Thesis (MPH.) -- University of Limpopo, 2021 / Background:Patient satisfaction is an important means of measuring the effectiveness of health care delivery and medical care. Patient satisfaction provides a picture of the extent to which the general health care needs of the patient provided by health care professionals are met to the satisfaction of the patient. Administration of patient satisfaction surveys provide an opportunity to identify and resolve potential problems before they become serious. Enhancing quality of service delivery in public health facilities is a prerequisite for the increased utilisation and sustainability of health care services to the population. The aim of the study was to investigate the level of patient satisfaction regarding service delivery provided by the doctors and nurses at a hospital in Botswana. Purpose:The study’s aim was to investigate the level of patient satisfaction regarding service delivery at a hospital in Botswana. Methods:Aquantitative approach using a self-administered structured questionnaire to collect data regarding patient satisfaction regarding service delivery at hospital was used.A consecutive sampling technique was used to select patients who fulfilled the study’s inclusion criteria. A sample size of 360 patients was required for the study, which was calculated based on the Taro Yamane formula. Data was analysed using SPSS version V.21.0. Results:The mean age of the outpatients was 38.5(SD ±15.6) years while,for the inpatients, the mean agewas 33.3(SD±12.4) years. The greater proportion of respondents in both groups was females. Nearly half (47%) of the outpatients were employed, whereas more than half (53%) of the inpatients were unemployed. The majority of the participants had a low level of education. The mean satisfaction level was 58.9 (SD±7.9)for outpatients, while for in patients, the mean satisfaction level was 70.3 (SD±12.5). A large proportion (65%) of the outpatients were satisfied compared to the inpatients (54%), however, the results were not statistically significant (p>0.05). There was no statistically significant relationship between the age, gender, employment status, level of education of the outpatients and their level of satisfaction. For inpatient variables, age, gender, and level of education were not associated with level of satisfaction (p>0.05). Conclusion: Inconclusion, regardless of the fact that certain aspects of care provided a t this hospital were unsatisfactory, the results of the present study revealed that, overall,more than half of the patients were satisfied with the inpatients and outpatient aspects of the xiv care they were provided.

In English / This study investigates the resilience of caregivers at a Gauteng-based hospice with patients living with HIV/AIDS. The primary focus of this study was to describe the impact on caregivers working with terminally ill patients predominantly with HIV/AIDS. Six participants were selected for this study utilising purposive sampling. Their ages ranged between 30 and 70 years. For the purpose of data collection, face-to-face semi-structured interviews were undertaken. In analysing data, the themes and sub-themes were extracted and presented by employing thematic analysis. The findings of this study revealed that in times of adversity and setbacks most caregivers utilise various skills to bounce back, and they still showed contentment in serving community members. However, caregivers have also voiced the concern that the support offered at work was not sufficient in meeting their needs. Recommendations for further research, on the resilience of caregivers when working with terminally ill patients is highlighted. / Psychology / M.A. (Clinical Psychology)

In English / This study investigates the resilience of caregivers at a Gauteng-based hospice with patients living with HIV/AIDS. The primary focus of this study was to describe the impact on caregivers working with terminally ill patients predominantly with HIV/AIDS. Six participants were selected for this study utilising purposive sampling. Their ages ranged between 30 and 70 years. For the purpose of data collection, face-to-face semi-structured interviews were undertaken. In analysing data, the themes and sub-themes were extracted and presented by employing thematic analysis. The findings of this study revealed that in times of adversity and setbacks most caregivers utilise various skills to bounce back, and they still showed contentment in serving community members. However, caregivers have also voiced the concern that the support offered at work was not sufficient in meeting their needs. Recommendations for further research, on the resilience of caregivers when working with terminally ill patients is highlighted. / Psychology / M. A. (Clinical Psychology)

Thesis (M. Tech.) -- Central University of Technology, Free State, 2010 / South Africa currently faces one of the highest HIV prevalence rates in the world. As this prevalence rises, the strain placed on its hospitals is likely to increase due to the shortage of beds. The devastating effects of HIV/AIDS initiated the establishment of a hospice which is a non-governmental organisation whose goal is the provision of care for terminally ill patients, either in their homes, in hospitals or in a hospice’s own in-patients wards. Part of the hospice’s mission is to offer palliative care without charge to anyone who requires it. The basic elements of hospice care include pain and symptom management, provision of support to the bereaving family and promoting a peaceful and dignified death. This also includes the provision of cooked foods to the patients using the kitchen facilities of the hospices for this activity. It is well known that the kitchen is particularly important in the spread of infectious disease in the domestic environment due to many activities that occur in this particular setting. Food and water safety is especially important to the persons infected with the human immunodeficiency virus (HIV) or with immunodeficiency syndrome (AIDS).It is estimated that food-borne pathogens (disease–causing agents) are responsible for 76 million illnesses, some resulting in death, in the United States alone every year. In one study of patients with AIDS, two-thirds had diarrhoeal disease and in two-thirds of these, the following enteric pathogens were identified: Salmonella, Shigella, Listeria, Yersnia, Cryptosporidium, Entamoeba histolylica and Campylobacter sp. In an epidemiological study of patients with HIV infection a close association was found between consumption of raw or partially cooked fish and antimicrobial-resistant Mycobacterium avium complex. Antibiotic resistance in food-borne pathogens has become a reality and this poses a serious threat to the medical fraternity since it diminishes the effectiveness of treatment. This study was undertaken to determine the prevalence of foodborne pathogens including bio aerosols isolated from the kitchen surfaces and food handler’s before and after cooking. The antibiotic resistance of the isolated pathogens was further determined to assess their impact on treatment. The following microbiota were isolated: Total viable counts (TVC), Coliforms, Escherichia coli, Staphylococcus aureus, Pseudomonas and presumptive Salmonella. The hospices had high counts of E.coli and S.aureus on the cutting boards for the breakfast session compared to the traditional home based kitchens. It was speculated that this could have originated from crosscontamination via the foodhandler’s hands and the food served. It is evident from the results that hospices lack a management system regarding the prevalence of E. coli as it was present on the cutting boards throughout the food preparation sessions. Gram negative organisms (coliform and P. aeruginosa) were in particular both resistant to oxacillin and this pose a great challenge in this particular setting. This can be addressed by putting emphasis on hygiene as a strategy per se for reducing antibiotic resistance.

