Occupational stress of nurses has been widely researched, for example in specific health care units - intensive care, specific conditions - cancer. Personal characteristics like emotional involvement and depersonalisation of patients are also suggested as stressors for nurses. In South Africa the Department of Health has made a number of changes since 1994. One of the changes involved the restructuring of the different departments to unify the fragmented health services. No comparison study was found for professional and enrolled nurses. The objectives of this study were to determine the construct validity and internal consistency of the Nursing Stress Indicator (NSI) and to identify differences between occupational stressors of professional and enrolled nurses. A cross-sectional survey design was used. An random sample of professional nurses (N = 980) and enrolled (N = 800) nurses of seven of the nine provinces of South Africa were used. The NSI was developed as measuring instrument and administrated together with a biographical questionnaire. Descriptive statistics and inferential statistics were used to analyse the data. Five internally consistent factors were extracted. The first factor was labelled Stress: Patient Care. It relates to stress because of the care nursing staff provide to patients. The second factor was labelled Stress: Job Demands, and refer to the demands associated with the work of the nurse. The third factor indicated a lack of support in the organisation as well as from supervisors and colleagues, and was labelled Stress: Lack of Support. The fourth factor was labelled Stress: Staff Issues, because it included item loadings on things like shortage of staff, and fellow workers not doing their job. The fifth factor contains items concerning working hours, especially overtime, and was labelled Stress: Overtime. The results indicated that a difference in stress levels exists between professional and enrolled nurses. Professional nurses' severity for the different stressors are higher on all five the extracted factors than those of the enrolled nurses. The sources of occupational stress for professional and enrolled nurses were almost the same. One source of stress for professional nurses that the enrolled nurses did not experience is management of staff. Professional nurses (compared with enrolled nurses) obtained practically significant higher scores on two stressors, namely stress because of making a mistake when treating a patient and stress because of disagreement with medical practitioners or colleagues concerning the treatment of a patient. Recommendations for future research were made. / Thesis (M.A. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2004.

This thesis sets out to explore some important gaps in the sociological and feminist understanding of the provision of maternity care and of women's health needs. The research was concerned with an exploration of the implementation of proposals for the provision of user-centred maternity care which emerged from the critiques of current medicalised provision. It evaluates the effects of an attempt to provide user-centred maternity care within the Primary Health Care sector (PHC) from both the women's and workers' perspectives and experience. The central questions addressed within the research have been: Firstly, to assess the degree to which such models of service delivery provide a user centred approach. Secondly, to identify the form of the relationship between the women users and providers from the practices and to develop an understanding of the mechanisms of interaction between them. Thirdly, to explore the extent to which the provision of such care is appropriate to match women users' self identified needs. Finally, to assess the potential of female health workers to adopt a form of provider and user relationship where the balance of power is altered in the users' favour. The main body of the research consisted of a qualitative study conducted in two general practices. These were chosen as specific examples of innovative practices attempting to provide a genuinely user-centred maternity service. The fieldwork consisted of three methodological components: Firstly, unstructured interviews were conducted with women users and workers. A sample of 30 women who were pregnant for the first time were interviewed on three occasions during their pregnancy and in the immediate post-natal period. In addition, 10 second time mothers were also interviewed post-natally. In terms of the workers', in depth interviews were conducted with midwives, GPs and practice nurses within the PHC setting. Secondly, observations were undertaken on the interactions between the women and workers and between members of the PHC team during the course of the women's antenatal and post-natal care. Finally, a structured questionnaire was used with a sample of women from one of the practice's well woman clinic. The research findings indicate the existence of a user-centred frame of reference held by female health workers - especially the midwives - for the provision of health care to women, which was opposed to the medical model. It explores the translation into practice of this model of maternity care and identifies the way that it functioned to enable women to exercise greater control over their health care and experience of pregnancy. Within this model the traditional 'with woman' role of the midwife was found to be central. Considerable convergence was found between the models held by the main parties in the interaction - issues concerned with choice, control and the provision of information were all found to be central to the care provided and to women's and workers' models. However, constraints on the effective implementation of the model were found in terms of the influence of professionalism (particularly on the GPs) and the dominance of the hospital system. These resulted in limits to the women workers' ability to meet the needs of women users.

