In South Africa, mental health care is being integrated into primary health care services. The integration of services was aimed at increasing the accessibility and availability of all health care services at primary health care level. The integration was well intentioned, and it was hoped that mentally ill clients would benefit from having a service near their homes. However, the process of integration is fraught with challenges, for instance, staff shortages, which lead to ineffective nursing management of mentally ill clients at the primary health care clinics. As a result, one professional nurse is often allocated to manage the clinic services on a daily basis with the assistance of an enrolled nurse or auxiliary nurse. The professional nurses therefore experience high levels of stress due to gross staff shortages and lack of time to conduct proper nursing assessments. This led to the research question: “What are the experiences of professional nurses with regards to the nursing management of mentally ill clients in rural primary health care clinics in the O.R. Tambo District in the Eastern Cape?’’ The proposed objectives of the study were to explore and describe the experiences of professional nurses working in rural primary health care clinics with regard to the nursing management of mentally ill clients. The researcher thereafter made recommendations to the district managers regarding effective nursing management of mentally ill clients in rural primary health care clinics. A qualitative, exploratory, descriptive and contextual design was used. The research population comprised of professional nurses working in rural primary health care clinics in the O.R. Tambo District in the Eastern Cape. Purposive sampling was used to identify participants and the sample number was determined by data saturation. Unstructured interviews and observation notes were used to collect data. The eight steps of data analysis suggested by Tesch were utilized to analyze the data. The researcher conducted an in-depth literature review in order to identify research gaps pertaining to the study. To ensure that a high level of validity and reliability was exercised throughout the study, the researcher conformed to Lincoln and Guba’s model of trustworthiness. The study was conducted in an ethical manner and ethical principles were adhered to. Findings: Three themes with subthemes emerged. The study showed that professional nurses experienced challenges related to the nursing management of mentally ill clients. These challenges included shortage of staff, a heavy workload, and lack of resources, lack of in-service training and workshops related to mental health issues coupled with lack of support from the supervisors. Due to the challenges, the mentally ill clients were not getting quality nursing care leading to complications and relapse. Conclusion: It emerged from the study that matters pertaining to mental illness and mental discomfort were still a serious problem in rural areas. The problems were related to the challenges which prevented professional nurses from providing quality nursing care to mentally ill clients with subsequent complications and relapse. Recommendations: Recommendations were made as an effort to ensure that the nursing management of mentally ill clients in rural primary health care clinics is improved. These recommendations were categorized as related to nursing practice, nursing education and nursing research.

Family planning services are rendered at no cost in all clinics in Mdantsane. Mdantsane is situated in the Eastern Cape and falls under Amathole District Municipality. The high rate of adolescent pregnancy in the area raises a question as to whether the family planning services are adequate. This issue reflects on the quality of family planning service delivery. According to Roux (1995:94), a quality service is a safe, easily available and readily acceptable service, delivered by well trained family planning personnel through well planned programmes. Aims and Objectives: To assess the quality of family planning service delivery by health providers to adolescents; determine the opinions of adolescents regarding accessibility, friendliness of staff, privacy, confidentiality, reproductive health information and resources at Mdantsane clinics from June to July 2009. Method: A questionnaire was designed to collect data. The questionnaire was administered on the adolescents utilizing the reproductive health services at eleven primary health clinics in Mdantsane. A sample consisting of 110 adolescent youth between 19 and 24 years was selected by using random sampling. A response of “yes” will indicate that the participant is satisfied with the specific item, while a response of “no” will indicate dissatisfaction with that item. A specially designed spreadsheet was developed to analyze the data. Data was analyzed by using the Microsoft Excel 2007 Version 6. Results: The results from this research study suggest that there is a definite need for improvement of adolescent reproductive health services at Mdantsane clinics. It is clear that the current available maternal and child health programmes, school health services and reproductive health services are not able to meet the adolescent sexual and reproductive needs. Conclusion: The research findings from this study indicated the constraints to good quality family planning health care service delivery. Satisfaction responses from the five categories: health facility amenities, accessibility, staff characteristics, availability of sexual and reproductive health services and availability of educational material accessibility were mostly below 70%. The responses regarding the question on the “full information about the available contraceptives”showed the least level of satisfaction. Deficiencies in physical facilities and equipment, disruptions in supplies, insufficient information provided to clients and providers‟ insensitivity to the feelings and needs of the clients are issues that discourage adolescents from utilizing contraceptive services. Recommendations: Adolescents need a safe and supportive environment that offers information and skills to equip them on all aspects related to sexual and reproductive health issues. To satisfy adolescent reproductive needs, the following key elements should be improved: accessibility of reproductive health services, friendliness of clinic staff, availability of information about reproduction and sexuality and maintenance of issues regarding confidentiality and anonymity. Quality requires the presence of trained personnel in well-equipped clinics where clients are treated courteously. To avoid issues of courtesy bias, there is a need to conduct a similar survey utilizing alternative community settings, namely homes of participants or a school.

