Dissertation submitted in partial compliance with the requirements for the Master's Degree of Technology: Nursing, Technikon Natal, 2002. / The Integrated Management of Childhood Illness (IMCI) is an approach that aims to reduce the mortality and morbidity in children under the age of five years. When this programme was initiated, the conditions targeted were acute respiratory infections, diarrhoea, fevers associated with malaria and measles and malnutrition. As a result of the HIV pandemic in South Africa, the identification of children who are symptomatic of HIV infection was included. This study evaluates the use of the HIV portion of the IMCI algorithm by nurses in selected, public sector, primary health clinics in KwaZulu Natal. IMCI nurses were observed as they used the IMCI approach while consulting with sick children. Data was collected in relation to the accuracy with which the nurses used the algorithm and the extent to which the HIV portion of the algorithm was used to guide their management decisions when consulting with the children. Seventy-two observations were undertaken. In-depth interview were conducted with 13 IMCI nurses to establish factors that influenced the use of the HIV portion of the algorithm. The study showed a poor level of accuracy when using the HIV portion of the algorithm. In addition, as a result of poor accuracy when using the algorithm to assess and classify for symptomatic HIV infection, it appeared that nurses were not using the HIV portion of the algorithm to guide management decisions regarding children who were possibly symptomatic of HIV infection. I A general poor level of knowledge about HIV infection was identified which the researcher felt could be one of the factors influencing the use of the HIV portion of the algorithm. Death anxiety, low level of counselling skills and burnout also seemed to play some role in the use of the HIV portion of the algorithm.Recommendations were made to adapt future training of IMCI nurses and include an HIV training course and a course on growth monitoring of children in this age group. Further recommendations to continually evaluate the practice of nurses were made. Future areas for research were suggested. / M

Tuberculosis (TB) has re-emerged as a major worldwide public health challenge in the last decade with an increasing incidence amongst children. The diagnosis of TB in children is difficult as the presentation is not always classical and available diagnostic modalities are imperfect. Diagnosis is, especially complex in developing countries where resources and access to sophisticated diagnostic facilities are limited. Thus practical score charts combining a number of complementary clinical characteristics with affordable special investigations have been developed to aid diagnosis. The new South African primary health care (PHC) nurse-driven system demands that first line nurses be equipped to suspect, diagnose, confirm the diagnosis and treat children with TB. Very little is known about the ability of PHC nurses to diagnose TB in children. In Mpumalanga province relatively low rates of notified paediatric TB prompted an investigation to determine the ability of local PHC nurses to diagnose TB in children and explore whether the PHC setting allowed this. Within method triangulation was used in this quantitative descriptive study by combining a self-completed knowledge survey with clinic visits to audit records and assess access to diagnostic aids and tests. Important deficiencies in knowledge and limited access to certain diagnostic modalities found in this study must be addressed if appropriate management of TB in children is to be assured. / Health Studies / M. A. (Public Health)

Bakgrund. I omvårdnaden ska distriktssköterskan se till människans hela situation och omvårdnaden ska utföras på ett personcentrerat och säkert sätt. I hemsjukvården utförs vården i patientens hem, antingen i ordinärt eller särskilt boende. Trycksår är en vanlig vårdskada och nutritionen är viktig för att förebygga och behandla trycksår. Syftet var att beskriva i vilken utsträckning som distriktssköterskor i hemsjukvården använder nutritionsåtgärder som trycksårsbehandling. Metod. För att besvara syftet användes en kvantitativ design där redan insamlad data från en trycksårsmätning togs del av. Resultatet visade att nutritionsåtgärder användes som trycksårsbehandling till 65% av patienterna. Bland varannan distriktssköterska som inte använde nutritionsåtgärder framkom olika orsaker. Det var vanligare att nutritionsåtgärder användes vid risk enligt riskbedömningarna MNS och SF-MNA. De vanligast använda nutritionsåtgärderna var näringsdryck och extra mellanmål. Resultatet visade att det fanns skillnader i trycksårens svårighetsgrad i förhållande till boendeform. Slutsats. Det fanns utrymme för förbättringar i att använda nutritionsåtgärder vid trycksår. Nutritionen spelar en betydelsefull roll i behandlingen av trycksår och det är viktigt att riskbedömningar utförs. Genom att tidigt använda nutritionsåtgärder som trycksårsbehandling kan distriktssköterskan främja hälsa, förebygga sjukdom och skada samt minska patientens lidande. / Background. In Nursing Care, it's important to see to the whole perspective of the patient, and the care should be performed in a person-centred and safe way. The purpose was to describe district nurses [DN] using of nutrition therapy as treatment for patients with pressure ulcers in home healthcare. Method. A quantitative design, where material from an already collected pressure ulcer study, was used. The result showed that nutritional therapy was used as pressure ulcer treatment in 65% of the patients. Among every other DN who did not use nutritional therapy as treatment of pressure ulcer, various causes were identified. It was more common to use nutritional therapy when risks according to MNS and SF-MNA assessments were found. The most common nutrition therapies were nutritional drinks and extra snacks. The result showed that there were differences in the severity of pressure ulcers in relation to patients' housing type. Conclusion. There was room for improvements in using nutrition therapy as pressure ulcer treatment. Nutrition plays an important role in the prevention and treatment of pressure ulcer, and it's important that risk assessments are performed. By initiating nutritional treatment early, the DN can promote health, prevent disease and injury, and reduce the patient's suffering.

