Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: This study investigates the relevance of Pastoral Caregivers (PCGs) in the Nigerian hospital context from a pastoral theological perspective. It argues that illness is a reality that confronts all humanity at certain times. It brings untold pain and suffering to the afflicted, physically, emotionally, psychologically and spiritually. As such, wholeness and health are some of the most important concerns of Nigerians and the global community as demonstrated by the Millennium Development Goals (MDGs) of the United Nations (UN). The Nigerian quest for wholeness is a search for meaning, significance, and purpose in life especially in illness, pain and suffering. This search involves questions about God’s involvement in suffering. For this reason, illness comprises a complex reality that defies easy remedy. However, affected persons often seek remedy in the hospital. But research shows that the medical model, despite its benefits, has limited capacity to fulfil the human quest for meaning. Also, the Draft Health Policy for Nigeria (DHPN) (2005:np) and National Strategic Health Development Plan (NSHDP) 2010-2015 (2010:5) has also stated that the health system of Nigeria is poor and Nigeria is not “on track towards significant improvement in meeting the health expectation of its people inclusive of achieving the health MDGs” (NSHDP 2010:10). However, the NSHDP 2010-2015 (2010:11) has also stated that a purposeful reform of the national healthcare delivery system is necessary for strengthening the weak and fragile national health delivery system and improving its performance towards achieving quality caregiving and quality of life. In line with these Ministry of Health reform plans, this study argues that such healthcare reforms should necessarily include pastoral caregivers (PCGs) as valuable and a necessary human resource for health, partnership for health and research. Religion and spirituality (the domain of pastoral care) have been put forward as best responding to many people’s quest for meaning. Consequently, this research has employed a practical theological methodology. Within this methodology a postfoundationalist paradigm according to Park (2010) has been utilised. In this regard, the structure of the chapters is aligned with the four tasks of practical theology as proposed by Osmer (2008). It further utilised relevant literature in the fields of theology, medicine and other social sciences from within Nigeria, Africa and beyond. It has been argued that the absence of meaningful pastoral care dimension is a significant weakness of the medical model as practised in Nigeria. It is inconsistent with the promotion of the health of patients and the community which the Nigerian Code of Medical Ethics (2004) articulates as the goal of medicine in Nigeria. It is also inconsistent with the holistic view of Nigerians on illness. Additionally, it is not consistent with the National Policy on Private Partnership for Health in Nigeria (NPPPHN) (2005) declaration that “alternative health providers, whose practices are of proven value, shall be encouraged and supported as frontline of health care provision for many people”. As the above Nigerian policies on health suggest – and this is also the position of this study – illness demands a holistic and multidisciplinary approach to combat it. This study has established that pastoral care embodies a vision of wholeness which resonates with the Nigerian holistic view of life whose practices are of proven value. Therefore, the inclusion of the PCG with a holistic theological approach into Nigerian hospital care could contribute to holistic and quality care of patients in hospitals. They could contribute towards the implantation of the NSHDP 2010-2015. This study is strongly motivated by the fact that human beings are made in the image of God and deserve love, respect for their values and desires, and dignity especially in the face of illness and suffering. Therefore, it recommends that hospitals and clinics in Nigeria should of necessity include PCGs in their hospitals and on their clinical team, as well as provide basic training for all members of the medical team in the pastoral assessment of patients. / AFRIKAANSE OPSOMMING: Hierdie studie ondersoek die relevansie van pastorale versorgers (PV’s) in die Nigeriese hospitaalkonteks vanuit ’n pastoraal-teologiese