Magister Curationis - MCur / Worldwide concerns have been raised about the presence and association of depressive symptoms, cognitive impairment, and dementia in older adults (60 years and older), which are often unrecognised and untreated in long-term care facilities (LTCF’s). The progression of cognitive impairment to dementia reduces quality of life with negative consequences of physical, mental, and psychosocial health. In many LTCF’s internationally, the standardised interRAI system is used to capture depressive symptoms and cognitive impairment. However, there is a fragmentation of systems for making evidence-based decisions to plan and manage care for residents with depressive symptoms, cognitive impairment, and dementia. This study, being the first of its kind in South Africa, addressed this gap, by describing a profile of depressive symptoms and cognitive impairment in residents, and analysing their coexistence, using the interRAI-LTCF in a LTCF in the Cape Metropole in South Africa. A quantitative, descriptive, and analytical cross-sectional secondary data analysis was conducted using the records of all 173 resident’s medical records of residents with a last interRAI-LTCF assessment from 2014 and 2016. The objectives were to determine the levels of depressive symptoms and cognitive impairment, and to assess variously associated demographics and clinical variables between depressive symptoms and cognitive impairment of the interRAI-LTCF in residents in a LTCF. Secondary data were analysed, using the IBM Statistical Package for Social Sciences (SPSS) software, version 25, to test any statistically significant relationship between the extracted variables (Significance was set as p˂0.05). The prevalence of possible depression, using the Depression Rating Scale (DRS) of the interRAI-LTCF in the residents in this study was 36.4%, of whom 54.3% had a documented clinical diagnosis of depression. The prevalence of cognitive impairment was 39.3%, using the Cognitive Performance Scale (CPS), of whom 34.1% had a documented clinical diagnosis of cognitive impairment/dementia. There were more females than males with the possibility for depression and cognitive impairment, especially in those who were older than 80 years of age, those without partners, and who had ≤12 years of education. The DRS and the CPS were able to predict the possibility for depression and CI. There is a 55.9% risk of possible depression with CI present as compared to a 23.8% risk of possible depression when CI is not present. That means that people meeting criteria for CI on the CPS are 2.3 times more likely to meet the criteria for possible depression on the DRS. Similarly, there is a 60.3% risk of CI with possible depression present as compared to a 27.3% risk of CI when possible depression is not present. That means that people meeting criteria for possible depression on the DRS are 2.2 times more likely to meet the criteria for CI on the CPS. The logistic regression confirmed the coexistence between depressive symptoms and cognitive impairment.

Magister Curationis - MCur / Worldwide concerns have been raised about the presence and association of depressive symptoms, cognitive impairment, and dementia in older adults (60 years and older), which are often unrecognised and untreated in long-term care facilities (LTCF’s). The progression of cognitive impairment to dementia reduces quality of life with negative consequences of physical, mental, and psychosocial health. In many LTCF’s internationally, the standardised interRAI system is used to capture depressive symptoms and cognitive impairment. However, there is a fragmentation of systems for making evidence-based decisions to plan and manage care for residents with depressive symptoms, cognitive impairment, and dementia. This study, being the first of its kind in South Africa, addressed this gap, by describing a profile of depressive symptoms and cognitive impairment in residents, and analysing their coexistence, using the interRAI-LTCF in a LTCF in the Cape Metropole in South Africa. A quantitative, descriptive, and analytical cross-sectional secondary data analysis was conducted using the records of all 173 resident’s medical records of residents with a last interRAI-LTCF assessment from 2014 and 2016. The objectives were to determine the levels of depressive symptoms and cognitive impairment, and to assess variously associated demographics and clinical variables between depressive symptoms and cognitive impairment of the interRAI-LTCF in residents in a LTCF. Secondary data were analysed, using the IBM Statistical Package for Social Sciences (SPSS) software, version 25, to test any statistically significant relationship between the extracted variables (Significance was set as p˂0.05).

Goal: On the base of analysis of cost make suggestion for effective data assimilation for added value in health care facility. Introduction: Every manager needs tools to manage company which help him to lead company to prosperity. There are direct tools as comands, meetings, etc. and indirect tools, for example economic management. Economic management includes whole line of elements which in their cohesion are integral part of every business, for example controlling, cost management, dealing with short term-assets, management accouting, investment decisions, financial analysis, material incentives. Recently every company focuses its management attention to cost management. We often meet such efforts to reduce costs, which in fact cal lead to damage in short-time or long-time period. In my thesis I will analyse main traps which managers confront while working in chosen health care facility. I will also describe more flexibile access to management costs which provides company with stable and tenable position in global market conditions. Achieving maximal outcomes from company resources and all at once minimalize costs is still one of main strategic target of company.