A quantitative study was conducted to determine the socio-economic outcomes for the beneficiaries of the Expanded Child Survival Initiative in Uganda. The population comprised of all orphans and vulnerable children who were trained under the Expanded Child Survival Initiative of which a sample of 102 respondents were included in the structured data collection process. The outcomes that were explored were employment, income, assets and family support to siblings and other dependants by the primary beneficiaries. The findings show that the outcomes of the Expanded Child Survival Initiative were positive and benefited socio economic lives of the respondents and their family members. The majority of the respondents were using the skills obtained from the training and were employed. The employment provided a source of income and the income earned facilitates the respondents in providing the basic needs of the family members. They were able to provide adequately for most of their basic needs. The findings also show that the respondents had accumulated some assets. A number of factors influenced the utilisation of the newly acquired skills including having tool kits, start-up capital and business management skills. It is recommended that training providers should provide start-up support to the apprentices in order to facilitate them to utilise the skills obtained from apprenticeship trainings. / Public Health / Thesis (M.A. (Public Health))

Background: Literature has shown that negative attitudes and unwillingness to care for HIV-infected patients are prevailing among healthcare workers. This study aimed to assess the attitudes and willingness of student nurses towards caring for HIV-infected patients in some public hospitals in Gert Sibande district, Mpumalanga. Method: A contextual exploratory quantitative descriptive survey was conducted among student nurses enrolled for a four-year nursing qualification in a nursing college at Mpumalanga province. Self-administered questionnaires were completed after obtaining an informed consent. Results: A total of 122 (70.9%) students participated in this survey. Findings showed that most participants had positive attitudes 66 (52.7%) and were willing 121 (99.1%) to care for HIV-infected patients. Significant associations were revealed between participants’ previous HIV testing (p=0.012), age group (p=0.009), and their willingness to provide care to HIV-infected patients. Conclusion: Results showed a generally positive attitude and willingness by participants to care for HIV-infected patients. / Health Studies / M.A. (Health Studies)

Thesis (M Social Work)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The South African government has laws and policies that forbid discrimination against individuals. These policies protect people from being discriminated against in the workplace due to sickness, race and many other factors. Discrimination against people living with HIV/AIDS has caused many people who suffer from this disease not to come forward with their illness because they fear being discriminated against and stigmatised; some even lose their jobs because they are infected with HIV. People infected with HIV are discriminated against not only in the workplace but also in their communities and families. This implies that people living with HIV/AIDS need support from all levels of society in order to live positive lives, which may lead infected people to live longer. This study explored HIV/AIDS as terminal illness and the stressors experienced by people infected with the virus. This was done by examining the support available to people living with HIV/AIDS, as well as identifying the support needed by these people. By adopting an ecological approach to the study, the need for support could be investigated on multiple levels. A combination of a quantitative and qualitative research design was used in the study. Data were gathered by means of a semi-structured interview schedule that was administered during individual interviews with service providers. This allowed for data that were both measurable as well as rich in description to be collected. The questions in the semi-structured questionnaire were based on the information retrieved from the literature review. The findings from the empirical