Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Primary Health Care (PHC) provide a quality, comprehensive health service to the community, based on the principles of equity, affordability, accessibility and community participation. It is a nurse driven service with the Clinical Nurse Practitioner (CNP), a registered nurse specialising in the clinical elements of primary, secondary and tertiary prevention at the forefront. It is against this background that this study was endeavored to investigate the community’s perceptions and lived experiences of the quality of care being rendered by CNPs in the West Coast rural district of the Western Cape. The objectives of this study included the following: - To explore and describe the perceptions of patients in the West Coast rural community regarding the attitudes, knowledge and skills of CNPs. - To provide policy makers with feedback and possible recommendations with regards to the implementation of this nurse driven PHC service. - To provide recommendations for improvement of the existing curricula at nursing education institutions based on whether the current training meets patients’ needs and thereby possibly influence curricular change. A qualitative, descriptive, research design was used. The guideline by Colaizzi (as cited in Streubert & Carpenter, 1999:14) was used for data collection and analysis. Twenty-six participants took part in five different group interviews. Semi-structured, open ended questions were used to encourage the participants to actively partake. Each interview was audio taped and field notes were taken. Thematic analyses was performed to highlight three main themes, i.e. the attitudes of the CNPs, the knowledge and skills of CNPs, and the impact of the current training programmes on the quality of care being rendered by these CNPs. Written approval from the Ethics Research Committee, University of Stellenbosch, as well as from the Research unit of the Western Cape Department of Health was obtained. Prior informed consent was further obtained from each participant, after being assured of voluntary participation, confidentiality and anonymity. Credibility, dependability and transferability were ensured by returning to two participants who validated that the transcripts were a true reflection of their experiencesand opinions. This study concluded that patients perceived CNPs as being unfriendly, uncompassionate and unprofessional. Dissatisfaction with the prevalence of unjust practices due to family members and certain race groups being attended to first by CNPs, were expressed. Participants found the competency levels of CNPs more than adequate when assessing, examining and providing health information and medicine. However, they expressed the need that CNPs should be able to prescribe a greater variety of medicines and perform more diagnostic tests than currently permitted by the scope of practice as set out by the South African Nursing Council. Therefore, these views of the participants indicated that the current postgraduate training programme do fulfill their health needs, although the need for expansion of the role and function of the CNP were expressed. Recommendations made included: - An in-depth investigation into the alleged rude attitudes of CNPs should be undertaken, soas to improve the professional behavior of CNPs towards patients. - Applicable policy makers should consider expanding the roles and functions of the CNP. - Enforcing continuous, professional competency through adequate and productive in-service training programmes. In conclusion, this study showed that CNPs need to be constantly aware that they work with human beings, with feelings and with health needs. The need for a therapeutic environment is thus crucial to the rendering of a quality, comprehensive service to the community they serve. / AFRIKAANSE OPSOMMING: Primêre Gesondheidsorg (PGS) voorsien ’n kwaliteit, omvattende gesondheidsdiens aan die gemeenskap, gebaseer op die beginsels van gelykheid, bekostigbaarheid, toeganklikheid en gemeenskaps-betrokkenheid.Dit is `n verpleegaangedrewe diens met die Kliniese Verpleegspraktisyn (KVP) wat gespesialiseerd is in die kliniese elemente van primêre, sekondêre en tersiêre voorkoming, aan die voortou. Dit is teen hierdie agtergrond wat hierdie studie aangepak is, ten einde ondersoek in te stel aangaande die gemeenskap se persepsies en geleefde ervarings van die kwaliteit van sorg wat deur KVPs in die plattelandse Weskusdistrik van die Wes-Kaap gelewer word. Die doelwitte van hierdie studie het die volgende ingesluit: - Om die persepsies van pasiënte, rakende die ingesteldhede (gedrag), kennis en vaardighede van KVPs te ondersoek. - Om toepaslike beleidsmakers metterugvoer en moontlike aanbevelings te voorsien aangaande die implimentering van verpleegaangedrewe, PGS. - Om aanbevelings te maak vir die verbetering van bestaande kurrikula aan verpleegopleidingsinstellings op grond van óf die huidige opleiding in pasiëntbehoeftes voorsien, en sodoende kurrikulumverandering moontlik te beïnvloed. ’n Kwalitatiewe, beskrywende navorsingsontwerp is gebruik. Die raamwerk van Colaizzi (soos beskryf in Streubert & Carpenter, 1999:14) is tydens datainsameling en analiese gebruik. Ses-en-twintig deelnemers het aan die vyf verskillende groepsonderhoude deelgeneem. Semi-gestruktureerde, oop-einde vrae was gebruik om die deelnemers aan te moedig om aktief aan die besprekings deel te neem. Elke onderhoud is op oudio band opgeneem en veldnotas is gemaak. Tydens analiese is drie hooftemas geïdentifiseer, nl die houdings van KVPs, die kennis en vaardighede van die KVPs sowel as die impak van die opleidingsprogram op die kwaliteit van sorg wat deur KVPs gelewer word. Skriftelike toestemming vir die studie is by die Etiese Navorsingkommittee, Universiteit van Stellenbosch, asook die Navorsingseenheid van die Wes- Kaapse Departement van Gesondheid verkry. Voorafgaande toestemming is voorts vanaf elke deelnemer verkry, nadat hulle verseker is van vrywillige deelname, konfidensialiteit en anonimiteit. Geloofwaardigheid, afhanklikheid en oordraagbaarheid is verseker, deur na twee van die deelnemers terug te gaan wat die transkripsies geverifieër het as juis en korrek. In hierdie studie is tot die slotsom gekom dat pasiënte KVPs as onvriendelik enongevoeligervaar het. Onbillike praktyke kom steeds voor, deurdat familielede en sekere rassegroepe voorkeur behandeling kry. Deelnemers se ervarings aangaande die bevoegdheid van KVPs was as toereikend beskryf aangaande die assessering, ondersoek en voorsiening van gesondheidsinligting en medisyne. Hulle het egter ook die behoefte uitgespreek dat die KVP’s `n groter verskeidenheid medisyne behoort voor te skryf en meer diagnostiese toetse behoort te kan uitvoer as wat tans binne die bestek van praktyk, soos neergelê deur die Suid-Afrikaanse Raad op Verpleging, moontlik is. Hierdie persepsie van die deelnemers impliseer dat die huidige nagraadse opleidingsprogram voldoende is en hul gesondheidsbehoeftes aanspreek. Die behoefte vir die uitbreiding van die rol en funksie van die KVP is egter uitgespreek. Die aanbevelings wat gemaak is sluit in: - ’n In-diepte ondersoek oor die onbeskofte ingesteldhede van KVPs behoort uitgevoer te word, ten einde die professionele gedrag van KVPs teenoor pasiënte te verbeter. - Beleidmakers behoort die uitbreiding van die rolle en funksies van die KVP te oorweeg. - Benadruk voortgesette, professionele bevoegdheid deur toepaslike en produktiewe indiensopleidingsprogramme. Ter aflsuiting: hierdie studie het aangetoon dat KVPs voortdurend bewus moetbly dat hulle met mense werk wat gevoelens het en wat gesondheidshulp benodig. Dit is uiters belangrik om aan die behoeftesvan ’n terapeutiese omgewing te voorsien, ten einde ’n kwaliteit, omvattende diens aan die gemeenskap te lewer.