Student Number : 9001367H - MPh research report - School of Public Health and Oral Health Sciences - Faculty of Health Sciences / Introduction: Compulsory Community Service (CS) for health professionals has been introduced in South Africa since 1997. Some of the aims for its introduction were to: 1) address the maldistribution of health service providers, 2) prevent qualified health professionals from emigrating and 3) improve clinical skills and knowledge of newly qualified medical graduates. The Oral Hygiene (OH) and Dental Therapy (DT) professions have as yet not been included in the performance of CS. However the Department of Health (DOH) is planning to introduce CS for these groups of health professionals in the near future. The role of the oral hygienist and dental therapist in South Africa (SA) cannot be over emphasized. Given the high caries levels, low oral hygiene education levels, large unmet oral health needs and the preventative approach of the DOH at all levels, the oral hygienist and dental therapist can provide invaluable human and technical resources that are currently required to address these concerns. Aims: To assess the attitudes of OH and DT students registered during 2004 at the five dental schools in South Africa regarding the introduction of CS. Objectives: 1) To obtain the demographic data of the OH and DT students, 2) to determine whether their current training programme prepares these students for CS, 3) to identify the provinces in which the OH and DT students would prefer to be placed for CS and 5) to identify the different types of professional activities that the OH and DT students would like to perform whilst completing CS. Methods: A self administered questionnaire was jointly developed between the Kwa- Zulu Natal Department of Health and the Division of Public Oral Health at the University of Witwatersrand, Johannesburg. The questionnaire was sent to all OH and DT students who were registered at each of the five dental schools in SA during 2004. Results: There were a total of 163 students (68%) who responded to the questionnaire. Of the respondents, 109 (70%) were OH students and 54 (64%) were DT students. There were 132 (81%) females and 31 (19%) males. The average age of the student’s was 21 years (17-37; mode 19; median 20 and SD 3.2). There were 59 (36%) Whites, 53 (33%) Black, 31(19%) Asian and 18 (11%) Coloured students. The majority of OH students (63%) were against the introduction of CS. There was a significant number (p<0.05) of White students who were registered for the OH degree that did not want to perform CS. A significant number of respondents (p<0.05) felt that they were adequately trained to perform all the necessary duties that may be required of them during their CS. Most of the respondents chose Kwa-Zulu Natal (26%), Western Cape (26%) and Gauteng (22%) provinces respectively as their first choice province for carrying out their CS. The majority of students (p<0.05) chose their resident province as their first choice province in which they would prefer to perform their CS. Students indicated a preference to perform oral health promotional activities (56%), health educational activities (21%) and clinical work (18%) in their CS programme. Conclusion: The majority of DT students supported the concept of CS. This was in contrast to the OH students where less than half of them supported its introduction. Overall, most of the students chose the more urban provinces (Kwa-Zulu Natal, Western Cape and Gauteng) to complete their CS.

A new category of community-service nursing practitioner who was the equivalent of a newly qualified nurse emerged in the years 1998–2007. Community service was introduced by the national Department of Health in an attempt to retain professional nurses. The community service nurse is registered with the South African Nursing Council in the category “community service”. Community service nurses need to obtain clinical experience under the supervision of experienced professional nurses in a public health facility for a period of one year. Globally, health-care systems have been affected by an increase in conditions such as maternal and child morbidity and mortality, an ever-increasing vulnerability to communicable diseases (tuberculosis and Acquired Immune Deficiency Syndrome) and violence in under-developed and developing countries. These challenges have resulted in the escalation of health-care costs and a shortage of human resources in the health-care system. The escalation of these conditions has put further strain on the effectiveness of an already struggling health-care system, and the delivery of health-care services to those who are most in need. This necessitated the implementation of community service. The provincial Department of Health usually identifies where the critical need for the placement of community service nurses is, and the diplomate or the graduate can select one of three placements. However, the final decision for placement remains that of the provincial Department of Health. This community service strategy, which aims to empower community service nurses, is a contentious matter, as these community service nurses are often placed in an area where they have to work independently within the first year after qualifying as a diplomate or graduate without being supervised and supported in the public health facility. The community service nurses experience a lack of confidence and competence due to limited clinical exposure resulting from full and compacted nursing education programmes. The need for an experienced professional nurse as supervisor with a clearly defined job description by the provincial Department of Health is mandatory to prevent role conflict and confusion. However, the provision of such supervision has not yet materialised because of the shortage of experienced registered nurses in the health-care system. Research design: A qualitative design using exploratory, descriptive and contextual strategies ensured access to tangible information regarding the supervision and clinical accompaniment needs of community service nurses. Data collection: Data was collected using semi-structured interviews, field notes and digital voice recordings. The participants were community service nurses who had completed six months of their community service year. A total of n = 12 participants out of N = 38 were interviewed in the three hospitals of the Amajuba District in KwaZulu-Natal until no new data emerged and data saturation was reached. Data analysis: Content analysis assisted the researcher in scrutinising the data by coding, categorising into themes and sub-themes to clarify the data. Literature control was used to underpin the research findings. Research findings: The community service nurses appeared to be in desperate need of clinical supervisors to guide, coach, support, and be a role model to them. Community service nurses needed to develop confidence, competence, independence and critical thinking skills during community service practice. In reality, not all community service nurses were fully competent and independent to practise autonomously during their community service, though some had acquired all the above mentioned skills. However, it stood to reason that competence developed in the period of community service and was influenced by clinical supervision from experienced registered nurses, who assisted with continued development of skills in clinical practice. / MCur, North-West University, Potchefstroom Campus, 2014

