The National HIV and AIDS and STI strategic plan for South Africa, 2007-2011 aims to reduce the rate of mother to child transmission to less than 5% by 2011. On the World Aids day in 2009, the Honorable President Jacob Zuma announced the intervention to improve antiretroviral therapy (ARV), access to priority group’s in order to decrease the disease burden, to address maternal and child mortality, and to improve life expectancy (PMTCT Guidelines: 2010). According to the literature reviewed, accepting attitudes may indicate better knowledge and understanding of HIV and AIDS. Marking a change in South Africa’s history of HIV the South African Government launched a major HIV Counseling and Testing program campaign (HCT) in 2010. For the PMTCT program to work and be acceptable, it needs to be known by its clients. It helps the individual to know about their status so that they make important choices for self and others. Amongst the important choices, medications for opportunistic medications, ARV’S, behavior change, etc, are included (Project Literacy 2006:40). Aim and Objectives: The study assessed the knowledge that the pregnant women have towards the prevention of mother to-child transmission which includes HIV testing, antiretroviral prophylaxis during pregnancy, labour, and post natal and feeding options. Methods: A quantitative descriptive method was used for this study. The questionnaires developed by the researcher were used for data collection. The items on the questionnaire were divided into four (4) subsections. The questionnaire was administered to all positive pregnant women coming for follow up visit and those available at the time of data collection. Conclusion: In this study evaluation of the level of knowledge and attitude of positive pregnant women with regard to PMTCT in 5 Buffalo City Municipality clinics was conducted. It was found that some of positive pregnant women have better knowledge about PMTC though there were still those that need further education. Recommendations: The service providers, who are the professional nurses, should be provided with proper training on PMTCT program to improve their standard of service delivery and to capacitate them with knowledge and skills. Integration of HIV related health aspects during assessment and treatment of pregnant women should be strengthened, as the purpose of implementation of PMTCT was to reduce mortality rate by 50%, and also to reach the 4th Millennium Development Goal of reducing these deaths by two-thirds by 2015.east london towards prevention of mother to child transmission (pmtct)

Academic support is critical in promoting success among student nurses. Support for student learning is a key element in optimizing student learning experiences, in any learning environment, and its importance has been widely discussed. Student academic support is closely related to motivation for learning, and helping students achieve their learning goals and objectives. Student nurses continue to struggle during their training, to the point of failing a year or being excluded from the course, in spite of the academic support provided through classroom facilitation, and remedial teaching provided by academic staff. They frequently complain that the course is difficult, the workload is heavy, and they are unable to integrate theory with practice. As a result they are too stressed, throughout their training. The purpose of this study is to explore and describe the perceptions of student nurses about the academic support provided to them at a public nursing college in the Eastern Cape Province. This study was guided by the Caring Curriculum Model, based on Watson‟s Theory of Caring. The core of this theory is the implementation of ten carative factors to promote health and equilibrium. Caring was endorsed as a core value in nursing education and practice, by the National League of Nursing and the American Association of Colleges of Nursing, while the centrality of a caring-healing relationship was recognized as a basis for all health professional education by the Pew Health Professions Commission. A quantitative approach, using a descriptive and explanatory design, was used to determine the perceptions of student nurses on the academic support they received from the public nursing college. Participants were selected by a simple random sampling method. A total of 189 student nurses, who registered for the 4-year diploma programme at the East London Campus of the Lilitha College of Nursing, participated in the study. Self-report data was collected by means of the Academic Support questionnaire, using a Likert scale which addressed both the performance and importance of academic support. Data were analysed using Statistical Analysis Systems version 9.3, using mean tables and graphical data analysis. The findings revealed high performance ratings for aspects relating to academic advising and teaching-learning process, indicating that there is satisfaction among students on these service attributes. Poor performance ratings were identified, relative to campus support services, indicating that student nurses were not happy with the availability and accessibility of library resources, and computer and internet services. Student nurses, at the college under study, were also not happy with aspects of service excellence relating to campus-based health care facilities, and personal student counselling services. The study identified a gap between the perceived performance and the importance of academic support at the nursing college, as the general performance was rated lower than the importance of academic support. The findings suggest the necessity for improved library facilities and resources, healthcare and counselling services and the establishment of student support programmes, to build the capacity of students and to enhance their chances of success.

