Background Trauma is the leading cause of death in the young (ages 1-44) and the current life situation is responsible for producing emergency injuries from motor vehicle accidents, violence and from acute life threatening illnesses. The training of emergency nurses is therefore of priority based on the increasing demands on the entire emergency health care system. The study evaluates the education and training of emergency nursing programme that has been offered for the past seven (7) years at a Nursing Education Institution (NEI) in the Limpopo province. The programme has not has not been formally evaluated. Aim The overall aim of the study is to explore and describe the views of students pertaining to the emergency nursing programme offered at the NEI in the Limpopo province and to make recommendations for the refinement of the emergency nursing programme, based on the views of the nursing students. Methods A qualitative design working from an Appreciative Inquiry approach was employed. Purposive sampling was used and focus group interviews were conducted with 20 Professional nurses who are trained as emergency nurses at the NEI from 2007 to 2013. Two main themes emerged: theoretical aspects and clinical aspects, which included both positive and negative views. The findings were used to make recommendations to refine the programme / Health Studies / M.A. (Health Studies)

Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Nursing In the Faculty of Health and Wellness Sciences At the Cape Peninsula University of Technology, 2013 / The syringe driver is a battery-operated device which accurately delivers a continuous subcutaneous infusion of a combination of medication to alleviate symptoms, such as pain, nausea and vomiting, noisy moist breathing and preterminal restlessness. The researcher who works in a palliative care unit in Cape Town noticed the ambivalence and negative attitudes from family members regarding the use of the syringe driver. This gave rise to distress, conflict and ambivalence in patients and between family members. This study aimed to gain insight into the understanding, perceptions and expectations of families of terminally ill patients commenced on a syringe driver in a palliative care unit. A descriptive, qualitative research method was employed using semi-structured interviews, diaries, observation and documentation as the data collection methods. Data was coded and arranged into themes. Thematic analysis and coding were used to analyse the data during this study. This study found that the lack of education and written information were the two major contributing factors towards negative attitudes causing ambivalence in family members whose relatives were on a syringe driver. This study also highlighted the need for quality improvement control when using the syringe driver in the palliative care unit. The need for continuous education and written information and support for the immediate and extendedfamily members was evident. KEY WORDS: Syringe driver, Symptom control, Family members, Terminally ill, Palliative care unit.

M.Cur.(Medical & Surgical Nursing: Critical Care General) / The majority of Africans use traditional medicine, but do not divulge this information to the nurses and doctors when admitted to critical care units. For this reason, patients develop complications, and these makes it difficult for nurses and medical doctors in critical care units to assess and to provide comprehensive quality care, as they treat only the visible clinical manifestations. The purpose of this study was to explore and describe the factors leading to non- divulgence by patients who used traditional medicines in critical care units of a Westrand mine hospital, in order to describe strategies to facilitate divulgence. The researcher used a qualitative, exploratory, descriptive and contextual research design. The population was composed of the patients who were envisaged to have used traditional medicines in the critical care unit of a Westrand mine hospital. Twelve participants were purposively selected from the critical care unit register because these patients displayed the symptoms of having used traditional medicine. Semi-structured individual interviews were conducted. Ethical principles were adhered to. Trustworthiness was ensured by using namely; credibility, transferability, dependability and confirmability. A qualitative open coding method of data analysis was used according to Tesch’s protocol. The following theme and subthemes emerged from the data analysis: Fear and anxiety as the main theme. Subthemes were 1. Fear to divulge secrets. 2. Fear of negative attitudes from nurses and 3. Fear to lose rights, norms and values. It is recommended that the strategies described be used in clinical practice, nursing education and for further research regarding divulgence of the use of traditional medicine to the nurses and doctors, in order to provide a comprehensive assessment and treatment of the patients in critical care units.