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Member states of the United Nations accepted eight Millennium Development Goals in 2000. Millennium Development Goal number four addresses the improvement of child health. The purpose of goal number four is to decrease the child mortality rate by 60% for the period 1990 to 2015. South Africa is one of twelve countries where the incidence of child mortality increased during this period. Guided by the research question “What are the experiences and perceptions of mothers utilizing child health services”, a study was done. A qualitative, descriptive phenomenological methodology was applied to explore the experiences and perceptions of mothers utilizing child health services for children younger than two years. The goal of this study was to determine the experiences and perceptions of mothers utilizing child health services. The objectives were to explore their experiences and perceptions, with specific reference to the service they receive regarding: - immunization - nutrition assessment - the growth of the child - the growth chart - other underlying illnesses Ethical approval was obtained from Stellenbosch University and various health authorities. Validity was assured by adhering to the principles of trustworthiness, namely credibility, transferability, dependability, and conformability. The population for this study was mothers who utilized ten clinics in a demarcated area of Cape Town for child health services. Purposive sampling was utilized to consciously select three clinics (N =10), and at each of the clinics four mothers were purposively selected to participate. A total of seventeen mothers participated in the study. An interview guide was used to conduct interviews with participants. The researcher conducted and recorded the interviews after obtaining written informed consent from each participant. A field diary was kept for notation of observations. Data analysis involved the transcribing of digitally recorded interviews, the coding of the data, the generating of themes and sub-themes, interpretation and organization of data and the drawing of conclusions. The Modeling Role-Modeling Nursing theory of Erickson, Tomlin and Swain were utilized as conceptual theoretical framework to facilitate application to the broad population. Findings of the study indicated varied experiences. All mothers did not receive information about the RtHB or RTHC. Not all mothers developed a relationship of trust with caregivers or were afforded the respect of becoming part of the child’s health care team. According to the mothers integrated child health care services were not practised. The consequences were missed opportunities in immunization, provision of Vitamin A, absence of growth monitoring, feeding assessment and provision of nutritional advice. Hospitals and private practitioners equally did not provide immunization services or offered holistic care. Simple interventions such as oral rehydration, early recognition and treatment of diseases, immunization, growth monitoring and appropriate nutrition are not diligently offered; that could reduce the incidence of child morbidity and mortality. The following recommendations are made: determine why hospitals do not immunize children. The root causes must be addressed to change practice. Rendering of child services must happen in an integrated approach. Staff must be empowered with skills regarding procurement, in particular regarding vaccines. / AFRIKAANSE OPSOMMING: In 2000 het die lidlande van die Verenigde Volke Organisasie die Millenium Ontwikkelingsdoelwitte aanvaar. Die Millenium Ontwikkelingsdoelwit nommer vier roer die kwessie van kindergesondheid aan. Die strategie om die voorkoms van kindersterftes met 60% te verminder vanaf 1990 tot 2015 is die vierde millenium doelwit. Suid Afrika is een van twaalf lande in die wêreld waar die kindersterftes vir hierdie tydperk toegeneem het. ‘n Studie is gedoen om te bepaal “Wat die ervaring en persepsies van moeders is wat van kindergesondheidsdienste gebruik maak. ‘n Kwalitatiewe, beskrywende, fenomenologiese studie is gedoen,om die ervaring en persepsies van moeders wat kinders jonger as twee jaar na klinieke geneem het, te bepaal. Die doel van die studie was om die ervaring en persepsies van moeders ten opsigte van kindergesondheidsdienste vas te stel. Spesifieke doelwitte was die bepaling van die ervaring en persepsies rondom: - immunisasiedienste - groeimonitering - voedingsvoorligting - die groeikaart - behandeling van siektes Etiese goedkeuring was verkry vanaf die Universiteit van Stellenbosch en die verskeie gesondheidsowerhede. Geldigheid van die studie is verseker deur die beginsels van geloofwaardigheid na te kom naamlik, aaneemlikheid, betroubaarheid, oordraagbaarheid en inskiklikheid. Die bevolking betreffende die studie was moeders wat kliniekdienste gebruik het vir hulle kinders in ‘n spesieke area van Kaapstad, bestaande uit tien klinieke. Drie klinieke (N=10) is doelgerig geselekter vir deelname. Vier moeders is doelgerig by elk van die drie klinieke geselekteer vir deelname. Onderhoude is met sewentien deelnemers gevoer. ‘n Onderhoudsgids is gebruik en die navorser het rekord gehou van waarnemings. Die navorser het onderhoude gevoer en opgeneem na skriftelike toestemming daarvoor van elke deelnemer verkry is. ’n Veldwerkdagboek is gehou van alle waarnemings. Data-analise het behels: digitale opnames wat woordeliks beskryf , tematies ontleed en geïnterpreteer is en volgens temas georganiseer is. Toepassing na die breër populasie is bevorder deur die gebruik van die verpleegteorie van Erickson, Tomlin en Swain. Bevindinge van die studie het getoon dat moeders verskillende ervaringe gehad het. Nie alle moeders het inligting ontvang omtrent die RtHB of RTHC nie. Nie alle moeders het vertroue in die kliniek nie en moeders word nie erken as bepalende faktore in die sorgspan nie. . Volgens die moeders is geïntegreerde gesondheidssorg nie beoefen nie. Die gevolge is dat geleenthede nie benut word om te immuniseer nie, vitamien A te verskaf, groei te kontroleer, voeding te bepaal en voedingsadvies te verskaf. Die voorraadvlakke van entstof word nie oral doeltreffend beheer nie. Hospitale en dokters beoefen nie altyd immunisering en holistiese kindergesondheidsdienste nie. Eenvoudige intervensies, wat die voorkoms van kindermorbiditeit en kindermortaliteit kan bestry, word nie verskaf nie. Voorbeelde van sulke intervensies is mondelinge rehidrasie, vroeë diagnose en behandeling van siektes, immunisering, groeimonitering en geskikte voedingsinligting. Daar word aanbeveel dat daar indringend bepaal word hoekom hospitale nie kinders immuniseer nie en dat die oorsake aangespreek word. Integrasie van dienste by klinieke moet as prioriteit gesien en geïmplimenteer word. Personeel se vaardighede betreffende beheer van voorraad moet verbeter word, veral t.o.v. entstof voorraad.