investigation revealed that people living with HIV/AIDS receive limited support from their families, the South African government and society at large. The findings further indicated that informal sources of support such as family, friends and partners are relatively supportive of people living with HIV/AIDS. However, the relationships between people living with HIV/AIDS and their families and partners are often strained, especially when a person first discovers his or her status as HIV positive. Furthermore, people living with HIV/AIDS are stigmatised on multiple levels because of their status. There is stigmatisation from family, friends, in the workplace and in the community. The most important recommendations resulting from the study are that services such as counselling are needed for people living with HIV/AIDS together with their families. This is of particular significance to the South African government, especially the health sector, which needs to improve the health care system. In addition, recommendations emphasise the importance of promoting education and awareness, which could have great value for people living with HIV/AIDS, their families and communities. Knowledge about HIV/AIDS would empower people at all levels to support those who live with the disease and would also be of great value in helping those living with the disease to contribute something of value towards their health condition. / AFRIKAANSE OPSOMMING: Die Suid-Afrikaanse regering beskik oor wette en beleide wat diskriminasie teen individue verbied. Hierdie wette en beleide beskerm mense teen diskriminasie in die werkplek, diskriminasie op grond van siekte, gestremdheid, ras en vele ander redes. Diskriminasie teen mense wat met MIV/vigs leef, laat baie van hulle hul MIV/vigs-status geheim hou omdat hulle diskriminasie en stigmatisasie vrees. Sommige verloor selfs hulle werk wanneer dit rugbaar word dat hulle aan MIV/vigs ly. Diegene met MIV/vigs ervaar egter nie net in die werkplek diskriminasie nie, maar ook in hul gemeenskappe en families. Dít impliseer dat mense met MIV/vigs op alle vlakke ondersteuning nodig het om ’n positiewe lewe te lei en daarmee hul lewensverwagting so ver moontlik te verleng. Hierdie studie het die stresfaktore van terminale MIV/vigs-lyers ondersoek. Daar is voorts ondersoek ingestel na die ondersteuning wat mense met MIV/vigs ontvang, sowel as die ondersteuning wat hulle nodig het. MIV/vigs-lyers se ondersteuningsbehoeftes op etlike vlakke is deur middel van ’n ekologiese navorsingsbenadering bepaal. ’n Kombinasie van ’n kwantitatiewe en kwalitatiewe navorsingsmetodologie is vir die studie gebruik. Data is met behulp van ’n semigestruktureerde vraelys ingesamel, wat gedurende individuele onderhoude met diensverskaffers afgeneem is. Sodoende kon meetbare sowel as hoogs beskrywende data ingesamel word. Die vrae in die semigestruktureerde vraelys was gegrond op die inligting uit die literatuuroorsig. Die bevindinge van die empiriese ondersoek toon dat mense wat met MIV/vigs leef beperkte ondersteuning van hul familie, die Suid-Afrikaanse regering en die groter samelewing ontvang. Die bevindinge dui voorts daarop dat informele ondersteuningsbronne, soos familie, vriende en lewensmaats, betreklik ondersteunend is teenoor diegene met MIV/vigs. Tog is die verhouding tussen MIV/vigs-lyers en hul families en lewensmaats ook dikwels onder druk, veral net nadat die persoon ontdek dat hy/sy MIV-positief is. Daarbenewens word mense met MIV/vigs op verskeie vlakke gestigmatiseer – deur hul familie, vriende, in die werkplek en die gemeenskap. Die belangrikste aanbeveling uit die studie handel oor die behoefte aan dienste soos berading vir mense wat met die virus leef, sowel as vir hul familie. Die aanbeveling behoort veral van belang te wees vir die Suid-Afrikaanse regering, en in die besonder die gesondheidsektor, wat hierdie behoefte in gedagte moet hou om die gesondheidsorgstelsel te verbeter. Ander aanbevelings beklemtoon die belang van meer opvoeding en bewusmaking, aangesien dit uiters waardevol kan wees vir mense met MIV/vigs, hul familie en gemeenskappe. Kennis oor MIV/vigs sal mense op alle vlakke bemagtig om diegene met die virus te ondersteun, terwyl dit MIV/vigs-lyers self ook sal help om hul eie gesondheidstoestand beter te bestuur.

