The adoption of digital health technologies has dramatically changed the healthcare sector landscape and thus generates new opportunities to collect, capture, store, access and retrieve electronic personal health information (ePHI). With the introduction of digital health technologies and the digitisation of health data, an increasing number of hospitals and peripheral health facilities across the globe are transitioning from a paper-based environment to an electronic or paper-light environment. However, the growing use of digital health technologies within healthcare facilities has caused ePHI to be exposed to a variety of threats such as cyber security threats, human-related threats, technological threats and environmental threats. These threats have the potential to cause harm to hospital systems and severely compromise the integrity and confidentiality of ePHI. Because of the growing number of security threats, many hospitals, both private and public, are struggling to secure ePHI due to a lack of robust data security plans, systems and security control measures. The purpose of this study was to explore the security of electronic personal health information in a public hospital in South Africa. The study was underpinned by the interpretivism paradigm with qualitative data collected through semi-structured interviews with purposively selected IT technicians, network controllers’, administrative clerks and records management clerks, and triangulated with document and system analysis. Audio-recorded interviews were transcribed verbatim. Data was coded and analysed using ATLAS.ti, version 8 software, to generate themes and codes within the data, from which findings were derived. The key results revealed that the public hospital is witnessing a deluge of sophisticated cyber threats such as worm viruses, Trojan horses and shortcut viruses. This is compounded by technological threats such as power and system failure, network connection failure, obsolete computers and operating systems, and outdated hospital systems. However, defensive security measures such as data encryption, windows firewall, antivirus software and security audit log system exist in the public hospital for securing and protecting ePHI against threats and breaches. The study recommended the need to implement Intrusion Protection System (IPS), and constantly update the Windows firewall and antivirus program to protect hospital computers and networks against newly released viruses and other malicious codes. In addition to the use of password and username to control access to ePHI in the public hospital, the study recommends that the hospital should put in place authentication mechanisms such as biometric system and Radio Frequency Identification (RFID) system restrict access to ePHI, as well as to upgrade hospital computers and the Patient Administration and Billing (PAAB) System. In the absence of security policy, there is a need for the hospital to put in place a clear written security policy aimed at protecting ePHI. The study concluded that healthcare organisations should upgrade the security of their information systems to protect ePHI stored in databases against unauthorised access, malicious codes and other cyber-attacks. / Information Science / M. Inf. (Information Security)

South Africa is experiencing shortage of resources in most health services, including tertiary hospitals. This leads to a situation where health care workers, especially professional nurses (PNs) leave to private nursing or go abroad for better work conditions. The aim of this study was to explore and describe experiences of PNs on the shortage of resources at a tertiary hospital in Tshwane District. The study followed a qualitative, explorative, descriptive design based on phenomenological interpretive approach. Purposive sample of 16 participants were recruited. Unstructured interviews with a grand tour question was used to conduct face-to-face individual interviews. Interviews were recorded and transcribed verbatim. TheTesch’s method of analysis was utilised. Target group was PNs aged between 25 and 65 years who have worked for two or more years in selected units. Experiences of PNs on shortage of resources was reported as the major findings of this study. / Health Studies / M.A. (Nursing Science)

Background: Cognitive impairment is prevalent in survivors of acute coronary syndrome (ACS) and increases risk for poor outcomes. Lifestyle changes are recommended to patients after ACS to reduce their risk for recurrent events, but cognitively impaired patients may encounter difficulties initiating these changes. This dissertation had three aims: (1) to examine cognitive status as a predictor of lifestyle changes after ACS, (2) to examine whether caregiver support moderates the association of cognitive status and initiation of lifestyle changes, and (3) to assess the reliability of self-reported lifestyle changes in cognitively impaired patients through comparison of their reports of lifestyle change with those from their caregivers. Methods: For aims 1 and 2, Poisson regression with robust error variance was used to examine the association of cognitive status and caregiver support with patient-reported initiation of five lifestyle changes (improving diet, increasing exercise, quitting smoking, reducing stress, and attending cardiac rehabilitation) in 881 patients from TRACE-CORE, a prospective longitudinal observational study of outcomes in ACS. For aim 3, pilot data from 78 patient-caregiver dyads from TRACE-CARE, an ancillary substudy, were used to examine whether patient-caregiver congruence on reports of lifestyle changes varied according to patients’ cognitive function. Results: Patient-reported rates of lifestyle change did not vary according to cognitive status, except for participation in cardiac rehabilitation. Caregiver support improved patient-reported rates of lifestyle change among cognitively intact patients but not cognitively impaired patients. Patients’ cognitive function was positively associated with patient-caregiver congruence on reports of initiation of lifestyle changes and patients with decreased cognitive function tended to over-report initiation of lifestyle changes compared to reports by their caregivers. Conclusion: Although cognitive status was not associated with initiation of most lifestyle changes and the influence of caregiver support on initiation of lifestyle changes was only beneficial to cognitively intact patients in this cohort of ACS patients, these null findings may be explained by the questionable validity of self-report in cognitively impaired patients. This dissertation yields new knowledge about secondary prevention in ACS patients and provides insight into the challenges of conducting patient-reported outcomes research in cognitively compromised populations.