M.Cur. / Die idee waarmee hierdie studie 'n aanvang geneem het, het ontstaan vanuit my waarneming dat al hoe meer polisiebeamptes opgeneem word in die psigiatriese kliniek waar ek, die navorser werksaam is. Hierdie polisiebeamptes vertel 'n storie van blootstelling aan talle traumatiese situasies in die beoefening van hul beroep, waar geweld, misdaad, lewensgevaar en die dood vir hulle bekende verskynsels is. Maar dit lei dikwels tot depressie, alkoholmisbruik en aggressie by die polisiebeamptes. Hierdie probleme word, volgens polisiebeampes, dikwels vererger deur 'n autokratiese bestuurstelsel in die SAPD, swak salarisse, 'n lae status in die gemeenskap en ontoereikende fasiliteite. Die winde van politieke verandering wat sedert 2 Februarie 1990 deur Suid-Afrika waai, verg van polisiebeamptes om sekere fundamentele aanpassings te maak en 'n nuwe benadering tot polisiering te volg. Hierdie aanpassings word dikwels as moeilik ervaar. Die gesinne van polisiebeamptes word dikwels direk geaffekteer deur al die genoemde faktore, in die sin dat, die polisiebeampte se manier van "dink en wees" as polisiebeampte, sy interaksie met sy gesin beInvloed. Ek het dus gewonder hoe die gesinne van polisiebeamptes dit beleef wanneer 'n lid van die gesin werksaam is as 'n polisiebeampte in 'n hoe-risiko metropolitaanse area in Gauteng. Geen studie is voorheen hieroor uitgevoer nie. Om hierdie vraag te beantwoord, het ek van 'n verkennende, beskrywende, kontekstuele en kwalitatiewe navorsingsontwerp gebruik gemaak in die uitvoering van hierdie studie. Semigestruktueerde, fenomenologiese onderhoude is gevoer met agt vroue van polisiebeamptes, werksaam by 'n geIdentifiseerde polisiestasie in Gauteng. Die vroue is volgens die sneeubalmetode geselekteer. Dit is gedoen nadat die nodige ingeligte toestemming van hulle verkry is. Stappe is deurgaans deur die studie geneem om vertrouenswaardigheid te verseker, volgens Guba se model. Daar is ook verseker dat hierdie studie op 'n etiese wyse uitgevoer is, deurdat ek myself laat lei het deur die Suid-Afrikaanse Verpleegstersvereniging se standaarde vir verpleegkundige navorsers. Die meta-teoretiese aannames wat hierdie studie rig, is verkry uit die Verplegingsteorie vir Mensheelheid, waarvolgens die mens 'n geestelike wese is wat op 'n gentegreerde, biopsigososiale wyse binne die gesin en gemeenskap funksioneer. Data is ontleed volgens die metodes van Tesch en die dienste van 'n onafhanklike kodeerder is verkry. Sodoende is ooreenstemming bereik oor die kategoriee en subkategoried van temas wat die storie van die vroue so akkuraat as moontlik sou kon beskryf. Die resultate het daarop gedui dat gebroke interaksie dikwels in die gesinne van polisiebeamptes vookom. Hierdie interaksie word gekenmerk deur oppervlakkige, konkrete kommunikasie, aggressie en fisiese, sowel as emosionele afwesigheid van die polisiebeampte in die gesin. Die vrou neem dikwels sekere rolle in die verhouding aan en ervaar emosies van pyn, alleenheid, woede, verwerping, vrees en onsekerheid. Riglyne is beskryf wat moontlik kan lei tot die ondersteuning van die gesinne van polisiebeamptes, deur die psigiatriese verpleegspesialis. Voorstelle vir die aanwending van die resultate in die verpleegonderwys, -praktyk en —navorsing is gemaak. Daar word tot die gevolgtrekking gekom dat die verkenning en beskrywing van die beleweniswereld van die gesinne van polisiebeamptes, die psigiatriese verpleegspesialis instaat kan stel om die gesinne te ondersteun in die mobilisering van hulpbronne en die gesin te fasiliteer in die bevordering, handhawing en herstel van gesinsgeestesgesondheid as 'n integrale deel van gesondheid.