Thesis (PhD)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Background A need for primary care practitioners to utilise clinical research evidence in practice has been identified and is well described. However a chasm between evidence and practice still exists in primary health care (PHC). Although clinical practice guidelines have been shown to improve the quality of clinical practice and attempt to bridge the gap between evidence and practice, practitioners are often not aware of practice guidelines and fail to access, adopt or adhere to evidence-based recommendations contained in them. Central question How can the implementation of clinical research evidence, using the example of the national evidence-based guideline on asthma, be improved in the PHC sector in the MDHS of the Cape Town metropole? Aim This research aimed to improve the implementation of clinical research evidence in PHC, by learning from the specific example of the national evidence-based asthma guideline in PHC practice in the Metro District Health System (MDHS) of the Cape Town metropole, and to make recommendations to key stakeholders regarding the future implementation of evidence-based guidelines. Objectives  To gain insight into the current quality of asthma care in PHC in the MDHS of the Cape Town metropole.  To determine whether the process of implementation of the new asthma guideline contributed to an improvement in the quality of care in the MDHS.  To explore ways of improving the process of implementation of the national asthma guideline in PHC in the MDHS.  To gain insight into the perceptions, attitudes and knowledge of asthmatic patients regarding their asthma management.  To explore how EBP is understood and perceived by doctors in PHC. Stellenbosch University https://scholar.sun.ac.za  To understand how PHC doctors in the public and private health sectors gain access to and use guidelines.  To explore the experiences, perspectives and understanding of family physicians (FPs) (academic, private and public sector) with regard to EBP and the implementation of guidelines in PHC practice.  To gain insight into the understanding of FPs regarding the perceived problems and main barriers to EBP and their views of the process of guideline implementation in PHC.  To gain insight into the knowledge, perceptions and attitudes of clinical nurse practitioners in the public sector with regard to EBP and the process of guideline implementation. Methodology This study was conducted in the PHC setting of the Cape Town metropole. This research was conducted in three phases and used cross-sectional surveys, quality improvement (QI) cycles, qualitative research methods, such as interviews with FPs, and participatory action research (PAR). Phase 1 involved a cross-sectional survey, which looked at the knowledge, awareness and perspectives of doctors, regarding evidence-based practice (EBP) and guideline implementation using the national evidence-based asthma guideline published in 2007. It also involved QI cycles conducted over a period of five years to assess the baseline quality of asthma care in the PHC sector and to evaluate improvement in asthma care as a result of the QI cycles and associated educational workshops. Phase 2 involved interviews conducted with FPs in academia as well as in the private and public health care sectors who were responsible for clinical governance in PHC in the Cape Town metropole. During this phase of the research the experiences, perspectives and understanding of FPs (academic, private and public sector) with regard to EBP and the implementation of guidelines in PHC practice were explored. Phase 3 involved PAR with primary care practitioners at community health centres (CHCs) using a co-operative inquiry group (CIG) to improve asthma guideline implementation in PHC. The CIG investigated how to improve the implementation of the asthma guideline in their respective CHCs and completed four cycles of planning-action-observation-reflection. The four cycles focused on implementation of an asthma self-management plan (ASMP), exploring the capability of clinical nurse practitioners to implement the guidelines, exploring the views of patients on their asthma care and implementing better patient education. A final consensus of the CIG’s learning was then constructed. Results With regard to quality improvement of asthma care in PHC: The first objective of the study was largely addressed through the baseline audits conducted in 2007 and 2008. This showed that the baseline quality of asthma care, with specific reference to the assessment of the patient’s level of control, measuring the patient’s peak expiratory flow rate (PEFR), assessing the patient’s inhaler/ spacer technique, recording the smoking status, the adequate prescription of controller and reliever metered dose inhalers (MDI) refills during visits and particularly the issuing of an ASMP during visits, was poor. The second objective was addressed through the annual audits conducted in 2007, 2008, 2010 and 2011 during the period of implementation. This showed that although clear cause and effect reasoning cannot be inferred, overall statistically and clinically significant improvements in the quality of care occurred in conjunction with the process of asthma guideline implementation. Despite the improvement in structural and process criteria there was no corresponding improvement in the outcome criteria and in fact the utilisation of facilities for emergency visits significantly increased, while the hospitalisation of patients remained constant. The third objective was to explore ways of improving the process of implementation of the national asthma guideline in PHC in the MDHS. This was largely addressed through the action-research process at selected