A new category of community-service nursing practitioner who was the equivalent of a newly qualified nurse emerged in the years 1998–2007. Community service was introduced by the national Department of Health in an attempt to retain professional nurses. The community service nurse is registered with the South African Nursing Council in the category “community service”. Community service nurses need to obtain clinical experience under the supervision of experienced professional nurses in a public health facility for a period of one year. Globally, health-care systems have been affected by an increase in conditions such as maternal and child morbidity and mortality, an ever-increasing vulnerability to communicable diseases (tuberculosis and Acquired Immune Deficiency Syndrome) and violence in under-developed and developing countries. These challenges have resulted in the escalation of health-care costs and a shortage of human resources in the health-care system. The escalation of these conditions has put further strain on the effectiveness of an already struggling health-care system, and the delivery of health-care services to those who are most in need. This necessitated the implementation of community service. The provincial Department of Health usually identifies where the critical need for the placement of community service nurses is, and the diplomate or the graduate can select one of three placements. However, the final decision for placement remains that of the provincial Department of Health. This community service strategy, which aims to empower community service nurses, is a contentious matter, as these community service nurses are often placed in an area where they have to work independently within the first year after qualifying as a diplomate or graduate without being supervised and supported in the public health facility. The community service nurses experience a lack of confidence and competence due to limited clinical exposure resulting from full and compacted nursing education programmes. The need for an experienced professional nurse as supervisor with a clearly defined job description by the provincial Department of Health is mandatory to prevent role conflict and confusion. However, the provision of such supervision has not yet materialised because of the shortage of experienced registered nurses in the health-care system. Research design: A qualitative design using exploratory, descriptive and contextual strategies ensured access to tangible information regarding the supervision and clinical accompaniment needs of community service nurses. Data collection: Data was collected using semi-structured interviews, field notes and digital voice recordings. The participants were community service nurses who had completed six months of their community service year. A total of n = 12 participants out of N = 38 were interviewed in the three hospitals of the Amajuba District in KwaZulu-Natal until no new data emerged and data saturation was reached. Data analysis: Content analysis assisted the researcher in scrutinising the data by coding, categorising into themes and sub-themes to clarify the data. Literature control was used to underpin the research findings. Research findings: The community service nurses appeared to be in desperate need of clinical supervisors to guide, coach, support, and be a role model to them. Community service nurses needed to develop confidence, competence, independence and critical thinking skills during community service practice. In reality, not all community service nurses were fully competent and independent to practise autonomously during their community service, though some had acquired all the above mentioned skills. However, it stood to reason that competence developed in the period of community service and was influenced by clinical supervision from experienced registered nurses, who assisted with continued development of skills in clinical practice. / MCur, North-West University, Potchefstroom Campus, 2014

Magister Scientiae (Occupational Therapy) - MSc(OT) / Professional socialisation is a key dimension within the professional development of an occupational therapy practitioner. Professional socialisation in the first year of practice involves a process of change within the individual with regards to knowledge, skills and reasoning. The process further involves the novice’s developmental induction into the culture of the profession and into the practice context. Novice practitioners who are not appropriately supported in their professional socialisation process may become demoralised as practitioners. It is necessary to explore professional socialisation from the perspectives of novice occupational therapy practitioners themselves, in order to generate an understanding of how professional socialisation can be supported in the first year of practice. This is of vital importance otherwise the profession may run the risk of attrition. Therefore, the aim of this study was to explore and describe novice occupational therapists’ perceptions and experiences regarding professional socialisation during the first year of practice. A qualitative research approach and exploratory descriptive research design was utilised in the public health system in South Africa. Purposive sampling was utilised to select nine participants for the study. Data collection methods included two semi-structured interviews and a dyad interview discussion which were audio-recorded, transcribed verbatim and analysed through thematic data analysis. The strategies of member checking, peer review, reflexivity, and an audit trail ensured trustworthiness of the study. Ethics clearance was obtained from the UWC Research Committee. Three themes originated from the findings of this study. The first theme, stepping into the unknown, illustrates a dissonance between the participants’ expectations for practice and the actual realities of practice that they encountered. The second theme, uncovering the occupational therapy culture, highlights power dynamics and inconsistencies within the profession as perceived by the participants. The third theme, becoming a professional, highlights how the participants responded to the challenge of transitioning from student to professional and started to internalise their professional identity. Recommendations to support the professional socialisation of novice therapists in the South African context are made in respect of occupational therapy education, continued professional development, support for novice therapists, transformation in the profession and future research.

