The purpose of this study was to show how information from the District Health Information System can be used to empower managers to make evidence-based decisions that will strengthen the health care system to reduce the under-five mortality rate. A quantitative, contextual, exploratory evaluative and descriptive approach was followed and a data extraction framework, based on systems theory, was developed to guide the process of extracting existing routine data. A results-based approach was used to measure under-five mortality related health care in terms of impact, outcomes, outputs, processes and inputs. The study has highlighted that proxy indicators obtained this way places health care managers in the position to monitor progress towards achieving the Millennium Development Goal for child mortality in the interim periods between large population surveys. The findings displayed in the diagnostic performance profile revealed that drastic interventions are required to reduce the under-five mortality rate. / Health Studies / M.A. (Health Studies)

The purpose of this study was to explore and describe the factors that motivate the Primary Health Care Nurses to render quality care in the Ekurhuleni Metropolitan Municipality Health Care Facilities (in the Northern Region). The Ekurhuleni Metropolitan Municipality is located in Gauteng, South Africa. To achieve this, a quantitative, descriptive research study was undertaken. A purposive and voluntary sample of (n=54) Primary Health Care Nurses with two or more years’ experience of working in the Ekurhuleni Metropolitan Municipality, in the Northern Region, participated in the study. Data was collected using structured questionnaires. Findings from the study indicated those factors that enhance the motivation of the Primary Health Care Nurses and those factors which may demotivate them. The findings further revealed the need for greater motivation for the Primary Health Care Nurses. Based on the study results, guidelines and recommendations were formulated according to the manner in which these nurses’ motivation may be implemented and improved / Health Studies / M. A. (Health Studies)

In South Africa, mental health care is being integrated into primary health care services. The integration of services was aimed at increasing the accessibility and availability of all health care services at primary health care level. The integration was well intentioned, and it was hoped that mentally ill clients would benefit from having a service near their homes. However, the process of integration is fraught with challenges, for instance, staff shortages, which lead to ineffective nursing management of mentally ill clients at the primary health care clinics. As a result, one professional nurse is often allocated to manage the clinic services on a daily basis with the assistance of an enrolled nurse or auxiliary nurse. The professional nurses therefore experience high levels of stress due to gross staff shortages and lack of time to conduct proper nursing assessments. This led to the research question: “What are the experiences of professional nurses with regards to the nursing management of mentally ill clients in rural primary health care clinics in the O.R. Tambo District in the Eastern Cape?’’ The proposed objectives of the study were to explore and describe the experiences of professional nurses working in rural primary health care clinics with regard to the nursing management of mentally ill clients. The researcher thereafter made recommendations to the district managers regarding effective nursing management of mentally ill clients in rural primary health care clinics. A qualitative, exploratory, descriptive and contextual design was used. The research population comprised of professional nurses working in rural primary health care clinics in the O.R. Tambo District in the Eastern Cape. Purposive sampling was used to identify participants and the sample number was determined by data saturation. Unstructured interviews and observation notes were used to collect data. The eight steps of data analysis suggested by Tesch were utilized to analyze the data. The researcher conducted an in-depth literature review in order to identify research gaps pertaining to the study. To ensure that a high level of validity and reliability was exercised throughout the study, the researcher conformed to Lincoln and Guba’s model of trustworthiness. The study was conducted in an ethical manner and ethical principles were adhered to. Findings: Three themes with subthemes emerged. The study showed that professional nurses experienced challenges related to the nursing management of mentally ill clients. These challenges included shortage of staff, a heavy workload, and lack of resources, lack of in-service training and workshops related to mental health issues coupled with lack of support from the supervisors. Due to the challenges, the mentally ill clients were not getting quality nursing care leading to complications and relapse. Conclusion: It emerged from the study that matters pertaining to mental illness and mental discomfort were still a serious problem in rural areas. The problems were related to the challenges which prevented professional nurses from providing quality nursing care to mentally ill clients with subsequent complications and relapse. Recommendations: Recommendations were made as an effort to ensure that the nursing management of mentally ill clients in rural primary health care clinics is improved. These recommendations were categorized as related to nursing practice, nursing education and nursing research.

