Thesis (MPhil)--Stellenbosch University, 2012. / Background: Preceptorship refers to a teaching and learning approach through which a well experienced clinician is contracted to provide clinical teaching, supervision, role‐modeling of professional and clinical practice skills and assessment of students in a clinical setting. This approach often involves three groups of people, namely: faculty, students, and clinicians (preceptors). The preceptor in this study refers to a registered nurse who supervises and conducts clinical assessment of students in a clinical area, while at the same time is responsible for patient care. The focus of this study was to explore preceptors’ opinions regarding the implementation of preceptorship in the diploma in the nursing curriculum diploma in the nursing curriculum in Botswana. Emphasis was placed on seeking information on how preceptorship is implemented, the strengths and challenges regarding its implementation and suggestions as to how it should be strengthened to contribute positively towards teaching and learning of students. Methodology: A mixed cross‐sectional descriptive design, using a survey was used. . The design was adopted because of its ability to provide a broad understanding of the concept under study by allowing participants to share their experiences and opinions about a specified situation. Both the qualitative and quantitative data were collected simultaneously. A standardized self‐developed structured questionnaire using both closed ended and few open ended questions and consisting of scaled self‐report items and checklists was used to collect data from forty‐four (44) preceptors and three (3) third year level coordinators from the three (3) health training institutions. Quantitative data were analyzed using SPSS, while the qualitative data were analyzed for frequency of common themes. Descriptive statistics in the form of frequency tables and charts, as well as measures of central tendencies, were used in the analysis of quantitative data. Results: The findings revealed that preceptorship program was not well coordinated as there were no preceptorship manuals to guide the implementation of preceptorship program. On the positive side, however, preceptors felt comfortable and competent to supervise and assess students, despite the fact that most of them had not received preceptorship training or orientation. With regard to preceptor support, it was evident that there was need for major support in regard to improved communication between preceptor and faculty, improved support by the health facility manager and the need for strengthening preceptor training and orientation. The majority of the respondents have recommended for preceptorship orientation /training targeted at addressing some of the following topics: Student and preceptor roles, curriculum requirements, clinical teaching and assessment skills, leadership skills and how to access resources from the health training institutions. A significant number of preceptors felt that it was important to receive feedback about students’ progress from faculty and to receive feedback from students regarding their experiences in the clinical internship sites. Lastly, preceptors also felt that there was need for introducing incentives into the preceptorship program Conclusion The key areas that emerged from the study indicated an uncoordinated and unstructured preceptorship program in the diploma nursing curriculum. Preceptor support is limited as evidenced by report of lack of training or orientation of preceptors to their preceptorship role. To ensure sustainability of preceptorship program there is need to improve the following areas: preceptorship training and orientation, and preceptorship support by both the health training institution and the health facility managers. Key words: Preceptors, preceptorship, orientation, socialization, student assessment, and faculty support, clinical teaching, mentor, clinical supervisor.

Over the last two decades there has been heightened interest in redefining faculty scholarship in higher education (Boyer, 1990). Trends have included the development of cultural frameworks for understanding how disciplines and institutions influence faculty work and how socialization processes impact academic career development. Despite the fact that the number of occupational therapy practitioners who have pursued doctoral training in pursuit of an academic career has failed to keep up with the need for qualified faculty, academic interest in developing disciplinary scholars to build the knowledge base of professional practice has been slow to develop. Furthermore, leadership interest in guiding the development of future faculty by studying how current occupational therapy faculty members are developing as scholars has been limited (AOTA, 2003). The purpose of this study was to develop a framework for describing scholarship in occupational therapy faculty members. A theoretically grounded case study design guided the selection of two occupational therapy departments, representing both a research university and a master’s college. Narrative data from occupational therapy faculty members in these institutions provided in-depth perceptions of how faculty members in diverse institutional settings develop a professional identity. Rich understandings of how clinical and academic socialization processes converge as faculty members in academic departments integrate competing influences from the academic culture, the institutional culture, and the professional culture to prioritize faculty work roles. The study revealed that although occupational therapy departments are succeeding within their institutional contexts, personal faculty priorities as clinicianteachers and institutional missions that create an imbalance in roles that favor teaching, continue to disadvantage certain faculty sub-cultures from evolving as disciplinary scholars. The implications of the failure of occupational therapy faculty members to adapt the researcher role as part of a professional identity include barriers to the development of disciplinary knowledge to support practice, and to the development of successful faculty careers that can be advanced in any institutional environment. The study identified a critical role for program leadership to act as change agents within departmental cultures to balance the need for productive disciplinary scholars, as well as effective clinician-teachers.

