This project was an assessment of elderly health care needs and access. Three urban San Bernardino communities in zip codes 92405, 92410, and 92411 were targeted. The assessment was structured according to King's theoretical construction of community as a multilevel interaction between personal, interpersonal and social systems. The components of the assessment included digital photographs, web-based internet assessments, key informant interviews, and community business visits.

The past two decades have witnessed transition from in-patient hospital settings to Community and Home Based Care in Zimbabwe. This is because of an increase in the number of people developing chronic health conditions such as diabetes, hypertension and cancers, and thus needing longer treatment durations. The increase in chronic conditions has mainly been attributed to the increase in incidence and prevalence of Human Immunodeficiency Virus and Acquired Immune-deficiency Syndrome in Sub-Saharan Africa. Many Governments, including that of Zimbabwe, endorsed and promoted community and home based care to provide a continuum of care to the chronically ill. Despite the implementation of Community and Home Based Care programmes, no studies known to the researcher have been done to investigate the congruency of service users’ needs and the programme goals. Purpose: The purpose of the study is twofold; firstly to explore whether Community and Home Based Care interventions provide services that effectively meet users’ goals in a dynamic social environment and secondly, to develop guidelines for enhancing care provision as well as congruency of service users’ needs and programme goals. Methods: A mixed-method approach combining qualitative and quantitative data collection and analysis was used. Concurrent collection of data with equal status was placed on both qualitative and quantitative data. For qualitative data interviews and focus groups were used with home based care service users, family care givers, and health providers. Structured questionnaires were used for the quantitative data. Framework: Imogene King’s Interacting Systems Framework and Theory of Goal Attainment were adopted to guide the study. These were utilised because of the assumption that mutual agreement on goals for effective care can be achieved through nurse-client interactions and communication Research findings: Community and Home Based Care programme in Zimbabwe does not comprehensively meet the needs of its service users. Service users have diverse needs and goals depending on the specific condition and symptoms they experience. They perceive access to medication for symptom management and pain control, food and financial stability, as priority needs. The study found that nursing services provided in Community and Home Based Care generally align with the physical needs of service users and was deficient in addressing the socio-economic and psycho-social needs of service users. Conclusion: No single sector can achieve the users’ and the programme`s goals of quality health on its own. The goals may only be realised when other stakeholders and relevant sectors contribute to the Community and Home Based Care programme, which requires diverse resources. Guidelines to enhance integration of Community and Home Based Care with social services were developed. / Health Studies / D.Litt. et Phil. (Health Studies)

This study investigated current use of American Association of Colleges of Nursing guidelines in preparing the baccalaureate nurse graduate to practice nursing in the community health sector of the healthcare delivery system and use of community based healthcare delivery sites by baccalaureate programs located in non-urbanized and urbanized areas. The extent of guidelines adoption, plans by colleges not currently using them to do so in the future, and impact of accreditation visits on the adoption of the guidelines were also explored. A qualitative survey design was used to describe the use of AACN guidelines in the development of baccalaureate nursing education.

This study investigated the performance of health workers in the decentralised services in Uganda in order to develop a management framework that may be used to improve performance. The study followed a mixed research methodology and was descriptive. The survey design was used to collect quantitative data by means of a structured questionnaire. Qualitative data was collected using a semi-structured interview guide. The study population for the quantitative strand comprised 276 health workers including doctors, clinical officers, and professional nurses working in four districts: Kumi, Mbale, Sironko and Tororo. The health workers were selected using stratified random sampling. The population for qualitative strand was health services managers (N=21) from the same districts. The managers were selected purposively. Quantitative data was analysed using SPSS version 18.0, while qualitative data was coded and analysed manually. The findings revealed that the performance of health workers is generally affected by health systems and work environment related factors. The findings indicated that health workers are skilled, competent, and generally have positive attitudes and behaviours towards their clients. The study uncovered loop holes in performance management in the district health sectors. In most cases there is no target setting, no performance management planning, performance indicators are not clearly defined, and the schedules for performance measurement are not always followed. There is limited career progression and lack of functional performance feedback and rewarding mechanisms. Although health workers are committed, there is widespread political interference and nepotism in the district health sector management. Overall, the researcher is optimistic that if the proposed performance management framework is implemented, the performance of health workers might improve. / Health Studies / D. Litt. et Phil. (Health Studies)

Public demands have forced countries to explore new ways of rendering primary health care to reach the poor who are not within reach of the modern health care systems. New categories of health care personnel, like lay health workers emerged. There are vast differences in the roles of these lay health workers as was revealed with an extensive literature search. The phenomenology qualitative research method was used to investigate perceptions of farm lay health workers regarding their roles in rural areas. A convenience, non-random sample (N=5) was used for focus group discussions and in-depth interviews to collect data. The latter revealed five main themes associated with the role of farm lay health workers: (1) community link; (2) carer; (3) community developer; (4) counsellor and (5) role model. Guidelines were formulated to enhance the role of lay health workers in the rural Western Cape Province and to improve the quality of care to rural communities / Health Studies / M.A. (Health Studies)

