M.Cur. / A single comprehensive, equitable and integrated National Health System must be created for South Afiica (ANC, 1994:19). This will be achieved by the ANC's commitment too promotion ofhealth through prevention and education. The Primary Health Care approach is the tenet for the restructuring ofthe health system. To be able to create a Health System which is single, comprehensive, equitable and integrated the system should be accessible, effective, acceptable, affordable and just. Community health nursing should be restructured to comply with these conditions. In this study the functions ofthe district nurse as a component ofthe Community Health Nursing Service within the National Health System is described. The aim ofthis study is to render more prominence to the promotive, preventive, curative and rehabilitive aspects ofcommunity health nursing in the home environment. Criteria for the delivery ofa district nursing service as component ofa community health nursing service will also be set and the position ofcurrent district nursing services investigated. An explorative, descriptive study was performed. The functions that the district nurse is supposed to perform will be obtained, by analysing duty sheets, a questionnaire and a literature review, to set guide lines for the delivery ofa district nursing service. Most ofthe district nurse's functions were found to be corresponding, in the duty sheets and questionnaires. But there were also some differences. The final findings are described

M.Cur. / Child development is a subject that is increasingly becoming the focus of discussion. The interest in this subject, however dates back to the twenties when Arnold Gesell started researching this field. Over the years scales were developed to make the measurement of the level of child development easier ...

M.Cur. (General Nursing) / Child development is a subject that is increasingly becoming the focus of discussion. The interest in this subject, however dates back to the twenties when Arnold Gesell started researching this field. Over the years scales were developed to make the measurement of the level of child development easier. The community health nurse should have a thorough knowledge of the use of child development scales. This will enable her to identify, diagnose and refer possible cases of retarded development found at healthy baby and toddler clinics. During this investigation the use of the child development scales by community health nurses, within the municipal boundries of Johannesburg, is evaluated. It was found that a lack of time during normal clinic hours, elaborate record-keeping systems, differences in community priorities, the training of community health nurses in the use of these scales, as well as the ignorance on parents regarding child development, influence the way in which the child development scales are used for community health purposes.

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.

The purpose of this study was to explore the lived experiences of the newly qualified professional nurses in midwifery section doing community service. A qualitative descriptive, interpretative phenomenological research was conducted to determine the experiences. The sample included newly qualified professional nurses doing community service. Data collection was conducted by means of unstructured interviews from ten (n=10) informants. Each interview was approximately 45 minutes. Ethical issues were considered. Hussel and Heidergadian’s data analysis steps were followed. Four (4) themes and eleven (11) sub-themes emerged from the data collected. The findings revealed that the newly qualified professional nurses were in a state of reality shock, demonstrated by challenges such as shortage of human and material resources; overcrowding; lack of support; and the placement of Midwifery Nursing Science in the curriculum has impacted negatively on midwives’ registration as professional nurses. Based on the current practical nursing education environment and further research, this study concludes by presenting its recommendations and limitations. / Health Studies / M. A. (Health Studies)

Submitted in Fulfillment of the requirements for the Master’s Degree in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Aim The aim of the study was to examine students’ perspectives regarding their learning in a community based undergraduate nursing programme at the Durban University of Technology in South Africa. Methodology A quantitative descriptive design was used to examine student nurses’ perspectives regarding their experiences in community-based education (CBE), with specific reference to perceived academic gains, local and global gains, intrapersonal gains and interpersonal gains. Hours spent by students outside their CBE schedule as well as most preferred clinical practice Participants included 203 undergraduate nursing students drawn from the 2010, 2011 and 2012 cohorts. A stratified random sampling technique was used. A modified 4-point Likert scale version of a questionnaire designed by Ibrahim (2010), which also comprised of open-ended questions for supportive qualitative information, was used to collect data. Analysis was done accomplished using SPSS Version 22 for the quantitative data and identification of themes for the supportive qualitative information. Results The study results revealed that students had benefited from CBE in all the four domains under study. Participants rated the impact of CBE on academic gains lowest ( ̅x = 3.09, SD = .38) with perceived impact of CBE on local and global gains rated highest ( ̅x = 3.33, SD = .38). The personal gains subscale was the second highly rated subscale with a mean of 3.27 (SD = .43), followed by the intrapersonal gains domain ( ̅x = 3.15, SD .48). No significant differences were found between groups on all the variables of interest. Furthermore, the results revealed that participants spent a varying number of hours outside of scheduled CBE placement. The majority of the participants spent 200 hours to 399 hours (n= 119) = 58.6% in the first semester and (n = 120) = 59% in the second semester. The majority (72%) of the participants indicated that their preferred clinical practice environment was Primary Health Care. / M