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.

South African hospitals, as a result of numerous factors, have the problem of an increasing workload for nursing staff, which in turn may affect patient treatment quality. This project aimed at addressing patient treatment quality specifically from the perspective of worker capabilities by investigating the strain level and predicted human error probability associated with specific patient-centered tasks in the South African health care sector. This was achieved through two independent yet interlinked studies which focused on seven patient-centred tasks. The tasks analysed were the tasks of setting up and changing intravenous medication, administering injection and pill medication, measuring blood glucose, temperature and heart rate and blood pressure. In the first study, work environment and task characteristics, task structure and execution were analysed. In addition to the task execution, the resulting strain levels, in the form of heart rate measures and subjective ratings of workload, were studied. The second study determined the error protocols and predictive error probability within the healthcare environment for the seven pre-defined tasks. The results for the first study established that different organizational and environment factors could affect task complexity and workload. The individual task components and information processing requirements for each task was also established. For the strain analysis, significant results for the tasks were determined for heart rate frequency and the heart rate variability measures, but some of these were contradictory. For the second study, specific error protocols and error reporting data were determined for the hospital where this research was conducted. Additionally the predictive error probability for the pre-defined tasks was determined. This combined approach and collective results indicate that strain and predictive error probability as a result of task workload can be determined in the field as well as being able to identify which factors have an effect on task strain and error probability. The value of this research lies in the foundation that the gathered information provides and the numerous potential applications of this data. These applications include providing recommendations aimed at improving nursing work environment with regards to workload, improving patient treatment as a result of a reduction in errors and the potential foundation these results provide for future research

Globally, the nursing profession is faced with a decline in school-leavers’ interest in nursing as a career. The decline in school leavers entering the nursing profession poses a threat to the future of nursing because, globally, the average age of nurses in many countries exceeds 40 years (International Council of Nurses, 2008). The role of marketing in attracting school leavers to careers of choice is well documented; however, there is a lack of documented marketing attempts by Nursing Education Institutions to market nursing as a career at secondary schools in the Nelson Mandela Bay Municipality. The purpose of the study was to determine the views that grade nine learners have regarding the marketing of nursing as a career to attract school-leavers to the profession. The researcher also explored and described how grade nine learners are being informed or wish to be informed of nursing as a career. Based on the findings of the study, broad guidelines were developed for nurse educators at Nursing Education Institutions so as to facilitate the marketing of nursing as a career for school leavers. To achieve the purpose of this study, a quantitative, explorative, descriptive and contextual study design was used. The study was conducted at selected senior secondary schools in the Nelson Mandela Bay Municipality. The research population in this study comprised of all grade nine learners at secondary schools in the Nelson Mandela Bay Municipality. A simple random sampling method was used to select participants. A structured self-administered questionnaire was used as the data collection tool. The data collected were analysed with the help of the statistician, using descriptive and inferential statistics. The study findings revealed that grade nine learners in the Nelson Mandela Bay Municipality had a positive response to choosing nursing as a career and that schools situated in the lower socio-economic areas had the highest percentage of grade nine learners indicating an interest in nursing as a career. The study concludes with recommendations for nursing practice, education and research. Ethical principles have been maintained throughout the study.

Valvular disorders can be corrected by means of surgery, after which very comprehensive discharge planning should be implemented to prevent the occurrence of post-operative complications. Advances in medical technology and intellect instigate earlier discharge for patients after they have undergone valvular surgery. The aim of this research study is to establish the extent of discharge planning by nurses for patients who have undergone valvular surgery, so that practice guidelines in the form of an in-service educational framework can be compiled for nurses in the management of these patients post-operatively. Patients, many of whom are from rural areas, are discharged without an adequate referral system. There are, currently, no set guidelines or referral persons to direct these patients during their rehabilitation period. Based on the researcher’s personal observations, it is evident that many patients suffer from bacterial endocarditis or clotted valves due to poor post-surgery management. However, both of these conditions could be avoided if proper health education was given to these patients. The study will take the form of a quantitative, exploratory, descriptive and contextual survey. Data will be collected by means of a structured questionnaire that will be completed by the nurses working in the cardiac general ward and the cardiac clinic. Findings of the research study will be used to assist the researcher in developing an in-service educational framework for staff that are both nursing and preparing post valvular surgery patients for discharge. The goal is to prevent complications such as clot formation and endocarditis and to enable patients to deal effectively with their rehabilitation period.