Health Studies / D. Litt. et Phil. (Advanced Nursing Science)

Text in English / The purpose of the study was to describe and explore the experiences of student nurses in caring for mental health users with profound intellectual disabilities in one of the care and rehabilitation centre at Gauteng province incorporating the Common Sense Model. Qualitative descriptive and explorative research was conducted to explore the experiences of student caring for mental health care users with profound intellectual disabilities and to recommend the best practices in caring for mental health care users with profound intellectual disabilities. Data collection was done using reflective diaries and in depth interviews. Twelve participants participated in the study. The study composed of student nurses (n=12) caring for mental health care users with profound intellectual disabilities. Five themes emerged from the study i.e. emotionally challenging, communication difficulties, lack of knowledge on the nature of intellectual disability, burden of care and mixed feelings. Findings of the study revealed that completing nurses find working with profound intellectual disabilities to be emotionally challenging and that negative experiences outweigh the positive experiences, resulting in their reluctance to want to work with profound intellectual disability users. It is therefore incumbent upon policy makers and hospital administrators to take cognisance of these negative feelings so that ways of minimising these frustrations and promoting the wellbeing of nurses caring for mental health care users with profound intellectual disabilities are promoted. / Health Studies / M.A. (Health Studies)

According to the Ministry of Health (1996:26), the most common chronic/terminal illnesses were cardiovascular disorders, diabetes, cancer, mental disorders, HIV/AIDS, tuberculosis and asthma. Long term treatment and care and the growing incidence of these conditions necessitated the introduction of home-based care (HBC). Consequently, family care givers play a major role in the provision of care to chronically/terminally ill patients and professional health care providers adopt a supervisory role. This study examined the quality of home care services provided in Botswana. The availability and accessibility of home-based care services and resources have a direct bearing on the quality of home-based care delivery system. The researcher used systems theory was used as the conceptual framework for this study. The study aimed to • determine the accessibility and availability of home-based care services in Molepolole East • investigate what the perspectives and experiences of family care givers, patients and professional health care providers of Botswana home-based care are • determine the roles of professionals health care providers, patients, and family care givers and their relationships in the context of home- based care • identify the needs of chronically/terminally ill patents and family care givers • determine the type of support given to family care givers and patients by professional health care providers and make recommendations for the improvement of home-based care • develop a model to prepare family care givers The research design combined quantitative and qualitative research methods. A sample of convenience was used to obtain information from patients' family care givers and professional health care providers. Interviews and questionnaires were used. A proposed care giving preparedness model is presented to meet needs of the family care givers. The study found that family care givers needs are neither known nor catered for by the professional health care provider. The family care givers were not adequately prepared before adopting the care-giving role. It is recommended that • The proposed preparedness care giving training model is considered for training of patients and family care givers before discharge and during HBC. • Increase patients and family care givers decision-making / Health Studies / D.Litt. et Phil. (Health Studies)

The purpose of the study was to determine professional nurses’ knowledge of culture- competent care at selected medical and oncology wards and outpatient departments in Mopani District, Limpopo Province. A quantitative descriptive design was used and data collected from one hundred and five professional nurses by means of a structured questionnaire. The study found that cultural knowledge needs to be nurtured through continuing education and mentoring and that culture-competent care should be included in the curriculum. Furthermore, cultural knowledge is not effective if there is no correlation of theory and practice and early clinical placement of student nurses during their basic training / Health Studies / M. A. (Health Studies)

Text in English / The purpose of the study was to describe and explore the experiences of student nurses in caring for mental health users with profound intellectual disabilities in one of the care and rehabilitation centre at Gauteng province incorporating the Common Sense Model. Qualitative descriptive and explorative research was conducted to explore the experiences of student caring for mental health care users with profound intellectual disabilities and to recommend the best practices in caring for mental health care users with profound intellectual disabilities. Data collection was done using reflective diaries and in depth interviews. Twelve participants participated in the study. The study composed of student nurses (n=12) caring for mental health care users with profound intellectual disabilities. Five themes emerged from the study i.e. emotionally challenging, communication difficulties, lack of knowledge on the nature of intellectual disability, burden of care and mixed feelings. Findings of the study revealed that completing nurses find working with profound intellectual disabilities to be emotionally challenging and that negative experiences outweigh the positive experiences, resulting in their reluctance to want to work with profound intellectual disability users. It is therefore incumbent upon policy makers and hospital administrators to take cognisance of these negative feelings so that ways of minimising these frustrations and promoting the wellbeing of nurses caring for mental health care users with profound intellectual disabilities are promoted. / Health Studies / M.A. (Health Studies)