MPH / Department of Public Health / Prostate cancer (PC) screening is a strategy to identify cancer before it causes symptoms. However, men’s participation in prostate cancer screening seems inadequate and remains a public health concern worldwide. This leads most men to be diagnosed with an advanced prostate cancer where cancer cells spread to other parts of the body. The aim of this study was to assess the knowledge and attitudes of males towards prostate cancer screening at a selected village in Thulamela Municipality, Limpopo province. The study adopted a quantitative approach using a descriptive cross-sectional survey. A well-structured questionnaire was used to collect data from 245 men who are 40 years and above. The sample was selected using the simple random sampling technique. The Statistical Package for Social Scientists (SPSS) version 25.0 was used to analyse the collected data; and the results were presented in percentages, frequencies and tables. Cross tabulation, Chi square and Phi and Cramer’s V test were also utilised to test for association and effects size respectively at .05 level of significance. Respondent’s knowledge as an explanatory variable, screening practices as response variable was assessed. The findings of this study showed that 64.1% of respondents had inadequate knowledge about prostate cancer. About 62.4% respondents had no prior knowledge regarding prostate cancer and 69% of respondents didn’t know the age at risk for the development of PC, while 81.9% of respondents had never heard about PC, and 35.9% didn’t know that PC can be treated. 84.9% of respondents had positive attitudes towards PC screening, however, 96.7% had never undergone screening for prostate cancer and 46.9% indicated that they will never undergo PSA test. Furthermore, the study found a significant association between men’s knowledge of PC and their willingness to undergo PC screening, X2 (3, N=245) = 48.44, p = .001; men’s knowledge of PC was significantly related to their attitudes towards PC, X2 (1, N = 245) = 17.63, p = .001. The effect size was moderate, ɸ = .27. Knowledge was significantly associated with all the demographic variables. Therefore, this study recommends widespread public health campaigns focusing on educating men about prostate cancer risk factors, symptoms, treatment and ways to prevent and manage it through healthy lifestyles. / NRF

The nursing team in a mental health care facility is a known dynamic at every hospital, rehabilitation centre and out-patient unit which enables these units to be functional. Currently nursing teams function in a challenged environment in mental health care facilities. The National Department of Health in South Africa states that one of the priority areas in the core standards of health care is to improve values and attitudes of health care professionals. One of the ways to accomplish this is that leaders at all levels should be positive role models to staff to encourage a culture of caring and positive attitudes that supports service delivery. However, mental health care in practice is in contradiction to this ideology of how mental health should function. In reality, regular involuntary treatment, minimal patient contact with therapists, negative attitudes, pressure of beds not being available as well as regular seclusions due to unmanageable situations are experienced in practice. The aim of this study is to explore and describe the role of the nursing unit manager to improve nursing teamwork in a mental health care facility in Gauteng in order to improve the quality of health care. A qualitative, explorative, interpretive descriptive and contextual design was selected to address the research question at hand. Non-probability, purposive sampling was used. A focus group discussion was held (n=8) and graphic team sculptings were done with each participant (n=9). The state of the current nursing team was described and explored as well as the practical intervention aimed at improving nursing teamwork. Data of the focus group was analysed using content analysis. Graphic team sculptings were analysed by interpretation analysis. The results of this research study indicated that nursing teamwork is influenced by various factors that can be categorized as organisational-, unit specific- and unit manager specific factors. There might be a negative organisational culture and negative attitudes of team members. There is uncertainty in the hierarchy structures, below the unit manager that causes power struggles, this has an effect on the responsibility and accountability in the absence of the unit manager. Individual team member’s needs constant supervision and direction to complete their daily tasks. The unit managers feel like there is poor support from top management. The general ward assistants and administrative clerks is seen as part of the team, although they are not directly involved with patient care, they contribute to the teams functioning. Mental health care facilities are overcrowded and this increases the workload of the nursing team. Trust and cohesion within the teams is low with poor communication between team members due to clique formation. The unit manager plays a vital role through leadership, collaboration, fair delegation and guidance. Individualism and diversity should be embraced. The unit managers acts as a role model and leader that bring the teams together and solve problems, facilitates effective communication and involves all the team members in decision making. / MCur, North-West University, Potchefstroom Campus, 2014

