The aim of the study was to: explore and describe patient’s perceptions regarding commencement of treatment following diagnosis with breast cancer at Frere Hospital in Buffalo City Metropolitan Municipality in the Eastern Cape, South Africa. Reasons why patients diagnosed with breast cancer delay in the commencement of the treatment were to be elicited and strategies for curbing the problem were looked into. A qualitative approach was used, with an exploratory, descriptive and contextual design. The purposive sampling technique was used. The sample comprised 15 participants, 14 Black Africans and 1 Coloured lady. Data were collected using an interview guide from female patients diagnosed with breast cancer whose age ranged from 18-72 years. Interviews were recorded on a tape. Tesch’s (1990) steps of qualitative data analysis guided the analysis process. The results revealed that being diagnosed with breast cancer is perceived as a traumatic and painful experience with negative emotional, social, physical impact and unbearable side effects of from the treatment. Fear of undergoing treatment emerged as a barrier for taking prompt treatment. In exploring, one needs to use empathy, particularly that the researcher engaged in bringing to surface painful information. With the use of understanding and broad mindedness, participants opened up. Recommendations were made regarding strategies for care.

The focus of the study was to explore and describe reasons for poor professional behaviour among nursing students at a public nursing college in the Eastern Cape. The objectives of the study were to explore and describe the reasons for poor professional behaviour among nursing students and to describe strategies to improve poor professional behaviour. The study has significance for the college management, staff, nursing students, registered nurses and everyone involved in professional development of nursing students. The population for this study consisted of third-year nursing students following the four-year comprehensive basic course for registration leading to the Diploma in Nursing (General, Community & Psychiatry) and Midwifery at a public nursing college. The research questions were: What do you understand by professional behaviour? What are the reasons for poor professional behaviour among nursing students? What could be done to improve professionalism among college nursing students? A qualitative, explorative, descriptive and contextual design was used as a framework for the study. Permission to conduct the study was obtained from the University of Fort Hare ethics committee and other relevant authorities as indicated in the study. Ethical principles were maintained and informed consent obtained. Data collection was done using focus groups and an audiotape with a purposefully sampling of 30 third-year nursing students at the public college of nursing. Data were analysed using Tesch’s method of analysis for qualitative research. Three major themes emerged: students’ understanding of professional behaviour, reasons for poor professional behaviour and methods to improve poor professional behaviour. It was concluded that poor professional behaviour has an effect on professionalism and it should be addressed and corrected for protecting the professional image. Recommendations: Policies regarding inappropriate professional behaviour at the college should be in place and easily accessible to every staff member and nursing student. Department of Health should conduct reflective courses and seminars on professionalism and these should begin at the same time as the academic programme.