CHCs. This showed that implementation could be improved by ongoing educational support and formal interactive training workshops with the staff members who were directly involved with patients. The development and use of educational aids and ASMPs based on the guideline recommendations were useful and encouraged patient participation in decision making regarding their care. The fourth objective, specific to asthma care, addressed by means of a survey and showed that even though the majority of asthma patients participated in decisions regarding their asthma and felt satisfied with the quality of care they received, the prevalence of smoking among asthma patients was high and opportunities for smoking cessation counselling were missed. Even though documentation of peak flow recordings and patients’ knowledge of the difference between the reliever and controller MDIs were good, patients’ perceptions with regard to education on the inhaler technique, the assessment of the level of control, the issue of written information regarding asthma and the use of ASMPs remained poor and could be improved. With regard to EBP and asthma guideline implementation in PHC: The fifth objective of the study was addressed by means of a survey which showed that the doctors in PHC used evidence in clinical decision making and agreed on the usefulness and importance of EBP in improving the quality of patient care in South Africa. There was a difference in the engagement with activities related to EBP between the public and private sector PHC doctors and there is a need for formal training in the skills and processes of EBP. The sixth objective was addressed by means of a survey which showed that a good proportion of both public and private sector doctors in the Cape Town metropole were well aware of the asthma guideline, had used the guideline and had adopted, acted on and adhered to specific guideline recommendations. There was a high level of general awareness of the asthma guideline and recommendations were being adopted in practice, although the lack of formal disease registers, monitoring and evaluation of asthma care and the utilisation of an ASMP could be improved on. The seventh objective was addressed by qualitative research which showed how the views and perspectives of FPs regarding EBP and the process of guideline implementation contributed to the development of a conceptual framework for the process of guideline implementation. The eighth objective was addressed by qualitative research, which identified barriers present in each step of the implementation process. Time constraints, practitioner workload, lack of financial resources, lack of ownership, the lack of timeous organisational support and practitioner resistance to change were important barriers to guideline implementation in an already overburdened PHC setting. A conceptual model was developed which showed that the process of guideline implementation should be tailored to the barriers identified. The ninth objective was addressed by means of a survey which showed that the concept of EBP was fairly new to CNPs in PHC and identified a need to learn more about it. CNPs agreed that clinical research evidence is useful in the daily management of patients, that their decision making is based on evidence, that evidence-based nursing can improve the quality of patient care, that there is a place for evidence-based nursing in their practices at their respective CHCs, that EBP will make a difference in the quality of care of their patients and that evidence-based nursing practice has an important role to play in South Africa. Although the awareness of CNPs with regard to the asthma guideline was poor, the vast majority reported that they personally educated patients on the difference between reliever and controller MDIs, recorded the smoking status of patients in the records, demonstrated the inhaler technique to all their asthma patients, assessed the level of control and agreed that inhaled corticosteroids are the mainstay of treatment in patients with chronic persistent asthma. However only a small minority (mainly at the CHCs where action research occurred) started issuing patients with ASMPs. In answering the central question: “How can the process of implementation of clinical research evidence, using the example of the national evidence-based guideline on asthma, be improved in the PHC sector in the MDHS of the Cape Town metropole?”, this thesis concludes that the process of guideline implementation can be improved in the PHC sector by an in depth understanding and systematic approach to the whole process. A conceptual framework is provided as a model which attempts to guide and make sense of this process of guideline implementation. A stepwise approach is presented and provides a summary of the main research findings. The model shows that the initial process of evidence creation should not only deal with research evidence of high quality, but should incorporate research evidence that is relevant to the particular context of care. In addition the model shows that guideline development should be inclusive and involve a wider spectrum of stakeholders as well as patients; that guideline contextualisation, dissemination and implementation should be carefully planned. Special consideration should be given to local decision making about adoption or prioritisation of specific recommendations as part of ongoing quality improvement cycles and the conversion of published guidelines into practical tools for practitioners to use in consultation, prior to dissemination. Implementation should anticipate that members of the PHC staff will differ in their readiness to change and that strategies should consciously embrace principles of behaviour change and build up a sense