MCur / Department of Advanced Nursing Science / Each year, an estimated 3.6 million infants die worldwide in the first four weeks of life due to complications of premature birth. One-third of Low Birth Weight (LBW) babies die within the first 12 hours after delivery. The main reasons premature babies are at greater risk of illness and death is that they lack the ability to control their body temperature meaning that they get cold or hypothermic very quickly. Kangaroo Mother Care reduces mortality and if widely applied it could reduce deaths in premature newborn babies. The purpose of this study is to explore and describe the lived experiences of mothers when providing Kangaroo Mother Care at the hospitals in Vhembe District of Limpopo province. Qualitative approach with explorative descriptive, contextual and phenomenological designs were employed to explore the experiences of mothers when providing Kangaroo Mother Care. The study population consisted of all mothers who were providing Kangaroo Mother Care. A non-probability convenience sampling method was used to determine the sample of the study. The size of the sample was determined by data saturation. In-depth individual interviews were conducted using a central question. The Tesch’s eight steps of open-coding model guided the process to analyse data. Trustworthiness was ensured throughout by employing the principles of credibility, dependability, conformability, and transferability. Ethical considerations were followed to protect the participants. Recommendations were made based on the research findings. The findings of the study revealed that mothers who provide Kangaroo Mother Care experience challenges. They received inconsistent information about the practice of Kangaroo Mother Care from nurses. The relationship between mothers and nurses was good. Recomendations were made based on the findings and relevant structures in order to ensure that mothers challenges are addressed. The study revealed ineffective support provided to mothers by nurses and family members. / NRF

Comprehensive management in the neonatal nursery involves medical treatment of the infant, as well as developmental care and the provision of guidance, counselling and information to the family who are part of the decision-making process regarding the infant’s care. Neonatal communication intervention is of utmost importance in a country such as South Africa, which has an increased prevalence of infants at risk for disabilities and where the majority of these infants live in poverty. Speech-language therapists fulfil an important role in the neonatal nursery and are an integral part of the team involved with the high risk neonatal population. Local literature showed a dearth of information on the current service delivery and roles of speech-language therapists and audiologists in neonatal nurseries in the South African context. From an asset-based perspective it appears that the South African population receiving services in neonatal nurseries have unique characteristics. This provides speech-language therapists with ample opportunity to intervene, providing that intervention is well-timed in the neonatal nursery context. The country-wide initiative to implement the evidence-based technique of kangaroo mother care indicates that speech-language therapists should recognise its importance and develop communication based materials and tools to complement this successful neonatal intervention. The aim of the research was to establish whether speech-language therapists have needs for assessment and intervention tools/materials in this context. The study furthermore aimed to compile a locally relevant neonatal communication intervention instrument/tool for use by speech-language therapists in the neonatal nurseries of public hospitals in South Africa in order to propose a solution to address the shortage of tools in the public health context. The study entailed descriptive, exploratory research. During Phase 1, a survey was received back from 39 speech-language therapists and two audiologists in six provinces. The data revealed that participants performed different roles in neonatal nurseries, which were determined by the environment, tools, materials and instrumentation available to them. Many participants were inexperienced, but were resourceful in their attempts to develop and adapt tools/materials. Participants expressed a need for culturally appropriate and user-friendly instruments for parent guidance and staff/team training on the topic of developmental care. During Phase 2 a tool for parent guidance titled “Neonatal communication intervention programme for parents” was compiled for use by speech-language therapists and justified by participants’ roles and needs as well as current early communication intervention (ECI) literature. The programme was piloted by three participants. Certain suggestions for enhancements of the programme were made such as providing a glossary of terms, adapting the programme’s language and terminology, and providing more illustrations. The programme complied with the guiding principles