A qualitative study following a phenomenological approach was undertaken to explore voluntary counselling and testing nurses' perception of educating HIV+ people about ARVs. Non-probability convenience sampling was used and in-depth semi-structured face-to-face interviews were conducted to collect data from 12 participants. The most important results were:  The need for extensive education on ARVs since it is a new technology used to curb the infection therefore clients need the information in order to use them effectively.  Stumbling blocks encountered when educating HIV+ people about the drugs. The problems are mainly due to the nurses lack of current knowledge about the drugs; patients' low economic status; severe side effects; difficulties in behaviour change; poor quality of life on ARVs and medical terminology.  Inability of clients to comply to the regimen because of severe side effects, complex regimen, lack of support from family and friends, lack of motivation, depression, cultural beliefs, lack of knowledge on how to use them and financial constraints.  Challenges for continuous education because of current nursing shortage, negative attitudes of some nurses, demotivation and inadequate funding for such activity. Recommendations include provision of continuing education and the incorporation of ARV therapy knowledge in the basic nursing curriculum in nursing education. / Health Studies / MA (HEALTH STUDIES)

The HIV/AIDS epidemic is described as a crisis by the Global Report (UNAIDS 2004:13). Swaziland¡¦s King Mswati III also declared the HIV/AIDS epidemic as a disaster when the HIV/AIDS prevalence rate increased from 3.9% in 1992 to 42.6% in 2004 (MOHSW 2004:3). In responding to the increasing numbers, the Government of Swaziland established various programmes; one of them being the Voluntary Counselling and Testing (VCT) services to meet societal needs. The MOHSW designed guidelines to be utilized when training nurses to be pre and post HIV test counselors (TASC 2003:2). The period of training ranges between 1 to 2 weeks, after which they are deployed to the VCT centres where nurses provide counseling and testing, treatment of opportunistic infections and distributing antiretroviral drugs. Much research has been done in Swaziland on HIV/AIDS however; there is insufficient knowledge on the impact of HIV/AIDS on nurses working at the VCT services. The objectives of the study were to: ,,« Explore and describe the experiences of nurses working in the VCT services. ,,« Explore and describe the experiences of clients receiving VCT services. ,,« Design and develop an empowerment programme for nurses working in the VCT services in Swaziland. ,,« Formulate and describe guidelines for the implementation of the programme. In this qualitative study, the exploratory descriptive and contextual methodology was utilized to look into lived experiences of nurses and clients. This was done within the adaptation of the intervention Design and Development genre proposed by Rothman and Thomas (1994). Data was collected through purposive sampling and analysed according to Tesch¡¦s methods (Tesch 1990:890) The study revealed one major theme; constant experience of stress that was related to psychological and physical factors (categories). Nurses identified the complexity of HIV/AIDS, shortage of staff, lack of social support, lack of a supportive working environment, and a need for staff development under psychological factors. Clients identified stigma and discrimination. Constant exhaustion and development of medical conditions were identified as physical factors that led to constant experience of stress. Conclusions drawn from the data analysis revealed that nurses were stressed and felt disempowered at working in the VCT services. An empowerment programme was designed and developed to enable these nurses to deal with issues and VCT services for rendering quality care and enjoy the work they do. Guidelines were formulated to implement the empowerment programme. The study concluded with the identification of limitations and recommendations for future endeavours. / Health Studies / D.Litt. et Phil.