of ownership, choice and control over local adoption of the guidelines. Academic centres, such as universities and professional bodies, have a role to play in identifying, appraising and synthesising the evidence, and giving input into guideline development. They can also assist by innovating and evaluating practical tools as part of the contextualisation stage and by providing continuing education during implementation as part of their social responsibility. The health care organisation (HCO) should prevent unnecessary delays in guideline implementation by ensuring that policy, resources and recommendations are aligned during the contextualisation stage; that barriers encountered should be dealt with throughout the entire process, and that ongoing monitoring and evaluation of the quality of care occurs. Conclusion This research used different methods and innovative PAR to bridge the gap between evidence and practice. A new conceptual model for guideline implementation is recommended for use to assist with implementation and knowledge translation in PHC locally, nationally and in similar Low Middle Income Countries (LMIC) in Africa. / AFRIKAANSE OPSOMMING: Agtergrond ‘n Behoefte om kliniese navorsingsbewyse in die praktyk te benut, is by primêre – sorg praktisyns geïdentifiseer en word goed beskryf. Daar bestaan egter steeds ‘n gaping tussen bewyse en die praktyk in primêre gesondheidsorg. Alhoewel getoon kon word dat kliniese praktykriglyne die kwaliteit van kliniese praktyk verbeter, en poog om die gaping tussen bewys en praktyk te oorbrug, is praktisyns dikwels nie bewus van praktykriglyne nie, en faal daarin om toegang te verkry tot bewysgebaseerde aanbevelings wat daarin vervat is, asook om dit aan te neem en na te kom. Sentrale vraag Hoe kan die implementering van kliniese navorsingbewyse, deur die voorbeeld van nasionale bewysgebaseerde riglyne oor asma te gebruik, verbeter word in die primêre gesondheidsorgsektor in die Metropooldistrik – gesondheidstelsel van die Kaapstad – metropool? Doel Die doel van hierdie navorsing was om die implementering van kliniese navorsingbewyse in die primêre gesondheidsorg te verbeter, deur te leer vanuit die spesifieke voorbeeld van die nasionale bewysgebaseerde asmariglyne in die primêre gesondheidsorgpraktyk in die Metropooldistrik – gesondheidstelsel van die Kaapstad - metropool, en om aanbevelings aan sleutel – rolspelers te maak aangaande die toekomstige implementering van bewysgebaseerde riglyne. Doelwitte  Om insig te verkry in die huidige kwaliteit van asmasorg in die primêre gesondheidsorg in die Metropooldistrik – gesondheidstelsel van die Kaapstad – metropool.  Om vas te stel of die implementeringsproses van die nuwe asmariglyne bygedra het tot ‘n verbetering in die kwaliteit van sorg in die Metropooldistrik – gesondheidstelsel.  Om maniere te verken om die implementeringsproses van die nasionale asmariglyne in die primêre gesondheidsorg in die Metropooldistrik – gesondheidstelsel te verbeter.  Om insig te verkry in die opvattings, houding en kennis van asmatiese pasiënte met betrekking tot hul asma – bestuur.  Om te verken hoe bewysgebaseerde praktyk verstaan en deur dokters in primêre gesondheidsorg toegepas word.  Om te verstaan hoe primêre gesondheidsorgdokters in die openbare - en privaatgesondheidsektore toegang tot, en die toepassing van riglyne verkry.  Om die ervaringe, perspektiewe en begrip van gesinspraktisyns (akademies, privaat en openbare sektor) met betrekking tot bewysgebaseerde praktyk, en die implementering van riglyne in primêre gesondheidsorg, te verken.  Om insig te verkry in die begrip van gesinspraktisyns met betrekking tot die probleme wat waargeneem is, hoofhindernisse tot bewysgebaseerde praktyk, asook hul persepsies van die proses van riglyn – implementering in primêre gesondheidsorg.  Om insig te verkry in die kennis, persepsies en houding van kliniese verpleegpraktisyns in die openbare sektor, met betrekking tot bewysgebaseerde praktyk en die proses van riglyn – implementering. Metodologie Hierdie studie is uitgevoer in die primêre gesondheidsorg - instellings van die Kaapstad – metropool. Hierdie navorsing is in drie fases uitgevoer, en het deursnee – ondersoeke, kwaliteitverbeteringsiklusse, kwalitatiewe navorsingsmetodes soos onderhoude met gesinspraktisyns, en deelnemende aksienavorsing gebruik. Fase 1 het ‘n deursnee – ondersoek behels oor die kennis, bewusmaking en perspektiewe van dokters met betrekking tot bewysgebaseerde praktyk en riglyn – implementering , deur die nasionale bewysgebaseerde asmariglyne te gebruik wat in 2007 gepubliseer is. Dit het ook kwaliteitverbeteringsiklusse behels wat oor ‘n tydperk van vyf jaar uitgevoer is, om die basislyn – kwaliteit van asmasorg in die primêre gesondheidsorg te assesseer, en om die verbetering in asmasorg te evalueer as ‘n uitvloesel van die kwaliteitverbeteringsiklusse en geassosieerde opvoedkundige werkswinkels. Fase 2 het onderhoude behels met gesinspraktisyns in akademia, sowel as in die privaat - en openbare gesondheidsorgsektore wat verantwoordelik was vir kliniese staatsbestuur in primêre gesondheidsorg in die Kaapstad – metropool. Gedurende hierdie fase van die navorsing was die ervaringe, perspektiewe en begrip van gesinspraktisyns (akademia, privaat – en openbare sektor) met betrekking tot bewysgebaseerde praktyk, en die implementering van riglyne in primêre gesondheidsorg, verken. Fase 3 het deelnemende aksienavorsing met primêre sorg – praktisyns by gemeenskaps – gesondheidsentrums behels, deur ‘n koöperatiewe ondersoekgroep te gebruik om die asmariglyn – implementering in primêre gesondheidsorg te verbeter. Die koöperatiewe ondersoekgroep het ondersoek ingestel hoe om die implementering van die asma – riglyne in hul onderskeie gemeenskaps – gesondheidsentrums