Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Haematopoietic stem cell transplantation has become an increasingly popular treatment option for persons with life-threatening blood related diseases such as leukemia, lymphoma, myeloma and certain forms of anaemia. Due to this new therapy the use of bone marrow from a healthy individual also called a living donor for transplantation is inevitable. These living donors can experience psychological and economic issues and these components needs to be addressed in the transplant protocol. The researcher described the psychosocial factors that influenced sibling donors during allogeneic bone marrow transplantation at a public sector hospital in Cape Town, whether the transplant team members explained the administrative process of the transplant in an understandable manner and language and the effect of the psychosocial factors and administrative process of the allogeneic bone marrow transplantation on the sibling donors. A quantitative research approach with a descriptive design was used in this study. The sample was selected by means of full population sampling. The final sample size of (n=64) stem cell sibling donors over 18 years of age participated in the study. A self-reporting questionnaire was used to gather data, inclusive of four open-ended questions to establish an in depth sense of what the donor experiences during the bone marrow donation process. Descriptive statistics used to describe the variables included frequency distributions in the form of histograms and frequency tables. The Pearson chi-square statistical analysis test was used to test for relationships amongst groups. The study drew on the Roy Adaptation Model (RAM) as the theoretical framework to explain the phenomena surrounding the psychosocial and administrative effect of the transplantation process on the sibling donor. Based on the findings the haematopoietic stem cell donors coped with the psychosocial impact of the donation process by making use of their coping mechanism to adapt to their situation according to the Roy Adaptation Model. This model also offers guidance to the nurses to apply this model to nursing practice. Results revealed that sibling donors developed feelings of anxiety in relation to the invasive procedures that cause them to experience physical pain. Most respondents claimed that they were not psychologically affected by the donation process. The moral obligation the sibling donor has towards his sister or brother outweighed the physical pain or discomfort experienced during the donation process. Results revealed that the responding donors claimed they were well informed regarding the donation process and understood the treatment plan of the recipient. However, results revealed that there was a lack in visual donor information such as books, pamphlets as well as internet information. Results concerning the demographics revealed that (n=29) respondents had no schooling and some respondents had some schooling which can give an indication of how to bridge the knowledge and information gap between them and the donor in terms of language. Statistical significance results regarding the emotional state and economic situation of the donors was found. Some of the respondents were responsible for their own transport and their own accommodation, some of those that are employed were responsible for leave without pay. An organ donation policy needs to be developed to prevent live organ donors from losing valuable working hours that could result in loss of salary and should provide other financial incentives. Furthermore, a lack in a post-donation follow-up medical to alleviate and detect post-donation complications was identified. Further nursing research can help nurses to understand living donation for transplantation, also how the nurses that practice in organ transplant units experience and deal with the psychosocial factors that influence them particularly. / AFRIKAANSE OPSOMMING: Hematopoïetiese stamseloorplanting het ’n toenemend gewilde-behandelingsopsie vir persone met lewensgevaarlike bloedverwante siektes soos leukemie, limfoom, miëloom en sekere soorte anemie geword. Vir hierdie tipe terapie word die beenmurg van ’n gesonde individu, ook bekend as ’n lewende skenker, vir oorplanting gebruik. Lewende skenkers kan sielkundige en ekonomiese probleme ervaar en hierdie kwessies moet in die oorplantingsprotokol hanteer word. In hierdie studie is ondersoek ingestel na die psigososiale faktore wat bloedverwante skenkers tydens allogeneïese beenmurgoorplanting by ’n openbare hospitaal in Kaapstad beïnvloed, of die oorplantingspan die administratiewe proses van die oorplanting op ’n verstaanbare manier en in verstaanbare taal verduidelik het, en wat die uitwerking wat die psigososiale faktore en administratiewe proses is op die bloedverwante skenkers tydens allogeneïese beenmurgoorplanting. ’n Kwantitatiewe benadering met ’n beskrywende navorsingsontwerp is in hierdie studie gebruik. Die steekproef is op grond van volledige populasiesteekproefneming gekies. ’n Finale steekproefgrootte van stamselskenkers (n=64) ouer as 18 jaar het aan die navorsing deelgeneem. ’n Selfverslaggewende vraelys is gebruik om data in te samel, wat vier oop vrae ingesluit het om grondige begrip te verkry van wat die skenker tydens die beenmurgskenkingsproses ervaar. Beskrywende statistiek wat gebruik is om die veranderlikes te beskryf, sluit in frekwensie-verspreidings in die vorm van histogramme en frekwensie-tabelle. Die Pearson chi-kwadraat- statistieseanalise is gebruik om die verwantskappe onder groepe te toets. Die Roy Adaptation Model (RAM) is as die teoretiese raamwerk vir die studie gebruik om die verskynsels betrokke by die psigososiale en administratiewe ervaring van die oorplantingsproses vir die bloedverwante skenker te verklaar. Op grond van die bevindinge het die hematopoïetiese stamselskenkers die psigososiale impak van die skenkingsproses hanteer deur gebruik te maak van hulle hanteringsmeganisme om by hulle situasie aan te pas, wat met die RAM ooreenstem. Hierdie model bied ook leiding aan verpleegkundiges om dit in die verplegingspraktyk toe te pas. Resultate het getoon dat bloedverwante skenkers gevoelens van angs ontwikkel het vanweë die indringende