Exploration of indigenous knowledge and practices of the relatives of mental health care users regarding the management of mental disorders. This study was conducted to explore the management of mental disorders amongst the indigenous people of the Dedza District in Malawi. The government of Malawi declared public mental health services to be free of charge, as a strategy to reduce the burden of disease to the country. Yet despite the free health care services, the indigenous people of Malawi did not take advantage of these free mental health care services, as they regarded them to be culturally incongruent. Instead they used traditional healing systems for mental disorders and consulted the Western health systems only when the traditional systems had failed, the mental health condition had become worse and the mental health care user had become unmanageable. This study was then conducted to explore what the Malawians regarded as culturally sensitive public mental health services. Method: A qualitative phenomenological research approach was adopted to explore the views of the relatives of mental health care users about culturally sensitive public mental health care services. A purposeful sampling method was used to select information rich participants amongst the relatives of mental health care users of indigenous Malawian origin. An unstructured interview guide was used to gather data through face to face interviews. Saturation of data was reached after interviewing fifteen (15) relatives. The verbatim transcribed data from the participants were content analyzed to identify the themes, categories and subcategories. Themes that emerged were: community beliefs; perceived causes, delayed decision making and health system factors. viii Findings: The community beliefs about the management of mental disorders were on traditional and religious health systems. The traditional healers were consulted in cases where mental illness was believed to be caused by witchcraft and spiritual healers were consulted where mental illness was believed to be caused by ancestral wrath. Even such consultations were delayed as the decisions on the type of healer to be used to manage the mental health care user, had to come from the extended family members. These processes took place during the acute phase of the mental illness and thus explain the delays in consulting with the Western mental health care systems. Such delays had a potential to contribute to the chronicity and the related complications of the illness. The Western health care services were only consulted when the indigenous healing systems were unsuccessful. Yet even the western healing systems were not the best option due to the negative and disrespectful attitudes of health care professionals, the impersonal nature of services, the use of foreign language and delays in service delivery. The recommendations were that the results of this study should be used as guidelines to develop strategies for culturally congruent mental health care services to the indigenous Malawians as the development of the strategies was beyond the scope of this study. The focus of the guidelines to ensure the development of evidence-based nursing practices in rendering culturally congruent mental health services to the indigenous Malawians. Firstly, there should be an integration of both the Western and the traditional healing systems to ensure a holistic patient centered approach to the care of the indigenous people of Malawi; secondly to use the nursing process phases, starting with the assessment, the formulation of the nursing diagnosis, the expected outcomes, the development and implementation of the nursing interventions and the discharge ix plans to incorporate the belief systems of the indigenous Malawians as identified in this study.

The focus of this study was to explore the perceptions of professional nurses in the quality of care rendered by nurses in the public hospitals. Nursing is a challenging, demanding, and yet fulfilling profession, whose goal is to provide quality care to individuals, families and communities. However, there are inconsistencies regarding the quality of care rendered by nurses in the public hospitals. The media and the public portray nurses as providing poor quality care in the health care facilities. Conversely, the nurses view that they are doing their best, considering the challenging circumstances under which they work in public institutions.The study followed a qualitative approach and an exploratory descriptive design. A purposive sample of 13 professional nurses participated in the study. The sample size was not pre-determined. Data were collected until data saturation, when the interviews yielded no new information. The study was conducted in a state hospital in the Eastern Cape, using an interview guide. Responses were recorded using a tape recorder. No incentives were given to participants. Data were collected and analysed following the Tesch’s method. Prior to conducting the study, the researcher obtained ethical clearance from the University of Fort Hare research ethics committee. The perceptions of the professional nurses who participated in this study were inconsistent. The majority pointed out that the quality of patient care was deteriorating which means the patient care is poor. whereas some participants indicated that the quality of patient care was still the same; it had not changed or deteriorated, The contributing factors to the poor quality patient care were indicated as; shortage of staff, shortage of resources such as equipment, inadequate empowerment of staff, insufficient training of students, staff arriving late for duties, lack of passion their work, skipping and missing of routines, support service that was not working hand in hand with the nursing staff, increased hospitalization of patients and the Eastern cape Department of Health failing to remunerate the nurses as promised.

Infant feeding in the context of HIV/AIDS poses a challenge among mothers. The implementation of UNICEF guidelines on infant feeding, which state that “when replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended” (WHO, 2003:12) are not easy to meet. In more developed countries, where these criteria are met, almost all HIV-infected mothers have ceased to breast feed. Consequently, infants of mothers in these countries are less likely to be infected with HIV postnatally. In South Africa, more specifically in the Eastern Cape, infant feeding is a challenge as a number of UNICEF criteria cannot be met. The Eastern Cape is one of the poorest Provinces in South Africa, with a number of rural communities. Earlier studies have shown that, if mothers select either exclusive breast feeding or exclusive formula feeding, this reduces mother-to-child transmission of HIV. A limited number of studies on adherence to the method of infant feeding selected before delivery were found in the literature, hence the need for the current study. The purpose of the study was to explore adherence to exclusive breast feeding and exclusive formula feeding among mothers with HIV infection and to determine the problems that mothers may be facing in implementing their pre-selected methods.