Self-efficacy in clinical performance is a very important aspect in quality of health care, because it is the ability of the person to produce the desired outcomes. The aim of the study was to evaluate self-efficacy in clinical performance of NIMART programme by professional nurses in Buffalo City Metropolitan in Eastern Cape Province South Africa. A quantitative, descriptive survey design was used to examine self-efficacy in clinical performance during implementation of NIMART programme. A purposive sample of 358 NIMART programme trained professional nurses was included in the study. Analysis of the finding was done using SPSS version 21.0. Descriptive statistics (frequencies, percentage, mean and standard deviations) were used to analyse categorical variables. To reduce data volume, factor analysis was used to identify six variable clusters: Evaluation; planning, assessment, implementation, and patient care mentoring. Factor 1 (evaluation) was highly loaded on patient driven results (0.63); nursing interventions (0.70); breakdown point location (0.80); prognosis based care decisions (0.79); prognosis based outcome monitoring (0.70); and prognosis based settings adjustment (0.70). These items collectively define evaluation of self-efficacy clinical performance of the participants. Factor 2 (planning) was termed planning of patient care in a clinical setting was significantly loaded on these items: data driven nursing diagnosis (0.51); patient driven nursing diagnosis (0.52); settings based nursing diagnosis (0.49); overall care plan formulation (0.52); short-term patients care formulation (0.58); long-term patient care formulation (0.66); goal based measurable outcomes (0.80); goal based daily patient care plan (0.79); settings based daily patient care plan (0.73). Factor 3 (assessment) which was termed assessment in clinical performance was not significantly loaded in some of the items: physical assessment (0.64); patient history (0.65); energy restoration (0.56); time management (0.71); objective patient health data (0.61); subjective patient health data (0.49); data collection documentation (0.44). Factor 4 (implementation) data source correlation; patient health data analysis (0.45); patient strength (0.46); nurse-patient/family communication (0.55); nurse patient collaboration (0.64); Experience driven decision making (0.58). Factor 5 (patient care) patient care plan adherence (0.65); setting based overall patient care (0.74); resource based overall patient care (0.59). Factor 6 (mentoring) patient’s concerns identification (0.48); patient problems prioritisation (0.46); mentor/colleague advice (0.43); mentor/colleague feedback use (0.61); patient discharge strategies (0.71); continuous reporting/documenting (0.63). The mean scores produced by the Kruskal-Wallis test showed the lowest scoring pattern as follows: 20122013201120142010. This order was the same for all the variables, confirming that the 2010 group scored significantly higher than any other group on all the variables. The overall results of the study revealed that professional nurses have high self-efficacy in clinical performance in implementation of NIMART programme, except in evaluation aspect of self-efficacy where they scored lessor. Professional nurses trained by FPD scored higher in the aspects of self-efficacy in clinical performance compared to RTC trained; but scored lower in evaluative ability of self-efficacy in both institutions (FPD and RTC). The findings of this study showed that the overall self-efficacy of the professional nurses trained on NIMART programme performed clinically satisfactorily. It is recommended that in-service education or continuous professional development for professional nurses working in PHC’s should not only concentrate on updating clinical skills, but also create opportunity for reflection and strengthening of professional nurses’ self-efficacy in clinical performance. Also, further study on other processes of goal realisation will aid our understanding of self-efficacy in achieving the desirable goals of the professional nurses for patient quality care. Further research is also needed to evaluate clients’ satisfaction during care based on the NIMART intervention programme.

The substandard care noted and reported on in midwifery practice at level one midwifery care institutions in South Africa raises a concern about the effectiveness of the assessment strategies used at nursing institutions in enhancing midwifery programme outcomes. The concern is mainly directed particularly at the performance of the newly qualified professional nurses as they are the ones that practise at level one institutions, had just gone through training and been found to be competent practitioners. The success of any training programme and specifically midwifery practice as in the content of this study is dependent on the effectiveness of the assessment techniques or strategies used; hence assessment is considered integral to monitoring the quality of the midwifery care programme. The current study used a quantitative research design to explore and describe the role of assessments in enhancing midwifery programme outcomes at a public nursing education institution in the Eastern Cape Province. Recommendations to enhance the role of assessments for the benefit of midwifery programme outcomes at a public nursing education institution that were made were guided by the findings of the study. Participants were non-randomly selected and were personally provided with a self-developed questionnaire to complete. 134 participants returned fully completed questionnaires while approximately 25% of the selected sample did not return theirs. Data was captured on an excel spread sheet and analysed using Cronbach’s alpha programme under the guidance of the statistician and supervisor. Findings of the study were that: • the participants perceived the role of assessments as positively enhancing the midwifery programme outcomes, • though they also agreed and strongly agreed that there were major factors that prevented enhancement of midwifery programme outcomes. Ethical considerations were autonomy, beneficence, justice and non-maleficence. The validity and reliability of the data- collection instrument was ensured. Furthermore, recommendations were made for nursing education, clinical practice and future research. The study was conducted during the period of July 2014 to January 2016.