This article describes the psychometric properties of the WHOQOL-OLD (an add-on module to the World Health Organization's Quality of Life measure for older people) in a South African sample. International literature cites three short versions of the WHOQOL-OLD instrument. The psychometric properties associated with these three short versions of the WHOQOL-OLD are also described. The unique challenges posed by ageing populations are evident in both developed and developing countries. In South Africa the elderly population is also increasing dramatically. There is a disproportionate distribution of older persons per ethnic group, with white older people representing the largest group of older South Africans (21%, proportional to ethnic group). Regardless of integration policies in post-apartheid South Africa, especially in terms of housing arrangements, the majority of long-term care facilities in South Africa remain to be occupied predominantly by white older people. For this reason the participants of this study were mostly older white South Africans. It is, however, projected that this picture will change in future times due to more aggressive transformation-driven policies. A national audit of residential care facilities by the Department of Social Development in 2010 indicated a need for psychosocial interventions since the QoL of residents was found to be undetermined. QoL research in South Africa has largely been conducted from socio-economic and health-care perspectives and has tended to focus on specific societies in which older people are usually not explicitly included. Evidence exists of various qualitative studies among older people living in long-term care facilities, from a psychological perspective. However, the short supply of quantitative studies in this setting is significant. The lack of measurements developed for an older population also resulted in an increasing need for the development of gerontological QoL measurements with sound psychometric properties. Internationally, various measures of QoL utilised in older age groups have become increasingly popular. This study took particular interest in the WHOQOL-OLD instrument. Under the auspices of the World Health Organization Quality of Life group, a collaborative effort among numerous researchers from various countries has led to the development of a measure focussing on the QoL in older population cohorts. The initial development of the generic WHOQOL measures of quality of life occurred in 15 different centres worldwide, excluding South Africa. In the development of an add-on module, 22 centres around the world were involved (again excluding South Africa). It cannot be assumed that measuring instruments developed in a Western context are applicable in an African context. South Africa is a very diverse nation - the majority of ethnic groups lead a collectivistic existence. As a result the determination of the psychometric properties of such instruments, for use within South Africa, was needed. It is of importance to note that the participants of this study were more individualistically inclined, which is comparable to Western societies. This study was the first step in exploring the instrument’s reliable use within South Africa. Surveys were completed by 176 older people who were fluent in both Afrikaans and English. Participants of the study resided in long-term care facilities in Potchefstroom in the North-West province of South Africa. Their ages varied between 61 and 95 and the mean age of participants was 77 years. Of the respondents, 50 were male and 126 were female. All reported average to good health and cognitive ability. The current study found encouraging results related to the original factor structure of the WHOQOL-OLD as well as the three shorter versions of this instrument. Results from the data of the current sample seem to fit the original structure model well. The reliabilities associated with the various sub-dimensions point to a reliable instrument. The original WHOQOL-OLD questionnaire with its 24 items or any of the three short versions of this instrument can therefore be utilised in a South African context. / MA (Clinical Psychology), North-West University, Potchefstroom Campus, 2015

The nursing team in a mental health care facility is a known dynamic at every hospital, rehabilitation centre and out-patient unit which enables these units to be functional. Currently nursing teams function in a challenged environment in mental health care facilities. The National Department of Health in South Africa states that one of the priority areas in the core standards of health care is to improve values and attitudes of health care professionals. One of the ways to accomplish this is that leaders at all levels should be positive role models to staff to encourage a culture of caring and positive attitudes that supports service delivery. However, mental health care in practice is in contradiction to this ideology of how mental health should function. In reality, regular involuntary treatment, minimal patient contact with therapists, negative attitudes, pressure of beds not being available as well as regular seclusions due to unmanageable situations are experienced in practice. The aim of this study is to explore and describe the role of the nursing unit manager to improve nursing teamwork in a mental health care facility in Gauteng in order to improve the quality of health care. A qualitative, explorative, interpretive descriptive and contextual design was selected to address the research question at hand. Non-probability, purposive sampling was used. A focus group discussion was held (n=8) and graphic team sculptings were done with each participant (n=9). The state of the current nursing team was described and explored as well as the practical intervention aimed at improving nursing teamwork. Data of the focus group was analysed using content analysis. Graphic team sculptings were analysed by interpretation analysis. The results of this research study indicated that nursing teamwork is influenced by various factors that can be categorized as organisational-, unit specific- and unit manager specific factors. There might be a negative organisational culture and negative attitudes of team members. There is uncertainty in the hierarchy structures, below the unit manager that causes power struggles, this has an effect on the responsibility and accountability in the absence of the unit manager. Individual team member’s needs constant supervision and direction to complete their daily tasks. The unit managers feel like there is poor support from top management. The general ward assistants and administrative clerks is seen as part of the team, although they are not directly involved with patient care, they contribute to the teams functioning. Mental health care facilities are overcrowded and this increases the workload of the nursing team. Trust and cohesion within the teams is low with poor communication between team members due to clique formation. The unit manager plays a vital role through leadership, collaboration, fair delegation and guidance. Individualism and diversity should be embraced. The unit managers acts as a role model and leader that bring the teams together and solve problems, facilitates effective communication and involves all the team members in decision making. / MCur, North-West University, Potchefstroom Campus, 2014