Volunteer home-based caregivers are critical role players in South Africa‘s health care system and in the South African government‘s strategy to fight HIV and AIDS. In order to achieve the aims that the government seeks to attain, it is important that the care and treatment provided to patients receiving community home-based care (CHBC) be of a high quality. While the need for quality care is supported by government and civil society, research indicates that it is not clear whether quality care is indeed being provided and therefore there is a need for research into the quality of CHBC. The research aimed to undertake a critical assessment of CHBC programmes to determine the quality of care provided by volunteer caregivers using social capital theory as a theoretical framework. The study examined the quality of CHBC by analysing the context of CHBC, by investigating the support that volunteer caregivers and their clients receive and by discussing the support that volunteer caregivers and their clients still need. The study used one-on-one in-depth interviews and focus groups to obtain relevant data. The participants included volunteer caregivers, clients and supervisors who took part in the one-on-one interviews. The focus groups consisted of key informants and supervisors respectively. The quantitative data consisted of descriptive statistics which helped describe the participants. The qualitative data was coded and themes and sub-themes were developed. The data was also analysed by an independent coder. The results showed that poverty, and the related problems of poor living conditions and a lack of food security affects the quality CHBC. In addition, unemployment and the problem of stipends also affect quality CHBC. Certain socio-economic factors were also found to lead people to choose to become volunteer caregivers and unemployment was found to be an important driving force behind the choice to undertake volunteer caregiving. Furthermore, the volunteer caregivers in the sample received organisational support from their supervisors and their fellow caregivers or peers. They also received social support from their families and their communities. Regarding the clients of the volunteer caregivers, it was found that they received a number of types of support including psycho- iv social counselling, spiritual counselling and care of a holistic nature. In addition, the study found that there is a need for standardised quality training of volunteer caregivers, which will equip them with multiple skills. It was also found that volunteer caregivers require mentoring and quality supervision in order to be able to provide quality CHBC to their clients. Government has the ability to put the necessary systems and structures in place, such as a scope of practice for volunteers, standardised training and monitoring and evaluation, to enable CHBC and its relevant role players to operate at optimum levels. It also has the authority to make the changes and to enforce rules. Furthermore, it has the ability to unite CHBC organisations and can create the necessary conditions that can lead to increased social capital. Furthermore, the study recommends that two additional dimensions of quality care be added to existing dimensions of quality in health care. The first is the holistic approach to caregiving and the second is social support systems, namely supervisor/mentor and peer support and family and community support. This second dimension is also closely linked to social capital and the networks that make up CHBC.

This study identifies the Integrated School Health Programme’s implementation constraints in (Ekurhuleni Metropolitan Municipality, Southern Region), and describes how these constraints have affected the implementation of school health services. This predominantly qualitative study employed the structured interview-based research design and focus group discussion approaches, with the target population consisting of school health nurses and educators working with them in Ekurhuleni Metropolitan Municipality, Southern Region. The criterion-referenced sampling strategy was opted for, because of the researcher’s knowledge of the research environment. The focus group discussions, structured interviews and participant observations complement the study’s data collection methods. The principal findings depicted the Integrated School Health Programme was not as effective as expected in its implementation. The main constraints were identified as lack of resources and knowledge; and poor teamwork of the Department of Health, the Department of Basic Education, and parents. Emanating from these findings, the study recommends innovative collaboration mechanisms between the two government departments, and that relevant and sufficient resources should be allocated for effectively implementing the Integrated School Health Programme. / Health Studies / M. P. H.