South Africa is called "the rainbow nation" because it has so many different cultures. These have an impact on the provision of primary health care. The purpose of this research is to foster good relationships between community health nurses and traditional healers and to explore, identify and describe the attitude of community health nurses towards the integration of traditional healers into primary health care. A non-experimental, explorative and descriptive research strategy was designed to explore the working relationship between community health nurses and traditional healers. Data was collected using a structured questionnaire. Quantitative as well as qualitative data analysis techniques were adopted to interpret the findings. The results indicated that respondents demonstrated positive attitudes towards working with traditional healers, especially in the provision of primary health care. Positive opinions, ideas and views were provided about the integration of traditional healers into primary health care. Respect, recognition and sensitivity were emphasized by respondents. / Health Studies / M.A. (Nursing Science)

South Africa is called "the rainbow nation" because it has so many different cultures. These have an impact on the provision of primary health care. The purpose of this research is to foster good relationships between community health nurses and traditional healers and to explore, identify and describe the attitude of community health nurses towards the integration of traditional healers into primary health care. A non-experimental, explorative and descriptive research strategy was designed to explore the working relationship between community health nurses and traditional healers. Data was collected using a structured questionnaire. Quantitative as well as qualitative data analysis techniques were adopted to interpret the findings. The results indicated that respondents demonstrated positive attitudes towards working with traditional healers, especially in the provision of primary health care. Positive opinions, ideas and views were provided about the integration of traditional healers into primary health care. Respect, recognition and sensitivity were emphasized by respondents. / Health Studies / M.A. (Nursing Science)

M.Cur. (Maternal and Child Nursing Science) / The implementation of the PMTCT programme was conceptualised in 2000. The aim of this study was to determine the views of midwives regarding the implementation of the PMTCT programmes in the public health centres in Soweto. Data was collected from midwives involved in the implementation of PMTCT in antenatal clinics by means of semi-structural interviews. Of the 20 midwives (N=20) interviewed, only five (5) midwives attended formal training. The discussion of the views of midwives regarding the implementation of PMTCT centered around the lack of formal training, lack of resources, lack of infrastructure, negative attitude of the community, lack of budgeting, lack of support by colleagues and poor management support, language barriers in communication and religious beliefs. This study found that midwives need to go for formal training on PMTCT programmes and that more research need to be done in this field. Moreover, the findings from this study have implications for clinical practice. In addition, guidelines were formulated to help midwives and other health care practitioners to implement the PMTCT programmes in antenatal care.