This article describes the psychometric properties of the WHOQOL-OLD (an add-on module to the World Health Organization's Quality of Life measure for older people) in a South African sample. International literature cites three short versions of the WHOQOL-OLD instrument. The psychometric properties associated with these three short versions of the WHOQOL-OLD are also described. The unique challenges posed by ageing populations are evident in both developed and developing countries. In South Africa the elderly population is also increasing dramatically. There is a disproportionate distribution of older persons per ethnic group, with white older people representing the largest group of older South Africans (21%, proportional to ethnic group). Regardless of integration policies in post-apartheid South Africa, especially in terms of housing arrangements, the majority of long-term care facilities in South Africa remain to be occupied predominantly by white older people. For this reason the participants of this study were mostly older white South Africans. It is, however, projected that this picture will change in future times due to more aggressive transformation-driven policies. A national audit of residential care facilities by the Department of Social Development in 2010 indicated a need for psychosocial interventions since the QoL of residents was found to be undetermined. QoL research in South Africa has largely been conducted from socio-economic and health-care perspectives and has tended to focus on specific societies in which older people are usually not explicitly included. Evidence exists of various qualitative studies among older people living in long-term care facilities, from a psychological perspective. However, the short supply of quantitative studies in this setting is significant. The lack of measurements developed for an older population also resulted in an increasing need for the development of gerontological QoL measurements with sound psychometric properties. Internationally, various measures of QoL utilised in older age groups have become increasingly popular. This study took particular interest in the WHOQOL-OLD instrument. Under the auspices of the World Health Organization Quality of Life group, a collaborative effort among numerous researchers from various countries has led to the development of a measure focussing on the QoL in older population cohorts. The initial development of the generic WHOQOL measures of quality of life occurred in 15 different centres worldwide, excluding South Africa. In the development of an add-on module, 22 centres around the world were involved (again excluding South Africa). It cannot be assumed that measuring instruments developed in a Western context are applicable in an African context. South Africa is a very diverse nation - the majority of ethnic groups lead a collectivistic existence. As a result the determination of the psychometric properties of such instruments, for use within South Africa, was needed. It is of importance to note that the participants of this study were more individualistically inclined, which is comparable to Western societies. This study was the first step in exploring the instrument’s reliable use within South Africa. Surveys were completed by 176 older people who were fluent in both Afrikaans and English. Participants of the study resided in long-term care facilities in Potchefstroom in the North-West province of South Africa. Their ages varied between 61 and 95 and the mean age of participants was 77 years. Of the respondents, 50 were male and 126 were female. All reported average to good health and cognitive ability. The current study found encouraging results related to the original factor structure of the WHOQOL-OLD as well as the three shorter versions of this instrument. Results from the data of the current sample seem to fit the original structure model well. The reliabilities associated with the various sub-dimensions point to a reliable instrument. The original WHOQOL-OLD questionnaire with its 24 items or any of the three short versions of this instrument can therefore be utilised in a South African context. / MA (Clinical Psychology), North-West University, Potchefstroom Campus, 2015

While the concept of person-centred care in dementia has been around for 15 years or more and has attracted much interest and enthusiasm, aged care facilities continue to have difficulty in actually implementing and maintaining person-centred practices. In this study I explore the experience of one aged care facility in order to identify the barriers to changing care practice. The research took place in an ethno-specific (Jewish) aged care facility, Star of David, which was in the process of setting up a program for its residents with dementia based on person-centred principles. The methodology used in the research study was ethnographic, involving participant observation and interview, with a particular focus on a limited number of participants: four residents and their families, four senior staff, four personal care attendants and the executive director. Interviews were also conducted with staff members from three other aged care facilities. The findings showed that Star of David was unable to bring about substantial change in its care practices, while the external interviews and the literature suggest that other facilities have similar difficulties. I identify three major types of barrier: procedural barriers within the institution itself; (government) policy; and barriers relating to hegemonic values and beliefs which underpin established health care practice. These three types of barrier interact with and reinforce one another. I conclude that if we are to change care practice in institutions, we must address all of these barriers at the same time. Finally, I suggest that person-centred care itself, which continues to place emphasis on professional service provision, may only be the beginning of necessary change. In order to be truly person-centred, we need to move towards a more community based or public health approach which recognizes the need of all persons to be treated both as significant individuals and accepted as part of a community.