The aim of the study was to investigate motivation, job satisfaction and attitudes of nurses in the public health services of Botswana. The objective was to discover how nurses felt about a wide range of variables in their work environment and ultimately to distil them into what they conceived as the mainstay motivators, job satisfiers and positive attitudes. The non pariel (unrivalled, unique) role of the government in creating both the hardware and the software of national health services was acknowledged and recognised with a particular reference to the primacy it placed on developing the human resources in the form of nurses, in order to realize the goals of administering the public health services efficiently and effectively. It was noted that nurses were the change agents and the axis in promoting quality standards of healthcare but in partnership with the government, which must be seen to be responsive and proactive in discharging its fiduciary responsibilities, in respect of both the content and the context of nurses’ occupational ambience. For the purposes of constructing a database from which both the government and the nurses can draw, the most salient thematic details of the theories of motivation, job satisfaction and attitudes were studied and examined and were used as a scaffolding for the empirical survey of nurses. Nine hundred questionnaires were distributed to both registered and enrolled nurses with a minimum of two years work experience in the public health sector and 702 of these were returned constituting a return rate of 78%. The findings indicated that a majority of nurses enjoyed job satisfaction in certain areas of their work namely autonomy, participating in decision-making, choice of type of nursing, change of wards or departments or work units, interpersonal relationships amongst nurses themselves and between nurses and their supervisors. Nurses also perceived the hospital as an environment in which they could continually learn and they were moreover satisfied with the nursing job or the work itself. The other end of the spectrum revealed an overwhelming majority of 92.2% of nurses who were dissatisfied with the level of pay and 88.5% who were not happy with the fringe benefits including the provision of accommodation. Working conditions were viewed as generally disliked by 67.3% of the nurses. Low pay, workload, lack of viii recognition for outstanding performance and or delayed promotional chances were singled out as being particularly disliked by 67.2%, 64.9%, 42.6% and 44.4% of the nurses respectively. Interviews held with 31 nurses yielded similar results. The research further showed that the most important motivators to nurses were dominated by competitive salary which was mentioned by 80.9% of the respondents, attractive or sufficient working conditions which were stated by 71.2% of the nurses, opportunity for continuous education which was rated by 63.8% of the nursing candidates, reduced workload which was claimed by 59.3% of the nursing cadres, opportunity for the recognition of outstanding performance and opportunity for promotion which were scored by 54.1% and 53.4% of the nurse respectively. Job satisfiers were also represented by competitive salary which received 76.1% of the nurses’ votes. Risk allowance occupied the second position with 69.1% and competitive working conditions were awarded a third ranking by 68.2% of the nurses. Those nurses who derived job satisfaction from the fact of each nursing shift being manned by an adequate number of nurses accounted for 63.1% of the sample. Competitive fringe benefits attracted 60.1% of the nurses. Opportunity to attend workshops and the need for high morale in nursing team-work were chosen as job satisfiers by 53.7% and 49.6% of the nurses respectively. In the section on recommendations the government was exhorted to invoke corrective or remedial measures in view of the detailed exegesis of the satisfactions and dissatisfactions in the nurses’ work environment and the ensuing problematique (doubtful, questionable) of raising the standards of health care in the public health services. Living up to these sanguine expectations should be the cherished longterm vision of the government if it is to meet and quench the soaring aspirations of its modernizing society for quality health care delivery and the escalating needs of the nurses. / Public Administration and Management / D.P.A.

Divorce is a phenomenon that affects the emotional, physical and social wellbeing of the divorcees and those close to them. The situation becomes complicated if the affected person has a responsibility of providing caring and nurturing services to the sick, either as a manager or as a practitioner. The extent of how the impact of divorce affects the performance of professional nurses in their roles as carers and as managers was unknown. The nature and quality of services that they render to their patients, their coping strategies and the support systems were unknown. The purpose of the study was to describe and explore the impact of divorce on work performance of professional nurses at the East London Hospital Complex with the aim of ensuring high quality patient care. The objectives of the study were to: explore and describe the lived experiences of female divorced professional nurses with regard to the impact of divorce on their work performance; identify their coping strategies and their support systems. An exploratory descriptive and contextual qualitative research design was used. A phenomenological approach was used. The participants were twelve (12) divorced female professional nurses. The purposive and snowball sampling as non-probability sampling techniques were used. An interview guide was used to conduct the interviews. Audiotape was used for recording the data. Tesch’s steps (1990) of analyzing qualitative data guided the data analysis process. According to the lived experiences of the participants, divorce is traumatic and painful with emotional, physical, financial and social impact. It had a negative impact on the professional nurses’ work performance. The coping strategies included acceptance of the reality, studying, involvement with club and church activities. Support was available from the families, church, friends, and colleagues. Recommendations are that: the employee assistance program be marketed more effectively by hospital management and be included in the hospital, departmental and unit orientation programmes; that a dedicated psychologist, as well as preventive intervention programs, be made available to employees dealing with divorce.