Thesis (MCur (Nursing Science))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Nursing documentation is the written evidence of nursing practice and reflects the accountability of nurses to patients. Accurate documentation is an important prerequisite for individual and safe nursing care. It is a severe threat for the individuality and safety of patient care if important aspects of nursing care remain undocumented. Nursing staff cannot rely on information that is not documented. Every patient is important and unique hence every patient’s care is individualised and different according to his/her needs. This is why important aspects of his/her care need to be documented. Ultimately, the documentation practices reflect the values of the nursing personnel (Isola, Muurinen and Voutilainen, 2004:79-80). The goal of this study was to investigate documentation of nursing care with reference to current practices and perceptions of nurses in a teaching hospital in Saudi Arabia Specific objectives of the study were:  to identify whether the hospital policies are being carried out  to identify whether the procedures regarding current documentation are being carried out and  to explore the perceptions of the nurses regarding the current documentation practices. Research Methodology For the purpose of this study, a non-experimental descriptive design with a quantitative approach was used. The study was carried out at King Faisal Specialist Hospital in Jeddah in Saudi Arabia. The total population of 90 registered nurses were used in this study. Questionnaires were distributed to the participants and they were answered with no identities written on the questionnaires. After the questionnaires were completed, it was posted in a box and was collected by the researcher. The questions are straightforward, easily understood, unambiguous, non-leading, objectively set and aimed at obtaining views, experiences and perceptions of documentation of nursing care. . Involvement of participants was voluntary and non-coercive. Data analysis were carried out with the support of a statistician, expressed in tables, frequencies and statistical associations were done between various variables based on a 95% confidence interval. The study revealed that:  Hospital policies are being carried out N=76 (95%)  Procedures pertaining to documentation of nursing care are being carried out N=67(83,7%).  Nurses N=45(56,3%) indicated that paper documentation included a lot of paperwork.  The Cerner (computer system) is regarded as the best system ever used for documentation of nursing care N=44(55%)  The Mycare system (medication ordering system) is regarded as the most reliable, user-friendly system and nurses are happy with it N=68(85%) Recommendations are:  Nurses still need to be taught about the hospital policies  Nurses should be taught the correct procedure on documenting the patient data  Nurse clinicians and managers should check the Cerner for compliance with regard to documentation of physical assessment when conducting audits  Use of paper for nursing documentation should be minimized by shifting some of the nursing documentation procedures from paperwork to electronic version  Continuous updating, in-service training and monitoring to keep nurses abreast with the dynamic nature of computer usage  Reviewing of the system, troubleshooting and suggestions from users need to be attended to on a continuous basis  It is recommended that a backup system (generator) is in place to ensure continuity of documentation. / AFRIKAANSE OPSOMMING: Die dokumentering van verpleegsorg is die skriftelike bewys van die verpleegpraktyk en weerspieël die toerekenbaarheid van verpleegsters teenoor pasiënte. Noukeurige dokumentering is ’n belangrike voorvereiste vir individuele en veilige verpleegsorg. Dit is ’n ernstige bedreiging vir die individualiteit en veiligheid van pasiënte-sorg, indien belangrike aspekte van verpleegsorg nie gedokumenteer word nie. ’n Mens kan nie inligting vertrou wat nie gedokumenteer is nie. Die versorging van elke pasiënt is belangrik en uniek. Dit is waarom belangrike aspekte aangaande haar/sy versorging gedokumenteer behoort te word. Uiteindelik weerspieël die dokumenteringspraktyke, die waardes van die verpleegpersoneel (Isola, Muurinen en Voutilainen, 2004: 79-80). Die doel van die studie was om dokumentasie van verpleegsorg met verwysing na huidige praktyke en persepsies van verpleegkundiges in ‘n opleidingshospitaal in Saudi Arabia te ondersopek. Spesifieke doelwitte was  om vas te stel of die hospitaal se beleidsrigtings toegepas word  om vas te stel of die prosedure t.o.v die huidige dokumentering uitgevoer is  en’n ondersoek na die persepsies van verpleegsters aangaande die huidige dokumenteringspraktyke Vir die doel van hierdie studie is ’n nie-eksperimentele beskrywingsontwerp met ’n kwantitatiewe benadering gevolg. Hierdie studie was in King Faisal Specialist Hospital in Jeddah, in Saudia Arabia gedoen. ’n Totale bevolking van 90 geregistreerde verpleegsters was betrokke. Vraelyste was versprei na die deelnemers en is naamloos beantwoord, sonder dat hulle identiteite op die vraelys aangebring is. Na voltooiing van die vraelyste, is dit in ’n houer geplaas en deur die navorser afgehaal. Die vrae is direk, eenvoudig, maklik verstaanbaar, ondubbelsinnig, nie-afleibaar, objektief opgestel en is daarop gemik om gesigspunte, ervaringe en persepsies oor dokumentering van verpleegsters te verkry. Betrokkenheid van deelnemers was vrywillig en nie afdwingbaar nie. Data is getabuleer en in histogramme en frekwensies voorgestel. Deur die Chi-square- toets te gebruik, is statisties betekenisvolle assosiasies tussen veranderlikes bepaal. Bevindinge sluit die volgende in:  Die hospitaalbeleid word toegepas N= 76(95%)  Prosedure t.o.v. dokumentering aangaande verpleegsorg word uitgedra N=67(83,7%)  Verpleegsters het aangedui dat dokumentering op papier, baie papierwerk behels N=45(56,3%)  Die Cerner (rekenaarstelsel) word beskou as die beste stelsel ooit in gebruik vir die dokumentering van verpleegsorg N==44(55%)  Die Mycare stelsel (medisyne bestellingstelsel) word beskou as betroubaar en gebruikersvriendelik, en een waarmee verpleegsters gelukkig is N=68(85%). Aanbevelings is gemaak, gebaseer op die volgende bevindinge:  Dit is steeds nodig dat verpleegsters die hospitaal se beleidsrigtinge geleer moet word  Verpleegsters moet die korrekte prosedure aangaande die dokumentering van die pasiënt se data geleer word  Verpleegklinici en bestuurders moet die Cerner nagaan ter voldoening van die dokumentering van fisiese waardebepalinge tydens ouditeringe  Die gebruik van papier vir verpleegdokumentering behoort afgeskaal te word deur van die praktyk van papierwerk na elektroniese dokumentering te skuif  Voortdurende bywerking van data, indiensopleiding en monitering van verpleegsters om hulle op die hoogte te hou van die dinamiese aard van rekenaargebruik  Hersiening van die stelsel, foutspeurdery en voorstelle van gebruikers moet op ’n voortdurende basis aandag geniet.