Childhood adversity is associated with numerous negative outcomes across multiple domains, including mental and physical health, interrelationships, and social functioning. Notably, research suggests that childhood adversity has a dose-response relationship with these outcomes; that is, greater numbers of adverse experiences in childhood are associated with worse outcomes. These outcomes overlap with many risk factors of homelessness. This study sought to address two questions: 1) Does a dose-response relationship exist between childhood adversity and chronic homelessness? 2) Does childhood adversity negatively predict the age at which homelessness first occurs? Adults experiencing homeless who are accessing homeless services in the Tri-Cities area of Northeast Tennessee responded to a brief instrument that includes measures of homeless chronicity, Adverse Childhood Experiences (ACEs), and age of onset of homelessness. Although relationships between ACEs and homeless chronicity was not observed, a relationship did emerge between number of ACEs and number of episodes and number of ACEs and age at initial onset of homelessness.

Motivation is critical to the effective management of social workers in an organisation. A literature study of the concept motivation and an empirical study on the motivational function of the social work manager were conducted. This exploratory/descriptive study aimed to set scientifically grounded guidelines for the implementation of motivation as management function of social work managers. The literature indicated that motivating employees is the responsibility of social work managers. Research showed that social workers, social work managers and the organisation do benefit from motivation. The respondents indicated that motivation as a management function is important. They highlighted that intrinsic motivation and internal and external motivators influence their motivation positively. Organisational policies and a leadership style characterised by autocracy and a laissez-faire approach are demotivating. Social work managers should apply the principles of motivation theories, motivational strategies and guidelines to maintain and sustain motivation. Conclusions and recommendations were made regarding the motivational function of the social work manager. / Social work / M. Diac. (Social Work)

This explorative, descriptive quantitative survey attempted to determine whether the reduced number of consultations and admissions of sick children less than five years in Emfuleni sub- district clinics is due to the utilisation of the IMCI strategy or other health services. The research population comprised of all the mothers/caretakers of children less than five years who utilised the clinics and those who consulted the private medical doctor. The convenient sample consisted of 169 candidates. Data was collected by means of a questionnaire and analysed using the SAS/Basic computer statistical software package. Findings of the study revealed a need to address the major concern about the waiting time and operational times in all the three clinics. Recommendations were made that staff allocation procedures and policies be reviewed in order to abate long waiting periods at the clinics where children with childhood illnesses are treated. / Health Studies / M.A. (Health Studies)

In this study the researcher attempted to determine the current role expectations of a clinic manager in a primary health care setting, to identify factors determining and influencing the role of a clinic manager, to determine what effect the current role expectations had on the management of primary health care services rendered at the clinic, to establish the developmental needs of clinic managers to enable them to adhere to their role expectations, and to identify and recommend measures to support clinic managers in the execution of their managerial role by addressing the identified deficiencies. The researcher selected a quantitative, exploratory, descriptive and contextual design. Clinic managers of fixed clinics in the Free State province were randomly selected to participate in the study and a questionnaire was utilised as data-collection instrument. The study found that the clinic manager's role is comprehensive and varies from telephonic booking patients to assessment of the quality of primary health care programmes. A number of non-managerial functions were identified, such as consultation of patients, management of medicine, dispensing of medicine and ordering of stock. It was also found that the respondents were not involved in a number of management functions such as financial and human resource management, and adherence to the implementation of standards. Factors that negatively influenced the clinic managers' management role included: * Lack of time due to the large number of patients they had to consult due to the shortage of staff. * Shortage of staff. * The execution of non-managerial tasks. Although it was found that the current role of the clinic manager was confusing as it entailed much more than just clinic management, it is foreseen that the role of the clinic manager could in future be clarified if the recommendations are implemented. / Health Studies / D. Litt. et Phil. (Health Studies)

In the last decade, the deployment of Electronic Health Records has increased tremendously in many developed countries. This increasing trend intensifies the need for developing countries like South Africa to implement electronic health record systems in state owned hospitals to facilitate e-referral processes to improve health care delivery. The aim of this research was to investigate the current process of patient record keeping, management, and the referral process of patients within the same hospital and to other hospitals and based on the findings compile an Electronic Health Record (EHR) framework to facilitate e- referral processes. This research study was based on a qualitative case study approach. A multiple data collection technique was used which included group interviews, questionnaires, document analysis and informal discussions with the hospital workers. Data were analysed by categorization and thematic approach. The findings obtained from state hospitals indicated that there is no EHR system which accommodates patient health record systems to facilitate e-referral processes. These findings led to a compilation of the Limpopo Electronic Health Record System (LEHRS) to aid e-referral processes in state hospitals. The increasing need for accurate, reliable, available and accessible EHR will be addressed by the implementation of LEHRS as information will be stored in a central database in a useable format and will be easily accessed. / Computing / M. Tech. (Information Technology)