perspektief. Daar word geargumenteer dat siekte ’n realiteit is wat die hele mensdom op bepaalde tye affekteer. Dit veroorsaak ongekende pyn en lyding vir die sieke, hetsy fisies, emosioneel, sielkundig of geestelik. Gevolglik is heelheid en gesondheid van die belangrikste oorwegings vir Nigeriërs, asook die globale gemeenskap, soos duidelik blyk uit die Verenigde Nasies se Millenniumontwikkelingsdoelwitte. Die Nigeriese strewe na heelheid is ’n soeke na betekenis, belangrikheid en sin in die lewe, veral in tye van siekte, pyn en lyding. Hierdie soeke betrek ook vrae oor God se rol in lyding. Om hierdie rede behels siekte ’n komplekse realiteit waarvoor daar geen maklike oplossing is nie. Siekes soek egter oplossings in die hospitaal. Navorsing bewys desnieteenstaande dat die mediese model, ten spyte van die voordele daarvan, beperkte kapasiteit het om die menslike soeke na betekenis te vervul. Nigerië se konsep-gesondheidsbeleid, die Draft Health Policy for Nigeria, of DHPN, (2005) en strategiese gesondheidsontwikkelingsplan, die National Strategic Health Development Plan, of NSHDP 2010-2015, (2010:5) stel dit verder dat die gesondheidstelsel in Nigerië swak is en dat die land nie op koers is na beduidende verbeterings in die voldoening aan die gesondheidsvereistes van sy mense gedagtig aan die gesondheidsbepalings van die Millennium-ontwikkelingsdoelwitte nie (NSHDP 2010:10). Die NSHDP 2010-2015 (2010:11) stel dit ook dat ’n doelmatige hervorming van die nasionale gesondheidsorgvoorsieningstelsel nodig is om die swak en breekbare nasionale gesondheidsvoorsieningstelsel te versterk en die werking daarvan te verbeter ten einde gehaltesorg en lewensgehalte te verseker. In lyn met die hervormingsplanne van die gesondheidsministerie, stel hierdie studie dit dat sodanige gesondheidsorghervormings noodwendig PV’s moet insluit as waardevolle en noodsaaklike menslike hulpbron vir gesondheid en vennootskap vir gesondheid en navorsing. Religie en spiritualiteit (die domein van pastorale sorg) is al gestel as uiters geskikte respons op mense se soeke na betekenis. Gevolglik het die navorsing ’n praktiese teologiese metodologie gebruik. Binne hierdie metodologie is gebruik gemaak van ’n post-fondamentalistiese paradigma volgens Park (2010). In hierdie verband is die struktuur van die hoofstukke belyn met die vier take van praktiese teologie soos voorgestel deur Osmer (2009). Verder word gebruik gemaak van relevante literatuur in die teologie, mediese wetenskap en sosiale wetenskappe van binne Nigerië, Afrika en verder. Dit word gestel dat die afwesigheid van ’n betekenisvolle pastoralesorgdimensie ’n beduidende swakheid is van die heersende mediese model wat in Nigerië geld. Dit is nie in pas met die bevordering van die gesondheid van pasiënte en die gemeenskap wat gestel word as die doel van die mediese wetenskap in Nigerië volgens die Nigeriese kode vir mediese etiek (2004) nie. Dit is ook nie in pas met Nigeriërs se holistiese beskouing van siekte nie. Verder is dit nie in pas met die nasionale beleid oor privaat gesonheidsvennootskappe in Nigerië, die National Policy on Private Partnership for Health in Nigeria, of NPPPHN (2005) nie, waarin dit gestel word dat alternatiewe gesondheidsverskaffers wie se praktyke as waardevol bewys is, aangemoedig en ondersteun sal word as voorste linie van gesondheidsorgverskaffing aan baie mense. Soos die bogenoemde Nigeriese beleide oor gesondheid voorhou – en dit is ook die posisie van hierdie studie – vereis siekte ’n holistiese en multidissiplinêre benadering om dit te beveg. Hierdie studie het bevestig dat pastorale sorg ’n visie van heelheid vergestalt wat resoneer met die Nigeriese holistiese siening van die lewe, waarvan die praktyke se waarde reeds bewys is. Die insluiting van die PV met ’n holistiese teologiese benadering by Nigeriese hospitaalsorg kan bydra tot holistiese en gehaltesorg vir pasiënte in hospitale. Dit kan bydra tot die vestiging van die NSHDP 2010-2015. Die studie word sterk gemotiveer deur die feit dat mense in die beeld van God gemaak is en liefde, respek vir hulle waardes en behoeftes en waardigheid verdien, veral in die aangesig van siekte en lyding. Hier word dus voorgestel dat hospitale en klinieke in Nigerië noodwendig PV’s in hulle hospitale en by hulle kliniese spanne moet insluit, en verder basiese opleiding in die pastorale assessering van pasiënte vir alle lede van die mediese span moet verskaf.