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

Volunteer home-based caregivers are critical role players in South Africa‘s health care system and in the South African government‘s strategy to fight HIV and AIDS. In order to achieve the aims that the government seeks to attain, it is important that the care and treatment provided to patients receiving community home-based care (CHBC) be of a high quality. While the need for quality care is supported by government and civil society, research indicates that it is not clear whether quality care is indeed being provided and therefore there is a need for research into the quality of CHBC. The research aimed to undertake a critical assessment of CHBC programmes to determine the quality of care provided by volunteer caregivers using social capital theory as a theoretical framework. The study examined the quality of CHBC by analysing the context of CHBC, by investigating the support that volunteer caregivers and their clients receive and by discussing the support that volunteer caregivers and their clients still need. The study used one-on-one in-depth interviews and focus groups to obtain relevant data. The participants included volunteer caregivers, clients and supervisors who took part in the one-on-one interviews. The focus groups consisted of key informants and supervisors respectively. The quantitative data consisted of descriptive statistics which helped describe the participants. The qualitative data was coded and themes and sub-themes were developed. The data was also analysed by an independent coder. The results showed that poverty, and the related problems of poor living conditions and a lack of food security affects the quality CHBC. In addition, unemployment and the problem of stipends also affect quality CHBC. Certain socio-economic factors were also found to lead people to choose to become volunteer caregivers and unemployment was found to be an important driving force behind the choice to undertake volunteer caregiving. Furthermore, the volunteer caregivers in the sample received organisational support from their supervisors and their fellow caregivers or peers. They also received social support from their families and their communities. Regarding the clients of the volunteer caregivers, it was found that they received a number of types of support including psycho- iv social counselling, spiritual counselling and care of a holistic nature. In addition, the study found that there is a need for standardised quality training of volunteer caregivers, which will equip them with multiple skills. It was also found that volunteer caregivers require mentoring and quality supervision in order to be able to provide quality CHBC to their clients. Government has the ability to put the necessary systems and structures in place, such as a scope of practice for volunteers, standardised training and monitoring and evaluation, to enable CHBC and its relevant role players to operate at optimum levels. It also has the authority to make the changes and to enforce rules. Furthermore, it has the ability to unite CHBC organisations and can create the necessary conditions that can lead to increased social capital. Furthermore, the study recommends that two additional dimensions of quality care be added to existing dimensions of quality in health care. The first is the holistic approach to caregiving and the second is social support systems, namely supervisor/mentor and peer support and family and community support. This second dimension is also closely linked to social capital and the networks that make up CHBC.

Family planning services are rendered at no cost in all clinics in Mdantsane. Mdantsane is situated in the Eastern Cape and falls under Amathole District Municipality. The high rate of adolescent pregnancy in the area raises a question as to whether the family planning services are adequate. This issue reflects on the quality of family planning service delivery. According to Roux (1995:94), a quality service is a safe, easily available and readily acceptable service, delivered by well trained family planning personnel through well planned programmes. Aims and Objectives: To assess the quality of family planning service delivery by health providers to adolescents; determine the opinions of adolescents regarding accessibility, friendliness of staff, privacy, confidentiality, reproductive health information and resources at Mdantsane clinics from June to July 2009. Method: A questionnaire was designed to collect data. The questionnaire was administered on the adolescents utilizing the reproductive health services at eleven primary health clinics in Mdantsane. A sample consisting of 110 adolescent youth between 19 and 24 years was selected by using random sampling. A response of “yes” will indicate that the participant is satisfied with the specific item, while a response of “no” will indicate dissatisfaction with that item. A specially designed spreadsheet was developed to analyze the data. Data was analyzed by using the Microsoft Excel 2007 Version 6. Results: The results from this research study suggest that there is a definite need for improvement of adolescent reproductive health services at Mdantsane clinics. It is clear that the current available maternal and child health programmes, school health services and reproductive health services are not able to meet the adolescent sexual and reproductive needs. Conclusion: The research findings from this study indicated the constraints to good quality family planning health care service delivery. Satisfaction responses from the five categories: health facility amenities, accessibility, staff characteristics, availability of sexual and reproductive health services and availability of educational material accessibility were mostly below 70%. The responses regarding the question on the “full information about the available contraceptives”showed the least level of satisfaction. Deficiencies in physical facilities and equipment, disruptions in supplies, insufficient information provided to clients and providers‟ insensitivity to the feelings and needs of the clients are issues that discourage adolescents from utilizing contraceptive services. Recommendations: Adolescents need a safe and supportive environment that offers information and skills to equip them on all aspects related to sexual and reproductive health issues. To satisfy adolescent reproductive needs, the following key elements should be improved: accessibility of reproductive health services, friendliness of clinic staff, availability of information about reproduction and sexuality and maintenance of issues regarding confidentiality and anonymity. Quality requires the presence of trained personnel in well-equipped clinics where clients are treated courteously. To avoid issues of courtesy bias, there is a need to conduct a similar survey utilizing alternative community settings, namely homes of participants or a school.

The purpose of this study was to explore the lived experiences of the newly qualified professional nurses in midwifery section doing community service. A qualitative descriptive, interpretative phenomenological research was conducted to determine the experiences. The sample included newly qualified professional nurses doing community service. Data collection was conducted by means of unstructured interviews from ten (n=10) informants. Each interview was approximately 45 minutes. Ethical issues were considered. Hussel and Heidergadian’s data analysis steps were followed. Four (4) themes and eleven (11) sub-themes emerged from the data collected. The findings revealed that the newly qualified professional nurses were in a state of reality shock, demonstrated by challenges such as shortage of human and material resources; overcrowding; lack of support; and the placement of Midwifery Nursing Science in the curriculum has impacted negatively on midwives’ registration as professional nurses. Based on the current practical nursing education environment and further research, this study concludes by presenting its recommendations and limitations. / Health Studies / M. A. (Health Studies)