The practice environment of nurses plays a very important role in the delivery of quality health care. However, there is limited knowledge on what positive practice environments entail with specific reference to the primary health context of the public health care sector of South Africa. Nurses in this context are the frontline health personnel and are affected not only by nursing shortages, but also high workloads as the public health care sector serves 83% of the South African population and the private health care sector only 17%. In this study the researcher decided to conduct a study to explore the practice environment of nurses in the primary health care context as no studies have previously been undertaken in this regard. The researcher used a case study design with quantitative and qualitative approaches and implemented descriptive, explanatory and contextual strategies. This design, together with the findings of objectives one, two and three, the World Health Organization Strengthening of Health Systems and Fourteen Forces of Magnetism Frameworks and inductive and deductive logic enabled the researcher to achieve the overarching aim, which is objective four, of this study. Descriptive statistics, confirmatory factor analysis and Cronbach’s alpha assisted the researcher in assessing the demographic profile (objective 1) and the status of the practice environment of community health centres in North West Province (objective 2). Thereafter, the researcher was also able to identify the community health centre with the most favourable practice environment in order to conduct semi-structured individual interviews (objective 3). The descriptive data of objective 1 revealed that community health centres in the North West Province are located on average 36 km from the nearest referral hospital to which an average of five patients per day are referred. The average number of patients consulted per month is 3 545 of which the nurse consults an average of 40 and the physician 15 patients per day. In the community health centres the average age of nurses is 40, with 10 years of nursing experience. There were more female than male nurses of which 65% of the registered nurses had a diploma in nursing and had only started their careers at 31 years of age. There is an average of eleven registered nurses, five auxiliary and one enrolled nurse in the community health centres of which only four of the registered nurses (36%) had a qualification in Clinical Health Assessment, Treatment and Care. The overall staff turnover rates were very low and the satisfaction levels were high. The factor analysis of objective 2 revealed that the Practice Environment Scale of the Nursing Work Index’s sub-scales staffing and resource adequacy and nurse participation in primary health care/community health centre affairs had means below 2.5, indicating that nurses were not in agreement with these sub-scales. However, nurse manager ability, leadership and support; collegial nurse-physician relationships and nursing foundations for quality of care had a mean above 2.5 indicating that the nurses were in agreement with these sub-scales. Lastly, the qualitative findings indicated that although the community health centres with the most favourable practice environment were affected by factors that decrease quality of care which included a lack of resources, limited infrastructure, limited support from pharmacy and staff shortages. These mentioned factors were not in the control of the community health centres. Although the community health centres were affected by the above-mentioned factors these community health centres excelled in support, leadership and governance, collegial nurse-physician relationships and factors influencing quality of care which were in the control of the community health centre. / Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2013.

The practice environment of nurses plays a very important role in the delivery of quality health care. However, there is limited knowledge on what positive practice environments entail with specific reference to the primary health context of the public health care sector of South Africa. Nurses in this context are the frontline health personnel and are affected not only by nursing shortages, but also high workloads as the public health care sector serves 83% of the South African population and the private health care sector only 17%. In this study the researcher decided to conduct a study to explore the practice environment of nurses in the primary health care context as no studies have previously been undertaken in this regard. The researcher used a case study design with quantitative and qualitative approaches and implemented descriptive, explanatory and contextual strategies. This design, together with the findings of objectives one, two and three, the World Health Organization Strengthening of Health Systems and Fourteen Forces of Magnetism Frameworks and inductive and deductive logic enabled the researcher to achieve the overarching aim, which is objective four, of this study. Descriptive statistics, confirmatory factor analysis and Cronbach’s alpha assisted the researcher in assessing the demographic profile (objective 1) and the status of the practice environment of community health centres in North West Province (objective 2). Thereafter, the researcher was also able to identify the community health centre with the most favourable practice environment in order to conduct semi-structured individual interviews (objective 3). The descriptive data of objective 1 revealed that community health centres in the North West Province are located on average 36 km from the nearest referral hospital to which an average of five patients per day are referred. The average number of patients consulted per month is 3 545 of which the nurse consults an average of 40 and the physician 15 patients per day. In the community health centres the average age of nurses is 40, with 10 years of nursing experience. There were more female than male nurses of which 65% of the registered nurses had a diploma in nursing and had only started their careers at 31 years of age. There is an average of eleven registered nurses, five auxiliary and one enrolled nurse in the community health centres of which only four of the registered nurses (36%) had a qualification in Clinical Health Assessment, Treatment and Care. The overall staff turnover rates were very low and the satisfaction levels were high. The factor analysis of objective 2 revealed that the Practice Environment Scale of the Nursing Work Index’s sub-scales staffing and resource adequacy and nurse participation in primary health care/community health centre affairs had means below 2.5, indicating that nurses were not in agreement with these sub-scales. However, nurse manager ability, leadership and support; collegial nurse-physician relationships and nursing foundations for quality of care had a mean above 2.5 indicating that the nurses were in agreement with these sub-scales. Lastly, the qualitative findings indicated that although the community health centres with the most favourable practice environment were affected by factors that decrease quality of care which included a lack of resources, limited infrastructure, limited support from pharmacy and staff shortages. These mentioned factors were not in the control of the community health centres. Although the community health centres were affected by the above-mentioned factors these community health centres excelled in support, leadership and governance, collegial nurse-physician relationships and factors influencing quality of care which were in the control of the community health centre. / Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2013.