prosedures, wat fisiese pyn veroorsaak het. Die meeste deelnemers het aangedui dat hulle nie sielkundig deur die skenkingsproses geraak is nie. Die morele verpligting wat die bloedverwante skenker het teenoor sy of haar broer of suster het die fisiese pyn of ongemak gedurende die skenkingsproses oortref. Resultate het getoon dat die deelnemende skenkers aangedui het dat hulle goed ingelig was oor die skenkingsproses en die behandelingsplan van die ontvanger verstaan het. Die resultate dui egter daarop dat daar ’n gebrek was aan visuele skenkersinligting soos boeke, pamflette en internet-inligting. Resultate rakende die demografie het bewys dat van die deelnemers (n=29) ongeskoold en sommige deelnemers laag geskoold is, wat ’n aanduiding kan gee van hoe die kennis- en inligtingsgaping tussen hulle en die skenker ten opsigte van taal oorbrug kan word. Statisties beduidende resultate rakende die emosionele toestand en ekonomiese situasie van die skenkers is gevind. Sommige deelnemers was verantwoordelik vir hulle eie vervoer en verblyf. Diegene wat werk, het verlof sonder betaling geneem. ’n Orgaanskenkingsbeleid moet ontwikkel word om te verhoed dat lewende orgaanskenkers kosbare werksure verloor, wat kan lei tot ’n verlies aan salaris. Ander finansiële aansporings behoort ook gegee te word. Voorts is ’n gebrek aan opvolg mediese behandeling vir skenkers om skenkingskomplikasies vas te stel en te verlig, geïdentifiseer. Voortgesette navorsing kan verpleegkundiges help om begrip te verkry van die implikasies van lewende orgaanskenking. Verpleegkundiges wat in hierdie orgaanoorplantings- eenhede werksaam is, kan ‘n beter begrip kry van die psigososiale faktore wat hierdie skenkers spesifiek beïnvloed.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The university environment provides many opportunities to be sexually active. University students are reported as tending to engage in high-risk behaviours related to sex, alcohol and drugs. First-year university students are reported to be most vulnerable, as they lack experience to make good and risk-aware decisions when it comes to sexual liaisons. Available initiatives aimed at improving sexual behaviours of students are reported as being implemented simply because they work well somewhere else, without prior assessment of the needs/characteristics of the target population. This can negatively affect their effectiveness. The following question motivated the study: What factors influence sexual behaviours of first-year students on a university campus? This study sought to describe the perceptions of first-year students about engaging in sexual behaviours at a university campus. To answer the research question, theory of planned behaviour (TPB) was applied as the framework of the study. The study was descriptive in nature. Data were collected by means of a self-administered questionnaire from a conveniently selected sample of 240 first-year university students from one campus in the Eastern Cape. The measuring instruments were constructed from the constructs of the TBP, namely attitudes (ATT), perceived social norms (PSN), perceived behavioural control (PBC), and behavioural intentions (BI). The SPSS was used to analyse data for frequencies of responses and multiple regression. Most participants reported being sexually active (85.3%) and the lack of provision of information on sexual issues from adults (parents (23.3%) and church authorities (10.8%) was apparent. Perceived social norms were the most prominent factor that showed to be predictive of sexual behaviours with three significant predictor variables, namely partner age difference (beta = .059, ρ< .040), number of sexual partners in 3 months (beta = .238, ρ< .008) and condom use (beta = .095, ρ< .014). Behavioural intentions also showed some prediction, to a lesser extent, with one predictor variable, namely age at first willing intercourse (beta = .86, ρ< .001). The results from this study suggested that targeting social norms in intervention efforts aimed at improving sexual behaviours of first-year university students in the target population could be beneficial. More studies to explore available social norms in this target group and intervention to change negative norms are recommended. / AFRIKAANSE OPSOMMING: Die universiteitsomgewing bied studente meer geleenthede om seksueel aktief te wees. Daarbenewens is universiteitstudente na bewering geneig om hoërisikogedrag met betrekking tot seks, alkohol en dwelmmiddels te openbaar. Eerstejaarstudente word as die kwesbaarste beskou, aangesien hulle die ervaring kortkom om goeie, risikobewuste besluite oor seksuele verhoudings te neem. Tog word die beskikbare inisiatiewe vir die verbetering van seksuele gedrag onder studente blykbaar slegs in werking gestel omdat dit elders goed werk, sonder om eers die behoeftes/kenmerke van die teikenpopulasie te bepaal. Dít kan die doeltreffendheid van dié inisiatiewe benadeel. Die vraag wat as beweegrede vir hierdie studie gedien het, was: Watter faktore beïnvloed die seksuele gedrag van eerstejaars op ’n universiteitskampus? Die navorsing wou dus ondersoek instel na eerstejaars se opvattings oor seksuele gedrag en seksuele verhoudings op ’n universiteitskampus. Om hierdie navorsingsvraag te beantwoord, is ’n teorie van beplande gedrag (TPB) as studieraamwerk gebruik. Die studie was beskrywend van aard. Data is met behulp van ’n vraelys van ’n gerieflik gekose steekproef van 240 eerstejaar-universiteitstudente op ’n enkele kampus in die Oos- Kaap ingesamel. Die deelnemers het self die vraelys ingevul. Die meetinstrumente is saamgestel uit die verskillende konstrukte van die TPB, naamlik houdings (ATT), waargenome sosiale norme (PSN), waargenome gedragsbeheer (PBC) en gedragvoornemens (BI). SPSS-sagteware is gebruik om die data vir die frekwensie van response en meervoudige regressie te ontleed. Die meeste deelnemers het aangedui dat hulle seksueel aktief is (85,3%), en die gebrek aan inligting oor seksuele kwessies vanaf volwassenes (ouers 23,3%) en die kerk (10,8%) blyk duidelik. Waargenome sosiale norme het as die sterkste voorspeller van seksuele gedrag na vore getree, met drie beduidende voorspellerveranderlikes, naamlik ouderdomsverskil met bedmaats (Beta = .059, p< .040), aantal bedmaats in drie maande (Beta = .238, p< .008) en kondoomgebruik (Beta = .095, p< .014). Gedragvoornemens het ook ’n mindere mate van voorspellingsvermoë getoon, met een voorspellerveranderlike, naamlik ouderdom met eerste gewillige seksuele omgang (Beta = .86, p< .001). Die resultate van hierdie studie dui daarop dat intervensiepogings om seksuele gedrag onder eerstejaar-universiteitstudente te verbeter, by ’n klem op sosiale norme kan baat vind. Verdere studies oor die bestaande sosiale norme van hierdie teikengroep, sowel as intervensie om negatiewe norme te verander, word aanbeveel.