Thesis (MCur (Nursing Science))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: The work environment in critical care units in South Africa is hampered by a profound shortage of nurses, heavy workloads, conflict, high levels of stress, lack of motivation and dissatisfaction among the staff. The task of managing a C.C.U. has therefore become a challenge. It is important that unit managers apply a leadership style that matches these challenges. The aim of this study was to investigate the ideal style of leadership. The objectives set for the study were to identify the ideal leadership style required in the following areas:  administrative functions  education functions  patient care  research An explorative, descriptive research design was applied, with a quantitative approach to determine the ideal leadership style for unit managers in critical care units of private health care institutions. The research sample consisted of all nurses working permanently in eleven private hospitals in the Cape Metropolitan area. A questionnaire consisting of predominantly closed questions was used for the collection of data, which was collected by the researcher in person. Ethical approval was obtained from the Committee of Human Science Research at Stellenbosch University. Permission to conduct the research was obtained from the institutions and informed consent from the participants. A pilot study was conducted to test the questionnaire at a private hospital which did not form part of the study. A 10% sample of the relevant staff, namely 27 participants were involved in this study. The validity and reliability was assured through the pilot study and the use of a statistician as well as experts in nursing and a research methodologist. Data was tabulated and presented in histograms and frequencies. Statistical significant associations were drawn between variables, using the Chi-square test. The Spearman rank (rho) order correlation was used to show the strength of the relationship between two continuous variables. Findings of the study show that participatory leadership style and transformational leadership approach were valued in all four (4) of the objectives. Emphasis was placed on consultation prior to any decisions. Nurses requested an opportunity to give feedback on a regular basis regarding the unit managers conduct (Chi-square test p = 0.025). They also agreed that unit managers should apply the necessary rules and procedures (Chi-square test p = 0.016). A huge request was made for integrity, trust, impartiality, openness, approachability and particularly honesty. The nurses also maintained that the nurse manager’s behaviour should be congruent. Furthermore, the results indicate that nurses would like to be empowered by:  being involved in the scheduling of off-duties  taking the lead in climate meetings  being granted opportunities (to all categories of nurses) to attend managerial meetings. N = 41 (48.2%) of nurses admitted that unit managers would instruct them to cope with insufficient staffing pertaining to ventilated patients, putting them under severe strain and at risk legally. N = 39 (47%) of nurses admitted that unit managers only consider qualifications and experience in the delegation of tasks if the workload in the unit justifies it. Safe patient care is not always a priority. N = 99 (96%) of nurses agreed that autocratic behaviour relating to task delegation exists. Recommendations included the application of transformational leadership and participatory management. The aim to create a healthier, more favourable work environment for critical care nurses will hopefully be attained through applying the ideal leadership style and leadership approach. / AFRIKAANSE OPSOMMING: Die werksverrigtinge in kritieke sorgeenhede in Suid-Afrika word deur ‘n ernstige tekort aan verpleegsters, hoë werklading, konflik, spanning, min motivering en baie ontevredenheid onder verpleeglui gekortwiek. Die leiding en bestuur van ‘n kritieke sorgeenheid is dus nie ‘n maklike taak nie. Dit is dus belangrik dat eenheidsbestuurders ‘n leierskapstyl aan die dag lê wat dié uitdagings doeltreffend aanspreek. Die doel van die studie is dus om ondersoek in te stel na die wenslike leierskapstyl vir kritieke sorgeenhede. Die doelwitte daargestel is dus om die ideale leierskapstyl in elk van die volgende funksies te bepaal:  administrasie  opleiding  pasiënte-sorg  navorsing Die ideale leierskapstyl vir eenheidbestuurders in kritieke sorgeenhede in privaathospitale is bepaal deur ‘n kwantitatiewe benadering met ‘n beskrywende ontwerp toe te pas. Die populasie het alle kritieke sorg verpleeglui ( permanent werksaam by een van elf privaathospitale in die Kaapse Metropool) ingesluit. Instrumentasie het ‘n vraelys behels (met oorwegend geslote vrae) en data is persoonlik deur die navorser ingevorder. Etiese toestemming is vanaf die Etiese Komitee van die Mediese Fakulteit te Universiteit Stellenbosch verkry asook die hoofde van die verskillende privaathospitale waar navorsing plaasgevind het. Ingeligte toestemming is ook van elkeen van die deelnemers verkry. Ten einde die vraelys te toets, is ‘n loodstudie by ‘n privaathospitaal ( wat nie by die studie ingesluit was nie) gedoen. Die loodstudie het N = 27 (10%) van die totale populasie behels. Die betroubaarheid en geldigheid van die studie is deur die loodstudie, die gebruik van ‘n statistikus, verpleegdeskundiges en die navorser-metodoloog versterk. Data is getabuleer en in histogramme en frekwensies voorgestel. Deur die Chi-square- toets te gebruik, is statisties betekenisvolle assosiasies tussen veranderlikes bepaal. Ten einde sterkte van verhoudings tussen twee opeenvolgende veranderlikes te bepaal, is die Spearman rangordekorrelasie (rho) aangewend. Die bevindings van die studie het getoon dat ‘n deelnemende bestuurstyl en transformasie-leierskapbenadering die mees aangewese keuse vir al vier doelwitte is. Die toepassing van veral ‘n deelnemende besluitnemingsproses het groot voorrang geniet, Verpleegkundiges wil daarbenewens ook op ‘n gereelde basis geleentheid hê om terugvoering oor die leierskapgedrag van die eenheidsbestuurder te gee (Chi-square toets p = 0.025). Ook verlang die deelnemers dat eenheidsbestuurders nie reëls en regulasies moet verontagsaam nie (Chi-square toets p = 0.016). ‘n Ernstige versoek is gerig ten opsigte van integriteit met pertinente verwysing na eerlikheid, vertroue, onpartydigheid, deursigtigheid, toeganklikheid en dat die leier se woorde en dade moet ooreenstem. Die resultate het verder getoon dat verpleegsters graag bemagtig wil word deur:  betrokkenheid in die skedulering van afdienste,  leiding in klimaatsvergaderings te wil neem,  geleentheid te hê om bestuurvergaderings by te woon (alle kategorieë van verpleegkundiges).. N = 39 (48.2%) van verpleegkundiges het erken dat hulle gedwonge personeeltekorte ten opsigte van geventileerde pasiënte ervaar en dus aan mediese geregtelike risiko’s en onnodige druk blootgestel word. N 39 (47%) van verpleegkundiges het erken dat eenheidsbestuuders kwalifikasies en ondervinding slegs in ag neem indien die werklading in die eenheid dit toelaat..Veilige pasiëntesorg kry dus nie altyd voorkeur nie. N = 99 (96%) van verpleegkundiges het erken dat outokratiese gedrag ( wat met werkstoewysing verband hou) wel voorkom. ‘n Transformasie leierskapsbenadering en deelnemende bestuurstyl is dus aanbeveel. Die hoop word dus uitgespreek dat deur aan die verpleegkundiges se versoeke ten opsigte van die ideale bestuursbenadering en bestuurstyl te voldoen, die werksatmosfeer binne kritieke sorgeenhede toenemend gesonder en dus aangenamer sal word.