M.Cur. / In this study a qualitative design which is explorative, descriptive and contextual in nature is followed. The objective of the study is three-fold: firstly, to explore and describe the opinions of members of the community about the reasons for the under-utilization of the Midwifery Obstetrical Unit ; secondly, to explore and describe the suggestions of the community for improving the utilization of the Midwifery Obstetrical Unit and, thirdly, to formulate intervention strategies for community nurses to improve the utilization of the MOU. Data was collected by means of focus group interviews, and was analysed using Tesch's method of data analysis. Trustworthiness was ensured by using the method of Guba and Lincoln. The participants in research were mothers who delivered their babies at the hospital, mothers who delivered their babies at the MOU, members of the Community Health Committee and MOU nurses.

Indiana University-Purdue University Indianapolis (IUPUI) / Parents have increasingly participated in their children’s bedside care. Parental participation has led to more provider-parent interactions and communication during such stressful events. Helping parents through such stressful events requires nurses to be skilled communicators. Brief methods of training emotion-focused communication with newly licensed nurses are needed, but as yet are rare. The purpose of this study was to evaluate the impact of a validated brief communication (Four Habits Model) training program for newly licensed pediatric nurses. The intervention focused on ways to improve nurses’ emotion-focused conversations with parents. Information processing and Benner’s novice to expert informed this study. The intervention is based on the four habits model, with “habits” providing a structure for nurses to organize their thinking and behavior during emotion-focused conversations with parents. Thirty-five pediatric nurses with 0–24 months of nursing experience at a large mid-western children’s hospital participated in the study. Mixed methods provided data for this experimental study, using a group-by-trials repeated measures ANOVA design. Participants randomized to the intervention group participated in a one-hour three-part training: adapted four habits model content, simulated nurse-parent communication activity, and debrief. Participants randomized to the control group observed a one-hour travel video. Key outcome variables were Preparation, Communication Skills, Relationships, Confidence, Anxiety, and Total Preparation. Compared with the controls, the intervention group improved significantly in the following areas: Preparation, F(1,33) = 28.833, p < .001; Communication Skills, F(1,33) = 9.726, p = .004; Relationships, F(1,33) = 8.337, p = .007; Confidence, F(1,33) = 36.097, p < .001; and Total Preparation, F(1,33) = 47.610, p < .001. Nurses’ experience level had no effect, with the exception of Anxiety. Nurses with more experience (≥ 12 m) showed a greater reduction in Anxiety, when compared to nurses with less experience (< 12 m), F(1,31) = 5.733, p = .023. Fifty-two percent of the nurses involved in the intervention later reported specific examples of implementing the four habits when working with parents in clinical settings. A one-hour four habits communication-training program is effective in improving newly licensed nurses’ preparation for emotion-focused conversations with parents.