Thesis (MPhil)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Worldwide the stigma attached to psychiatric patients, psychiatric disorders, psychiatrists and the field of Psychiatry is of great concern. The stigmatising perceptions of medical practitioners and medical students towards psychiatric patients have a negative impact on effective treatment, considering the increasing burden psychiatric disorders are placing on communities and health systems. Numerous efforts were attempted and recommendations made for destigmatising medical students' perceptions towards psychiatric patients. It was found that perception usually improved after a clinical rotation in Psychiatry, but the stigmatising perceptions mostly returned a year later. The first clinical exposure to Psychiatry for medical students at the Faculty of Medicine and Health Sciences, Stellenbosch University, is during the fourth or fifth year of study. This rotation was revised in 2010 and a service-learning component added. The research question which consequently developed, is: What is the influence of a service-learning approach on destigmatising students' perceptions towards psychiatric patients? The research followed a phenomenological school of thought in an interpretative paradigm with a qualitative-inductive approach. On the last day of a rotation students handed in their written reflections and an in-depth focus group interview was conducted. The focus group interviews were repeated a year later. Students' reflections and the transcribed texts were analysed. This served as the basis for conclusions from which recommendations were made. It was found that students had stigmatising perceptions towards psychiatric patients before their first clinical rotation in Psychiatry. Directly after that students' perceptions were destigmatised to a greater extend. A year later non-stigmatising perceptions of understanding, acceptance, comfortableness, compassion, respect and responsibility were still present, although a few students experienced the limited return of stigmatising perceptions. Students attributed the positive changes to their service-learning experience in combination with the clinical placement at a psychiatric hospital with a friendly atmosphere and where they were exposed to patients not suffering from complex and extreme psychiatric disorders. The non-stigmatising perceptions a year after a clinical rotation in Psychiatry demonstrates the transformative value of service-learning. Service-learning is where meaningful and relevant service is rendered with and in the community, social responsiveness is purposefully emphasised and structured reflections are done to enhance academic learning. As a result of this study medical schools worldwide can take cognisance that a service-learning approach made a significant contribution to the stained destigmatisation of medical students' perceptions towards psychiatric patients. / AFRIKAANSE OPSOMMING: Stigma teenoor psigiatriese pasiënte, psigiatriese steurings, psigiaters en Psigiatrie as vakgebied is wêreldwyd ʼn groot bron van kommer. Medici en mediese studente se stigmatiserende persep-sies teenoor psigiatriese pasiënte het ʼn negatiewe impak op effektiewe behandeling, veral gesien in die lig van die groterwordende las wat die toename in psigiatriese steurings op gemeenskappe en gesondheidsisteme plaas. Heelwat pogings is aangewend en aanbevelings gemaak om mediese studente se persepsies teenoor psigiatriese pasiënte te destigmatiseer. Daar is bevind dat persepsies gewoonlik verbeter direk na ʼn kliniese rotasie in Psigiatrie, maar dat stigmatiserende persepsies meestal binne ʼn jaar terugkeer. Mediese studente aan die Fakulteit Geneeskunde en Gesondheidswetenskappe, Universiteit Stellenbosch, se eerste kliniese blootstelling aan Psigiatrie is tydens die vierde of vyfde studiejaar. In 2010 is dié rotasie hersien en ʼn diensleerkomponent bygevoeg. Die navorsingsvraag wat hieruit ontwikkel is, is: Wat is die invloed van ʼn diensleerbenadering op die destigmatisering van mediese studente se persepsies teenoor psigiatriese pasiënte? Die navorsing het ʼn fenomenologiese denkrigting gevolg in ʼn interpretatiewe paradigma met ʼn kwalitatief-induktiewe benadering. Studente het skriftelike refleksies op die laaste dag van ʼn rotasie ingehandig en ʼn in-diepte fokusgroeponderhoud is gevoer. ʼn Jaar later is die fokus-groeponderhoude herhaal. ʼn Ontleding van studente se refleksies en die getranskribeerde tekste en gedoen. Dit het gedien het as basis vir die gevolgtrekkings waaruit aanbevelings gemaak is. Daar is gevind dat studente voor hulle eerste kliniese rotasie in Psigiatrie, stigmatiserende persepsies teenoor psigiatriese pasiënte gehad het. Direk daarna was studente se persepsies grotendeels gedestigmatiseer. Na ʼn jaar was nie-stigmatiserende persepsies van begrip, aanvaar-ding, gemaklikheid, deernis, respek en verantwoordelikheid steeds teenwoordig, alhoewel stigma-tiserende persepsies tot ʼn mate by sommige teruggekeer het. Studente het die positiewe verande-ring toegeskryf aan die diensleerervaring in kombinasie met 'n kliniese plasing in die psigiatriese hospitaal waar ʼn vriendelike atmosfeer geheers het en waar daar blootstelling was aan pasiënte wat nie aan komplekse en ekstreme psigiatriese steurings gely het nie. Die nie-stigmatiserende persepsies ʼn jaar na ʼn kliniese rotasie in Psigiatrie toon die transformatiewe waarde van diensleer. Met diensleer word sinvolle en relevante diens met en in die gemeenskap gelewer, doelbewuste klem word op sosiale verantwoordbaarheid gelê en ge-struktureerde refleksie word gedoen om beter akademiese leer te laat plaasvind. Na aanleiding van hierdie studie kan mediese skole wêreldwyd kennis neem dat ʼn diensleer-benadering ʼn betekenisvolle bydrae gelewer het tot die volhoubare destigmatisering van mediese studente se persepsies teenoor psigiatriese pasiënte.