Diabetic retinopathies is a complication of diabetes mellitus causing blindness globally, and as patients live longer, cases of diabetic retinopathy increases. Despite efforts to educate patients at their eye visits, yearly follow up visits is still a major challenge. Key words: Diabetes, Diabetic retinopathy, health systems, non-attendance, knowledge, attitude, behaviour, gender, fear and anxiety Objectives: The objectives of the study were to investigate the reasons for non-compliance by determining the relationship among the selected factors (knowledge/ confidence/ fear and anxiety) and adherence to yearly reviews. Methods: Data were collected from adult diabetic patients who attended the private practice for an eye review by the ophthalmologist. The instrument used was a semi- structured questionnaire with sections covering demographics, statements regarding diabetes and diabetic eye care and one section with an open ended question to determine the reasons for non- attendance. Data analysis: Measures of central tendency were checked and expressed in terms of percentages and tables. The inferential statistics was also conducted to determine the relationship amongst variables. Chi square tests were used to determine the relationship amongst the categorical variables and eye reviews. Spearman’s correlation analysis was carried out to determine the association amongst variables, (behaviour, control, stigma and satisfaction). The open ended question was used to analyse the reason for non-compliance. Results: A total of 300 diabetic patients were randomly selected for the study. The participants were sampled in a stratified way such that each level of compliance is equally represented. The dataset was acceptably complete with very few missing values. The distribution of the participants across the different biographical variables was cross tabulated by compliance with annual reviews. Of the 300 participants, 151 (50.3%) were compliant. The results show that there were more females than males 166 (56.3%), more Africans than any other ethnic group 168 (57.1%), more married people than any other marital status group 183 (61.0%), more Christians than any other religion 227 (92.3%), and more living with their families than any other living arrangement 223 (74.8%). Of these variables 5 (1.7%) missing values were recorded for gender, 6 (2%) for ethnicity, and 2 (0.7%) for living arrangements, while marital status and religion were complete. The majority of the participants had a secondary school education 130 (43.3%), and most felt that they were in good health 148 (49.3%). As for payment of medical expenses, 255 (87%) had a medical aid, and yet 147 (51.6%) last visited a doctor more than a year from the date of data collection. Conclusion: Compliance with doctor’s visits was found to be associated with positive behaviour and more knowledge and control. Knowledgeable patients were more satisfied with the medical services. Fear of stigma associated with diabetes mellitus was found to be associated with demographic variables such as gender, race, marital status, employment status and educational level. The main reasons for non-compliance were lack of information, negligence, busy work schedules and lack of finance. These results suggested there is a need to raise awareness of eye health and access to affordable medical services.

Indigenous people tend to consult traditional healers when a family member manifests change in behaviour, whilst conventional treatment disregards spirituality when preserving mental health. The aim of the study was to explore the perceptions of indigenous people and the role of traditional healers in the management of mentally ill persons within the Cacadu District in the Eastern Cape Province of South Africa. The study has adopted a qualitative approach which was exploratory and descriptive in nature. The sample consisted of nine relatives of mental health care users (MHCUs) and six traditional healers. Ethical principles were also taken into consideration by the researcher during the process of conducting the study. Data were collected from two strata, namely, relatives of the MHCUs and the traditional healers and an interview guide was used to conduct in-depth face-to-face interviews. Data were analysed using Tesch’s method of data analysis. Four themes emerged from the data categories and sub categories were identified. According to the themes participants indicated the negative impact of mental illness; as a result they portrayed great desperation regarding the means of accessing a cure for mental illness. Some participants showed insufficient knowledge regarding mental illness and had different perceptions and beliefs regarding the origin of mental illness. Available literature was used to emphasise and support the views that were expressed by both traditional healers and relatives of MHCUs. It has been highlighted from this study that indigenous people of Cacadu District view mental illness as spiritual in origin but they include Western medication for the benefit of the mentally ill. In addition, the relatives of the MHCUs highlighted the economic burden as the major problem that results from mental illness.