It is important for nurses to show acceptable behaviour when interacting with the patients. The purpose of this study was to explore and describe the factors that contribute to nurses’ negative behaviour when rendering patient care and to determine the effects of nurses’ behaviour on patient outcomes. The study used a non-experimental explorative and descriptive quantitative design. Data collection was done using a structured questionnaire. The sample comprised of 64 respondents which consisted of 25 registered nurses and 39 enrolled nurses. The study found that besides the known contributing factor, that is, the shortage of nurses, further identified contributing factors to nurses’ negative behaviour when rendering patient care are failure to retrain nurses identified with negative behaviours, poor condition of employment and patients’ behaviours and cultural beliefs. These results suggested a need to train more nurses, improve conditions of employment, as well as support and retrain nurses identified with negative behaviours. / Health Studies / M.A. (Public Health)

The focus of this study was to explore reasons for the failure of student nurses to present themselves for assessment of clinical skills at a public nursing college in the Eastern Cape. The objectives were to explore and describe reasons why these student nurses were not presenting themselves for such assessment of clinical skills; to develop strategies to motivate them to present themselves for clinical skills assessment; and to make recommendations for assessment of clinical skills. The population of the study was the second and the third-year student nurses undergoing a four-year comprehensive diploma course at a public college of nursing in the Eastern Cape. Non-probability convenience sampling was used. The research questions were, firstly, why the student nurses were not presenting themselves for assessment of clinical skills? Secondly, what recommendations could be made to motivate the student nurses to present themselves for clinical skills assessment? A qualitative, explorative, descriptive and contextual research design was used. Focus group interviews with six participants per group were used to collect data. The total number of participants five focus groups was 30 by the time data saturation was reached. Data were collected following the research question, “Why are you not presenting yourselves for clinical skill assessment?” Their responses were recorded using audiotape and notes with the help of an experienced colleague. Data was analysed following Teschʼs method. Findings presented one theme, being the reason for students not presenting themselves for feedback or delaying to do so. Categories indicated that students were afraid and overwhelmed with anxiety; had too much work to do; unpreparedness for learnt skills; equipment and resources; lack of confidence; and busy ward schedules. Subcategories included lecturersʼ attitude; unfamiliarity to lecturers accompanying them; having to study to master a lot of theory; having to prepare for many tests; unavailability of lecturers to mentor them; unavailability of unit professional nurses to guide them; reluctance of patients to be used for practising skills; a tendency not to practise skills; too many students; being used as work force; placement objectives; use of dolls for demonstration; tools used to support learning making reference to obsolete equipment; all skills demonstrated at the same time; lecturers improvising when they are demonstrating some skills, and not being released for practising of skills. The focus of this study was to explore reasons for the failure of student nurses to present themselves for assessment of clinical skills at a public nursing college in the Eastern Cape. The objectives were to explore and describe reasons why these student nurses were not presenting themselves for such assessment of clinical skills; to develop strategies to motivate them to present themselves for clinical skills assessment; and to make recommendations for assessment of clinical skills. The population of the study was the second and the third-year student nurses undergoing a four-year comprehensive diploma course at a public college of nursing in the Eastern Cape. Non-probability convenience sampling was used. The research questions were, firstly, why the student nurses were not presenting themselves for assessment of clinical skills? Secondly, what recommendations could be made to motivate the student nurses to present themselves for clinical skills assessment? A qualitative, explorative, descriptive and contextual research design was used. Focus group interviews with six participants per group were used to collect data. The total number of participants five focus groups was 30 by the time data saturation was reached. Data were collected following the research question, “Why are you not presenting yourselves for clinical skill assessment?” Their responses were recorded using audiotape and notes with the help of an experienced colleague. Data was analysed following Teschʼs method. Findings presented one theme, being the reason for students not presenting themselves for feedback or delaying to do so. Categories indicated that students were afraid and overwhelmed with anxiety; had too much work to do; unpreparedness for learnt skills; equipment and resources; lack of confidence; and busy ward schedules. Subcategories included lecturersʼ attitude; unfamiliarity to lecturers accompanying them; having to study to master a lot of theory; having to prepare for many tests; unavailability of lecturers to mentor them; unavailability of unit professional nurses to guide them; reluctance of patients to be used for practising skills; a tendency not to practise skills; too many students; being used as work force; placement objectives; use of dolls for demonstration; tools used to support learning making reference to obsolete equipment; all skills demonstrated at the same time; lecturers improvising when they are demonstrating some skills, and not being released for practising of skills. The researcher concluded that students had valid reasons for not presenting themselves for assessment of clinical skills but this could be rectified through the involvement of lectures, ward staff as well as students themselves. The researcher recommended that effective communication between the staff in clinical areas and the college is needed. Clinical laboratories needed laboratory managers and had to be well equipped. A revision of the student-lecturer ratio form feed-back on skills is also suggested.The researcher concluded that students had valid reasons for not presenting themselves for assessment of clinical skills but this could be rectified through the involvement of lectures, ward staff as well as students themselves. The researcher recommended that effective communication between the staff in clinical areas and the college is needed. Clinical laboratories needed laboratory managers and had to be well equipped. A revision of the student-lecturer ratio for feed-back on skills is also suggested.