Magister Public Health - MPH / Background: Malnutrition in children under the age of 5 years is a global public Health problem. The UNICEF report states that 10.9 million children under five die in developing countries each year due to malnutrition. According to the Zambia Demographic and Health Survey of 2008 malnutrition is one of the main childhood illnesses in Zambia with almost 50% of the under five children being stunted. The referral system in Zambia is organized in a way that starts at the Primary Health Care (PHC) level within the community and managed by the Community Health Workers (CHW). At this level, Community Health Workers screen and identify children that have childhood illnesses which require treatment and they refer them to the Rural Health Centre (RHC). When the problem cannot be handled at the RHC level the child is referred to the district hospital or provincial hospital level within a particular province. However, most children with malnutrition arrive late at the hospital for treatment. Some of them die soon after admission. It was not clear what prevent the mothers from bringing these children early to the hospital for treatment. Methods: The main aim of the study was to explore factors that are associated with detection and referral of malnourished children from Primary Health Care (PHC) at community level to the Health centres in Kalomo district. The study was conducted in Kanchele community of Kalomo in Southern Province of Zambia. Kanchele is a rural community with most basic services such as health facilities not being easily accessed. The study focused on two PHCs which had the highest prevalence of malnutrition. All participants were asked to sign a consent form after the purpose of study had been explained to them. They were informed that all information would be treated with confidentiality and that participation was voluntary and that they had the right to chose not to participate in the study. Furthermore each participant was asked if they agreed to maintain the confidentiality of the information discussed by participants and researchers during the focus group session. The study was qualitative in nature and focus group discussions were conducted with mothers or caregivers of children under five years, community members who have lived in the community for more than one year and community health workers who have also worked in the community for more than one year. Focus group discussions were used to collect data from mothers and community members. While in-depth interviews were used to collect data from CHWs and nutrition group leaders working at the PHC and community leaders. The data collected from the focus group discussions was analysed using thematic approach. Barriers or hindrances to rehabilitating a malnourished child mentioned by the respondents included lack of knowledge on malnutrition, failure to link malnutrition to poor feeding and bad health seeking habits, poor response to referral as a result of a system which is not supported with adequate resource such as transport, a system that does not support parents with food in-case of the child being hospitalised, the current hospital system only provides food to the patient. The failure by health staff to see that malnutrition is a key childhood disease. Data from this study will be used to develop interventions to improve the management of malnourished children. Conclusion: The study shows that mothers and community members are misinformed about the causes and treatment of malnutrition. It also clearly showed that traditional healers and grandparents played an important role in the diagnosis and treatment of malnourished children in this community. Interventions to improve identification and referral of these malnourished children needs to taken into consideration.

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The Director of the Health Service of the Cape Metropolitan Council was invited by ATICC to select seven health educators and nurses who were involved in health education and counselling in their local clinics to complete a six-month training course. The objective of this study was to evaluate the effectiveness of the ATICC training course on the counselling practice of trainees at their clinics.</span></p>

<p>The Western Cape AIDS Training,Information and Counselling Centre (ATICC) primarily focuses on the development and provision of information and different types of training programmes on HIV/AID/STIs. The Director of the Health Service of the Cape Metropolitan Council was invited by ATICC to select seven health educators and nurses who were involved in health education and counselling in their local clinics to complete a six-month training course. The objective of this study was to evaluate the effectiveness of the ATICC training course on the counselling practice of trainees at their clinics.</p>