Background: The National Department of Health realised that its TB control efforts had been ineffective and joined its international counterparts by adopting Directly Observed Treatment short course [DOTs] strategy to fight the spread of TB. DOT is the only globally recognised strategy for effective TB control. This strategy ensures that infectious TB patients are identified and cured using standardised drug combinations. Treatment supporters observe patients as they swallow their drugs daily (SA Tuberculosis control Programme practical guide, 2000). Objectives of the study are: to assess the relevancy and quality of training for DOT supporters at InxubaYethemba and Tsolwana sub – districts,to identify challenges faced by TB DOT supporters during the execution of their duties and to assess satisfaction of TB DOT supporters, with their remuneration packages and other conditions of employment. Method: A quantitative descriptive convenient design was conducted for this study. A self - administered questionnaire was used.The researcher’s targeted sample was 42 participants although only 39 filled in the questionnaires. The questionnaires were personally distributed by the researcher to TB DOT supporters. Items in the questionnaire included the following: Demographic data, working hours per day, distance covered, meeting with managers, salary and remuneration issues and acceptance by community members. Results: The research findings indicated that the TB DOT Supporters are generally not happy with the conditions they are working under. From the 100 percent (n=39) TB DOTS responses, 8 percent (n=11) received a three days training, which is not in line with the Department of Health’s guidelines, and resulted in rendering ineffective delivery of DOT programme. Of the 100 percent ) 23.1 percent (n=9) walk 8kilometres, 51.3 percent percent(n=20) walk 7kilometers, 12.8 percent (n=5) walk 5kilometers, 10.3 percent (n=4) walk 4kilometers. This is against the required distance allowed to travel by foot which is five kilometres. Conclusion:According the results of this study, the effectiveness of TB DOT Supporters is being distracted by many factors, such as: Not having transport for doing home visits, Less number of hours worked per day, few number of community health workers working as TB DOT supporters, not having meetings with the management to discuss their challenges, and most of all not being given a clear explanation as far as their salaries are concern. The mentioned factors render D OT Support programme is rendered in effective at the Chris Hani District. According to Tuberculosis, A training Manual proven for Health Workers (1998:13) the most effective means of controlling TB known to us is a strategy known as Directly Observed Treatment Short Course (DOTS). This strategy enables tuberculosis clients to complete their treatment and has four areas of strength when compared to previous TB control strategies in South Africa. Recommendation: The results from this study proves that there is a definite need for improvement of working condition amongst TB Co-ordinators, TB Managers and the TB DOT Supporters. It is clear that increased number of MDR/XDR is due to the challenges that were mentioned above. There is a need for the additional number of TB DOT Supporters, as the area is big for only two TB DOT Supporters in each area. Hours worked by TB DOT needs to be extended considering their salaries as well.Therefore it is essential to empower TB DOT Supporters with more knowledge and skills so that they can be able to make an impact in TB service delivery system.

The focus of the study was to evaluate the attitudes of midwives towards the implementation of the Choice on Termination of Pregnancy Act in the O.R. Tambo District hospitals in the Eastern Cape. There was no provision for termination of pregnancy (TOP) for unplanned pregnancy until 1994 when the Choice on Termination of Pregnancy (CTOP) Act was introduced. This act allowed any pregnant woman to request TOP when she wished for TOP. The midwives could voluntarily undergo training in TOP services and the designated institutions started offering TOP services, but stopped at a later stage. This resulted in overcrowding in health institutions which continued rendering TOP services. The researcher posed one question to be answered as: What are the attitudes of the midwives who are employed by health institutions in the O.R. Tambo District in the Eastern Cape Province towards the implementation of the Choice on Termination of Pregnancy Act? The aim of the study was to evaluate the attitude of midwives towards the implementation of the CTOP Act in the O.R. Tambo District hospitals. The objective of this study was to determine the attitudes of these midwives towards the implementation of these services in the O.R. Tambo District in the Eastern Cape Province. A quantitative descriptive design was used in this study. The population consisted of 150 midwives from two hospitals in the O.R. Tambo District. The sample consisted of 75 midwives; 30 midwives from Hospital 1 and 45 midwives from Hospital 2. Random systemic sampling was used in selecting the participants. Data were collected using a questionnaire developed by the researcher and approved by the supervisor and the University of Fort Hare Ethics Committee. In the study, using a sample of (n = 75), the attitude on the implementation of CTOP scale had high reliability of 0.81. Data were analysed with the help of a statistician using Statistix 8.1 software for Windows. Approval to conduct the study was obtained from the University of Fort Hare Ethics Committee, Eastern Cape Department of Health and Hospital 1 and Hospital 2 before the study was conducted. The dignity of the participants was maintained by explaining v the topic of the research study, the aim and objectives of the study, the method to be used for data collection and the significance of the study. The participants were allowed to ask questions and the name and telephone of the supervisor were provided in case they needed some clarity. Voluntary, written informed consent was obtained before the interviews were conducted. Privacy, anonymity and confidentiality were ensured and maintained through all the stages of the research process. The finding of this study was that the midwives employed by the health institutions in O. R. Tambo District Municipality displayed positive responses in the majority (n=11/61.1%) of 18 items in the questionnaire. Since the midwives in this study demonstrated a positive attitude towards TOP, it was recommended that the reason for stopping the TOP services in the concerned institutions should be investigated. The following are also recommended: Compulsory training of midwives should include aspects of reproductive epidemiology, in particular, the epidemiology of unsafe abortions. Training in TOP services should continue, so that there will be adequate number of midwives to provide the TOP services, and consideration of special remuneration for TOP providers. Employment of managers trained in TOP and voluntary training of managers working in TOP sections should be considered so that they may provide effective support to TOP providers. Formation of support centres for TOP providers at Provincial and National levels. Education of the community in prevention of unwanted pregnancies by means of contraceptives and indications for a need to provide TOP services, to prevent victimisation of the TOP providers. Availability of a toll free number for reporting victimisation of the TOP providers.