Angiogenesis is essential for the growth of a tumour, as it provides tumour cells with nutrients and oxygen for their survival. As the tumour expands, neovascularisation is facilitated by the release of enzymes called proteases, which degrade extracellular matrix and facilitate the metastatic spread of cancer. TNF[alpha] and IL-1[beta] are potent cytokines that share the ability to stimulate angiogenesis, hence their possible significance in metastasis has been a focus of intense research. TNF[alpha] and IL-1[beta] have been shown to regulate the activity of proteases such as MMP's and serine protease. The aim of this study was to investigate the effect of TNF[alpha] and IL-1[beta] on cathepsin B and DPP IV activity and their protein levels in HRT 18, HT 29 cells and HUVEC's. Further experiments were conducted to assess the viability of the cells upon treatment with the cytokines. In addition the potency of inhibitors Mu-Phe-Hph-FMK, for cathepsin B enzyme, and Gly-Pro-Gly-Gly, for DPP IV enzyme were assayed in the three cell lines studied. Addition of TNF[alpha] and IL-1[beta] resulted in the reduction of intracellular cathepsin B and DPP IV activity and an increase in its extracellular activity in HRT 18 and HT 29 cells, suggesting that the cytokines induced the release of the enzymes or may have inactivated intracellular enzyme while activating the latent extracellular enzyme. However, in HUVECs, both the cytokines led to an increase in intracellular as well as extracellular cathepsin B activity, possibly by activating the latent form of enzyme present within and outside the cell. With respect to DPP IV, there was an increased intracellular and extracellular activity with TNF[alpha], but with IL-1[beta], an increase in intracellular activity and a decrease in extracellular activity were observed, suggesting involvement of a different mechanism for the exopeptidase enzyme in HUVECs. The two Cytokines had a cytotoxic/cytostatic effect on all three cell lines, with prominent reduction in cell viability of HUVECs. In conclusion the varied response of intracellular and extracellular activity and protein levels of cathepsin B and DPP IV, in different cell lines suggests that TNF[alpha] and IL-1[beta] may act as important modulators of proteases in the process of angiogenesis in cancer and normal endothelial cells. Thus understanding the pleiotropic nature of these cytokines will further broaden the knowledge of involvement of these cytokines in cancer progression/cancer regression.

Accurate detection and segmentation of intracranial aneurysms plays an important role in diagnosing and reducing the incidence of subarachnoid haemorrhage (SAH) which is associated with high rates of morbidity and mortality. This research proposes a computer aided detection (CAD) and segmentation (CAS) of intracranial aneurysm in computer tomography angiography (CTA). The efficiency of the CAD/CAS system is boosted by pre-processing the input image with non-linear diffusion to smooth the CTA data while preserving the edges. A 3D region growing-based approach is used to extract the cerebral arteries followed by entropy-based search space reduction to retain the volume of the circle of Willis (CoW) and the proximal cerebral arteries where nearly all intracranial aneurysms are located, whilst eliminating the extracranial and very distal intracranial circulation. Because cerebral aneurysms vary in size we regard the problem of cerebral aneurysm detection as an intrinsically multi-scale problem and employ a multi-scale approach to all detection analysis. Shape index analysis is employed to determine potential aneurysmal regions (PARs). Hessian analysis and gradient vector field analysis which reveal 3D local shape information are used to further characterise the initial PARs. False positive reduction is then performed based on the analysis of the shape characterisations of the PARs. A ranking score is defined based on the outcomes of the shape analysis to rank the likelihood of PARs. The system allows user to navigate through the ranked PARs and select a candidate aneurysm for further analysis (CAS). The boundary of the selected aneurysm and its parent artery is delineated by using a 3D conditional morphology-based region growing approach. The output is presented to the user to be assessed for the aneurysm orientation relative to the parent vessel. A semi-automatic process is applied to detach the aneurysm from its parent artery. To have a fine segmentation of aneurysm which can be used for characterization of the aneurysm, a 3D geodesic active contour implemented in a level set framework is applied. The volume of the separated aneurysm is quantified as a typical characterization ofthe aneurysm. The system has been validated on a clinical dataset of 62 CT A scans with average 274 slices per scan (involving 17,028 CT slices) containing 70 aneurysms. Sizes of aneurysms vary between 3-16mm. 42 CTA scans have been used as a training dataset for parameter selection and 20 CTA scans have been used as a test dataset. The sensitivity of the systems for the CAD component is 97% with the average false positive of 2.24 per dataset (0.008 per slice). CAS performance was evaluated by dual visual judgment of an expert neuroradiologist and neurosurgeon. The detection and segmentation performance indicate the approach has potential in clinical applications.