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The focus of the study is on clients’ experiences of substance abuse recovery in a faith-based programme in the Western Cape. In describing the nature and extent of the substance abuse problem at an Imbizo on substance abuse, the speech of the Minister of Social Development, Benjamin (2006:1) stated that there are major challenges in rendering services to people who abuse substances. These challenges exist particularly with regard to prevention, rehabilitation and treatment of abusers. Baumann (1998: 238) stated that drug misuse is widespread and a growing problem in Southern Africa. This epidemic will have an increasing impact on mental and physical health. The focus of the literature review is to highlight the escalation of the problem over the last decade or so. Substance abuse is classified as a mental health illness, which could be healed in the application of various modalities of care. Little is understood and documented about the role of FBO programmes in substance abuse recovery in the Western Cape. The researcher hopes to add to the body of nursing research knowledge by conducting the study to answer the research question by understanding the experiences of clients accessing this level of care. The objective of the study is to explore, describe and interpret clients’ experiences of substance abuse recovery in a faith-based (FBO) programme in the Western Cape. An explorative, descriptive, interpretive, phenomenological, qualitative research design was chosen for this study. The population for this study comprised males and females, aged 18 years and older, who were admitted as in-patients in the 6-month residential substance abuse recovery facility, who followed the programme. The researcher used purposive sampling to recruit 7 participants who met the inclusion and exclusion criteria, until saturation of data was reached. The primary data collection tool used was in-depth semi-structured recorded interviews and field notes. The researcher used Nola Pender’s (1996) Health Promotion model (HPM) as the conceptual framework for the study as described The Braun and Clarke’s inductive thematic analysis (2006) was used to conduct the data analysis which yielded two overarching themes, namely, the positive recovery experience and the modified future experience. Recommendations were made based on the HPM assumptions and the thematic analysis. Ethical principles were followed in conducting the study and participants were advised that they are helping researchers to answer the research questions by participating in the study. / AFRIKAANSE OPSOMMING: Die studie fokus op kliënt-ervaringe van dwelmmisbruik-herstel in 'n geloof-gebaseerde programme in die Wes-Kaap. In die beskrywing van die aard en omvang van die dwelmmisbruikprobleem by 'n Imbizo op dwelmmisbruik tydens ‘n toespraak van die Minister van Maatskaplike Ontwikkeling (2006:1), is verklaar dat groot uitdagings heers met betrekking tot die lewering van dienste aan persone wat dwelmmidels misbruik. Hierdie uitdagings het veral betrekking op die voorkoming, rehabilitasie en behandeling van misbruikers. Baumann (1998: 238) verklaar dat dwelmmisbruik tans ‘n wydverspreide en groeiende probleem in Suider-Afrika is. Hierdie epidemie hou 'n toenemende impak op die geestelike en fisiese gesondheid van misbruikers in. Die fokus van die literatuuroorsig is om die verhoogde effek van die probleem uit te lig wat oor die laaste dekade voorgekom het. Die misbruik van dwelmmiddels word geklassifiseer as 'n geestesgesondheidsiekte wat gebruik kan word in die toepassing van verskeie modaliteite van gesondheidsorg. Daar is tans onvoldoende inligting beskikbaar om die rol van die FBO programme in die herstel van dwelmmisbruik in die Wes- Kaap behoorlik te kan ontleed en verstaan. Die navorser beoog om met die uitvoer van die studie die navorsingsvraag te kan beantwoord en sodoende ‘n meer ingeligte en in-diepte oorsig te kan vorm oor die ervaringe van kliente wat toegang het tot hierdie vlak van sorg. Die doel van die studie is om kliënt-ervaringe van dwelmmisbruik-herstel in 'n geloof-gebaseerde (FBO) programme in die Wes-Kaap te verken, beskryf en te interpreteer. Daar is besluit op 'n ondersoekende, beskrywende, verklarende en fenomenologiese kwalitatiewe navorsingsontwerp vir die studie. Die populasie vir hierdie studie het mans en vrouens in die ouderdom van 18 jaar en ouer ingesluit wat as kliente in die 6-maande residensiële dwelmmisbruik-herstel fasiliteit se progam toelating verkry het en wat deelgeneem het aan die programme. Die navorser het gebruik gemaak van ‘n doelgerigte steekproeftrekking en sodoende 7 deelnemers gewerf wat aan die insluitings en uitsluitings kriteria voldoen het. Die proses is gevolg totdat ‘n versadigingvlak van die data bereik is. Die primêre data insamelingsinstrument het die gebruik van ‘n in-diepte, ongestruktureerde onderhoud-metode behels, wat die neem van veldnotas en bandopnames ingesluit het. Die navorser het gebruik gemaak van die Pender se ‘Health Promotion Model’ (HPM) as die konseptuele raamwerk vir die studie. Die Braun en Clarke’s induktiewe tema-analise (2006) is gebruik om die data analise uit te voer wat twee oorkoepelende temas ingesluit het, naamlik, die positiewe herstelervaringetema en die gewysigde toekomstige ervaringe tema. Aanbevelings is gemaak wat op die HPM aannames en die tema analise gebaseer is. Etiese beginsels is streng gevolg en deelnemers is in kennis gestel dat hul deelname aan die studie die navorser instaat sou stel om die nodige data in te samel om sodoende die navorsingsvraag van die studie te kan beantwoord.