The study was aimed at furthering the health objectives of the government's Reconstruction and Development Programme (ANC 1994b) in the area of primary health care. . The purpose of the study was to examine the possible reduction of medical scheme claims for cardiovascular disease by means of primary health care, so that medical scheme benefits do not become exhausted so rapidly. The overall outcome of the study showed that if cardiovascular disease could be diagnosed and treated early, the financial benefits could be substantial. This was illustrated by the comparison of primary, secondary and tertiary treatment of cardiovascular disease using case studies over a period of one year. Recommendations centered around nurse-based primary health care for cardiovascular disease and the cost-effective management of the medical scheme. It was concluded that as a result of nurse-based primary health care, costs could be contained so that medical scheme benefits would not become exhausted so rapidly. / Health Studies / M.A. (Nursing Science)

Text in Afrikaans / Summaries in Afrikaans and English / Bemagtiging van verpleegkundiges in gesondheidsdienste in Suid-Afrika bly 'n voortdurende kwessie en die mate waartoe verpleegbestuur verpleegkundiges bemagtig om outonoom op te tree, is onbekend. Wanneer verpleegkundiges bemagtig is, lei dit tot verbeterde pasientsorg deur middel van verhoogde produktiwiteit en werktevredenheid. Die wyse waarop bemagtiging van verpleegkundiges meet geskied is nog nie in SuidAfrika in diepte ondersoek nie. Die doel van hierdie studie was om daardie elemente wat vir die verpleegbestuurder noodsaaklik is om verpleegkundiges te kan bemagtig, te identifiseer. Deur middel van 'n beskrywende, ontdekkende studie wat van 'n vraelys gebruik gemaak het om inligting te bekom, is die nodige elemente gei'soleer. Verpleegbestuurders in gesondheidsdienste in die Gauteng-area het as teikengroep gedien. Definisies van bestuursbemagtiging is geanaliseer ten einde 'n konseptuele raamwerk te ken saamstel. Ses konsepte het die raamwerk vir hierdie studie gevorm, naamlik: • die bydrae van bestuurstrukture tot die bemagtiging van verpleegkundiges; • die rel van magsdeling in die bemagtiging van verpleegkundiges; • deelnemende besluitneming in die bemagtiging van verpleegkundiges; • die verpleegbestuurder se vaardighede en verantwoordelikhede in haar daaglikse taakontwerp en bestuur wat tot die bemagtiging van verpleegkundiges bydra; • motivering- en beloningstrategiee wat tot bemagtiging bydra; en • eienskappe wat kenmerkend van 'n bemagtigende verpleegbestuurder is. Uit die ontleding van die data het die volgende belangrike elemente ender andere na vore gekom: • Daar behoort gedesentraliseerde verspreiding van mag na die laagste moontlike vlak in die gesondheidsdiens plaas te vind; • Die voorstelle van verpleegkundiges behoort erken en indien aanvaarbaar, geimplementeer te word; • Gesag behoort op so n wyse gedelegeer te word dat onafhanklike besluitneming bevorder word; • Verpleegkundiges se take behoort sodanig ontwerp te word dat onafhanklike optrede in die werkplek bevorder word. Die bevindinge van hierdie studie het getoon dat verpleegbestuurders positief ingestel is betreffende die bemagtiging van verpleegkundiges. Hulle beskou dit as deel van hulle bestuursfunksie. 'n Uitdaging waarmee die bestuurder van die toekoms te kampe sal he, is die van 'n omvattende begrip vir personeellede en om van beheer deur middel van streng burokratiese reels, af te sien. / Empowerment of nurses in health services in South Africa remains an ongoing issue, but the extent to which nursing management empowers nurses to act autonomously is not known. When nurses are empowered patient care and nursing services improve through enhanced productivity and job satisfaction. The way in which nurses could be empowered by management has yet to be addressed by researchers in South Africa. The aim of the present study was to identify those essential elements through which nurse managers can empower nurses. By making use of a descriptive exploratory study, utilizing a questionnaire to acquire the necessary information, the essential elements were isolated. Nurse managers in health services in the Gauteng region formed the target group. Definitions of empowerment in management were analyzed and from this a conceptual framework regarding empowerment was formulated. Six concepts served as the basis of this study: • the contribution of management structures, towards the empowerment of nurses; • the role of power-sharing in the empowerment of nurses; • participative decision making in the empowerment of nurses; • the management skills and responsibilities of the nurse manager in her daily task design and management that contribute to the empowerment of nurses; • motivation and reward strategies that contribute towards empowerment; • attributes which characterise an empowered nurse manager. From the analysis of. the data the following important elements among others emerged: • Decentralization of the distribution of power to the lowest possible level should take place in the health services; • The suggestions of nurses should be acknowledged and if found acceptable, to be implemented; • Authority should be delegated in such a way that independent decision making by nurses is enhanced; • Nurses' tasks should be designed in a way that promote independent performance in the work place. The findings of this study revealed that nurse managers are favourably disposed towards the empowerment of nurses. They see this as part of their managerial function. A challenge which confronts the manager of the future is that of comprehensively understanding staff members, and setting aside control through bureaucratic behaviour. / Health Studies / D. Litt. et Phil.