<p>The Western Cape AIDS Training,Information and Counselling Centre (ATICC) primarily focuses on the development and provision of information and different types of training programmes on HIV/AID/STIs. The Director of the Health Service of the Cape Metropolitan Council was invited by ATICC to select seven health educators and nurses who were involved in health education and counselling in their local clinics to complete a six-month training course. The objective of this study was to evaluate the effectiveness of the ATICC training course on the counselling practice of trainees at their clinics.</p>

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The Director of the Health Service of the Cape Metropolitan Council was invited by ATICC to select seven health educators and nurses who were involved in health education and counselling in their local clinics to complete a six-month training course. The objective of this study was to evaluate the effectiveness of the ATICC training course on the counselling practice of trainees at their clinics.</span></p>

In in low-and middle-income countries (LMIC), where there are very few trained physicians and nurses, community health workers (CHWs) are often the only providers of healthcare to millions of people. Such LMIC are countries that are classified, based on their geographic region and Gross National Income (GNI), as low-middle income by the World Bank Group, the worlds largest development bank. Research has shown digital health tools to be an effective strategy to improve the performance of frontline line health workers. The aim of this review was to systematically examine the literature on digital health tools that are used for decision support in LMIC and describe what we can learn from studies that have used these tools. As part of a larger parent study the following databases were searched: PubMed, Embase, Scopus, CINAHL, Global Health Ovid, Cochrane and Global Idex Medicus, to find ariticles in the following domains: training tools, decision support, data capture, commodity tracking, provider to provider communication, provider to patient communication and alerts, reminders, health information content. These domains were selected based on the World Health Organisation (WHO) framework for classifying digital health interventions. Content from all seven of these domains informed a series of reviews however this review focuses on how digital tools are used to provide decision support to FLHWs. Included studies were conducted in LMIC in Africa, Asia, North America and South America with the most common users of the tools being CHWs. Most tools for FLHW decision-support used in the interventions described in included articles were in either the pilot or prototype phases, and offered maternal and child health care services. Although decision support was the primary digital health function of all these studies, there was considerable variation in the number of digital health functions of each tool with most studies reporting decision support and data capture as their primary and secondary functions respectively. All the studies found their intervention to have beneficial effects on one or more of the following outcomes: beneficiary engagement, provider engagement, health effects and process/outputs. These findings show great potential for the use of decision support digital health tools as a means of improving the outcomes of health systems through; reducing the work load of FLHWs, reducing the costs of health care, improving the efficiency of service delivery and/or improving the overall quality of care.

Extensive research has been conducted on the attitudes of physicians and nurses toward euthanasia. However, little is known on the attitudes of suicide prevention workers (SPWs). The objectives of this study were to: (1) examine the attitudes of SPWs toward euthanasia for a non-descript person versus for a loved one; (2) verify the association between personal factors (experiences, sociodemographics) and attitudes, and (3) explore personal experiences of SPWs in relation to grievous illness. A survey was sent out to all suicide prevention centres across Quebec (n=32). A majority of SPWs (55.7%) held positive attitudes toward euthanasia for a non-descript person and for a loved one (49.5%). Statistically significant differences were found in attitudes among SPWs who had personal and professional experiences. There were no other statistically significant differences in the attitudes of SPWs toward euthanasia for a non-descript person or for a loved one, and any of the sociodemographic factors. Three themes emerged from the qualitative analysis of open-ended question on personal experiences of SPWs: respect of choice, suffering/low quality of life and palliative care. While some findings may be concluded from this study, it is essential that this topic be explored further as research on SPWs’ attitudes on euthanasia is limited. Research outcomes of this study can have important short-term and long-term implications on suicide prevention and training of SPWs to improve services offered to clients.