The study comprises an investigation of the quality of the clinical teaching environment of undergraduate students in the accredited Primary health care ( PHC) facilities used by a provincial nursing college in Limpopo. The researcher, who is employed full time in one of the accredited PHC facilities to which undergraduate students are admitted for clinical practice, became aware of the tension between the undergraduate students and professional nurses working in the PHC facility during the performance of clinical practice. Undergraduate students accused the professional nurses of neither supervising them properly during the execution of their clinical practice, nor assessing them on the prescribed practical outcomes. On the other hand, the professional nurses working in the PHC facility complained that undergraduate students were placed at the PHC facilities in large numbers with no clinical accompanist accompanying them. The research objectives were to determine the quality of clinical practice in the PHC clinical learning environment as rated by undergraduate students allocated by a provincial nursing college located working in a PHC facility in a district of Limpopo Province, and to formulate recommendations for the professional nurses in PHC districtmanagement to incorporate supervision for undergraduate students in order to enhance clinical teaching for undergraduate students in Primary health care facilities. The researcher used a quantitative, descriptive, explorative and contextual design. An all-inclusive sampling method was used to select research participants. Participants were undergraduate students of a provincial nursing college in Limpopo. Informed consent was obtained. Ethical approval was obtained from the relevant authorities. Data was collected by using an internationally validated Clinical Learning Environment Supervision and Nurse Teacher Instrument (Saariskoki & Leino-Kilpi, 2008:259-267).. Data analysis was done by using descriptive statistics and revealed that the clinical practice environment was not conducive to enhancing practical skills development in the real practical PHC practice. Evaluation of study, limitations and recommendations for education, research, practice and policy were discussed. / MCur, North-West University, Potchefstroom Campus, 2014

This study focuses on self care among patients with hypertension visiting primary health care clinics in the Naledi sub-district in the North-West Province. Hypertension is one of the chronic diseases that shorten the life expectancy of many people globally and remains the most common and rapid growing cardiovascular disease, affecting 20 million people in sub-Saharan Africa. Hypertension is one of the quadruple burdens of disease associated with risky lifestyle behaviours like unhealthy diets with excessive energy intakes, physical inactivity and tobacco use. Although taking the mentioned common modif iable factors and the fact that hypertension is a manageable condition into consideration, the reality remains that the hypertension. A non-experimental, quantitative research was used to reach the aim of the study namely to identify and describe the self care abilities of patients diagnosed with hypertension, as well as explore and describe their knowledge and perceptions on hypertension. This was done by means of objectives to explore and describe self care abilities, knowledge and perceptions among patients diagnosed with hypertension; if there is an association between self care, knowledge and perception in relation to the level of education, age, income and time period and if there was association between self care and knowledge and perception of patients with hypertension visiting PHC clinics in Naledi sub-district in the North-W est Province. A literature review was first conducted for a clear understanding of self care and hypertension. Thereafter a structured questionnaire, consisting of demographical information, and questions on self care, knowledge and perception among patients with hypertension, was employed. Trained field workers assisted in data collec tion. A number of 142 questionnaires were completed by patients visiting PHC clinics. The demographic data was first analysed with results shown in the frequency table. The exploratory factor analyses were done for data reduction on self care, knowledge and perception among patients with hypertension. Descriptive statistics and Cohen effect sizes for factors on self care, knowledge and perception in relation to the level of education, age, income and other chronic illnesses of patients diagnosed with hypertension, correlational descriptive statistics between self care and knowledge and perception were done. The results revealed that patients with hypertension with low levels of education lack information with regard to hypertension. The higher the income of patients with hypertension, the better their self care abilities compared to those with low income. Patients who are English and Afrikaans speaking have more internal positive power and have better management abilities of hypertension than those who are Setswana speaking. Younger patients have more internal positive power, which declines with age. Those patients who are newly diagnosed with hypertension have more information on management abilities than those who have been diagnosed more than two years. The conclusion regarding the relationship of self care and knowledge and perception of hypertension is that the patients diagnosed with hypertension need knowledge on hypertension in order to adhere to self care abilities. The more knowledge patients have the better they will be able to adhere to self care activities. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Integrated Management of Childhood Illnesses (IMCI) is a strategy that was developed by the World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF) to reduce the mortality and morbidity rate of children younger than 5 years and to improve the quality of life of these children. The reduction of child mortality and morbidity is one of the Millennium Developmental Goals (MDGs) as sub-Saharan Africa has a high child mortality and morbidity prevalence. The IMCI strategy has three components namely case management, the health system and the household and community component. This strategy was implemented internationally, including South Africa, where it is implemented within Primary Health Care (PHC) facilities. The implementation of the IMCI strategy was introduced to the PHC environment of South Africa and aims to enhance the equity, accessibility, affordability and availability of health care to all South African citizens, with the focus in this study on the child younger than 5 years. The North West province started training the professional nurses and implemented IMCI in 1998. The Dr. Kenneth Kaunda district (one of the districts in North West Province) and with specific focus on the Matlosana sub-district identified challenges in the implementation of the IMCI strategy by professional nurses. Challenges such as a lack of trained staff, the short time frame available for consultation amidst an already overburdened clinic and the physical infrastructure of the PHC facilities are such examples. The main aim of this research was to explore and gain insight and understanding in the challenges professional nurses working in PHC facilities face regarding the implementation of the IMCI strategy. A qualitative research design was used to conduct this study on daily work-life experiences of the professional nurses. Individual, semi-structured interviews were used as the method of data collection. The main question asked was: “What are the challenges faced by professional nurses in PHC facilities regarding the implementation of the IMCI strategy?” Data saturation was reached after 18 professional nurses were interviewed (N=18). Digitally voice recorded interviews were transcribed and content analysis was conducted. The findings of this research suggest that the professional nurses in the PHC facilities indeed experienced challenges regarding IMCI implementation. The main themes that emerged were challenges regarding the organisation and service delivery; challenges specific to the implementation of the IMCI strategy and also challenges external to the clinic that impacted directly on the IMCI strategy implementation. The findings were discussed with literature integration. From the research results and conclusions, the researcher compiled recommendations for nursing education, nursing research, and community health practice. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

The study comprises an investigation of the quality of the clinical teaching environment of undergraduate students in the accredited Primary health care ( PHC) facilities used by a provincial nursing college in Limpopo. The researcher, who is employed full time in one of the accredited PHC facilities to which undergraduate students are admitted for clinical practice, became aware of the tension between the undergraduate students and professional nurses working in the PHC facility during the performance of clinical practice. Undergraduate students accused the professional nurses of neither supervising them properly during the execution of their clinical practice, nor assessing them on the prescribed practical outcomes. On the other hand, the professional nurses working in the PHC facility complained that undergraduate students were placed at the PHC facilities in large numbers with no clinical accompanist accompanying them. The research objectives were to determine the quality of clinical practice in the PHC clinical learning environment as rated by undergraduate students allocated by a provincial nursing college located working in a PHC facility in a district of Limpopo Province, and to formulate recommendations for the professional nurses in PHC districtmanagement to incorporate supervision for undergraduate students in order to enhance clinical teaching for undergraduate students in Primary health care facilities. The researcher used a quantitative, descriptive, explorative and contextual design. An all-inclusive sampling method was used to select research participants. Participants were undergraduate students of a provincial nursing college in Limpopo. Informed consent was obtained. Ethical approval was obtained from the relevant authorities. Data was collected by using an internationally validated Clinical Learning Environment Supervision and Nurse Teacher Instrument (Saariskoki & Leino-Kilpi, 2008:259-267).. Data analysis was done by using descriptive statistics and revealed that the clinical practice environment was not conducive to enhancing practical skills development in the real practical PHC practice. Evaluation of study, limitations and recommendations for education, research, practice and policy were discussed. / MCur, North-West University, Potchefstroom Campus, 2014

This study focuses on self care among patients with hypertension visiting primary health care clinics in the Naledi sub-district in the North-West Province. Hypertension is one of the chronic diseases that shorten the life expectancy of many people globally and remains the most common and rapid growing cardiovascular disease, affecting 20 million people in sub-Saharan Africa. Hypertension is one of the quadruple burdens of disease associated with risky lifestyle behaviours like unhealthy diets with excessive energy intakes, physical inactivity and tobacco use. Although taking the mentioned common modif iable factors and the fact that hypertension is a manageable condition into consideration, the reality remains that the hypertension. A non-experimental, quantitative research was used to reach the aim of the study namely to identify and describe the self care abilities of patients diagnosed with hypertension, as well as explore and describe their knowledge and perceptions on hypertension. This was done by means of objectives to explore and describe self care abilities, knowledge and perceptions among patients diagnosed with hypertension; if there is an association between self care, knowledge and perception in relation to the level of education, age, income and time period and if there was association between self care and knowledge and perception of patients with hypertension visiting PHC clinics in Naledi sub-district in the North-W est Province. A literature review was first conducted for a clear understanding of self care and hypertension. Thereafter a structured questionnaire, consisting of demographical information, and questions on self care, knowledge and perception among patients with hypertension, was employed. Trained field workers assisted in data collec tion. A number of 142 questionnaires