This thesis addresses the theory of Socio-Technical Systems (STS) within the context of Information Systems (IS), a complicated field combining Information Technology and social shaping impacts. IS have been changing our society for some decades. From Office Automation (OA) to E-Commerce and E-government, IS are creating a new era of Mobilisation. Different industries have all been adopting Information Technology to enhance their business, from enterprises to public sectors. All these changes bring dramatic impacts for organisational behaviour and people's living, which need to be studied. According to academic literature, health informatics, being one of the important and complex fields in IS, started to employ mobile technical systems to improve healthcare service delivery for citizens at the start of the new Millennium. Comparing with other theoretical models in IS, the author argues that the Socio-Technical approach can explain comprehensively the new changes to organisations and society. Following the theories of STS, these case studies were decided by the researchers as field work in Chinese Community Healthcare Service Centres, where there are various mobile services for the citizens. Through multiple case studies, the author found that Leader Emphasis is one new social element in the field of the IS, while Participation, as another social element is essential to the context of this research project. These two social shaping elements, combining together within a model of STS, provide new decision making process, which is vital to a successful development of Mobile Health Information Systems (MHIS). The model has affected organisational behaviour, organisational structure, culture and society, following the usage of Mobile IS. Based on the result of the field work and the relevant literature of E-govemment, this research also concludes that M-govemment can be the transformation of E-govemment, as public service can be delivered efficiently by Mobile IS. A developing model is presented in this thesis.

This thesis tells the tale of a special group of healthcare 'customer service' workers called the Patient Advice Liaison Service (PALS). It looks at how their job is designed and explores the impact this has, on their wellbeing by using a mixed-method research design which includes one quantitative and one qualitative study. The starting occupational level study is based on quantitative data from 138 participants using a questionnaire that measures global wellbeing, job satisfaction and psychosocial work conditions. A high incidence of strain is reported, statistically higher than that of other customer service employees and more comparable to social workers. Psychosocial conditions at work are revealed to be dire and in need of urgent action; and yet, the same group of workers report satisfaction with their job. To further unwrap the complex lived experience of PALS workers, an individual level study was conducted. Interpretative phenomenological analysis was undertaken with nine participants. Four emergent themes affirm that when it comes to their job, others just don't really get it, especially the extent of their emotion work. Changing the NHS is compared to changing a super tanker's direction and participants confess to having had a breaking point. Nevertheless, PALS staff declare that this is a vocation and I wanna do it. Reflexive interpretations suggest that some customer service employees actually engage in rather complex work that is not easily captured by the broad 'customer service' label. For individuals engaged in this type of relational work emotion work was found to be both a source of distress and motivation. Comparisons between these healthcare workers and other public sector relational workers are made and the new discourse of expertise services is proposed. Theoretical and policy implications are discussed.