Thesis (MCur (Nursing Science))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Communication in nursing is to establish a nurse-patient relationship. Some nurses are quite effective at this whilst others are not so effective. The female patient diagnosed with cancer of the breast can face many dilemmas ranging from a physical, psychological and psychosocial domain. Nursing, being an interactive skill, requires the nurse to be able to communicate with the patient. The inability to communicate can hamper this very crucial relationship. For the purpose of this study it was decided to provide an in-depth account of the management of the nurse-patient communication in the ward. The rationale for choosing this setting (ward) were based on the comprehensive functions of a professional nurse and his/her ability to communicate. The objectives set for the study were to describe the manner in which professional nurses communicated with the patient diagnosed with cancer of the breast and who underwent a mastectomy, barriers that prohibited the communication and the patient’s perception of the communicative processes. A quantitative, exploratory and descriptive approach was applied to investigate and describe factors that influence communication between the patient with breast cancer and the professional nurse within a provincial hospital in the Western Cape. The total population included only female patients diagnosed with cancer of the breast who underwent a mastectomy and who were referred to the breast outpatient clinic. These female patients had to be diagnosed during a twenty month period as of January 2007 to August 2008 and had to be hospitalised within a ward setting after their diagnosis. The population size consisted of 27% of the total population with a 9% refusal rate. A survey was done using a six point Likert scale ranging from strongly disagree, disagree and mildly disagree to mildly agree, agree and strongly agree. The questionnaire consisting of close-ended questions were used for the collection of data and the researcher personally collected data. Ethical approval was obtained from the Committee of Human Science Research at Stellenbosch University and the Department of Health - Cape Town. Consent to conduct the research was obtained from the institution and informed consent from the participants. A pilot study was conducted to test the questionnaire which did form part of the study. A 10% sample of the population, namely 10 participants, was involved in this study. The validity and reliability was assured through the pilot study and the use of a statistician, experts in oncology nursing, an oncology doctor and the research methodologist. Data was tabulated and presented in histograms and frequencies. Statistical significant associations were drawn between variables, using the Chi square test. The Spearman rank (rho) order correlation was used to show the strength of the relationship between two continuous variables. Findings included statistical significance between the level of schooling and the nurse, who took the respondents at face value and communicated what she deemed necessary (rho=0.29, p=0.00). The respondents also showed concern and disagreed that the ward nurses provide their family with relevant information (p=0.00). R ecommendations include:  Nursing education should include a module in communication on a graduate and post graduate level  In-service training programmes should focus on the interpersonal relationship between the nurse and the patient and the importance thereof.  Continuous Quality Improvement should include patient satisfaction surveys.  Awareness campaigns about the importance of communication between the patient and the health professional should be conducted  Developing protocols and policy guidelines that can assist the nursing staff with the communication process. Since communication is an interactive process it requires skillful conduct. Nurses need to realize the importance communication plays in the health sector and the impact it has on patients, irrespective of whether it is from a verbal or non-verbal content. Effective communication or not can have an everlasting impact. / AFRIKAANSE OPSOMMING: Kommunikasie in verpleging behels die vestiging van ’n verpleegster-pasiënt verhouding. Sommige verpleegsters is taamlik effektief hierin, terwyl andere nie so effektief is nie. Die vroulike pasiënt wat met borskanker gediagnoseer is, kan baie dilemmas in die gesig staar wat wissel van ’n fisiese, psigologiese tot ’n psigo-sosiale domein. Verpleging, wat ’n interaktiewe vaardigheid is, vereis dat die verpleegster met die pasiënt moet kan kommunikeer. Die onvermoë om te kan kommunikeer, kan hierdie beslissende verhouding belemmer. Vir die doel van die studie is besluit om ’n indringende verslag van die bestuur van die verpleegster-pasiënt kommunikasie in die saal te doen. Die rasionaal vir die keuse van die omgewing (saal) is gebaseer op die komprehensiewe funksies van ’n professionele verpleegster en sy/haar vermoë om te kan kommunikeer. Die doelstellings wat uiteengesit is vir hierdie studie is om die manier te beskryf waarop professionele verpleegsters met die pasiënt wat met borskanker gediagnoseer is, en wat ’n mastektomie ondergaan het, omgaan, asook die hindernisse wat kommunikasie en die pasiënt se persepsie van die kommunikatiewe prosesse belemmer het. ’n Kwantitatiewe, verkennende en beskrywende benadering is toegepas om faktore te ondersoek en te beskryf wat kommunikasie tussen die pasiënt met borskanker en die professionele verpleegster in ’n provinsiale hospitaal in die Wes-Kaap beïnvloed. Die totale bevolking het slegs vroulike pasiënte wat met kanker gediagnoseer is en ’n mastektomie ondergaan het en na die bors buite-pasiënt kliniek verwys is, ingesluit. Hierdie vroulike pasiënte moes gedurende ’n periode van twintig maande vanaf Januarie 2007 tot Augustus 2008 gediagnoseer en gehospitaliseer gewees het in ’n saalomgewing na hul diagnose. Die bevolking grootte het bestaan uit 27% van die totale bevolking met ’n 9% verwerpingskoers. ’n Opname was gedoen wat die ses punt Likert skaal gebruik wat wissel vanaf sterk verskil van mening, verskil en effense verskil van mening tot effens saamstem, saamstem en sterk saamstem. Die vraelys wat uit geslote vrae bestaan, was gebruik vir die insameling van data en die navorser het die data persoonlik gekollekteer. Etiese goedkeuring was verkry van die Raad vir Geesteswetenskaplike navorsing aan die Universiteit van Stellenbosch en die Departement van Gesondheid – Kaapstad. Toestemming om die navorsing uit te voer is verkry van die inrigting en ingeligte toestemming van die deelnemers. ’n Loodsprojek is uitgevoer om die vraelys te toets wat deel van die navorsing uitgemaak het. ’n 10% Steekproef van die bevolking, naamlik 10 deelnemers, was betrokke by die studie. Die geldigheid en betroubaarheid was verseker deur die loodsprojek en die gebruik van ’n statistikus, kenners in onkologie verpleging, ’n onkologiese dokter en die navorsingsmetodoloog. Data is getabulleer en aangebied in histogramme en frekwensies. Statistiese beduidende assosiasies is gemaak tussen veranderlikes, deur gebruik te maak van die Chi-kwadraat toets. Die Spearman rang (rho) orde korrelasie is gebruik om die sterkte van die verhouding tussen die aaneenlopende veranderlikes te wys. Bevindings het statistiese beduidendheid ingesluit tussen die vlak van geleerdheid en die verpleegster wat die respondente op sigwaarde geneem het en die kommunikasie wat sy noodsaaklik gevind het (rho=0.29, p=0.00). Die respondente het ook besorgdheid getoon en het nie saamgestem dat die saalverpleegsters hul gesinne van die relevante inligting voorsien het nie (p=0.00). A anbevelings sluit in:  Verpleegopleiding behoort ’n module in kommunikasie op graad en nagraadse vlak in te sluit.  Indiensopleidingsprogramme behoort te fokus op die interpersoonlike verhouding tussen die verpleegster en die pasiënt en die belangrikheid daarvan.  Deurlopende kwaliteitsverbetering behoort pasiënt tevredenheidsopnames in te sluit.  Bewusmakingsveldtogte oor die belangrikheid van kommunikasie tussen die pasiënt en die gesondheidsprofesioneel behoort geloods te word.  Protokolle en beleidsriglyne wat die verpleegpersoneel kan help met die kommunikasie proses behoort ontwikkel te word. Sienende dat kommunikasie ’n interaktiewe proses is, word vaardige gedrag geverg. Verpleegsters behoort die belangrikheid wat kommunikasie speel in die gesondheidssektor te besef en die impak wat dit op die pasiënte het, ongeag of dit verbaal of nie-verbaal is. Effektiewe kommunikasie aldan nie, kan ’n ewigdurende impak hê.

Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Critical care nursing is the specialty within nursing that deals with an individual's response to life-threatening problems. These life threatening problems require continuous in-depth assessment and intense therapeutic measures and interventions. The level of nursing care is intense and the amount of documentation is enormous in the intensive care unit. Failure to document any aspects, may threaten the continuity of care and patient safety. Furthermore, it may result in negligence that may result in litigation. The purpose of this study was to retrospectively analyse nursing documentation in the intensive care units of an academic hospital in the Western Cape. The objectives set for this study were to determine whether the documentation of the: • assessment of the patients were adequate; • diagnoses were based on the assessment; • nursing care plans were based on the diagnoses; • nursing care plans were implemented and • nursing care plan shows evidence of continuous evaluation A retrospective exploratory- descriptive research design with a quantitative approach was applied to audit objectively the status of nursing documentation of patients who were admitted to the ICU’s of an academic hospital in the Western Cape in the first 48 hours of admission. Ethical approval was obtained from the University of Stellenbosch and consent from the Chief Executive Officer of the academic hospital to conduct the research in the hospital under study. The research population (N) was the documentation (files) of patients admitted in the ICU’s between 1 July 2008 and 31 December 2008. A stratified sample was drawn consisting of 151 files. The researcher collected the data personally utilising a pretested audit instrument. The reliability and validity was assured through experts in nursing science and intensive care nursing, a statistician and a research methodologist. A pilot study was conducted to pretest the instrument and the feasibility of the study. Modifications to the instrument were done based on suggestions from the experts and findings of the pilot study. Data analysis included statistical associations between variables using the Chi-square test on a 95% confidence level. Data is presented in the form of figures, tables and frequencies. The findings of the study show that the nursing documentation in the intensive unit is inadequate with the following total mean scores: • Assessment 62.6% • Nursing diagnosis 53.1% • Nursing care plans 37.1% • Implementation 72.6% • Evaluation 40.5%. In conclusion nursing documentation of patients admitted to an ICU is inadequate during the first 48 hours of admission. Poor documentation threatens the safety of patients and demands urgent improvement. Recommendations to improve the documentation include nursing practice supervision, quality improvement programmes, in-service training, evidence based practice and further research. / AFRIKAANSE OPSOMMING: Kritieke-sorg verpleging is die spesialiteit in verpleging wat betrekking het op die individu se reaksie.op lewensgevaarlike probleme.Hierdie lewensgevaarlike probleme benodig deurlopend deeglike beraming en intense terapeutiese benaderings en intervensies. In die intensiewesorg eenheid is die vlak van verpleegsorg baie intens en die dokumentasie hoeveelheid is enorm. Versuim om enige aspekte van sorg deeglik en akkuraat te dokumenteer, kan die deurlopendheid van sorg sowel as die veiligheid van die pasient bedreig. Verder kan dit tot regsstappe lei as gevolg van nalatigheid. Die doel van hierdie studie was om ‘n retrospektiewe analise van verpleeg dokumentasie in die intensiewe sorgeenhede van ‘n akademiese hospitaal in die Wes Kaap te doen. Die doelwitte van hierdie studie was om vas te stel of die dokumentasie van die: • beraming van die pasiênt voldoende gedoen is • verpleegdiagnose gebaseer is op die beraming • verpleegsorgplan gebaseer is op die diagnose • implementering van die verpleegsorgplan en • verpleegsorgplan bewyse toon. van deurlopende evaluasie ‘n Retrospektiewe eksploratiewe-beskrywende navorsingsontwerp met ‘n kwantitatiewe benadering is toegepas ten einde die status van verpleegdokumentasie van pasiente wat toegalaat is tot die intensiewesorg eenhede van ‘n akademiese hospitaal in die Wes Kaap in die eerste 48 uur na toelating te bepaal. Etiese goedkeuring is verkry van die Universiteit van Stellenbosch asook vanaf die Hoof Uitvoerende Beampte van die akademiese hospitaal om die navorsing daar uit te voer. Die navorsings populasie (N) was die dokumentasie (lêers) van die pasiente wat opgeneem is in die intensiewesorg eenheid tussen 1 Julie 2008 en 31 Desember 2008. ‘n Gestratifieerde steekproef is getrek bestaande uit 151 lêers. Die navorser het die data persoonlik kollekteer deur gebruik te maak van ‘n voortoets oudit instrument. Die betroubaarheid en geldigheid is verseker deur kundiges in verpleegkunde en intensiewesorg verpleging, asook ‘n statistikus en ‘n navorsingsmetodoloog. ‘n Loodstudie is gedoen om die instrument vooraf te toets en om die uitvoerbaarheid van die navorsing te bepaal. Veranderinge is aangebring op grond van die voorstelle van die kundiges sowel as die bevindinge van die loodstudie. Data analise het ingesluit die statistiese assosiasies tussen veranderlikes deur gebruik te maak van die Chi-kwadraat toets tot ‘n 95% sekerheidsvlak. Data is aangebied in die vorm van figure, tabelle en frekwensies. Die bevindinge van die studie wys dat die verpleegdokumentasie in die intensiewesorg eenheid is onvoldoende met die volgende gemiddelde telling: • Beraming 62.6% • Verpleegdiagnose 53.1% • Verpleegsorgplanne 37.1% • Implementering 72.6% • Evaluering 40.5% Ten slotte, verpleegdokumentasie van pasiënte wat tot die intensiewesorg eenheid toegelaat is, is onvoldoende gedurende die eerste 48 uur van toelating. Swak dokumentasie bedreig die veiligheid van pasiënte en verg dringende verbetering. Aanbevelings om die dokumentasie te verbeter sluit in toesig oor verpleegpraktyke kwaliteit verbeteringsprogramme, indiensopleiding, bewysgebaseerde praktyke en verdere navorsing.

Thesis (MCur)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: Informal discussions and the work experience of the researcher in the field of health care raised concerns about the problems regarding the sexual health of adolescents. This demonstrated the need for an integrated health care system to promote adolescent sexual health. Against this background the study was undertaken to: • Identify the attitudes of adolescents towards sexual health. • Determine their knowledge of sexual health • Determine what the practice of sexual health by adolescents entail. • Provide recommendations where applicable. Triangulation, which is a combination of qualitative and quantitative research methods, was used. The findings reflected the following: • A positive attitude towards sexual health, but adolescents are involved in high risk sexual behaviour. • Sub-optimal knowledqë regarding sexual issues. • A need for sexual education by parents and health workers, especially nurses. The following recommendations, are proposed: • Sex education should start at an age as early as possible, at home, by parents. • Health workers should be trained to give proper information and advice to adolescents about their sexual health. • Condoms should be freely available and accessible to all the people of Namibia. • Adolescents should be actively involved in the promotion of their own sexual health. Keywords: Prevention of teenage pregnancy I Sexually transmitted diseases I HIV I AIDS and Sex education. / AFRIKAANSE OPSOMMING: Informele besprekings en praktiese ervaring van die navorser in die gesondheidsorgveld het probleme rakende die seksuele gesondheid van adolessente uitgewys. Dit het gedui op die behoefte aan 'n geïntegreerde gesondheidsorgsisteem ten einde die seksuele welsyn van adolessente te bevorder. Teen dié agtergrond is die studie onderneem om: • Die houding van adolessente teenoor seksuele welsyn te bepaal. • Die kennis van adolessente omtrent seksuele welsyn te bepaal. • Te bepaal wat die praktyk van seksuele welsyn van adolessente behels. • Aanbevelings soos van toepassing te maak. Die metode van triangulasie, wat 'n kombinasie van 'n kwalitatiewe en kwantitatiewe navorsingsmedotiek is, is gebruik. Die bevindings reflekteer die volgende: • 'n Positiewe houding jeens seksuele gedrag, maar adolessente is betrokke by riskante seksuele ged rag. • Suboptimale kennis ten opsigte van seksuele kwessies. • 'n Behoefte aan seksuele onderrig deur ouers en gesondheidswerkers, veral verpleegkundiges. Die volgende aanbevelings word voorgestel: • Onderrig ten opsigte van seksuele gedrag moet op die jongste moontlike ouderdom deur die ouers tuis gedoen word. • Gesondheidswerkers moet opgelei word om die regte en relevante advies en inligting aan adolessente oor te dra rakende hul seksuele gesondheid. • Kondome moet vrylik beskikbaar en bekombaar wees vir alle inwoners van Namibië.Adolessente moet aktief betrokke wees in die bevordering van hul eie seksuele welsyn. Sleutelwoorde: Voorkoming van tienerswangerskappelseksueel oordraagbare siektes I MIV I VIGS en seksuele voorligting.