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Taking into consideration the long duration of standard treatment for Mycobacterium tuberculosis (TB), the high prevalence of HIV co-infection and the growing prevalence of drug-resistant TB, there is an urgent need for improved treatment approaches for TB and HIV. However, there is inadequate information regarding the burden being placed on the Department of Health (DOH) systems by the current treatment of patients established on Antiretroviral Therapy (ART) who are newly diagnosed with TB, and by their clinical management. The aim of the study was to determine what proportion of patients established on ART were newly diagnosed with TB, and what their clinical and treatment outcomes were in different public sector settings in the eThekwini Region, KwaZulu-Natal (KZN). Approval for the study was obtained from the Human Research Committee of Stellenbosch University and from the Biomedical Research Committee, KZN. The study used a retrospective, quantitative, cohort technique at both TB and ART clinics at three sites in the eThekwini region, KZN. These sites were DOH clinics and were selected as they all had a TB clinic and a DOH-registered ART clinic. The study focused on a period of one year prior to a patient established on ART developed TB. The study population comprised all TB patients who attended the selected DOH clinics. A data collection tool was developed and pilot-tested. A small sample of patient files (n=15, representing 2% of the study population) was randomly selected; five from each site. The files and data were excluded from the main study. A total of 1824 files (579 from the TB clinics and 1245 from the ART clinics) were reviewed. The data were captured into an electronic database (EpiData Version 3.3) and analyzed using STATA (Version 11.0) with the assistance of a statistician. The findings show that of the study sample from the TB clinics (N=579), 78% (454/579) were newly diagnosed with TB. Of the new TB cases, 90% (409/454) had pulmonary TB and 71% (413/579) were HIV-positive. Nearly 50% (68/137) of the patients had commenced ART prior to TB diagnosis and treatment, and 14% (19/137) had commenced ART after TB. Of those who commenced ART prior to TB diagnosis and treatment, 29% (20/68) had commenced ART more than three months prior to acquiring TB. The findings from the ART clinics show that of the files (N=1245) reviewed, 40% (501/1245) had TB, and of these 8% (42/501) developed TB after three months or more of ART. Missing data in the patient medical files was a major challenge. The lack of recorded data about ART in the TB clinics and about TB in the ART clinics suggests suboptimal clinical management and poor integration of HIV and TB services. It was therefore not possible to derive a combined HIV-TB outcome measure. Recommendations to promote and implement the integration of TB and HIV services included policy changes and implementation, management and practice suggestions, education and training to integrate TB/HIV services and increase research to identify gaps in clinical management and to improve integration of services. / AFRIKAANSE OPSOMMING: Met inagneming van die lang duur van die standaard behandeling vir Mycobacterium tuberkulose (TB), hoë voorkoms van MIV-infeksie en die groeiende voorkoms van dwelmweerstandige TB, is daar ’n dringende behoefte aan verbeterde behandelingbenaderings vir TB en MIV. Daar is egter ’n gebrek aan inligting oor die las geplaas op die Departement van Gesondheid (DvG) se stelsels deur die huidige behandeling van pasiënte op antiretrovirale terapie (ART) wat gediagnoseer is met TB en deur hul kliniese bestuur. Die doel van die studie was om vas te stel watter persentasie van pasiënte wat op ART gevestig is, wel met TB gediagnoseer is, en wat hul kliniese en behandeling-uitkomste was in verskillende openbare-sektorinstellings in die eThekwini-streek, KwaZulu-Natal (KZN). Goedkeuring vir die studie is verkry van die Menslike Navorsingskomitee van die Universiteit van Stellenbosch en van die Biomediese Navorsingskomitee, KZN. Die studie het gebruik gemaak van ’n retrospektiewe, kwantitatiewe ‘cohort’-tegniek by beide TB en ARB-klinieke op drie plekke in die eThekwini-streek, KZN. Hierdie terreine was DvG-klinieke en is gekies omdat hulle almal oor ’n TB-kliniek en 'n DvGgeregistreerde ART-kliniek beskik. Die studie het gefokus op ’n tydperk van een jaar voor ’n pasiënt wat op ART is, TB ontwikkel het. Die studiepopulasie bestaan uit alle TBpasiënte wat die geselekteerde DvG-klinieke bygewoon het. ’n Data-insamelinginstrument is ontwikkel en getoets. ’n Klein voorbeeld van die pasiëntlêers (n = 15, 2% van die studie bevolking verteenwoordig) is ewekansig gekies: vyf uit elke plek, en die data is vervat in ’n elektroniese databasis (EpiData Version 3,3). ’n Totaal van 1824 lêers (579 in die TB-klinieke en 1245 lêers in die ART-klinieke) is ondersoek. Die data is ontleed deur gebruik te maak van Stata (weergawe 11,0) met die hulp van ’n statistikus. Die bevindinge toon dat van die studiemonster in die TB-klinieke (N = 579), 78% (454/579) met TB gediagnoseer is. Van die nuwe TB-gevalle, het 90% (409/454) pulmonêre TB gehad en was 71% (413/579) MIV-positief. Byna 50% (68/137) van die pasiënte het ART begin vóór hulle TB-diagnose en -behandeling, en 14% (19/137) ART ná TB. Van dié wat ART voor TB-diagnose en -behandeling begin het, het 29% (20/68) meer as drie maande voor die opdoen van TB met ART begin. Die bevindinge van die ART-klinieke toon dat van die lêers (N = 1245) wat bestudeer is, 40% (501/1245) TB het, en hiervan het 8% (42/501) TB na drie of meer maande van ART ontwikkel. Ontbrekende data in die pasiënt se mediese lêers was ’n groot uitdaging. Die gebrek aan aangetekende data oor ART in die TB-klinieke en oor TB in die ART-klinieke dui op suboptimale kliniese bestuur en swak integrasie van MIV- en TB-dienste. Dit was dus nie moontlik om ’n gesamentlike MIV-TB uitkomsmaatreël af te lei nie. Aanbevelings om die integrasie van TB- en MIV-dienste te bevorder en te implementer, het beleidveranderinge en -implementering ingesluit, asook bestuur- en praktykvoorstelle, onderwys en opleiding om TB-/MIV-dienste by DvG-vlak te integreer en meer navorsing om gapings in die kliniese bestuur te identifiseer en die integrasie van dienste te verbeter.

Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The aim of this study was to compare the impact of a four-day structured Basic Infection Prevention and Control course on the knowledge of, and adherence to, Standard Precautions in clinical nursing practice amongst nurses who had completed the course and those who did not. The specific precautionary measures of investigation included hand hygiene, personal protective equipment (PPE) and sharps management. The secondary aim of the study was to identify any personal and contextual factors that influenced the application of such Standard Precautions measures in public healthcare facilities within the Cape Winelands and Overberg District. Sixty eight students (those who had been trained) with a similar number of controls (who had not been trained) were enrolled in the study. Although both the participants and controls had the knowledge, their adherence to hand hygiene, PPE and sharps management in clinical nursing practice was poor. Staff attitude was found to be the main factor for non-adherence. The knowledge of the participants was good as they had answered most of the questions correctly. It seems as if there was retention of knowledge after the four-day Basic Infection Prevention and Control course. There were, however, no significant differences between the two groups. For both groups attitude and behavioural change must be addressed in order to improve adherence to hand hygiene, PPE and sharps management. The findings of the study will form recommendations towards improved infection prevention and control practices at public healthcare facility level in the Cape Winelands District. / AFRIKAANSE OPSOMMING: Die doel van die studie was om die impak van 'n 4-dag gestruktureerde Basiese Infeksiebeheerkursus op die kennis en toepassing van Standaard Voorsorgmaatreëls in kliniese praktyk in die Kaapse Wynland en Overberg Distrikte ondersoek, vergeleke met 'n groep wat nie die kursus bygewoon het nie. Die spesifieke Voorsorgmaatreëls wat ondersoek is, het handhigiëne, die gebruik van beskermende drag en die hantering en beheer van skerpvoorwerpe ingesluit. Die studie het ook gekyk na enige kontekstuele en persoonlike faktore wat die toepassing van Standaard Voorsorgmaatreëls in openbare gesondheidsorgfasiliteite beïnvloed. Agt en sestig verpleegkundiges het die 4-dag Basiese Infeksiebeheerkursus bygewoon en 'n gelyke aantal kontrole studente het nie die kursus bygewoon nie. Alhoewel beide groepe die kennis van handhigiëne, die dra van beskermende drag en die hantering van skerpvoorwerpe gehad het, was die toepassing van die Standaard Voorsorgmaatreëls in kliniese praktyk baie swak. Personeel se houding was die grootste faktor wat gelei het tot die nie-toepassing van Standaard Voorsorgmaatreëls. Die kennis van die kursusgangers was goed, want albei groepe het die meeste van die vrae korrek beantwoord. Die waarneming wat gemaak is, is dat die kursusgangers se kennis wel verbeter het na die bywoning van die 4-dag Basiese Infeksiebeheerkursus. Data weerspieël egter geen noemenswaardige verskille tussen die groepe nie. Beide groepe se houding en gedrag moet aangespreek word om die toepassing van handhigiëne, die dra van beskermende drag en die hantering van skerpvoorwerpe te verbeter. Die bevindinge van die studie sal gebruik word om aanbevelings te maak ten einde infeksiebeheerpraktyke in die Kaapse Wynland Distrik te verbeter.

Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The imbalance between job demands and available resources could cause burnout which may impact quality patient care. A scientific investigation was conducted to evaluate burnout amongst primary health care (PHC) nurses. The objectives for the study were to identify the prevalence of burnout amongst PHC nurses and to explore the contributing factors to burnout in PHC settings. The Job Demands-Resources (JD-R) model (Bakker and Demerouti, 2007:309) was used as a conceptual framework for the study. A non-experimental, descriptive cross-sectional design with a quantitative approach was applied. The population and sample consisted of professional nurses (PN) and clinical nurse practitioners (CNP) (n=72) in the Eden District of the Western Cape. A self-report questionnaire was used to collect the data in an uncontrolled, natural environment. Analysis of the results exposed high levels of burnout amongst PHC nurses. Nurses in PHC facilities all had an equal chance to develop burnout, regardless of their level of experience. The occurrence of burnout is equal in community health centres and in community clinics, although a trend was observed that subjects in community clinics may experience more emotional exhaustion. Work pressure, workload or an increase in job demands, lack of organisational support and management problems were rated as the main factors contributing to burnout. Recommendations were made to improve the working environments of PHC nurses in order to increase motivational levels, job satisfaction and to foster work engagement, as well as to reduce levels of burnout. Opportunities for further research are recommended. / AFRIKAANSE OPSOMMING: Die wanbalans tussen beroepseise en beskikbare hulpbronne kan uitbranding veroorsaak en gevolglik kwaliteit patiëntsorg beïnvloed. ‘n Wetenskaplike studie is gedoen om uitbranding onder primêre gesondheidsorg (PGS) verpleegkundiges te evalueer. Die doelstellings van die studie was om die voorkoms van uitbranding onder PGS-verpleegkundiges te identifiseer, en om die bydraende faktore wat aanleiding gee tot uitbranding in PGS-instellings, te ondersoek. Die Beroepseise-Hulpbronne model (Bakker and Demerouti, 2007:309) is as ‘n konsepsuele raamwerk vir die studie gebruik. 'n Nie-eksperimentele, beskrywende dwarssnit studie met 'n kwantitatiewe benadering, is toegepas. Die populasie en die steekproef het bestaan uit professionele verpleegkundiges en kliniese verpleeg praktisyns (n=72) in die Eden Distrik van die Wes-Kaap. ‘n Self-rapport vraelys was gebruik om data in ‘n ongekontroleerde, natuurlike omgewing te versamel. Die analisering van resultate het hoë vlakke van uitbranding onder verpleegkundiges in PGS-dienste ontbloot. Verpleegkundiges in PGS-fasiliteite het almal 'n gelyke kans om uitbranding te ontwikkel, ongeag die vlak van ondervinding. Die voorkoms van uitbranding is dieselfde in gemeenskaps-gesondheidsentrums en gemeenskapsklinieke, alhoewel daar ‘n neiging sigbaar was dat personeel in gemeenskapsklinieke meer emosionele uitputting ervaar. Werkdruk, werklas of toename in beroepseise, die gebrek aan organisatoriese ondersteuning en bestuursprobleme is aangewys as die hoof redes wat aanleiding gee tot uitbranding. Voorstelle is gemaak om die werksomgewing van PGS-verpleegkundiges te verbeter en om motiveringsvlakke en werkstevredenheid te herstel. Dit sal werksverbintenis versterk en die voorkoms van uitbranding beperk. Geleenthede vir verdere navorsing is aanbeveel.

Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The support for portfolio-based learning as an authentic assessment method is increasing globally. However, there are no guidelines in South Africa for a clinical practice assessment portfolio (CPAP) for primary clinical practitioner training. The study set out to develop a CPAP for the Clinical Nursing Science, Health Assessment Treatment and Care programme. An exploratory, descriptive design was used that developed over three phases. In phase one, a CPAP was developed based on an extensive review of the literature. The CPAP was validated in phase two by experts and finally, student primary clinical practitioners assessed the possible contribution of the developed CPAP to their learning in phase three. The study sample for the three phases comprised of selected relevant studies published on portfolio development (n=15); experts in the field of primary health care and education in the Cape Metropole (n=11); and student primary clinical practitioners of one higher education institution in the Cape Metropole (n=45). Structured questionnaires were used for data collection from expert and student participants after they reviewed the CPAP. Ethical approval was obtained from the Health Research Ethics Committee of the Faculty of Health Sciences (N09/09/233), Stellenbosch University. Permission to conduct the research was obtained from the higher education institution. The content validity index for items (I-CVI) was used to determine the degree to which expert participants agreed with the content of the CPAP. Results identified an I-CVI of between 0.91 and 1.00, indicating that the contents and technical format of the CPAP constitute a suitable learning tool for student practitioners. Experts suggested minor revisions regarding the clarity of items, and those were included in the final CPAP. The data analysis of the student’s responses showed that adequate guidance was provided to complete the activities in the CPAP and that the CPAP would have a positive contribution to learning. Portfolio-based learning is an important teaching and learning strategy in the Clinical Nursing Science, Health Assessment Treatment and Care programme, whereby students can demonstrate their acquired clinical competencies. Recommendations include the use of a competency framework and consensus amongst stakeholders when developing the contents of a portfolio. / AFRIKAANSE OPSOMMING: Die ondersteuning vir portefeulje-gebaseerde leer as ’n outentieke assesseringsmetode is besig om globaal te verhoog. In Suid-Afrika is daar egter nie riglyne vir ’n kliniese praktyk-assesseringsportefeulje (KPAP) vir primêre kliniese praktisynsopleiding nie. Hierdie studie het ten doel om ’n kliniese praktyk-assesseringsportefeulje vir die Kliniese Verpleegkunde-, Gesondheidsassesseringbehandeling- en Sorgprogram te ontwikkel. ’n Verkennende, beskrywende ontwerp wat oor drie fases ontwikkel het, is gebruik. In fase een is ’n KPAP ontwikkel gebaseer op ’n ekstensiewe literatuurstudie. Die geldigheid van die KPAP is in fase twee deur kundiges verklaar en in fase drie is die moontlike bydrae van die KPAP tot die leerproses deur primêre kliniese praktisynstudente geassesseer. Die studiegroep vir die drie fases het bestaan uit geselekteerde relevante studies wat handel oor portefeulje ontwikkeling (n=15), kenners op die gebied van primêre gesondheidsorg en opvoeding in die Kaapse Metropool (n=11); en primêre gesondheidsorg studentpraktisyns van een van die tersiêre instansies in die Kaapse Metropool (n=45). Gestruktureerde vraelyste is gebruik vir data-insameling van kenners en studentedeelnemers nadat hulle die KPAP ondersoek het. Etiese toestemming is verkry van die Gesondheidsnavorsingsetiekkomitee van die Fakulteit Gesondheidswetenskappe (N09/09/233), Stellenbosch Universiteit. Toestemming om die navorsing uit te voer, is van die tersiêre instansie verkry. Die inhoud van die item-geldigheidsindeks is gebruik om die mate waarmee kenner-deelnemers met die inhoud van die KPAP saamstem, te bepaal. Resultate van die inhoud van die item-geldigheidsindeks van tussen 0.91 en 1.00 is geïdentifiseer, wat ’n aanduiding is dat die inhoud en tegniese formaat van die KPAP ’n toepaslike leerinstrument vir studentpraktisyns is. Kenners het klein veranderings vir die duidelikheid van items voorgestel en dit is ingesluit in die finale KPAP. Die data-analise van die studente se antwoorde het aangedui dat genoegsame leiding voorsien was om die aktiwiteite in die KPAP te voltooi en dat die bydrae van die KPAP positief is tot die bevordering van die leerproses. Portefeulje-gebaseerde leer is ’n belangrike onderrig- en leerinstrument vir die Kliniese Verpleegkunde-, Gesondheidsassesseringbehandeling- en Sorgprogram, waardeur studente kan demonstreer dat hulle die kliniese bevoegdhede bekom het. Aanbevelings sluit in die gebruik van ’n bevoegdheidsraamwerk en konsensus onder belanghebbendes wanneer die inhoud van ’n portefeulje ontwikkel word.

Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The profession of nursing is a twofold vocation that has a scientific theory as the foundation of all nursing intervention or skill. Despite clinical preceptorship being a useful strategy of teaching, many training hospitals and clinical facilities are without this avenue of learning and where available, it is often not optimally utilised. The aim of this study was to explore the role of the clinical preceptor in enhancing nursing education at Edendale Hospital and Edendale campus of a nursing college. A mixed method approach was applied utilizing both qualitative and quantitative methods to collect information about the experiences and challenges as well as clarify existing problems. Samples were drawn from all stakeholders of nursing education i.e. nursing students, nurse educators and ward managers of Edendale Hospital and Campus using random and purposive sampling respectively. Data were collected using selfadministered questionnaires for students and nursing managers and an interview guide for focus group interviews for nurse educators. Ethical approval was sought from the Health Research Ethics Committee at the Faculty of Medicine and Health Sciences at Stellenbosch University, the Department of Health, the Kwazulu-Natal College of Nursing and Edendale Hospital and Campus. The findings of this study support Weidenbach’s Prescriptive Theory in which the author maintains that nursing is a practice discipline designed to produce explicit desired results which here refers to the enhancing of nursing education with the contribution of clinical preceptorship. Patricia Benner’s Dreyfus and novice to expert models were used to express the need for meaningful practical experience in nursing students and to shows nurse educators how to identify the practical learning needs of the students and assist them acquire competence. The results of the study suggest that the clinical preceptor is a mentor and a guide who facilitates the correlation of theory and practice in nursing education. The results also suggest that students are experiencing problems in clinical practice and that clinical preceptorship is needed. A number of recommendations are made based on limitations