Family planning services are rendered at no cost in all clinics in Mdantsane. Mdantsane is situated in the Eastern Cape and falls under Amathole District Municipality. The high rate of adolescent pregnancy in the area raises a question as to whether the family planning services are adequate. This issue reflects on the quality of family planning service delivery. According to Roux (1995:94), a quality service is a safe, easily available and readily acceptable service, delivered by well trained family planning personnel through well planned programmes. Aims and Objectives: To assess the quality of family planning service delivery by health providers to adolescents; determine the opinions of adolescents regarding accessibility, friendliness of staff, privacy, confidentiality, reproductive health information and resources at Mdantsane clinics from June to July 2009. Method: A questionnaire was designed to collect data. The questionnaire was administered on the adolescents utilizing the reproductive health services at eleven primary health clinics in Mdantsane. A sample consisting of 110 adolescent youth between 19 and 24 years was selected by using random sampling. A response of “yes” will indicate that the participant is satisfied with the specific item, while a response of “no” will indicate dissatisfaction with that item. A specially designed spreadsheet was developed to analyze the data. Data was analyzed by using the Microsoft Excel 2007 Version 6. Results: The results from this research study suggest that there is a definite need for improvement of adolescent reproductive health services at Mdantsane clinics. It is clear that the current available maternal and child health programmes, school health services and reproductive health services are not able to meet the adolescent sexual and reproductive needs. Conclusion: The research findings from this study indicated the constraints to good quality family planning health care service delivery. Satisfaction responses from the five categories: health facility amenities, accessibility, staff characteristics, availability of sexual and reproductive health services and availability of educational material accessibility were mostly below 70%. The responses regarding the question on the “full information about the available contraceptives”showed the least level of satisfaction. Deficiencies in physical facilities and equipment, disruptions in supplies, insufficient information provided to clients and providers‟ insensitivity to the feelings and needs of the clients are issues that discourage adolescents from utilizing contraceptive services. Recommendations: Adolescents need a safe and supportive environment that offers information and skills to equip them on all aspects related to sexual and reproductive health issues. To satisfy adolescent reproductive needs, the following key elements should be improved: accessibility of reproductive health services, friendliness of clinic staff, availability of information about reproduction and sexuality and maintenance of issues regarding confidentiality and anonymity. Quality requires the presence of trained personnel in well-equipped clinics where clients are treated courteously. To avoid issues of courtesy bias, there is a need to conduct a similar survey utilizing alternative community settings, namely homes of participants or a school.

South Africa has the highest number of people living with HIV/AIDS in the world. The estimated 5,7 million South Africans that are living with HIV need comprehensive and holistic care. Psychosocial support is a vital aspect of care for HIV positive people. Support groups have been identified as a basic form of psychosocial support. The aim of this study was to evaluate the role of support groups in the lives of HIV positive people in East London, Eastern Cape. A qualitative study design was implemented using focus group interviews to explore the role of HIV support groups. The research questions were designed to elicit responses pertaining to the needs, expectations and experiences of HIV positive support group attendees. Activities conducted in support groups as well as the attitude of support group members towards recruiting other HIV positive people to join the group were also explored. Findings revealed that the benefits of attending a support group included emotional and psychological support, sense of belonging to a “family”, assistance with disclosure issues, gaining information about HIV and treatment as well as material benefits such as food parcels and job opportunities. The greatest need of support group attendees was assistance in obtaining a Social Support or Disability Grant. A few negative experiences were reported which included: unfulfilled promises by people outside of the group, unfair allocation of grants and food parcels, as well as negative group dynamics at times. Support group members agreed that even though there were few negative experiences, the benefits clearly outweighed the negative experiences. Most participants agreed that they would recommend the support group to other HIV positive people so that they could also enjoy the stated benefits. In summary, the study concluded that support groups are very helpful in the lives of HIV positive people.