Background: Quality of life (QoL) of long term care facility (LTC) residents is being recognized as an important outcome of care by LTC providers, researchers, and policy makers. For residents, measurement of QoL is a valued opportunity to express their perception of the quality of their daily life in the LTC facility. For clinicians, self-reported QoL provides useful information in planning and implementing resident-centred care. Purpose: The purposes of this study were: (1) to examine the distributional and psychometric properties of the interRAI Self-Report Nursing Home Quality of Life Survey (interRAI_QoL Survey); and (2) to explore the relationship of selected socio-demographic and clinical characteristics of residents and LTC facility attributes with residents’ self-reported QoL. Methodology: This was a cross-sectional observational study. A convenience sample of 48 volunteer LTC facilities from six Canadian provinces was involved in this study. Nine hundred and twenty eight (928) residents agreed to participate in this study. Resident inclusion required an interRAI Cognitive Performance Scale score of 0 (intact) to 3 (moderate impairment). Residents’ self-reported QoL was measured by trained surveyors using the interRAI_QoL Survey instrument. Residents’ socio-demographic and clinical characteristics were obtained from the most recentResident Assessment Instrument –Minimum Data Set 2.0 prior to the QoL interviews. LTC facility attributes were measured by a survey form specifically designed for this purpose. Descriptive statistics were used to describe the participating LTC facilities, the sample of residents, and residents’ self-reported QoL. Psychometric tests for reliability (test-retest and internal consistency) and validity (content and convergent) were conducted. Bivariate analyses were conducted to examine the relatioships between QoL and resident and facility charateristics. Multivariate linear and logistic regression analyses were conducted to identify predictors of residents’ QoL. Results: The study confirmed the feasibility of assessing LTC facility residents’ self-reported QoL. The findings showed positive ratings of some aspects of residents’ daily lives while negative ratings in other aspects. Psychometric tests showed that the interRAI_QoL Survey instrument had test-retest reliability, internal consistency, content validity and construct (convergent) validity. Several resident and facility characteristics were associated with self-reported QoL. Religiosity and highest education level attained were significantly and positively associated with QoL. Other resident characteristics such as age, gender and marital status were not. Mild cognitive impairment, depression, aggressive behaviour, hearing impairment, bowel and bladder incontinence, and extensive assistance in activities of daily living were significantly but negatively associated with QoL. LTC facility ownership showed significant association with QoL. Residents in municipal LTC facilities followed by private LTC facilities reported higer QoL in contrast to charitable LTC facilities. Profit status, accreditation and leadership stability were not associated with QoL. Residents in rural settings reported significantly higher QoL than those in urban settings. Facility size (measured in number of beds), registered nurse hours of care, nursing staff turnover, and ratios of registered to non-registered nursing staff did not have a significant association with QoL. However, higher management hours and total hours of care had significant and positive associations with residents’ overall QoL. Multiple linear regression showed that residents’ religiosity, degree of social engagement, post secondary education, dependence in activities of daily living, and positive global disposition, and LTC facilities situated in rural settings and ownership type together accounted for 24% (adjusted R2=0.24) of the variance in overall QoL (the dependent variable). In logistic regression, low QoL was used as the binary dependent variable. Residents who were religious, were socially engaged and had a positive global disposition were less likely to report low QoL. In contrast, residents with dependence in activities of daily living and post secondary education were more likely to report low QoL. Residents in LTC facilities located in rural settings and operated by municipal or private operators were less likely to report low QoL compared to charitable facilities. Strengths and Limitations: This study had several strengths, including a sample of 928 residents who self-reported on their QoL and the use of RAI-MDS 2.0 for objective, external indicators of QoL. This study had several limitations, including response bias due to method of sample selection, inability to draw causal inferences due to study design; limited generalizability due to use of a convenience sample, lack of monitoring of surveyors for the integrity of resident interviews, and exclusion of residents with cognitive performance scale scores of more than three or inability to communicate in English. Future research should address these limitations. As well, future research should conduct more stringent psychometric analyses such as factor analysis and use multi-level modeling procedures. Implications: The findings of this study have implications for improving residents’ QoL, LTC facility programming, future research, and social policy development. Conclusion: QoL can be measured from resident self-reports in LTC facilities. Self-reports from residents may be used by clinicians to plan and implement resident-centred care. There are significant associations of residents’ QoL with select resident socio-demographic and clinical characteristics and facility attributes. Some of these resident characteristics and facility attributes may serve as predictors of QoL.