identified in the present teaching-learning process. One of the recommendations is that partnership building strategies be fostered between the hospital, the campus and the Faculty of Nursing Education. This team approach could clearly define the role of the clinical preceptor to ensure optimum nursing education. Further research is recommended. / AFRIKAANSE OPSOMMING: Verpleging is ’n tweeledige beroep met ’n wetenskaplike teorie as grondslag vir elke verpleegintervensie of -vaardigheid. Ten spyte daarvan dat kliniese instruksie (“preceptorship”) ’n nuttige onderrigstrategie is, ontbreek dit by baie opleidingshospitale en kliniese fasiliteite, en waar dit beskikbaar is, word dit dikwels suboptimaal aangewend. Die doel van hierdie studie was om ondersoek in te stel na hoe belanghebbendes by verpleegopleiding by Edendale-hospitaal en -verpleegkampus kliniese instruksie ervaar, en om sodoende vas te stel of kliniese instruksie verpleegopleiding by daardie fasiliteite versterk. ’n Gemengde benadering van sowel kwalitatiewe as kwantitatiewe metodes is gevolg om inligting oor die ervarings en uitdagings in te win en bestaande probleme te verklaar. Steekproewe is met behulp van onderskeidelik lukrake en doelbewuste seleksie uit alle belanghebbendes by verpleegopleiding by Edendale-hospitaal en - verpleegkampus geneem, met inbegrip van verpleegstudente, verpleegopvoeders en saalbestuurders. Data is deur middel van selfvoltooiingsvraelyste vir studente en eenheidsbestuurders, en ’n onderhoudsgids vir fokusgroepgesprekke met verpleegopvoeders ingesamel. Etiekgoedkeuring is verkry van die Gesondheidsnavorsingsetiekkomitee van die Fakulteit Geneeskunde en Gesondheidswetenskappe aan die Universiteit Stellenbosch, die Departement van Gesondheid, die KwaZulu-Natalse Verpleegkollege sowel as Edendale-hospitaal en - verpleegkampus. Die bevindinge van die studie ondersteun Wiedenbach se voorskriftelike teorie, waarin sy volhou dat verpleging ’n praktiese dissipline is wat ontwerp is om bepaalde gewenste resultate te behaal. Patricia Benner se Dreyfus- en beginner-tot-kennermodel is ook gebruik om die behoefte aan sinvolle praktiese ervaring by verpleegstudente te staaf, en om verpleegopvoeders te wys hoe om studente se praktiese leerbehoeftes te bepaal en hulle vaardighede te help ontwikkel. Die resultate van die studie dui daarop dat die kliniese instrukteer as mentor en begeleier die korrelasie tussen teorie en die praktyk van verpleegonderwys fasiliteer. Die resultate dui verder daarop dat student probleme in kliniese praktyk ervar en kliniese instruksie benodig. ’n Aantal aanbevelings word gedoen op grond van beperkinge wat in die huidige onderrig-en-leer-proses uitgewys is. Een van die aanbevelings is die ontwikkeling van strategieë om vennootskappe tussen die hospitaal, die verpleegkampus en die fakulteit verpleegkunde te bou. Hierdie spanbenadering kan die rol van die kliniese instrukteur duidelik omlyn ten einde optimale verpleegopleiding te verseker. Verdere navorsing word aanbeveel.

Thesis (DCur)--Stellenbosch, 2000. / ENGLISH ABSTRACT: Guided by the researcher's clinical experience and through recent outreach research projects (Stellenberg, 1996 and 1997) the factors influencing the health status of two communities were identified through health screening. It was further identified that these problems affecting the health status of these communities were magnified through the poor accessibility, availability, and affordability of health services. According to the researcher, despite the efforts of the Government and attempts to remedy the disparities of the past, the introduction of any such policy should be based on scientific evidence. The researcher decided to investigate the factors influencing the health status of the Coloured people of the Western Cape. This population group is the largest in the Western Cape, being 60,8%. Its domination in this province determines the health status of the province. By acquiring knowledge about the factors influencing the health status of the Coloured population, it will be possible for the policy makers in health care to direct their emphasis on health care policies more appropriately. Currently differences in socio-economic and knowledge levels, along with existing inequalities in health service pose major challenges for the policy makers in health care. Therefore, knowledge about the health status, health practices and health beliefs of minority groups will improve the average health status of the general population. It is against this background, that this research study was undertaken. Specific objectives were set for the study. • To determine the health status of economically active Coloured people in an urban area as defined with specific reference to the indicators as identified by the researcher • To determine the prevalence of factors influencing the health status of economically active Coloured people in an urban area as defined. • To determine the relationship between the health status and the factors influencing the health status of economically active Coloured people in an urban area as defined. • To determine an association between factors influencing the health status of economically active Coloured people in an urban area as defined. • To make recommendations to the health policy-makers concerning factors influencing the health status of the economically active Coloured people in an urban area as defined and possibly related ethnic groups. These objectives were met through an in-depth research study of this population group in six identified suburbs. Factors influencing the health status of an individual as described in the literature were explored and described. The recommendations based on the findings confirmed that the health status of the Coloured population is influenced by the following factors: • Socio-economic Level (education, financial income and occupation) • Lifestyle of individuals (High Risk Behavioural Practice such as smoking, use of alcohol and illegal drugs, dietary intake, minimal exercise, stress management and leisure time) • Ethno-cultural Beliefs: health and illness • Religion, health and illness • Environmental factors • Health Services: accessibility and affordability of services Recommendations based on the findings • Emphasis on re-development and health education of all age groups. • The introduction of social grants for those who are unable to support themselves and their families have become essential in order to improve their health status. • The creation of jobs to improve the socio-economic circumstances of the populations. • Current health services at primary health care level and environmental factors influencing the health status of the population require urgent attention. / AFRIKAANSE OPSOMMING: Gelei deur die navorser se persoonlike kliniese onde'rvinding asook onlangse navorsingsprojekte oor uitreikingsaksies ten opsigte van gemeenskapsgesondheid (Stellenberg, 1996 en 1997), is faktore wat In rol in die gesondheidstatus van gemeenskappe speel, geïdentifiseer. Daar is ook bevind dat faktore wat probleme rondom die gesondheidstatus van hierdie gemeenskappe vererger, elemente is soos toeganklikheid, beskikbaarheid en bekostigbaarheid van