Introdução: Voluntário é termo polissêmico, mas, de forma geral, designa o cidadão que doa tempo, trabalho e talento, espontaneamente e sem remuneração, para causas de interesse comum. As motivações para o voluntariado são variadas, apesar de esta ação ser vista, socialmente, como altruísmo. Objetivo: Analisar as motivações para o voluntariado em um hospital público da cidade de São Paulo, especializado em HIV/Aids. Método: Estudo de caso descritivo-analítico, com base em Método Misto. A coleta de dados foi feita por entrevista semiestruturada e aplicação dos instrumentos, adaptados e validados para a população brasileira: Critério de Classificação Econômica Brasil; Inventário de Funções do Voluntariado e Questionário de Perfis de Valores Refinada. Fez-se a análise de conteúdo dos discursos e os questionários foram analisados estatisticamente. Resultados: A maioria do voluntariado é feminina, branca, solteira, natural de São Paulo, praticante de religião. Houve igual proporção de assalariados e aposentados e todos eram das classes sociais A, B ou C. Os relacionamentos sociais se mostraram importantes na motivação e vínculo com os pacientes foi, ao mesmo tempo, fonte de motivação e satisfação. Encontraram-se indícios de motivação altruísta: benevolência, como cuidado; universalismo, como compromisso; entendimento; engrandecimento social. Conclusão: A convergência das análises quantitativa e qualitativa pode indicar a coerência interna dos participantes, fortalencendo os indícios de altruísmo como motivação do grupo para o voluntariado. / Introduction: Volunteer is a polysemy word, but, in general, refers to the citizen who donates, spontaneously and without payment, time, effort and talent for causes of common interest. The motivation for volunteering is varied, although, socially, this action is considered as altruism. Objective: To analyse the motivations for volunteering in a public hospital in São Paulo, specialized on HIV / AIDS. Method: Descriptive and analytical case study, based on Mixed Method. For data collection we used semi-structured interviews and scales which are adapted and validated for Brazilian population: Economic Classification Criterion Brazil Volunteer Functions Inventory, and Refined Portrait Values Questionnaire. Data was analysed by content analysis and statistically. Results: Most of the volunteers are female, white, single, and native of Sao Paulo, religious practitioner. There were equal proportions of active workers and retirees and all participants were from social classes A, B or C. The social relationships are very important to motivation and the affective bonding with patients was, at the same time, a source of motivation and satisfaction. The results pointed out evidence of altruistic motivation: benevolence, as care; universalism, as commitment; understanding; social aggrandizement. Conclusion: The convergence of quantitative and qualitative analysis might indicate the internal coherence of the participants, what reinforces the evidence of altruism as the group\'s motivation for volunteering.

Este estudo tem como objetivo identificar e discutir condições e riscos no trabalho dos Agentes Comunitários de Saúde que atuam em uma Área Programática da cidade do Rio de Janeiro. O referencial teórico foi o da saúde do trabalhador, e as normativas relativas à formação do ACS e de seu processo de profissionalização. O estudo foi realizado em equipes que atuam em duas comunidades, por meio de um estudo de observação sistemática, não-participante, utilizando um roteiro prévio com conteúdo de riscos ocupacionais. Os dados foram coletados a partir do acompanhamento de 23 ACS que realizaram 74 visitas domiciliares nos meses de março a junho de 2008, e organizados sob a forma de um diário de campo descritivo. A organização e análise basearam-se na abordagem qualitativa da análise de conteúdo. Os resultados são apresentados e discutidos segundo a seguinte organização: i) atividades realizadas pelos ACS; ii) comparação entre atividades prescritas e atividades reais e iii) principais riscos identificados e suas possíveis repercussões na saúde do ACS. Nas considerações finais, são discutidas as implicações para o SUS e para a enfermagem, que tem supervisionado os ACS, e a importância de se aprofundar, por meio de estudos posteriores, as situações e condições de trabalho desenvolvido na Atenção Básica. / This study aims to identify and discuss occupational risks and word conditions on Community Health Agents (CHA) that work in an area of Rio de Janeiro city. Theoretical discussion was based on workers health field, and on educational and profesional legislation. The research was carried on two communities, using systematic, non-participant observation, and a previous guideline with occupational risks content. Data collection was developed by observation of 23 CHA that made 74 domiciliary visits from March to July of 2008, and organized in a descriptive diary. Organization and analysis were based on Content Analysis technique. Results are presented and discussed as follows: i) activities developed by HCA; ii) comparison between prescribed and real activities and iii) main occupational risks identified and their possible repercussions on workers health. In final considerations, implications to health care system and nurses that supervise the HCA are discussed, as also the necessity to develop further studies to analyze work conditions and situation in Primary Health Care level.