for best practice in ECI (ASHA, 2008) and can therefore contribute to neonatal care of high risk infants in South Africa. Speech-language therapists and audiologists must contribute to neonatal care of high risk infants to facilitate optimal health and development and to support their families. AFRIKAANS : Omvattende intervensie in die neonatale sorgeenheid behels mediese behandeling van die neonaat, sowel as ontwikkelingstoepaslike sorg en die verskaffing van leiding, berading en inligting aan die gesin wat deel is van die besluitnemingsproses rakende die baba se sorg. Neonatale kommunikasie intervensie is van uiterste belang in Suid-Afrika aangesien daar ‘n hoër prevalensie van babas is wat ‘n risiko het vir ontwikkelingsafwykings en aangesien die meerderheid van hierdie babas in armoede leef. Spraak-taalterapeute vervul ‘n belangrike rol in die neonatale sorgeenheid en is ‘n integrale deel van die span wat betrokke is by die hoërisiko neonatale populasie. Plaaslike literatuur dui op ‘n tekort aan inligting rakende die huidige dienslewering van die spraak-taalterapeut en oudioloog in neonatale sorgeenhede in die Suid-Afrikaanse konteks. Vanuit ‘n bate-benadering kom dit voor of die Suid-Afrikaanse populasie wat dienste in neonatale sorgeenhede ontvang, unieke eienskappe het. Dit bied genoegsame geleenthede aan spraak-taalterapeute om intervensie te verskaf, solank die behandeling betyds in die neonatale sorgeenheid konteks aanvang neem. Daar is ‘n landswye inisiatief om die bewysgerigte tegniek van kangeroe moedersorg toe te pas. Spraak-taalterapeute moet dus die belang daarvan herken en kommunikasie gebasseerde terapiemateriaal ontwikkel om hierdie suksesvolle neonatale intervensie te komplementeer. Die navorsing se doel was om vas te stel hoe wyd spraak-taalterapeute en oudioloe ‘n behoefte aan evaluasie en intervensie instrumente en –materiaal in hierdie konteks het. Die navorsing het verder ten doel gestel om ‘n relevante terapie instrument saam te stel vir spraak-taalterapeute in die neonatale sorgeenhede as ‘n moontlike oplossing vir die tekort aan relevante terapiemateriaal in die plaaslike publieke gesondheidsorgkonteks. Die studie het beskrywende, eksplorerende navorsing behels. Gedurende Fase 1 is ‘n vraelys terug ontvang van 39 spraak-taalterapeute en twee oudioloë in ses provinsies. Die data het aangedui dat deelnemers verskillende rolle in hierdie konteks vervul, wat beïnvloed was deur die omgewing, die instrumentasie en materiaal wat tot hulle beskikking was. Die meerderheid van die deelnemers was onervare, maar was vindingryk in hulle pogings om terapiemateriaal aan te pas en te ontwikkel. Deelnemers het ‘n behoefte vir kultureel toepaslike- en gebruikersvriendelike instrumente en materiaal uitgedruk met die oog op ouerleiding en personeel/span opleiding oor die onderwerp van ontwikkelingstoepaslike sorg. Gedurende Fase 2 is ‘n terapie instrument naamlik “Neonatale kommunikasie intervensie program vir ouers” saamgestel vir die gebruik in die neonatale sorgeenhede deur spraak-taalterapeute. Die samestelling van hierdie program is verantwoord deur die deelnemers se rolbeskrywing en behoeftebepaling van Fase 1, sowel as deur huidige vroeë kommunikasie intervensie (VKI) literatuur. Die program is deur drie deelnemers in ‘n loodsstudie geëvalueer. Voorstelle vir die verbetering van die program is verskaf, naamlik die byvoeging van ‘n terminologielys, aanpassing van die program se taalgebruik en terminologie en verskaffing van meer illustrasies. Die program het ooreengestem met die beginsels vir beste praktyk in VKI (ASHA, 2008) en kan daarom tot neonatale sorg van hoërisikobabas in Suid-Afrika bydra. Spraak-taalterapeute en oudioloë moet bydra tot neonatale sorg van hoërisiko neonate om sodoende optimale gesondheidsorg en ontwikkeling te fasiliteer en gesinne te ondersteun. Copyright / Dissertation (MCommunication Pathology)--University of Pretoria, 2010. / Speech-Language Pathology and Audiology / unrestricted

v anglickém jazyce The thesis deals with the care of premature newborns. The structure of the thesis is divided into several chapters, which focus on the definition of neonatology and development of the neonatal care in the Czech Republic and abroad and on the definition of premature newborn and their most common diseases. Substantial part is devoted to development of the care of premature newborn and its current status. The final part of the thesis is devoted to interviews with the nurses, who have been working in the neonatal intensive care unit for long time. The thesis is formed by description and used it in written and electronic resources. The aim of the thesis is overview of the development of care of premature newborn in the past and present. Key words: Neonatalogy, development of neonatalogy, Oxygen therapy, Kangaroo mother care, history of incubators, Virginie Apgar, UPMD history, classification of the newborn, resuscitation of the newborn, congenial defects, history of Gynaecology and Obstetric Clinic VFN, history of the Institute for the care for mother and child, newborn screening, newborn nutrition