The study explored professional nurses' experience of working in a remote rural hospital in the Eastern Cape Province. A qualitative phenomenological design was used and the study was conducted in a remote rural hospital in region `D'. Eight professional nurses were selected non-randomly from a population of professional nurses who had been working in the hospital for more than one year. Purposive sampling was used to select the participants and semi-structured phenomenological interviews were conducted to collect data. Colaizzi's eight-step method was used for data analysis. The themes that emerged from the data analysis were shortage of human and material resources, poor access, communication problems and lack of safety and insecurity. The study found that the professional nurses at the remote rural hospital experience many obstacles to quality service delivery. / Health Studies / M.A. (Health Studies)

Text in Afrikaans / 'n Opname is onder verpleegkundiges in diens van geselekteerde hospitale onderneem ten einde te bepaal watter ondersteuningstelsels tans in die hospitale vir verpleegkundiges beskikbaar is. Daar is ook bepaal hoe effektief hierdie ondersteuningstelsels benut word, en indien nie waarom nie en ten laaste of ondersteuningstelsels as 'n vereiste fasiliteit gesien word. Die leemtes betreffende ondersteuningstelsels in hierdie hospitale is ge·identifiseer, soos die gebrek van verpleegbestuur om outokratiese en burokratiese bestuurstyle met deelnemende bestuurstyle te vervang. Daar bestaan ook leemtes in ondersteuning by die beplanning van verpleegsorg, wat moontlik toegeskryf kan word aan verpleegbestuur se swak deelname en betrokkenheid by verpleegsorgbeplanning. Aanbevelings is geformuleer om hierdie leemtes aan te spreek. Tydens orientering behoort alle nuwe personeel ingelig te word oor die hospitaalbeleid, sodat doelstellings gesamentlik beplan kan word. Die funksie van bestuur en hulle bydrae tot personeelondersteuning behoort deel van die orienteringsprogram te vorm / A survey to establish which support systems are at present available to nurses, was undertaken in selected hospitals. It was determined how effective these support systems have been utilised, and if not, why not and whether the support systems were seen as an essential facility. The failure of nursing management to replace autocratic and burocratic management styles with participative management styles is a deficiency in the support systems of these hospitals. There is also a need for support in the planning of nursing care. This can possibly be due to the nurse manager's poor participation and involvement in the planning of nursing care. Recommendations were formulated to address these needs. During orientation all new personnel should be informed of hospital policy to enable them to plan collectively, to accomplish objectives. The functions of management and their contribution towards personnel ought to form part of the orientation programme / Agriculture & Environmental Sciences / M.A. (Verpleegkunde)

Thesis (MCur (Nursing Science))--University of Stellenbosch, 2008. / ENGLISH ABSTRACT: Clinical teaching and training is undertaken to correlate theory and practice (Mellish et al., 1998:211). Clinical teaching is the means by which student nurses learn to apply the theory of nursing in a clinical situation so that an integration of theoretical knowledge and practical skills in the clinical situation becomes the art and science of nursing. (Mellish et al., 1998:207). The role of the lecturer/facilitator is to bridge the theory-practice gap between nursing education and practice. Since the merger of the nursing colleges in the Eastern Cape Province (South Africa) and the abolishment of the clinical department in the hospital it became essential to evaluate the clinical facilitation needs of students and tutors. For the purpose of this study the researcher evaluated the clinical facilitation, with the focus area being on the clinical needs and problems of nursing tutors and nursing students at a nursing college in the Eastern Cape Province. The objectives of this study were to determine the following: the clinical facilitation needs of student nurses of the Nursing College, clinical facilitation needs of tutors of the Nursing College, clinical facilitation related problems facing student nurses and tutors in the Nursing College and associations between the clinical facilitation of the campuses of the Nursing College. The following research question was evaluated: What are the needs and problems of nursing students and tutors in clinical facilitation at the Lilitha Nursing College? The research methodology was a descriptive exploratory design with a quantitative approach. The population for this study was the fourth-year nursing students, and all tutors of the nursing college. A convenient sample was drawn. All students available at the time of data collection were included in the study. A structured questionnaire was used to collect the data. The final sample of students was N =100 (45%) of a total population of 222 students. The final sample of tutors was N=35 (36%) of a population of 97. Reliability and validity were assured by means of a pilot study and the use of experts in nursing education, research methodology and statistics. Data were collected personally by the researcher. Ethical approval was obtained from Stellenbosch University, Department of Health ECP, and Head of the Nursing College and Principals of the campuses. Informed written consent was obtained from the participants. Statistical associations with reference to clinical facilitation between the various campuses of the nursing college were determined using the Chi-square tests. The results of this study are presented in percentages, tables and histograms. On completion of the study the following recommendations were made: standardization of policies and procedures; preplanning and publishing of clinical placement dates; manuals, rules, student needs and outcomes be available before clinical placement; improvement of communication between clinical staff, facilitators and students; improvement of infrastructure, equipment and materials.