Thesis (Mcur)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: The researcher has identified several problems in the North West Health Directorate community of Namibia regarding malaria and malaria related deaths. Against this background the study was undertaken to: • Identify the attitude(s) of the community towards malaria. • Determine the community's knowledge of malaria. • Determine the prevention strategies the community employed to guard against malaria. • Make recommendations. Methodological triangulation was used to obtain data and the findings reflected the following: • Lack of knowledge about malaria, its causes, management and prevention due to lack of adequate health information. • Socio-cultural factors have an influence on the community's knowledge of malaria, their attitudes towards malaria and on strategies employed by the community to prevent malaria. Recommendations included provision of proper and adequate health information to the community by health workers, increasing community participation in order to enhance attitude change and co-ordination and collaboration between traditional healers and the Ministry of Health and Social Services. Keywords: malaria I community I prevention I knowledge I attitudes / AFRIKAANSE OPSOMMING: Die navorser het verskeie probleme rakende malaria en malaria verwante sterftes in die gemeenskap van die Noordwes Gesondheidsdirektoraat van Namibië geïdentifiseer. Teen hierdie agtergrond is die studie gedoen om: • Die houding van die gemeenskap teenoor malaria te identifiseer. • Die gemeenskap se kennis omtrent malaria te bepaal. • Die voorkomende strategieë wat die gemeenskap toepas om malaria te voorkom te bepaal. • Aanbevelings te maak. Metodologiese triangulasie is gebruik om data te verkry en die bevindinge het die volgende gereflekteer: • Gebrek aan kennis aangaande malaria, die oorsake, hantering en voorkoming van malaria as gevolg van 'n gebrek aan voldoende gesondheidsinligting. • Sosio-kulturele faktore beïnvloed die gemeenskap se kennis van malaria, hul houding teenoor malaria en die strategieë wat hul toepas om malaria te voorkom. Aanbevelings sluit in die voorsiening van korrekte en voldoende gesondheidsinligting aan die gemeenskap deur gesondheidswerkers, verhoging van gemeenskapsdeelname om houdingsveranderinge teweeg te bring asook om die koërdinasie en samewerking tussen tradisionele helers in die Ministerie van Gesondheid en Welsyn te verbeter. Sleutelwoorde: malaria I gemeenskap I voorkoming I kennis I houding.

Thesis (MCUR)--University of stellenbosch, 2001. / ENGLISH ABSTRACT: In trauma the priority is given to identifying the life-threatening injuries and immediately implementing treatment (Demetriades, 1993:3). Severe trauma resuscitation and assessment often have to be carried out simultaneously to detect and treat conditions that are rapidly fatal if not attended to immediately and according to priority. Urgent priorities in trauma management include maintaining a clear and patent airway to facilitate respiration and cervical spine protection by avoiding rough manipulation of the head and neck by supporting the neck with a neck immobiliser. Any external bleeding has to be controlled by applying direct pressure to the wound. Cardiovascular problems, for example shock or myocardial infarction, respiratory problems and hypoxia which are detrimental, particularly in the case of head injury, should be excluded. A detailed head-to-toe examination which includes the head, neck, chest, abdomen, back, musculo-skeletal system, rectum and vagina has to be performed. For the head-injured patient, correct any condition, which may complicate the existing head injury, for example hypoxia, shock, pneumothorax and fractures of long bones or pelvis. Implement the A (airway), B (breathing), C (circulation), D (disability, neurological and drugs) and E (environment) for structured management of the patient. Muller's, (1996) two-phase model was utilised to formulate and validate nursing outcome standards. In phase one literature was explored to develop provisional standards on polytrauma patients with traumatic brain injuries. In phase two the provisional standards were validated by experts (doctors and nurses) in critical care, trauma and emergency nursing including nurses and a doctor working in the casualty department of a provincial hospital in Mafikeng. Final standards were formulated and adapted accordingly. Standards for the management of a polytrauma patient with traumatic brain injuries included: A safe environment for patients, nurses and doctors Primary survey in casualty department which includes the maintenance of airway, breathing, circulation, disability/ neurological, drugs and exposure The secondary survey that includes the head to toe examination, definitive orthopaedic care and stabilisation before transfer to the intensive care unit A standard on all relevant equipment which might be needed in case the patient goes into cardiac arrest on the way to the intensive care unit, was also formulated. The standard on documentation included the primary and secondary survey in the casualty department, transport to the intensive care unit, activities and the condition of the patient. The final standards dealt with the accurate handing over of the patient to the intensive care personnel. The following recommendations were made: • Implement the outcome standard by means of a quality improvement programme through a top-down approach. • Provide training: Nurses and doctors have an obligation to render quality care, therefore they have the right to be trained in emergency procedures. • All registered nurses working in the casualty or emergency departmentsshould be trained in at least Basic Life Support (CPR), Advanced Cardiac Life Support (ACLS), Advanced Paediatric Life Support (APLS) and Advanced Trauma Life Support (ATLS) while waiting to be sent for the trauma-nursing course. • Improve infection control measures in the casualty department • Emergency drugs must always be available. • Improve the on-call system. • Formulate a policy on sharing of the equipment by both casualty and ICU staff. • Motivate for the necessary equipment. Implement procedures for debriefing of staff, the evaluation of actions during resuscitation and implement measures for psychological support of the family. • For further research, implement and test a training programme whereby nurses can formulate their own standards. • Evaluate whether the standards have improved the quality of trauma care, and develop standards for leu nursing of the brain injured patient and the rehabilitation of polytrauma patients with traumatic brain injuries The uniqueness of the study lies in the fact that no formal outcomes standard for trauma patients with traumatic brain injuries have been developed in any of the North West Provincial hospitals. / AFRIKAANSE OPSOMMING: Die identifisering van lewensbedreigende beserings en die onmiddellike implementering van behandeling, is in trauma 'n eerste prioriteit (Demetriades, 1993: 3). Resussitasie en die beraming van erge traumagevalle noodsaak in baie gevalle, gelyktydige hantering. Sou hierdie hantering nie gelyktydig en onmiddellik volgens prioriteit plaasvind nie, kan dit noodlottige gevolge inhou. Belangrike prioriteite in traumabehandeling sluit in, die instandhouding van 'n patente lugweg om asemhaling te onderhou asook die beskerming van die servikale rugmurgkolom, deur die ruwe manipulasie van die kop en nek te vermy deur die implementering van 'n nekimmobiliseerder. Kardiovaskulere probleme, byvoorbeeld skok of miokardiale infarksie, asook respiratoriese probleme wat lewensbedreigend vir die pasient met 'n hoofbeseering is, moet uitgesluit word. 