The aim of this study was to describe the nurses‘ perception of termination of pregnancy and her perception of her conduct towards clients that request termination of pregnancy guided by Kings‘ Systems Approach and Goal Attainment Theory. A non-experimental quantitative descriptive correlational design was used. A non-probability purposive sampling method was used consisting of institutions in the Western Cape, available to participate in this study, which deliver termination of pregnancy services, gov ernment health care institutions (21) and Marie Stopes clinics (3). Non-probability convenience sampling was used consisting of registered nurses who are working in termination of pregnancy units in these facilities (N=82). Data were collected through the administration of a self-designed questionnaire. The main findings of the study indicate that respondents (personal system) appear to feel positive about the work they are doing. Formal improvement and development are however not utilised optimally. Regarding the interpersonal system, respondents also show a positive orientation to both the woman opting for termination of pregnancy and the foetus. The potential towards transaction and ultimately goal attainment reside within this system. The respondents are also positive about legislation, employers and policies (social system) relating to termination of pregnancy. This orientation creates a milieu that is conducive to transactions, interactions and goal attainment.The main recommendation is that three systems as proposed by King be continuously integrated within the termination of pregnancy setup through, amongst other measures: values clarification, management support, in service education, the inclusion of termination of pregnancy in undergraduate programmes, focus groups and the like. / Die doel van hierdie studie was om die verpleegkundige se persepsie van terminasie van swangerskap en haar persepsie van haar houding en gedrag teenoor kliёnte wat terminasie van swangerskap versoek, aan die hand van King se Sisteembenadering en Doelwitbereikingsteorie te ondersoek en te beskryf. `n Nie-eksperimentele kwantitatiewe beskrywende korrelasie navorsingsontwerp was gebruik. `n Nie-waarskynlike doelbewuste-steekproefneming van die staatsgesondheidsorg-instansies wat terminasie van swangerskapdienste aanbied, is geneem en wat beskikbaar vir hierdie studie was (21) asook die Marie Stopesdienste (3), in die Wes-Kaap. `n Nie-waarskynlike gerieflikheidsteekproefneming is van verpleegkundiges geneem wat swangerskappe in hierdie afdelings termineer of moet termineer (N=82). Data is met behulp van `n selfontwerpte vraelys ingesamel. Die hoofbevindings van die studie dui daarop dat respondente (persoonlike sisteem) positief voel oor hul werk. Formele ontwikkelingshulpbronne word egter nie optimaal deur die sisteem benut nie. Wat die interpersoonlike sisteem betref, toon respondente ook ‗n positiewe oriëntasie tot beide die vrou wat terminasie van swangerskap aanvra en die fetus. Die potensiaal tot transaksie-sluiting en uiteindelike doelwitbereiking is binne hierdie sisteem geleë. Die respondente is ook positief oor wetgewing en die werkgewer en beleid (sosiale siteem) ten opsigte van terminasie van swangerskap. Hierdie oriëntering laat ‗n milieu wat bevorderlik is vir transaksie-sluiting, interaksie en doelwitbereiking. Die hoofaanbeveling is dat voortdurend gepoog moet word na die integrasie van King se drie sisteme binne die terminasie van swangerskapafdelings deur onder meer: waarde-uitklaringswerkswinkels, ondersteuning van bestuur, indiensopleiding, die insluiting van terminasie van swangerskap in voorgraadse kurrikula, fokusgroepe en so meer. / Health Studies / D. Litt. et Phil. (Gesondheidstudies)