Human Immunodeficiency Virus (HIV) positive patients are at increased risk for developing mental health problems when compared with the general population. The identification and management of symptoms of mental illness in HIV-positive patients is thus crucial in reducing the risk to developing severe mental illness. The severe mental illness may lead to poor adherence to anti retro-viral drugs resulting in increased morbidity and mortality. The primary health care nurses are largely responsible for managing the treatment of HIV-positive patients as they spend the greatest degree of their time with these patients as compared to other health care professionals. Consequently it is important for primary health care nurses to identify symptoms of mental illness. However, it was unclear to the researcher, a professional psychiatric nurse, as to the level of knowledge among primary health care nurses concerning symptoms of mental illness in HIV-positive patients. Therefore, the aim of this study was to determine the knowledge of primary health care nurses regarding symptoms of mental illness in HIV-positive patients attending primary health care services. In addition, recommendations were developed for primary health care nurses for the purpose of improving their competence in the identification of symptoms of mental illness in HIV-positive patients attending primary health care services. The researcher has utilised quantitative, explorative, descriptive and contextual design. Bloom’s Taxonomy was used as a theoretical lens, to explore the primary health care nurse’s knowledge regarding symptoms of mental illness in HIV-positive patients. The study was conducted in the primary health care services situated in the Nelson Mandela Metropolitan area. The research population consisted of the primary health care nurses working with HIV-positive patients in these primary health care services. The researcher utilised census survey to recruit participants. A structured questionnaire, with 3 sections was used in this study. The necessary principles of reliability and validity were exercised to ensure research of the highest quality. The data was analysed by using descriptive and inferential statistics. All ethical considerations pertaining to beneficence, maleficence, justice, autonomy and obtaining permission from relevant structures to conduct the study were strictly adhered to.

The study explored professional nurses' experience of working in a remote rural hospital in the Eastern Cape Province. A qualitative phenomenological design was used and the study was conducted in a remote rural hospital in region `D'. Eight professional nurses were selected non-randomly from a population of professional nurses who had been working in the hospital for more than one year. Purposive sampling was used to select the participants and semi-structured phenomenological interviews were conducted to collect data. Colaizzi's eight-step method was used for data analysis. The themes that emerged from the data analysis were shortage of human and material resources, poor access, communication problems and lack of safety and insecurity. The study found that the professional nurses at the remote rural hospital experience many obstacles to quality service delivery. / Health Studies / M.A. (Health Studies)

Text in Afrikaans / 'n Opname is onder verpleegkundiges in diens van geselekteerde hospitale onderneem ten einde te bepaal watter ondersteuningstelsels tans in die hospitale vir verpleegkundiges beskikbaar is. Daar is ook bepaal hoe effektief hierdie ondersteuningstelsels benut word, en indien nie waarom nie en ten laaste of ondersteuningstelsels as 'n vereiste fasiliteit gesien word. Die leemtes betreffende ondersteuningstelsels in hierdie hospitale is ge·identifiseer, soos die gebrek van verpleegbestuur om outokratiese en burokratiese bestuurstyle met deelnemende bestuurstyle te vervang. Daar bestaan ook leemtes in ondersteuning by die beplanning van verpleegsorg, wat moontlik toegeskryf kan word aan verpleegbestuur se swak deelname en betrokkenheid by verpleegsorgbeplanning. Aanbevelings is geformuleer om hierdie leemtes aan te spreek. Tydens orientering behoort alle nuwe personeel ingelig te word oor die hospitaalbeleid, sodat doelstellings gesamentlik beplan kan word. Die funksie van bestuur en hulle bydrae tot personeelondersteuning behoort deel van die orienteringsprogram te vorm / A survey to establish which support systems are at present available to nurses, was undertaken in selected hospitals. It was determined how effective these support systems have been utilised, and if not, why not and whether the support systems were seen as an essential facility. The failure of nursing management to replace autocratic and burocratic management styles with participative management styles is a deficiency in the support systems of these hospitals. There is also a need for support in the planning of nursing care. This can possibly be due to the nurse manager's poor participation and involvement in the planning of nursing care. Recommendations were formulated to address these needs. During orientation all new personnel should be informed of hospital policy to enable them to plan collectively, to accomplish objectives. The functions of management and their contribution towards personnel ought to form part of the orientation programme / Agriculture and Environmental Sciences / M.A. (Verpleegkunde)