The diagnostic radiography curriculum and the process of its enactment are under researched in the United Kingdom. To date, there have been no published studies which have investigated the curriculum and the role of radiography educators from the multiple perspectives of radiography students, university radiography educators and clinical radiography educators, that is, a radiography education community. Accordingly, this study describes the perceptions and experiences of a radiography education community in relation to three research questions: 1. How does a radiography education community conceptualise the radiography knowledge and skills required of a diagnostic radiographer? 2. How does a radiography education community conceptualise the role played by university based and clinically based radiography educators in helping the radiography student acquire radiography knowledge and skills? 3. How does the community in this study compare with Lave and Wenger’s theoretical constructs of a situated learning, legitimate peripheral participation and Communities of Practice (CoP)? The epistemological foundation of the study is constructivism and the overarching methodology is a case study conducted within a single higher education institution and three of its associated clinical practice partner settings. The primary data collecting method comprised semi-structured interviews, supplemented by a critical review of germane literatures, government policy and the curriculum guidance provided by the relevant professional and statutory bodies. The theoretical framework in which the study is situated is based upon Lave and Wenger’s theories of situated learning, legitimate peripheral participation and communities of practice. The findings of the study reveal a radiography education community which is lacking any unifying pedagogic discourse. In particular, there is an absence of opportunities for cross-community working, especially in collaborative curriculum development and the process of its enactment. This is further compounded by the community’s narrow interpretation of what a curriculum should comprise. Currently there is a clear focus on knowledge content and curriculum as a product which fails to take into account praxis and the social context in which learning takes place. These findings have been summarised by a representation of the enacted curriculum as compared with the ‘ideological’ function of a radiography curriculum. Specific developments required of the curriculum include: (i) placing a greater emphasise on the vocational relevance of radiography knowledge; (ii) gaining a better understanding of tacit radiography knowledge; (iii) ensuring greater familiarity with the curriculum and (iv) enhancing the standard of clinical supervision. The radiography education community in this study evidences both convergence and divergence with Lave and Wenger’s theoretical constructs of situated learning, legitimate peripheral participation and community of practice. Within the context of radiography education the study also highlights the consequence of power relationships, the complexity of learning in and across multiple communities of practice and the importance of individual learner biographies, all of which are underdeveloped in Lave and Wenger’s theoretical discourse. These findings have been summarised in a proposed theoretical model for a radiography education community of practice. Three specific pedagogic and managerial inferences may be drawn from this study which will require staff development and consideration of how the diagnostic radiography programme is managed across the community. Firstly, context, process and praxis need to be carefully considered in the collaborative development, design and implementation of the curriculum. Secondly, the university and clinical educators need to reflect on their own learning and teaching skills by engaging more fully with pedagogy. Thirdly, communication across the radiography education community of practice must be improved.

Parenting capacity assessments (PCA) have been used in the child intervention system in Canada since at least the 1970s. They are used in other Western jurisdictions including the United Kingdom, Australia, New Zealand and the United States. There is a relatively large literature that considers the ways in which these assessments might be conducted. This thesis, drawing upon the prior work of the candidate, seeks to show that, despite widespread use, the PCA is a colonial methodology that should not be used with Indigenous peoples of Canada. The PCA draws upon Eurocentric understandings of parenting, definitions of minimal or good enough parenting, definitions of family and community as well as the use of methods that have neither been developed nor normed with Indigenous peoples. Using critical theory, particularly "Red Pedagogy" which is rooted in an Indigenous lens, the PCA is deconstructed to examine applicability to Indigenous populations of Canada, and potentially other populations that do not fit a Eurocentric understanding of family and parenting. Implications for clinical practice with Indigenous peoples are drawn which may have relevance for other populations.

This study aims to understand the use of a computer during GP consultations and to enable the development of EPR systems which are easier to review, enter data into, use to take action, and is more sensitive to the clinical context. This thesis reports the development of a multi-channel video and data capture toolkit, the ALFA (Activity Log File Aggregation) because existing observation techniques have limitations. None of the existing tools are designed to assess human-computer interaction in the context of the clinical consultation, where the social interaction is the prime focus. The ALFA tool-kit has been used to observe and study 163 live primary care consultations supported by computer systems with four different designs. A detailed analysis of consultation interactions was then performed focusing on doctor-patient communication and the integration of the computer into the consultation workflow. The data collection elements of the ALFA supported recording of consultation activities by providing rating techniques attuned with the characteristics of those interactions. The Log File Aggregation (LFA) component of the ALFA toolkit aggregated those multitudes of data files into a single navigable output that can be studied both quantitatively and qualitatively. A set of Unified Modelling Language (UML) sequence diagrams were then created as they could be used by software engineers to develop better systems. This research proposes a framework with three elements to analyse the computerised clinical consultation; (1) the overview of the context within which the consultation was carried out, (2) time taken to perform key consultation tasks and (3) the process used. Traditional analysis with its emphasis on the technology often misses crucial features of the complex work environments in which the technology is implemented. Direct observation could inform software designers in developing systems that are more readily integrated into clinical workflow. Direct observation of the consultation, using the ALFA toolkit is acceptable to patients; captures the context of the consultation the precise timing and duration of key tasks; and produces an output a software engineer can understand. ALFA offers a range of possibilities for research in the consulting room. The computer should be considered as an active element of the consultation; room layout and consultation models should let the computer in, while software engineers take in the capacity to sustain patient centred social interactions as a core facet of their design agenda.