'n Gedetailleerde van kop-tot-tone ondersoek, wat die kop, nek, borskas, abdomen, rug, muskulo-sketale stelsel, rektum en vagina insluit, moet uitgevoer word. In die pasient met hoofbeserings moet enige toestand byvoorbeeld frakture van die langbene of die pelvis, skok of 'n pneumothorax, eers behandel word. Implementeer die A (Iugweg - "airway"), B (asemhaling - "breathing"), C (sirkulasie -"circulation"), D (gestremdheid - "disability", neurologies- "neurological" en drogerye-"drugs") en E (omgewing - "environment") vir die gestruktureerde behandeling van die pasient. Die twee fase model van Muller (1996) is gebruik vir die formulering en validering van die verpleeguitkomsstandaarde. In fase een is die literatuur verken om die voorlopige standaarde vir polytrauma pasiente met traumatiese breinbeserings te ontwikkel. In fase twee is die voorlopige standaarde gevalideer deur kundiges (dokters en verpleegkundiges) in kritieke sorg, trauma en noodverpleging. Die verpleegkundiges en dokter wat werksaam is in die ongevalle-eenheid van 'n plaaslike provinsiale hospitaal in Mafikeng is ook ingesluit. Finale standaarde is geformuleer en dienooreenkomstig aanvaar. Die standaarde vir die politrauma pasient met traumatiese breinbeserings, sluit in: 'n Veilige omgewing vir pasiente, verpleegkundiges en dokters. Die prirnere beraming in ongevalle ten opsigte van instandhouding van die lugweg, asemhaling, sirkulasie, gestremdheid, drogerye en blootstelling. Die sekondere beraming: wat behels die kop-tot-tone ondersoek. Definitiewe ortopediese behandeling en stabilisering voor oorplasing na die intensiewe-sorg-eenheid. 'n Standaard met betrekking tot die nodige toerusting wat benodig mag word tydens 'n hart stilstand, oppad na die intensiewe-sorg-eenheid, is ook geformuleer. Die standaard ten opsigte van dokumentasie sluit die primere, en sekondere beraming, vervoer na die intensiewe-sorg-eenheid, aktiwiteite en toestand van die pasient, in. Die finale standaarde is gebaseer op die oorhandiging van die pasient aan die intensiewe-sorg-personeel. Die volgende aanbevelings word gemaak: • Implementeer die uitkomsstandaarde deur middel van 'n gehalteverbeteringsprogram deur gebruik te maak van 'n "top-down" benadering -, • Voorsien opleiding: Verpleegkundiges en dokters het 'n verpligting om gehaltesorg te lewer, hulle het dus 'n reg om onderrig te ontvang in noodprosedures, en verder het die pasient die req op gehalter noodbehandeling. • Aile geregistreerde verpleegkundiges wat in die ongevalle en die noodafdeling werk, behoort opgelei word in ten minste basiese lewensondersteuning (CPR), Gevorderde Trauma Lewens Ondersteuning (ACLS), Gevorderde Pediatriese lewensondersteuning (APLS) en Gevorderde Trauma lewensondersteuning (ATLS), terwyl gewag word om die trauma verpleegkundigekursus te deurloop. • Verbeter mteksiebeheermaatreels in ongevalle. • Noodmedikasie moet ten aile tye beskikbaar wees. • Verbeter die op-roepstelsel ("on cali"). • Formuleer 'n beleid oor die gesamentlike gebruik van toerusting deur beide ongevalle- en intensiewe-sorg-eenheid-personeel. • Motiveer vir die nodige toerusting. • Implementeer prosedures om personeel to te laat vir ontlonting (debriefing), die evaluering van aksies tydens die resusitasie prosedure en implementeer metodes vir die sielkundige ondersteuning van die familie. • Ten opsigte van verdere narvorsing behoort 'n opleidingsprogram qeunplernenteer en getoets te word met betrekking tot verpleegkundiges wat hulle eie standaarde will formuleer. • Evalueer of die standaarde die gehalte van traumasorg verbeter het en ontwikkel standaarde vir intensierwe-sorg-verpleging van die breinbeseerde pasient asook die rehabilitasie van politrauma pasiente met traumatise breinbeesering. Die unieke bydra van die studie word gevind in die feit dat daar nog geen gerformaliseerde uitkomstandaarde vir traumapasiente met breinbeseerings in enige van die Noord Wes Provinsie se hospitale ontwikkel is nie.

Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: South Africa’s Department of Health has stated that knowledge about contraception and reproduction is generally poor, mentioning the substantial uncertainty and misperceptions concerning contraception (Department of Health, 2003:10). Students in higher education institutions are presumed to have a generally higher level of awareness of accessible methods regarding contraception and emergency contraception, but the request rate for the termination of pregnancy among students in higher education remains high (Roberts et al., 2004:441). The researcher identified a need for a study to assess students’ knowledge of contraception and emergency contraception. The goal of this study was to explore the scope of undergraduate students’ knowledge on the matter and to determine to what extent students make use of contraception and emergency contraception. In this study a quantitative approach with an explorative-descriptive research design was applied. The target population of this study included all the full-time undergraduate students at a particular university in South Africa (N=15 872). A non probability, convenience sample was used to select a sample size of 200 undergraduate students at the particular university. Reliability and validity were assured by means of a pilot test conducted over a period of two weeks. The researcher personally collected the data which was gathered by means of self-administered questionnaires. Ethical clearance for this study was obtained from the University Health Research Ethics Committee. As university students were involved this study, consent was also obtained from the university’s Director of Institutional Research. The raw data was entered on a Microsoft Excel spreadsheet. A statistician from the University Centre for Statistical Consultation was consulted regarding the analysis of the data by making use of Statistica version 9-software. Quantitative data was presented in histograms and tables, while qualitative data was analysed by means of Tesch’s approach. The overall conclusion was that students at a higher education institution generally had a sound knowledge of contraception, but that their knowledge of emergency contraception was poor. The overall recommendation was that students should be provided with accurate, specific information regarding contraception and emergency contraception, and that this information would need to be user friendly, easily accessible and widely available in order to decrease students’ misperceptions about contraception. / AFRIKAANSE OPSOMMING: Suid-Afrika se Departement van Gesondheid het die stelling gemaak dat kennis oor kontrasepsie en voortplanting oor die algemeen gebrekkig is en dat daar baie onsekerheid en wanopvattings oor kontrasepsie bestaan (Department of Health, 2003:10). Studente aan hoëronderwysinstellings is veronderstel om ‘n algemene hoër vlak van bewustheid te hê omtrent toeganklike metodes van kontrasepsie en noodkontrasepsie, maar die aantal versoeke vir die terminasie van swangerskappe is steeds hoog onder hoëronderwysstudente (Roberts et al., 2004:441). Die navorser het die behoefte geïdentifiseer aan `n studie om studente se kennis betreffende kontrasepsie en noodkontrasepsie te bepaal. Die doel van die studie was om die omvang van studente se kennis te ondersoek en vas te stel tot watter mate voorgraadse studente van kontrasepsie en noodkontrasepsie gebruik maak. In hierdie studie is ‘n kwantitatiewe benadering met ‘n ondersoekend-beskrywende navorsingsontwerp gevolg. Die teikenpopulasie van die studie het alle voltydse voorgraadse studente aan ‘n Universiteit in die Wes-Kaap (N=15 872) ingesluit. ‘n Niewaarskynlike, gerieflikheidsteekproef is gebruik om ‘n steekproefgrootte van 200 uit die voorgraadse studente van die betrokke universiteit te selekteer. Betroubaarheid en geldigheid is deur ‘n loodsstudie verseker. Die loodsstudie het oor ‘n periode van twee weke plaasgevind. Die navorser het die data wat deur middel van self-geadministreerde vraelyste ingewin is, persoonlik ingesamel. Etiese toestemming vir die studie is van die universiteit se Etiese Komitee vir Gesondheidsnavorsing verkry. Aangesien universiteitstudente by die studie betrokke was, is toestemming ook van die Direkteur van Institusionele Navorsing van die betrokke universiteit bekom. Die rou data is op ‘n Microsoft Excel werkblad ingevoer. ‘n Statistiese ontleder van Stellenbosch Universiteit se Sentrum vir Statistiese Konsultasie is geraadpleeg omtrent die analise van data met behulp van Statistica weergawe 9-sagteware. Kwantitatiewe data is voorgestel deur histogramme en tabelle, en die kwalitatiewe data is geanaliseer deur middel van Tesch se benadering. Die hoofbevindinge was dat studente aan ‘n hoëronderwysinstelling se kennis van kontrasepsie oor die algemeen goed was, maar dat hulle nie voldoende kennis oor noodkontrasepsie gehad het nie. Die hoofaanbeveling was dat studente voorsien moet word van akkurate, spesifieke inligting rakende kontrasepsie en noodkontrasepsie, en dat die inligting verbruikersvriendelik, maklik toeganklik en wyd beskikbaar moet wees om studente se wanopvattings ten opsigte van kontraseptiewe middels te verminder.