te verbeter, en het vier siklusse van beplanning – aksie – observasie – refleksie voltooi. Die vier siklusse het gefokus op die implementering van ‘n asma – selfbestuurplan, die bekwaamheid van kliniese verpleegpraktisyns om die riglyne te implementeer te verken, die persepsies van pasiënte oor hul asmasorg te verken, en die implementering van beter pasiënt – opvoeding. ‘n Finale konsensus van die koöperatiewe ondersoekgroep se studie was toe opgestel. Resultate Met betrekking tot gehalteverbetering van asmasorg in primêre gesondheidsorg: Die eerste doelwit van die studie is hoofsaaklik aangespreek deur die basislyn – oudit wat in 2007 en 2008 uitgevoer is. Dit het getoon dat die basislynkwaliteit van asmasorg, met spesifieke verwysing na die assessering van pasiënte se vlak van beheer, meting van die pasiënt se piek ekspiratoriese vloeitempo, assessering van die pasiënt se inhaleringstegniek, optekening van die pasiënt se rookstatus, die voldoende voorskryf van reguleerder - en verligter gemeterde dosis inhaleerderhervullers tydens besoeke, en veral die verskaffing van ‘n asma – selfbestuurplan tydens besoeke, swak was. Die tweede doelwit is aangespreek deur die jaarlikse ouditte wat uitgevoer is in 2007, 2008, 2010 en 2011 gedurende die periode van implementering. Dit toon dat, hoewel duidelike oorsaak en effek – argumentering nie afgelei kan word nie, algehele statisties en klinies - beduidende verbeterings in die kwaliteit van sorg voorgekom het, in samewerking met die proses van asmariglyn – implementering. Ten spyte van die verbetering in strukturele – en proseskriteria, was daar geen ooreenstemmende verbetering in die uitkomskriteria nie. In werklikheid het die benutting van fasiliteite vir noodbesoeke aansienlik verhoog, terwyl die hospitalisasie van pasiënte konstant gebly het. Die derde objektief was om maniere te verken om die implementeringsproses van die nasionale asmariglyne in primêre gesondheidsorg in die Metropooldistrik – gesondheidstelsel te verbeter. Dit was hoofsaaklik aangespreek deur ‘n aksienavorsingproses by geselekteerde gemeenskaps – gesondheidsentrums. Dit het getoon dat implementering verbeter kon word deur deurlopende opvoedkundige ondersteuning en formele interaktiewe opleidingswerkswinkels met die personeellede wat direk betrokke was met die pasiënte. Die ontwikkeling en gebruik van opvoedkundige hulpmiddels, en asma - selfbestuurplanne gebaseer op die riglyn – aanbevelings was nuttig, en het pasiëntdeelname in besluitneming rakende hul sorg, aangemoedig. Die vierde doelwit, spesifiek met betrekking tot asmasorg, is aangespreek by wyse van ‘n opname. Dit het getoon dat, alhoewel die meerderheid van asma – pasiënte deelgeneem het aan besluite rakende hul asma, en tevrede was met die kwaliteit van sorg wat hulle ontvang het, die voorkoms van rook onder asma – pasiënte hoog was, en geleenthede vir rookstaking – berading was gemis. Alhoewel dokumentasie van piekvloei – opnames en pasiënte se kennis van die verskil tussen die verligter en kontroleerder - gemeterde dosis inhaleerders goed was, was pasiënte se persepsies met betrekking tot opvoeding in die inhaleringstegniek, die assessering van die vlak van beheer, die uitreiking van geskrewe inligting ten opsigte van asma, en die gebruik van asma – selfbestuurplanne steeds swak en kon dit verbeter word. Met betrekking tot bewysgebaseerde praktyk en asmariglyn – implementering in primêre gesondheidsorg: Die vyfde doelwit van die studie is aangespreek by wyse van ‘n opname wat getoon het dat die dokters in primêre gesondheidsorg bewyse in kliniese besluitneming gebruik het, en saamgestem het met die nuttigheid en belangrikheid van bewysgebaseerde praktyk in die verbetering van die kwaliteit van pasiëntsorg in Suid – Afrika. Daar was ‘n verskil in omgang met aktiwiteite wat verband hou met bewysgebaseerde praktyke tussen die openbare – en privaatsektordokters. Daar is dus ‘n behoefte aan formele opleiding in die vaardighede en prosesse van bewysgebaseerde praktyke. Die sesde doelwit is aangespreek by wyse van ‘n opname wat getoon het dat ‘n goeie proporsie van beide openbare en privaatsektordokters in die Kaapstad- metropool wel bewus was van die asmariglyn en het spesifieke riglyn – aanbevelings aangeneem, daarop gereageer en nagekom. Daar was ‘n hoë vlak van algemene bewustheid van die asmariglyn, en aanbevelings was aangeneem in die praktyk, alhoewel daar verbeter kon word op die gebrek aan formele siekteregisters, monitering en evaluering van asmasorg, en die benutting van ‘n asma – selfbestuurplan. Die sewende doelwit is aangespreek deur kwalitatiewe navorsing wat getoon het hoe die persepsies en perspektiewe van gesinspraktisyns ten opsigte van bewysgebaseerde praktyk en die proses van riglyn – implementering bygedra het tot die ontwikkeling van ‘n konseptuele raamwerk vir die proses van riglyn – implementering. Die agste doelwit is aangespreek deur kwalitatiewe navorsing, wat hindernisse in elke stap van die implementeringsproses identifiseer het. Tydbeperkings, praktisynswerklading, gebrek aan finansiële hulpbronne, gebrek aan eienaarskap, die gebrek aan tydige organisasie – ondersteuning en praktisynsweerstand ten opsigte van verandering, was belangrike hindernisse in riglyn – implementering in ‘n reeds oorlaaide primêre sorg – omgewing. ‘n Konseptuele model is ontwikkel wat getoon het dat die proses van riglyn – implementering aangepas moet word by die geïdentifiseerde hindernisse. Die negende doelwit is aangespreek by wyse van ‘n opname wat getoon het dat die konsep van bewysgebaseerde praktyk betreklik nuut was vir kliniese verpleegpraktisyns in primêre gesondheidsorg, en het ‘n behoefte geïdentifiseer om meer hieroor te leer. Kliniese verpleegpraktisyns het saamgestem dat kliniese navorsing nuttig is in die