This study explored and described the strategies used by nurses to manage newly diagnosed HIV positive pregnant women who do not return to the clinic within a month following diagnosis, for continuity of care. The main aim was to prevent mother-to-child transmission of HIV (PMTCT). Method: The study sites were two accredited antiretroviral- ante-natal care (ARV-ANC) clinics at the Dimbaza community health centre (CHC) and the East London Hospital Complex (ELHC) which comprises of Cecilia Makiwane and Frere hospitals, in the Buffalo City Metropolitan Municipality (BCM). The majority of health personnel at these clinics are professional nurses. An in-depth semi structured interview guide was used to collect data through focus group interviews from professional nurses who work in these units. They were required to share their experiences about intervention strategies used for newly diagnosed HIV- positive, pregnant women who fail to return for continuity of care within a month after diagnosis. Results: Follow up of these women is done by tracking them (by calling them; calling the clinic nearest to their homes and doing home visits). Decentralisation of further management and care to the nearest clinic was also cited, especially for the patients who stay far from these accredited sites. Family support was also mentioned as a strategy to intervene for the non-compliant patients. Challenges: The challenges that were encountered with these interventions include wrong contact details, wrong addresses and being evasive when visited at home. Another challenge cited was related to the stigma attached to the diagnosis and the tracking devices used, for example, the car as it is familiar to the community it serves. Despite known benefits for early initiation of HIV treatment newly diagnosed HIV- positive, pregnant women continue to refrain from accessing care after diagnosis, thus posing a risk to the transmission of HIV to the baby and further comprising their own health. They miss out on general HIV management and ante-natal care. Conclusion: The identified intervention strategies used by nurses to follow up newly diagnosed HIV- positive, pregnant women need to be reinforced and strategies put in place to control the related challenges for a better response by the patients.

Critical illness is typically associated with a catabolic stress state in which patients commonly demonstrate a systemic inflammatory response that brings about changes in their body systems. Changes in the body systems make the critically ill dependent on mechanical ventilation and inotropic support for longer periods in order to survive. However, this inflammatory response can be attenuated by the timely introduction of nutritional support to provide energy and nutrients to diminish catabolism and promote anabolism. The result could be a decrease in the morbidity and mortality rates, as well as the financial burden on the patients, institutions and the state. Since registered nurses initiate and utilise feeding protocols to achieve target goals, there is a strong need for nurse-initiated feeding protocols. These protocols should be coupled with a comprehensive nurse-directed nutritional educational intervention that will focus on their safe and effective implementation. This focus on nursing nutrition education represents a major shift away from traditional education which has focused on dietitians and physicians. Evidence suggests that incorporating guideline recommendations into nurse-initiated protocols for starting and advancing enteral feedings is an effective strategy to improve the delivery of nutritional support. The study was aimed at exploring the provision of nutritional support to critically ill hospitalised patients by registered nurses to identify and describe possible gaps in the practice, through determining the potential relationship between the provision of nutritional support and characteristics of its providers. A quantitative, descriptive correlational study was undertaken. Seventy registered nurses working in neonatal/paediatric and adult critical care units in two public and three private hospitals in East London in the Eastern Cape participated in the study. The sample also included public critical care students. The results showed that registered nurses in private hospitals have more knowledge about the importance of nutritional support than their public hospital counterparts and students. The mean score was on the question was 80.3% with the highest score of 91% which was for the private hospital nurses, followed by 77.2% for public and 71.4% for students. Again, the mean score for knowledge on timing of initiating nutritional support was 48%, the highest score being 69.4% for students followed by private hospital nurses with 49.6%. Close to 63% (n = 44) of these nurses were either unsure about the availability of nutritional protocols or clearly attested to their non-availability. This is seen as an issue of concern because a protocol is meant to be a standard document with which all members of the ICU should be familiar. It is meant to guide and facilitate the manner of working in the unit. While facilitation of maintenance of nutritional support to patients is the responsibility of registered nurses, according to Regulation 2598(1984) section 45 (1) (q) of the South African Nursing Council, 68% (n = 48) of the respondents felt that this was in the practising scope of doctors and dietitians. The study concluded that the nurses are knowledgeable about the importance of nutritional support but knowledge gaps have been identified as far as the timing of initiating nutritional support is concerned. Some attested to unavailability of standard guidelines that are tailored into protocols guiding the provision of nutritional support by registered nurses in the critical care units. Nutrition should be prioritised as an important therapy for improving the outcomes of critically ill patients. Nurses need to analyse its provision, identify barriers to nutritional strategies and engage in nutritional education to empower themselves regarding the practice. Most importantly, there is a need for nurse-initiated nutritional protocols that are tailored from the broad nutritional guidelines and aligned with the local context and ways of practising. Nutritional support should be included as a key component of the curriculum in academic programmes that specialise in critical care nursing.