This study was aimed at investigating the attitudes of nurse managers towards quality improvement programmes in the East London Hospital Complex. The research design comprised a qualitative, exploratory and descriptive approach. A purposive sample of 10 nurse managers participated in the study. The data were collected through interviews, using a semi-structured interview guide. Interviews were recorded using audiotape. Data were analysed manually and by using the computer software Atlas ti. Positive and negative themes were identified and ethical consideration was ensured by means of privacy, confidentiality and anonymity. The findings revealed that nurse managers in the East London Hospital Complex had overall positive attitudes towards quality improvement programmes. A few negative attitudes and their contributory factors were also identified. The limitations of the study and recommendations based on the findings of the study are presented

Basic Antenatal Care (BANC) is a way of training or upgrading the knowledge and skills of all nurses, midwives and doctors involved in antenatal care at the primary health care level so that the minimum care can be provided effectively. This study was conducted to investigate the implementation of the BANC program by midwives in the Mdantsane clinics during February 2009. Methods: A descriptive study design was undertaken targeting midwives providing antenatal care to pregnant women, in 14 clinics of Mdantsane. Data was collected from 25 midwives in the clinics, and from 140 ANC cards of women attending ANC on the day of their visit to the clinic. Results: The majority of midwives providing BANC in Mdantsane clinics were not trained in BANC. There were 10 trained midwives and 15 not yet trained. A total of twenty five midwives were involved in the study. The number of visits according to the BANC schedule was well known by the midwives in the study. The content of the visits was well known for the first visit, but for subsequent visits, the participating midwives could not state exactly what they do on these visits. They perceived BANC as something beneficial for both midwives and pregnant women with 24 of the participating midwives rating BANC as advantageous. In completing an ANC card, the midwives scored between 48 percent and 100 percent. Under examination, they scored between 52 percent and 100 percent. Lastly on interpretation and decision making, they scored between 0 percent and 92 percent. This could have troubling consequences for the health status of the mother and baby. Weaknesses in providing antenatal care identified in the study included participating midwives failing to fill in the last normal menstrual period (LNMP) and the estimated date of delivery (EDD), which was a worrying observation. Plotting of the gestational age at first visit was also not carried out well as only 47 percent of the midwives in the study did this, meaning that there would be a miscalculation of the gestational age thereafter throughout the pregnancies. The body mass index (BMI) was not calculated as the maternal height and weight were not written on the ANC card. This should be completed in order to check the nutritional status of the pregnant woman to help supplement, if malnourished, and educate on diet, if overweight. Only 17 percent of the midwives in the study plotted the foetal presentation. Failure to plot foetal presentation could lead to complications during delivery because women with abnormal presentations could end up delivering in a clinic instead of the hospital.Conclusion: This study showed that even though midwives are implementing BANC among pregnant women, it is not being carried out correctly. Therefore the programme will not be as beneficial as it would be if put into practice correctly. This is highlighted by the lack of knowledge from the untrained midwives regarding the content of care on subsequent visits. Thus there is an urgent need for BANC training to be conducted and monitored at various sites.

The aim of this study was to determine the ability and proficiency of the newly qualified professional nurses in utilising psychiatric nursing skills at Chris Hani District Psychiatric Health Care Services in the Eastern Cape, South Africa. The research method was a qualitative, phenomenological approach. A purposive sample of newly qualified professional nurses and supervisors participated in the study. The data were collected through interviews and focus group discussions, using semi – structured interview guides. Interviews responses were recorded on the interview guide. Data were analysed using the computer software Atlas ti and manually. Positive and negative themes were identified. Ethical considerations were ensured by means of privacy, anonymity and confidentiality. Ethical clearance was obtained from the University of Fort Hare and permission from the Provincial Department of Health and Chris Hani District Health and Mental Health Institution at Queenstown was sought. The findings revealed that newly qualified professional nurses performed well, according to the perception of their supervisors. Newly qualified professional nurses were faced with challenges such as shortage of resources, mental illness not considered as a priority and lack of skills development. The study also revealed that newly qualified professional nurses focussed on the curative aspect of ailments, rather than preventive care. However community health workers (CHW) focussed on the preventive aspect of care. Limitations and recommendations based on the findings of the study are presented.