The purpose of health service research is to produce knowledge that will contribute to the improvement in the delivery of health care and it is in this spirit that this study of the quality of paediatric care at King Edward VIII Hospital was undertaken. The main method utilized was an evaluation of aspects of the process of care of selected conditions, as measured against a predefined set of standards. This was accomplished by a retrospective review of patient records. Assessments were also made of the utilization of the Department's services, manpower and equipment. The surveys conducted involved the Outpatient's Department, the General and the Neonatal Wards of the Paediatric Department of the King Edward VIII Hospital, Durban. The Hospital Administration's routine and computerized data were also analyzed. Among the findings was that the routinely collected data is inadequate,providing only limited information for management purposes. The assertion that the utilization of the Department is high was confirmed, as was the claim that some resources are inadequate to cope with increasing demand. Many factors contribute to this, including high bed occupancy, high patient to doctor ratios, and several factors outside of direct hospital control (primary care services). The general clinical care of patients is high, but particular aspects were found to be in need of attention; for example, the metabolic and fluid management of the ill young patient and medical records in general. Immediate and long-term recommendations pertaining to the Paediatric Department and the Administration are presented.

This ethnographic study of nurses at King Edward VIII Hospital in Durban, South Africa was designed to seek insights into the lives of women as nurses during the socio-political transition of the 1990's. It suggests that this period of dramatic political change in the country created spaces for redressing uneven social relations and chronic disparities faced by nurses in their personal and professional lives, particularly those constructed through the social engineering of apartheid policies. The study describes the particular evolution of nursing in South Africa, the process undertaken to unify the professional nursing associations formed through the 1980's and the national labour unrest that rippled through the health care system between 1994 and 1996. It considers the diverse locations of nurses as the backbone of the healthcare system, primarily in their capacities as professionals, managers, care-providers, team-players and colleagues and describes practices that operate to constrain nurses as women and health care practitioners. Feminist, post-structural perspectives framed the theoretical approach taken in this qualitative study. These were guided by Foucauldian theories of knowledge, power and discourse, and feminist contributions regarding resistance and agency. Over the course of four years in the field, methods of participant observation and in-depth interviews were employed to develop insights into the subject locations of nurses in their private and public lives. Twenty-six nurses of the professional and subprofessional categories contributed to the main narratives. In addition, a series of interviews were undertaken with key informants from the medical, paramedical, nursing and administrative services. The study illustrates the practices of patriarchal, institutional and organisational relations of power that intersected and dominated the realities of the nurses in all spheres of their day-to-day lives. Within the post-colonial moment in South Africa, these were conceptualized as subaltern institutional relations. The study found that as a consequence of their subjugation within the subaltern institutional relations, the realities of nurses were diverse, divergent, and fragmented. It argues that these relations imbued a lack of professional and personal coherence that impaired the capacity of nurses to contest the chronic professional and work place disparities. Often multiple and compounding in their manifestation, these relations and practices reinforced the isolation of nurses, compounding their incapacity to meaningful challenge professional and personal obstacles during the socio-political transition of the 1990's. / Thesis (Ph.D.)-University of Natal, Durban, 2000.

The increasing frequency of enterococci as a major cause of nosocomial infections and the transmission of these organisms amongst hospital patients demands a greater awareness of the Enterococcus. Therapy of enterococcal infections is complicated by the pathogens continually changing resistance patterns to many broad-spectrum antibiotics. In addition, the ability of enterococci to cause serious invasive infections including endocarditis and septicaemia with associated high mortality rates; prompted this study which was aimed at identifying the biological properties of enterococci isolated from blood cultures of patients admitted at King Edward VIII hospital, Durban. Enterococci were identified to species level by the API 20 Strep system which identified 68% and a conventional biochemical system of Facklam and Collins which identified 100% of the isolates.The emergence of beta-Iactamase producing enterococci in other countries encouraged the testing of all isolates for this enzyme. All were beta-Iactamase negative. The reported false susceptibility for aminoglycosides and cephalosporins with blood enriched media encouraged the testing of these antibiotics with and without the supplementation of 5% lysed blood. The results showed that an average false susceptibility of 55 % occurred for gentamicin and 35% for tobramycin and netilmicin. The cephalosporins affected, cefotaxime and cefuroxime showed a false susceptibility of 28% and 17% respectively. The choice of treatment for serious enterococcal infections is a syllergistic combination of a beta-Iactam antibiotic plus an aminoglycoside for enterococci with intrinsic low-level resistance. The development of high-level aminoglycoside resistance, MIC 22000,ug/ml results in loss of synergism. This study showed that 26.4 % of enterococcal isolates displayed high level aminoglycoside resistance i.e. to gentamicin and streptomycin. Time-kill study showed reduced killing rate for these organisms for the beta-Iactams and glycopeptides with low-level gentamicin resistance. The results confirmed that a cell-wall active agent combined with gentamicin can be successfully used for enterococcal therapy if the organism has intrinsic low-level resistance to this amino glycoside. Pulsed-field gel electrophoresis (PFGE) carried out on a selected number of Enterococcus faecalis and Enterococcus faecium with high-level aminoglycoside resistance showed a variability in the restriction endonucelase digestion patterns. This suggests independent development of high-level gentamicin resistance and not clonal expression. The ease and reliability with which enterococcal isolates may be typed using this technique to compare different strains represent a significant advance. / Thesis (M.Med.Sc.)-University of Natal, 1999.