Philosophiae Doctor - PhD / The purpose of this qualitative study was to identify ways in which the University of the Western Cape (UWC) occupational therapy (OT) curriculum could be developed to prepare its graduates to advance occupational justice in community service practice. The background to the study is the development of occupational therapy practice and education within a policy context of health reform that gave momentum to the shift in emphasis from a bio-medical to a more socio-political approach to health in South Africa. Underpinning this study was the assumption that OT education informs professional practice and that uncovering new graduates’ practice experiences can inform the development of the UWC OT curriculum. The aim of the studyn was to examine how UWC OT graduates conceptualised occupational justice and how it manifested in their daily practice of community service in three provinces in South Africa. The study is framed within the theories of occupational justice and critical curriculum theory, in particular, critical pedagogy. A literature review pertaining to the application of occupational justice in OT practice and education is presented. This includes the background values that inform the practice of occupational justice, the application of occupational justice as it relates to OT practice and the relationship between OT education and occupational justice. The research design that was adopted is that of a single, interpretive case study. Through purposive sampling seven occupational therapy graduates from UWC who graduated in 2009, and who practiced in under-resourced, rural community service settings in 2010, were selected to participate in the study. The methods of data collection that were utilised were participant observation, a reflective journal, semi-structured paired or dyadic interviews and document review. The findings revealed that occupational justice held considerable value for the participants. They conceptualised occupational justice as enhanced health and well-being, and broader social change as an outcome of the facilitation of occupational enablement. The nature of their community service practice settings, however, posed several challenges for the participants. From the perspective of the participants, the dominance of the medical model, lack of resources and system of bureaucracy appeared to be the biggest challenges they encountered. While the participants’ education was geared towards equipping them to provide appropriate services as indicated by local needs, the health system was not ready tob accommodate their practice. Consequently, the participants appeared to encounter hegemony in practice. In encountering hegemony, however, they displayed an attitude of defeatism, leaving them with feelings of guilt, despondency and powerlessness. They lacked the skills to respond to power dynamics and to interact with people in positions of power. The main conclusion drawn from the study findings is that for OT graduates to impact the contexts in which they practice in South Africa, OT education must ensure that students develop competence to deal with the complexities of community service practice. This implies that transformational learning as pedagogical practice is of the essence, as it frames student preparation not just as learning but as a process of critical reflexivity that equips them to respond to power dynamics and intervene in matters related to occupational justice as active agents of change. The role and practice of occupational justice are subjects of debate in the context of OT education as they are for the profession broadly. This study contributed to this conversation through its examination of UWC OT graduates’ actual practice and the transmission of occupational justice-promoting practice through UWC OT education. The study highlighted that it is imperative that OT curricula in South Africa provide opportunities for students to engage in critical reflection on ways in which indigenous knowledge and a local understanding of occupational justice, as it relates to collective agency and critical consciousness, can be made more explicit in everyday practices. To this end, recommendations for the development of the UWC OT curriculum are made in respect of curriculum structure, content and approach; interdisciplinary education and practice, support for community service graduates and occupational therapy continued professional development.

Text in English / In South Africa, retention of newly qualified professional nurses in public health institutions upon completion of their year of compulsory remunerated community service remains a challenge that exacerbates the shortage of professional nurses in these institutions. The literature indicates that many newly qualified professional nurses leave the public health institutions due to lack of professional development support and heavy workloads while they are still finding their feet. A mixed-methods design of concurrent triangulation approach was used to answer the question: How are the newly qualified professional nurses supported in terms of induction and professional development during community service in South Africa? Triangulation was achieved by using both quantitative and qualitative methods. Induction/orientation documents from public health institutions were analysed using a checklist. A survey questionnaire with mixed quantitative closed items (1–43) and qualitative open-ended questions (43–46) was sent to newly qualified professional nurses who had recently completed community service. Focus groups held with operational nurse managers and individual interviews with coordinators of community service for nurses yielded rich qualitative data. Descriptive and inferential statistics were used to describe and synthesise data. The qualitative findings confirmed the quantitative findings. Findings were lack of professional development support in some public health institutions, informal, non-comprehensive support where given, shortage of experienced professional nurses, reluctance by some professional nurses and operational nurse managers to supervise newly qualified nurses, and increased workload due to the shortage of experienced professional nurses in the public health institutions. Inadequate clinical skills, poor discipline and lack of professionalism in the newly qualified professional nurses also played a part. Respondents suggested constructive recommendations for the induction and professional development support of the newly qualified professional nurses, and these were incorporated in the recommended guidelines for the induction and professional development support of newly qualified professional nurses during community service. / Health Studies / D. Litt. et Phil. (Health Studies)