gesondheidsdienste. Ten spyte van pogings van die regering om die ongelykhede van die verlede uit die weg te ruim behoort die regstelling daarvan volgens die navorser op wetenskaplike bewyse gegrond te word. Die navorser het daarom besluit om die faktore wat gesondheidsorg van die Kleurlinggemeenskap in die Wes-Kaap beïnvloed, te ondersoek. Hierdie bevolkingsgroep is die grootste in die Wes-Kaap, naamlik 60,8%. Die oorheersing van die Kleurling in die provinsie bepaal grootliks die gesondheidstatus van die provinsie. Deur kennis in te win van faktore wat die gesondheidstatus van die Kleurlinggemeenskap beïnvloed, is dit moontlik vir besluitnemers in gesondheidsorg om dit beter te bestuur. Daarom sal kennis oor gesondheidsorg, gesondheidspraktyke en -gelowe van minderheidsgroepe die gesondheidstatus van die totale bevolking verbeter. Dit is teen hierdie agtergrond wat die navorsing onderneem is. Spesifieke doelwitte vir die studie was om die volgende te bepaal: • Die gesondheidstatus van die ekonomies aktiewe Kleurling-gemeenskap in In stedelike gebied soos gedefinieer met spesifieke verwysing na die indikatore soos geïdentifiseer deur die navorser • Die prevalensie van faktore wat 'n invloed op die gesondheidstatus van die ekonomies aktiewe Kleurling-gemeenskap in In stedelike gebied soos gedefinieer • Die verwantskap tussen die gesondheidstatus en die faktore wat In invloed uitoefen op die gesondheidstatus van die ekonomies aktiewe Kleurling-gemeenskap in In stedelike gebied soos gedefinieer • Die moontlike assosiasie te bepaal tussen faktore wat die gesondheidstatus beïnvloed van die ekonomies aktiewe Kleurlinggemeenskap in In stedelike gebied soos gedefinieer. • Aanbevelings aan die gesondheidsowerheidsbeleidmakers oor bevindings wat In invloed uitoefen op die gesondheidstatus van die ekonomies aktiewe Kleurling-gemeenskap in In stedelike gebied soos gedefinieer, en moontlike verwant etniese groepe. Die doel is bereik deur in-diepte navorsingsonderhoud met die Kleurling bevolkingsgroep in ses geïdentifiseerde gebiede. Faktore wat die gesondheidstatus van individue soos in die literatuur beskryf beïnvloed, is ondersoek en beskryf. Die aanbevelings is gebasseer op bevindings gedoen in die ondersoek van die gesondheidstatus van die Kleurling bevolking, en is deur die volgende faktore in die ondersoekgroep beïnvloed: • Die sosio-ekonomiese vlak (opleiding, inkomste en beroep) • Lewenstyl van respondente (hoë risiko faktore soos rook, die gebruik van alkohol, verdowingsmiddeis, daaglikse dieët, oefening, hantering van spanning en vryetydsaktiwiteite). • Etnies-kulturele gelowe: gesondheid en siekte • Geloofsgesondheid en siekte • Omgewingsfaktore • Gesondheidsdienste: toeganklikheid en bekostigbaarheid van dienste Aanbevelings wat op die navorsingsbevindings gebaseer is, is die volgende: • Beklemtoning van die herontwikkeling van gesondheidsvoorligting vir alle ouderdomsgroepe. • Die instel van In toelae vir individue wat nie in staat is om hulself en hulle gesinne te help nie, is noodsaaklik vir die verbetering van hulle gesond heidstatus . • Die skep van meer werk om sosio-ekonomiese omstandighede in die bevolking te verbeter • Huidige gesondheidsdienste op pnmere gesondheidsorgvlak en omgewingsfaktore wat die gesondheidstatus van die gemeenskap beïnvloed, vereis dringend aandag.

Thesis (MCur)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: Research and in certain instances the lack of research as well as extensive experience of the researcher in this field of study convinced the researcher that a scientific study / exploration is critical on the different aspects of adolescent sexual health. A study, based on a combination of qualitative and quantitative methods (triangulation), was conducted to identify and describe the factors playing a role in adolescents’ experiencing problems in maintaining their sexual health. Adolescents are at risk of contracting Sexually Transmitted Diseases including HIV/AIDS because of their sexual behaviour. Initiation of early sexual relations contributing to possible multiple sexual partners and failure to consistently use condoms contribute to this risk. Failure to continuously use a reliable contraceptive method also enhances the risk of unintended pregnancies and consequent exposure to the risks involved in termination of pregnancy or the psychological effects of giving the baby up for adoption, the hardship of raising the baby as a single parent or being forced to marry at a young age. Thus the physical-, emotional-, and social well being of the adolescent is at risk when they are not equipped to maintain their sexual health.The study concludes that adolescents that are sexually active and have multiple sexual partners have a higher probability of not maintaining their sexual health. Based on the outcome of this study the researcher feels strongly that the following needs to be addressed in order to promote the maintenance of adolescent sexual health: • Professional nurses need to be trained and sensitized to guide and manage adolescents seeking sexual or reproductive advice; • Sexuality programmes need to be integrated into school curricula; • Positive use of the mass media to promote healthy lifestyles; and • Training programmes for parents and adolescents. / AFRIKAANSE OPSOMMING: Navorsing en in sekere gevalle die gebrek daaraan sowel as ekstensiewe ondervinding van die navorser in die studieveld, het die navorser oortuig dat ‘n wetenskaplike studie / eksplorasie oor die veskillende aspekte van adolessente seksuele gesondheid krities was. ‘n Studie, gebaseer op ‘n kombinasie van kwalitatiewe en kwantitatiewe metodes (triangulasie), was uitgevoer om die faktore wat ‘n rol speel in adolessente se vermoëns om hul seksuele gesondheid te handhaaf, te identifiseer en te bepreek. Adolessente se risiko is hoog om Seksueel Oordraagbare siektes, insluitend MIV/VIGS, op te doen weens hul seksuele gedrag. Die aanvang van vroeë seksuele verhoudings dra by tot moontlike meervoudige seksmaats en die gebrek aan konsekwente gebruik van kondome verhoog die risiko. Gebrek aan die aaneenlopende gebruik van ‘n betroubare kontraseptiewe metode verhoog ook die risiko van ‘n ongewensde swangerskap en gevolglike blootstelling aan die risiko’s verbonde aan terminasie van swangerskap of die psigologiese effekte wat gepaard gaan met aanneming, enkel ouerskap en geforseerde trou op ‘n vroeë ouderdom. Derhalwe word die fisiese-, emosionele- en sosiale welsyn van die adolessent bedreig as hulle nie toegerus is om hul seksuele gesondheid te handhaaf nie.Die gevolgtrekking van die studie is dat adolessente wat seksueel aktief is en meervoudige seksmaats het, ‘n hoër waarskynlikheid het om nie hul seksuele gesondheid te handhaaf nie. Gebaseer op die uitkoms van die studie is die navorser van mening dat die volgende aangespreek moet word ten einde die handhawing van adolessente seksuele gesondheid te bevorder: • Geregistreerde vepleegkundiges moet opgelei en gesensitiseer word om adolessente te hanteer en van leiding te voorsien; • Seksualitiet programme moet in die skool kurrikulum integreer word; • Positiewe gebruik van die massa media om gesonde lewenstyle te bevorder; en • Opleidingsprogramme vir ouers en adolessente.