daaglikse bestuur van pasiënte, dat hul besluitneming gebaseer moet wees op bewyse, dat bewysgebaseerde verpleging die kwaliteit van pasiëntsorg kan verbeter, dat daar ‘n plek is vir bewysgebaseerde verpleging in hul praktyke by hul onderskeie gemeenskap-gesondheidsentrums, dat bewysgebaseerde praktyk ‘n verskil sal maak in die kwaliteit van sorg van hul pasiënte, en dat bewysgebaseerde verpleegpraktyk ‘n belangrike rol kan speel in Suid – Afrika. Alhoewel die bewustheid onder kliniese verpleegpraktisyns met betrekking tot die asmariglyne swak was, het die oorgrote meerderheid verslag gegee dat hulle die pasiënte persoonlik opgevoed het oor die verskil tussen verligting – en beheerder gemeterde dosis - inhaleerders, die rookstatus van pasiënte in die verslae opgeteken het, die inhaleringstegniek aan al hul pasiënte gedemonstreer het, die vlak van beheer geassesseer het, en saamgestem dat geïnhaleerde kortikosteroïede die staatmaker van behandeling is in pasiënte met chroniese, aanhoudende asma. Slegs ‘n klein minderheid (hoofsaaklik by die gemeenskap – gesondheidsentrums waar aksienavorsing geskied) het egter begin om pasiënte van asma – selfbestuurplanne te voorsien. In die beantwoording van die sentrale vraag: “Hoe kan die proses van implementering van kliniese navorsingsbewyse, deur die voorbeeld van die nasionale bewysgebaseerde riglyne oor asma, verbeter word in die primêre gesondheidsorgsektor in die Metropooldistrik - gesondheidstelsel van die Kaapstad – metropool?”, kom hierdie tesis tot die gevolgtrekking dat die proses van riglyn – implementering in die primêre gesondheidsorg verbeter kan word deur ‘n in – diepte begrip en sistematiese benadering tot die hele proses. ‘n Konseptuele raamwerk word voorsien as ‘n model wat poog om te lei en sin te maak van hierdie proses van riglyn – implementering. ‘n Stapsgewyse benadering word aangebied en verskaf ‘n opsomming van die hoof – navorsingbevindinge. Die model toon dat die aanvanklike proses van bewyse – skepping nie slegs navorsingbewyse van hoë kwaliteit moet oorweeg nie, maar navorsingbewyse moet inkorporeer wat relevant is tot die bepaalde konteks van sorg. Boonop toon die model dat riglyn – ontwikkeling inklusief behoort te wees, en behels dit ‘n wyer spektrum van rolspelers sowel as pasiënte; dat riglyn – kontekstualisering, verspreiding en implementering versigtig beplan behoort te word. Spesiale oorweging moet gegee word aan plaaslike besluitneming oor die aanneming of prioritisering van spesifieke aanbevelings as deel van volgehoue kwaliteitverbeteringsiklusse, en die omskakeling van gepubliseerde riglyne na praktiese hulpmiddels vir praktisyns om te gebruik in die konsultasiefase, alvorens verspreiding daarvan plaasvind. Implementering behoort te verwag dat lede van die primêre gesondheidsorg sal verskil in hul gereedheid om te verander, en dat strategieë doelbewus die beginsels van gedragsverandering sal insluit en ‘n gevoel kweek van eienaarskap, keuse en beheer oor plaaslike aanneming van die riglyne. Akademiese sentrums, soos universiteite en professionele liggame, het ‘n rol om te speel in die identifisering, gehalteversekering en sintetisering van die bewyse, en om insette te lewer in die riglyn - ontwikkeling. Hulle kan ook behulpsaam wees deur praktiese hulpmiddels te innoveer en te evalueer as deel van die kontekstualiseringfase, en om deurlopende opvoeding te verskaf gedurende implementering as deel van hul sosiale verantwoordelikheid. Die gesondheidsorg – organisasies moet onnodige vertragings in riglyn – implementering voorkom deur te verseker dat beleid, bronne en aanbevelings in lyn is gedurende die kontekstualiseringsfase; dat hindernisse wat teëgekom word, regdeur die hele proses hanteer word, en dat volgehoue monitering en evaluering van kwaliteitsorg plaasvind. Gevolgtrekking Hierdie navorsing het van verskillende metodes en innoverende deelnemende aksienavorsing gebruik gemaak om die gaping tussen bewyse en praktyk te sluit. ‘n Nuwe konseptuele model vir riglyn – implementering word aanbeveel vir gebruik om behulpsaam te wees met die implementering en kennis -translasie in primêre gesondheidsorg plaaslik, nasionaal en in soortgelyke lae - en middel - inkomstelande in Afrika.

published_or_final_version / Community Medicine / Master / Master of Philosophy

Exploratory case studies investigated the day care benefit from the multiple perspectives of the person with dementia, caregiver, and day care worker. The routines, daily processes, and factors promoting benefit were reported. The day care client was also queried to explore their ability to contribute useful information about their care environment. The adult day care is primarily a social occasion for its clients, who enjoy the benefits of companionship and interaction. Day cares were differentiated by the environmental features: worker:client ratio, size, suitability of the site for intended purpose, quality of client-worker relationships, and quality of the activities offered. The quality of each of these features is an important component in the day care environment. All components at their highest quality are not necessary for the environment to be beneficial. The most important factors contributing to day care quality were workers who (1) communicated safety to the client through a relaxed, uncritical environment, and (2) facilitated client stimulation through activity and personal interaction, satisfying the clients’ basic needs to be safe and occupied. This evaluation was comprised of: two sets of case studies. Each evaluation was concurrently conducted and consistently designed. Participant observation and survey were the primary methods of data collection. Informed consent was sought from day care clients with dementia, family caregivers, and day care workers.