State dependency and the lingering impacts of colonialism dancing with Aboriginal peoples are known realities across the Canadian health care landscape. However, delving into the discourses of how to reduce health disparities of a colonized population is a sophisticated issue with many factors to consider. Specifically, nurses can play a central role in the delivery of essential health services to the ‘Other’ within isolated Northern Aboriginal communities. As an extension of the state health care system, nurses have a duty to provide responsive and relevant health care services to Aboriginal peoples. The conducted qualitative research, influenced by a postcolonial epistemology, sought to explore the roles and challenges of nurses working within rural, remote, and Northern Canadian Aboriginal communities, as well as individual, organizational, and system level factors that supported or impeded nurses’ work in helping to meet Aboriginal peoples’ health needs with meaningful care. Theorists include the works of Fanon on colonization and racial construction; Kristeva on semiotics and abjection; and Foucault on power/knowledge, governmentality, and bio-power were used in providing a theoretical framework to help enlighten the research study presented within this dissertation. Critical Discourse Analysis of twenty-five semi-structured interviews with nurses, physicians, and regional health care administrators was deployed to gain a better understanding of the responsibilities and challenges of nurses working in Northern Canada. Specifically, the research study was conducted in one of the three health regions within Northern Saskatchewan. Major findings of this study include: (1) the Aboriginal person did not exist without being in a relation with their colonial agent, the nurse, (2) being ‘Aboriginal’ was constructed as a source of treating illnesses and managing diseases, and (3) as a collective force, nursing was utilized as means of governmentality and as provisions of care situated within colonial laws. Historically, nurses functioned as a weapon to ‘save’ and ‘civilize’ Aboriginal peoples for purposes of the state. Primarily, present day nursing roles focused on health care duties to promote a decency of the state, followed by missionary tasks. In turn, the findings of this research study indicate that nurses must have a better understanding of the impact of colonialism on Aboriginal peoples’ health before they engage with local communities. Knowledge development through postcolonial scholarship in nursing can help nurses and health service providers to strengthen their self-reflective practice, in working towards de-signifying poor discourses around Aboriginal peoples’ health and to help create new discourses.

M.Cur. / With the announcement of the devolution of primary health care services to the local authority by the Cabinet in 1991, the role fulfilment of the community health nurse becomes more complex and greater demands are continuously made on her. The question, to what extent will the Implementation of primary health care (with the critical elements as framework) make greater demands on her role and function, led to this study. An exploratory, descriptive study, within a contextual framework was carried out. The purpose of the research was to analyse the task of the nursing staff working at local government, to determine which critical elements In primary health care are seen as part of the tasks of the community health nurse and to give guidelines with regard to primary health care and community health nursing. Content analyses done of job descriptions Indicated that some of the critical elements of primary health care are not expected to be performed by the nursing staff. According to the information gained through the questionnaires, nurses do more than is expected of them as Indicated In their job descriptions. " According to the conclusions resulting from this study, most of the critical elements of primary health care is being performed by nurses as part of their duty. The most Important recommendations Include the training of those nurses who feel that they need refresher courses with regard to the examination of patients and the making of diagnoses. Nurses need to know about the changes and what Is expected of them In future as a result of these changes.