No decorrer da história humana, a hanseníase esteve atrelada ao imaginário social da lepra e do leproso, produzindo significados e sentidos relacionados ao isolamento dos acometidos, a caridade, ao estigma e preconceito. O que está em produção social e que regem as práticas profissionais não estão descritos apenas nos manuais e nas rotinas dos serviços de saúde, mas também são guiados pelos significados e sentidos do processo saúde-doença-cuidado. Para Vigotski significados e sentidos são construídos socialmente nas relações socioculturais, a partir da interação com o outro. Diante disso, buscamos responder a seguinte pergunta: Quais são os significados e sentidos da hanseníase para os trabalhadores da saúde de serviços ambulatoriais, de uma cidade no interior paulista, voltados ao tratamento de hanseníase? Nesse contexto, o objetivo deste estudo foi de analisar os significados da hanseníase para os trabalhadores da saúde. Utilizou-se a abordagem histórico-cultural, por meio da proposta da identificação dos Núcleos de Significação provenientes da análise das entrevistas com os trabalhadores. Ao todo, o estudo, contou com a participação de treze trabalhadores de diferentes disciplinas (enfermagem, medicina, serviço social e fisioterapia). Os resultados foram discutidos dentro de quatro capítulos. No capítulo 1 foi abordado os aspectos relacionados a vivência pessoal dos participantes (infância, formação, trabalho, família) em relação a hanseníase. Alguns trabalhadores contaram que tiveram algum familiar ou conhecido próximo com hanseníase e, relatam como essa experiência influenciou nas formas de significar a doença. Muitos relataram que tiveram uma formação deficiente ou até mesmo nula em relação a hanseníase. No segundo capítulo, identificou-se aspectos relacionados ao estigma e ao preconceito ainda presente na sociedade, mesmo após a descoberta da poliquimioterapia. Aspectos estes enraizados culturalmente e que vem sendo traduzidos nas ações das políticas públicas e do trabalho em saúde. O terceiro capítulo relaciona-se as dicotomias, desafios e potencialidades no cotidiano dos trabalhadores da saúde, o qual identificou o olhar e a postura dos profissionais atrelados ao sentimento de \"dó\", caridade, contrariando os princípios da política nacional de humanização. O último capítulo foi escrito buscando articular questões entre a hanseníase e a tuberculose, no contexto francês e brasileiro a partir da experiência da pesquisadora. Em suma, os significados e sentidos são produtos históricos e sociais e são construídos desde a infância, perpassam a vida profissional e continuam se modificando no decorrer do dia a dia do trabalho. / Throughout human history, Hansen\'s disease has been linked to the social imagery of leprosy and lepers, producing meanings and senses related to the isolation of those affected and to charity, stigma and prejudice. What is in social production and that govern professional practices are not only described in the manuals and routines of health services, but are also guided by the meanings and senses of the health-disease-care process. For Vygotsky meanings and senses are socially constructed in sociocultural relations, from the interaction with another. In view of this, we sought to answer the following question: What are the meanings and senses of Hansen\'s disease from the point of view of outpatient services health workers from a city in São Paulo state focused on this disease treatment? In this context, this study aimed to analyze the meanings of Hansen\'s disease for health workers. The historical-cultural approach was adopted, by means of the proposal of the meaning core identification from the analysis of the interviews with the health workers. In total, thirteen workers attended the study from different disciplines (nursing, medicine, social work and physiotherapy). The results were discussed within four chapters. In chapter 1, the aspects related to the personal experience of the participants (childhood, training, work, family) in relation to Hansen\'s disease were presented. Some workers reported having had a close family member or acquaintance with this disease, and described how that experience influenced the ways of meaning it. Many have reported that they have had a poor or even null training in Hansen\'s disease. In the second chapter, aspects related to the stigma and prejudice still present in society, even after the discovery of multidrug therapy, were pointed out. These aspects are culturally rooted and have been translated into public policies and health work. The third chapter concerns the dichotomies, challenges and potentialities in the daily routine of health workers, which identified the look and posture of professionals linked to the feeling of \"pitty\" and charity, contradicting the principles of the National Humanization Policy. The last chapter was written seeking to articulate questions between Hansen\'s disease and tuberculosis, in the French and Brazilian contexts, based on the researcher\'s experience. In sum, meanings and senses are historical and social products that are built from childhood passing through professional life and continue to change in the course of daily work.