The aim of this study was to describe the nurses‘ perception of termination of pregnancy and her perception of her conduct towards clients that request termination of pregnancy guided by Kings‘ Systems Approach and Goal Attainment Theory. A non-experimental quantitative descriptive correlational design was used. A non-probability purposive sampling method was used consisting of institutions in the Western Cape, available to participate in this study, which deliver termination of pregnancy services, gov ernment health care institutions (21) and Marie Stopes clinics (3). Non-probability convenience sampling was used consisting of registered nurses who are working in termination of pregnancy units in these facilities (N=82). Data were collected through the administration of a self-designed questionnaire. The main findings of the study indicate that respondents (personal system) appear to feel positive about the work they are doing. Formal improvement and development are however not utilised optimally. Regarding the interpersonal system, respondents also show a positive orientation to both the woman opting for termination of pregnancy and the foetus. The potential towards transaction and ultimately goal attainment reside within this system. The respondents are also positive about legislation, employers and policies (social system) relating to termination of pregnancy. This orientation creates a milieu that is conducive to transactions, interactions and goal attainment.The main recommendation is that three systems as proposed by King be continuously integrated within the termination of pregnancy setup through, amongst other measures: values clarification, management support, in service education, the inclusion of termination of pregnancy in undergraduate programmes, focus groups and the like. / Die doel van hierdie studie was om die verpleegkundige se persepsie van terminasie van swangerskap en haar persepsie van haar houding en gedrag teenoor kliёnte wat terminasie van swangerskap versoek, aan die hand van King se Sisteembenadering en Doelwitbereikingsteorie te ondersoek en te beskryf. `n Nie-eksperimentele kwantitatiewe beskrywende korrelasie navorsingsontwerp was gebruik. `n Nie-waarskynlike doelbewuste-steekproefneming van die staatsgesondheidsorg-instansies wat terminasie van swangerskapdienste aanbied, is geneem en wat beskikbaar vir hierdie studie was (21) asook die Marie Stopesdienste (3), in die Wes-Kaap. `n Nie-waarskynlike gerieflikheidsteekproefneming is van verpleegkundiges geneem wat swangerskappe in hierdie afdelings termineer of moet termineer (N=82). Data is met behulp van `n selfontwerpte vraelys ingesamel. Die hoofbevindings van die studie dui daarop dat respondente (persoonlike sisteem) positief voel oor hul werk. Formele ontwikkelingshulpbronne word egter nie optimaal deur die sisteem benut nie. Wat die interpersoonlike sisteem betref, toon respondente ook ‗n positiewe oriëntasie tot beide die vrou wat terminasie van swangerskap aanvra en die fetus. Die potensiaal tot transaksie-sluiting en uiteindelike doelwitbereiking is binne hierdie sisteem geleë. Die respondente is ook positief oor wetgewing en die werkgewer en beleid (sosiale siteem) ten opsigte van terminasie van swangerskap. Hierdie oriëntering laat ‗n milieu wat bevorderlik is vir transaksie-sluiting, interaksie en doelwitbereiking. Die hoofaanbeveling is dat voortdurend gepoog moet word na die integrasie van King se drie sisteme binne die terminasie van swangerskapafdelings deur onder meer: waarde-uitklaringswerkswinkels, ondersteuning van bestuur, indiensopleiding, die insluiting van terminasie van swangerskap in voorgraadse kurrikula, fokusgroepe en so meer. / Health Studies / D. Litt. et Phil. (Gesondheidstudies)