Service delivery to children with severe disabilities (CSDs) in developing countries share some common characteristics. These include inaccessible services due to the fact that the majority of services are located in a few large cities, the focus of services are usually on school-age children (with few for pre-schoolers), many services require specialised staff and high technology equipment that is not always available and professionals who tend to work in isolation with minimal integration between services. A particularly vulnerable group within the sphere of CSDs are beginning communicators because of their inability to articulate their needs, feelings and rights. Programmes to specifically address these communication needs by equipping them with the necessary skills to interact and participate in society, are very limited. Often the first contact that primary caregivers of a CSD have with professionals, is with the community health nurse. Furthermore, they often remain the only professionals who provide continuous support and assistance to these caregivers. It is therefore clear that these nurses need to be equipped with the necessary knowledge and skills in order to assist caregivers in dealing with their children with severe disabilities. This can be done by training these nurses (through multiskilling) to function as transdisciplinary professionals. Furthermore, a need for appropriate materials for service delivery to this population also exists. Consequently the BCIP (Beginning Communication Intervention Protocol) was developed. The BCIP addresses four important communication domains, namely communication means (including objects, photographs, manual signs, PCS symbols and a simplified 4-option digital speaker), functions (namely informational functions e.g. requesting more, requesting help, etc. and social functions, e.g. greeting, drawing attention to self, etc.), partners (both adults and peers) and the deliberate creation of communication opportunities (e.g. by providing small portions, placing desired items out of research) etc. Care was taken to ensure culture sensitivity and the authenticity of the BCIP. Twenty community health nurses were trained in the application of the BCIP. Training employed adult learning principles and was one week long, followed by three follow-ups that were conducted in situ (at two weeks, six weeks and five months post-training). Multiple measurements were used to evaluate the knowledge and skills acquired after training, namely questionnaires, structured interviews, skill demonstrations (which were video recorded and rated by the researcher and an independent rater) and a focus group. Results indicated that the BCIP training is relevant in bringing about a significant change in the targeted domains, namely knowledge and skills. Peripheral behaviours (namely attitudes, job satisfaction and type of service delivery provided) were all rated high at the onset of the research and thus quantitative data failed to show improvement. On the other hand, qualitative data from the focus group suggested improvement. / Dissertation (PhD (Augmentative and Alternative Communication))--University of Pretoria, 2004. / Centre for Augmentative and Alternative Communication (CAAC) / unrestricted

The purpose of the study was to describe and explore the provision of quality care in the primary health care clinics of Limpopo within the framework of the Batho Pele principles' service standards by determining the level of implementation of these principles. The aim was to improve compliance with the Batho Pele principles. The researcher conducted a quantitative, exploratory and descriptive study in four selected primary health care clinics. Data collection was done using structured questionnaires for interviews and observation. Two groups of respondents participated in the study, namely patients (n=185) and nurses (n=21). The study highlighted the level of implementation of the Batho Pele principles in four primary health care clinics in the Capricorn District, Limpopo. The findings revealed that the Batho Pele principles were regarded as important criteria to assess quality care. Recommendations were made to improve the level of implementation of some of the principles. / Health Studies / M. A. (Health Studies)

The purpose of the study was to describe and explore the provision of quality care in the primary health care clinics of Limpopo within the framework of the Batho Pele principles' service standards by determining the level of implementation of these principles. The aim was to improve compliance with the Batho Pele principles. The researcher conducted a quantitative, exploratory and descriptive study in four selected primary health care clinics. Data collection was done using structured questionnaires for interviews and observation. Two groups of respondents participated in the study, namely patients (n=185) and nurses (n=21). The study highlighted the level of implementation of the Batho Pele principles in four primary health care clinics in the Capricorn District, Limpopo. The findings revealed that the Batho Pele principles were regarded as important criteria to assess quality care. Recommendations were made to improve the level of implementation of some of the principles. / Health Studies / M. A. (Health Studies)

AIM The purpose of this study was to explore and describe factors that contribute to the non-initiation of Antiretroviral Therapy (ART) amongst Pre-Antiretroviral Therapy eligible patients and to make recommendations for health care workers to enhance early initiation of pre-ART-eligible patients for primary health care facilities in Swaziland. METHOD A qualitative design was applied in rural primary health care (PHC) facilities in the Hhohho region of Swaziland. The target population for this study included nurses who have successfully completed the National Nurse Led Antiretroviral Therapy Initiation in Swaziland (NARTIS) training, and who actively initiated ART to eligible patients in rural PHC facilities. Data was collected through semi-structured interviews and field notes. Purposive, convenient sampling was applied. Eleven respondents were interviewed for the study, and data was collected until data saturation was reached. Data from transcripts and field notes was analysed and categorised with thematic analysis through Tesch’s open coding process. RESULTS The study identified the following three predominant themes: 1) systematic enablers of prompt ART initiation, 2) barriers to prompt ART initiation, 3) sources of support. Categories included public health care (PHC) factors, community level factors, the interdependence of the health care system, patient centred barriers, individual patient agency, and NARTIS nurse support. CONCLUSION The recommendations for health care workers that emerged from the study included continued HIV treatment scale-up and decentralisation to grass roots levels, aggressive treatment prioritisation among pre-ART patients, building the capacity of the local health care system and continued research initiatives. It is hoped that recommendations emerging from the findings of this study will have positive implications for programming and practice regarding the initiation of ART for eligible pre-ART patients in Swaziland. / Health Studies / M. PH.