A dissertation submitted to the Faculty of Arts in fulfilment of the requirements for the Degree of Doctor of Philosophy (Library and Information Studies) in the Department of Information Studies at the University Of Zululand, 2017 / This study examined access and use of clinical informatics among medical doctors at University College Hospital, Nigeria and King Edward VIII Hospital, South Africa. The specific objectives of the study were to explain the purposes of using clinical informatics; determine the benefits of using clinical informatics in the selected teaching hospitals; ascertain the availability of clinical informatics infrastructure in the selected teaching hospitals; identify the clinical informatics facilities that are accessible to medical doctors in the selected teaching hospitals; determine the factors that influence the behavioural intention to use clinical informatics by medical doctors in the selected teaching hospitals; determine the policies that guide the effective accessibility and utilisation of clinical informatics among medical doctors in the selected teaching hospitals; and investigate the challenges that faced both the access to and the use of clinical informatics among medical doctors in the selected teaching hospitals. The study adopted the post-positivist paradigm which combines both qualitative and quantitative research methods. The study largely used a survey design. The sample for the study was drawn from medical doctors in two purposively selected teaching hospitals in Nigeria and South Africa. The teaching hospitals were King Edward V111 hospital, Durban, South Africa and University College Hospital, Ibadan, Nigeria. The two teaching hospitals were selected because they belong to the first generation of teaching hospitals in Nigeria and South Africa, among other reasons. It was believed that they would be well established in terms of funding towards infrastructure and human development in their respective countries. Convenience sampling was used to select the respondents for the study. The questionnaire was administered to 413 medical doctors, 258 (63%) of whom returned the questionnaire. Interviews were also conducted with the heads of the ICT units at the University College Hospital in Ibadan, Nigeria, and King Edward VIII Hospital in Durban, South Africa. The quantitative data aspect of the study was analysed using descriptive statistics and Statistical Package for Social Sciences (SPSS), while the qualitative aspect of the data was analysed through the use of qualitative contents analysis. The study was guided by the Unified theory of acceptance and use of technology (UTAUT). The essence of using this theory is to identify the factors that influence the use of clinical informatics. The finding of the study reveals that there was an association between the demographic variables and the use of clinical informatics. It was established that there was a significant association between the medical department and the use of electronic medical records. An assessment of the socio-demographic characteristics and the use of the Clinical Decision Support System revealed that there was a significant association between the years of medical practice and the use of Clinical Decision Support System. The finding also revealed that social demographic variables such as age, years of practice and position were all significant related with the use of diagnostic image archiving. Furthermore, the surveyed medical doctors stated that their main purpose of using clinical informatics is for medical diagnosis. It was also discovered that there is association between the teaching hospitals and the use of clinical informatics for knowledge sharing. In addition, clinical informatics was found to influence the spirit of team work amongst the medical doctors through knowledge sharing with their professional colleagues and their medical students. Similarly, there were association between the teaching hospitals treatment of patients and effective healthcare delivery. In addition, the major benefit of using clinical informatics in the two hospitals was to reduce medical errors. The most available clinical informatics tools in the selected teaching hospitals were the Diagnosis Image Archiving and Clinical Decision Support System. Performance expectancy and effort expectancy were identified as the factors from the UTAUT that influenced the medical doctors’ behavioural intention to use clinical informatics resources in the selected teaching hospitals. The non-availability of clinical informatics resources was identified as the main challenge facing the effective access to and use of clinical informatics. In addition, the two hospitals relied on the ICT policies of other institutions and did not have their own ICT policies, which was problematic. The study concluded that the clinical informatics environments in the two teaching hospitals are inadequate and there is poor access to clinical informatics resources among medical doctors in the selected teaching hospitals. Major recommendations of the study include the need to establish ICT policies and increase investment in clinical informatics resources at the surveyed teaching hospitals in order to promote effective and value-based healthcare delivery. In addition, the hospital management should create awareness on the importance and benefits of clinical informatics particularly for the medical doctors through informal and continuing education and training such as workshops and short courses. Moreover, the hospital managements need to partner with relevant stakeholders such as government, corporate bodies, and departments of health. This is for the provision of adequate and suitable environment to support the access and use of clinical informatics. Further studies on the various types of health informatics such as nursing informatics, pharmacy informatics and veterinary informatics are recommended. It is also suggested that the study should be extended to other regions of Africa. The study is significant and makes tangible contributions to technology acceptance and use in clinical medicine from developing country contexts such as Nigeria and South Africa giving the increasing role of information and communication technology in diagnosis, prescription, treatment, monitoring and overall management of patient care in an environment characterized by complex diseases. The study has the potential to inform policy, practises, and also contribute to this research in the general area of social information in Africa.