Introduction: There is evidence-based concern that nurses on general wards do not recognise signs of physiological and clinical deterioration and delay calling for more skilled assistance for review of a patient showing signs of deterioration. Aim: The development and validation of a questionnaire to assess factors influencing general ward nurses’ ability to recognise and respond to patient deterioration; nurses’ knowledge of physiological and clinical parameters associated with patient deterioration; and nurses’ self-reported clinical reasoning ability. Methodology: A mixed methods sequential 4-phase study design was employed: 1) an indepth literature review to identify and develop content domains and item statements for a prototype questionnaire; 2) determining the index of content validity (CVI) (n=5 expert registered professional nurses) of all item statements; 3) conducting cognitive interviews (n=3 expert registered professional nurses) to explore face validity and the quality of the revised prototype questionnaire; and 4) assessing stability of the final validated questionnaire through test-retest reliability testing (n=30 nurses: Registered Professional Nurses with four years of training, Enrolled Nurses with two years of training, Enrolled Nursing Auxiliaries with one year of training) two weeks apart. Results: The CVI exceeded the pre-set proportion of ≥70% agreement for 56/65 (86.2%) item statements scoring 3 (relevant only needing minor editing) or 4 (extremely relevant); removal of 3/65 (4.6%) items from the prototype questionnaire. Cognitive interviews then resulted in amendment of 30/78 (38.5%) item statements; removal of 2/78 (2.6%) from the revised prototype questionnaire. The weighted kappa statistic for level of agreement beyond chance for nurse respondents’ test-retest data was fair (0.21-0.4) for 18/47 (38.3%) items, moderate (0.41-0.6) for 12/47 (25.5%) items and substantial (0.61-0.8) for 13/47 (27.7%) items. Registered Professional Nurses’ responses between time 1 and time 2 were more consistent than for Enrolled Nurses and Nursing Auxiliaries. Conclusion and recommendations: The researcher-developed questionnaire was validated by registered professional nurses, but there is concern about its stability, tested on three categories of nurses. The questionnaire should be reassessed for content and face validity using a sample inclusive of all categories for nurses who take and interpret patients’ vital signs in an attempt to improve the reliability of the questionnaire.

Background: Chronic haemodialysis treatment of 3-4 hours' duration two or three times a week is the most common renal replacement therapy for adult patients diagnosed with stage 5 end-stage kidney failure. During the procedure 200-250 ml/minute of the patient's blood volume is extracorporeal and patency of the circuit is maintained by an anticoagulant, for example, unfractionated heparin (UFH). Incorrect dosage or time of administration of UFH can have serious adverse effects if not fatal consequences for patients. It is important to perform base-line clotting studies before the initial administration and subsequent doses of UFH. There is a paucity of published information on renal unit practitioners' knowledge, attitude and practice (KAP) concerning the administration of UFH globally and no published South African studies were located. Aim: To describe renal unit practitioners' self-reported KAP regarding use and effects of UFH in purposively selected adult chronic haemodialysis centres in the Cape Town Metropole. Secondly, to determine whether there is an association between KAP regarding the use and effects of unfractionated heparin and selected variables (category of renal unit practitioner, years of experience, duration of orientation to the adult chronic haemodialysis unit and in-service education on the pharmacology of UFH).