of the provisional guidelines in stage 3 of the study was informed by the four main themes identified from the research findings. Before embarking on guideline development, the researcher familiarized herself with theory related to the clinical guidelines. These included clarifying the concept ‘clinical guidelines’, justifying the need for developing clinical guidelines as well as giving consideration to concerns about clinical guidelines. The research findings as well as literature related to these findings informed the researcher on the development of the guidelines. Provisional guidelines were therefore developed on responsibilities of role players in inter-level health service referral of women in labour at first level of referral, namely the midwife obstetric units, transport personnel and maternity care providers at the referral hospital. Steps were taken throughout the study to adhere to ethical standards of research. The researcher will ensure that the research report is available to all health authorities involved, the participants included in the study and the health care providers who may benefit from the research findings.
- Full Text:
- Date Issued: 2008
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