Introduktion: Attityder och kunskap om amning och dess effekter har med tiden förändrats på grund av forskning och utvecklingen av amningsalternativ. I distriktssköterskans arbete ingår amning vilket innebär att en god kunskapsnivå ska upprätthållas efter lagar och förordningar. Syfte: Var att utifrån litteraturen beskriva råd och stöd som nyblivna mammor får vid amning. Metod: Systematisk litteraturstudie utifrån Polit och Becks niostegsmodell. Studien baseras på tio artiklar från Cinahl och Pubmed. Sju kvalitativa, två kvantitativa och en mixad artikel mellan åren 2010-2020. Artiklarna analyserades genom Graneheim och Lundmans kvalitativa innehållsanalys. Resultat: I analysen framkom tre kategorier: Informativa Praktiska och Emotionella. Konklusion: Varierande information till nyblivna mammor kunde bero på bristande utbildning och påverkan från familjemedlemmar. Attityden och motivationen hos sjuksköterskan var avgörande för mammors egenvård. Lyhördhet, tid och goda råd stärkte relationen mellan mamma och sjuksköterska som resulterade i en ökad amningsfrekvens och självsäkerhet hos mammor.

Introduktion: Antalet äldre personer ökar vilket kräver anpassning av hälso- och sjukvården. Robotdjur är elektroniska gosedjur som är utvecklade för att likna sällskapsdjur och används som en omvårdnadsåtgärd hos äldre personer med kognitiv sjukdom. Syfte: Att beskriva omvårdnadspersonalens erfarenheter av att använda robotdjur i omvårdnaden av personer med kognitiv sjukdom på särskilt boende. Metod: Kvalitativ metod med induktiv ansats. 15 intervjuer utfördes där materialet analyserades utifrån tematisk analys enligt Braun & Clarke. Resultat: Två huvudteman och åtta underteman. Under huvudtemat En del i vardagen beskrevs hur robotdjuren användes i vardagen genom fem underteman. Under det andra huvudtemat Behov av kunskap och engagemang beskrevs vad som behövdes för att kunna använda robotdjuren i tre underteman. Konklusion: Robotdjur skapar lugn och gemenskap för äldre personer med kognitiv sjukdom. Robotdjuren ska inte ses som en generell åtgärd utan som ett av redskapen i en personcentrerad omvårdnad. För att detta ska fungera behöver distriktssköterskan ta den ledande rollen i implementeringen och utbildningen av personal och verka för att robotdjuren införs som en del i en personcentrerad omvårdnad. / Introduction: The number of elderly people is increasing, which requires adaptation of health care. Robotic pets are electronic stuffed animals that are designed to resemble pets and are used in nursing care of elderly people with cognitive illness. Aim: To describe nursing staffs’ experiences of using robotic animals in nursing care of people with cognitive illness in long term care. Method: Qualitative method with inductive approach. 15 interviews were conducted and were analyzed based on thematic analysis according to Braun & Clarke. Result: Two main themes and eight sub-themes. The main theme A part of everyday life describes how the robotic pets were used in everyday life in five sub-themes. The second main theme Need for knowledge and commitment describes what was needed to be able to use the robotic pets in three sub-themes. Conclusion: Robotic pets create calm and fellowship. The robotic pets should not be seen as a general intervention but as one of the tools in person-centered care. In order for this to work, the district nurse needs to be the leader of implementation and training of staff and work for the robotic pets to be introduced as part of a person-centered care.

A Collaborations for Leadership in Applied Health Research and Care (CLAHRC) funded study engaged health visitors in investigating the ways in which routinely collected data were captured, stored, transferred, analysed and then used to inform clinical practice. This report focuses on the establishment of a community of practice (CoP) to support these activities and then presents the outcome of the CoP's investigations into the collection and use of data on one key area of concern; maternal smoking behaviour. Evidence-based recommendations for clinical practice made by the CoP ranged from simple changes to the daily working practices of health visitors to ensure accurate data collection and dissemination of information, to major changes to processes and procedures relating to data quality and data sharing. The findings of the CoP emphasised the importance of cross-discipline communication and collaboration.