were completed by patients visiting PHC clinics. The demographic data was first analysed with results shown in the frequency table. The exploratory factor analyses were done for data reduction on self care, knowledge and perception among patients with hypertension. Descriptive statistics and Cohen effect sizes for factors on self care, knowledge and perception in relation to the level of education, age, income and other chronic illnesses of patients diagnosed with hypertension, correlational descriptive statistics between self care and knowledge and perception were done. The results revealed that patients with hypertension with low levels of education lack information with regard to hypertension. The higher the income of patients with hypertension, the better their self care abilities compared to those with low income. Patients who are English and Afrikaans speaking have more internal positive power and have better management abilities of hypertension than those who are Setswana speaking. Younger patients have more internal positive power, which declines with age. Those patients who are newly diagnosed with hypertension have more information on management abilities than those who have been diagnosed more than two years. The conclusion regarding the relationship of self care and knowledge and perception of hypertension is that the patients diagnosed with hypertension need knowledge on hypertension in order to adhere to self care abilities. The more knowledge patients have the better they will be able to adhere to self care activities. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Integrated Management of Childhood Illnesses (IMCI) is a strategy that was developed by the World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF) to reduce the mortality and morbidity rate of children younger than 5 years and to improve the quality of life of these children. The reduction of child mortality and morbidity is one of the Millennium Developmental Goals (MDGs) as sub-Saharan Africa has a high child mortality and morbidity prevalence. The IMCI strategy has three components namely case management, the health system and the household and community component. This strategy was implemented internationally, including South Africa, where it is implemented within Primary Health Care (PHC) facilities. The implementation of the IMCI strategy was introduced to the PHC environment of South Africa and aims to enhance the equity, accessibility, affordability and availability of health care to all South African citizens, with the focus in this study on the child younger than 5 years. The North West province started training the professional nurses and implemented IMCI in 1998. The Dr. Kenneth Kaunda district (one of the districts in North West Province) and with specific focus on the Matlosana sub-district identified challenges in the implementation of the IMCI strategy by professional nurses. Challenges such as a lack of trained staff, the short time frame available for consultation amidst an already overburdened clinic and the physical infrastructure of the PHC facilities are such examples. The main aim of this research was to explore and gain insight and understanding in the challenges professional nurses working in PHC facilities face regarding the implementation of the IMCI strategy. A qualitative research design was used to conduct this study on daily work-life experiences of the professional nurses. Individual, semi-structured interviews were used as the method of data collection. The main question asked was: “What are the challenges faced by professional nurses in PHC facilities regarding the implementation of the IMCI strategy?” Data saturation was reached after 18 professional nurses were interviewed (N=18). Digitally voice recorded interviews were transcribed and content analysis was conducted. The findings of this research suggest that the professional nurses in the PHC facilities indeed experienced challenges regarding IMCI implementation. The main themes that emerged were challenges regarding the organisation and service delivery; challenges specific to the implementation of the IMCI strategy and also challenges external to the clinic that impacted directly on the IMCI strategy implementation. The findings were discussed with literature integration. From the research results and conclusions, the researcher compiled recommendations for nursing education, nursing research, and community health practice. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

In this study the focus is on Batho Pele (a Sotho translation for 'people first'), an initiative to get people that work in the public services to be service orientated and to strive for excellence towards continuous service delivery improvement (SA, 2004a:8). Batho Pele consist of a framework with two primary functions that apply to this study; service delivery to people as the customers (patients in this study) and the possibility to hold individual public servants (health care personnel in this study) accountable for poor service delivery. This, in fact, implies that poor performance lead to poor service delivery; thus, compliance with the Batho Pele principles plays a pivotal role to improve quality health care service delivery. The purpose of the study was to make recommendations to enhance the current compliance with the Batho Pele principles in a Primary Health Care (PHC) context that would positively improve quality care and patient satisfaction. A non–experimental, quantitative, descriptive study was undertaken within the philosophical framework of the Batho Pele principles as well as the Patients‘ Right Charter. All participants completed a structured questionnaire to determine the level of compliance with the Batho Pele principles as experienced by the patients and viewed by the health care personnel in a PHC context. The data collected, was analysed using descriptive statistics. Four PHC clinics were involved, situated at Umzinyathi District Health in the Kwazulu Natal (KZN) Province of South Africa. The study included two patient–population samples, based on convenience; the participants that visited the clinics (n=132) and the participants visited by the researcher at home (n=101). Fifty– six (n=56) health care personnel who voluntary agreed to participate in the study were an all–inclusive sample. The findings revealed that the patients in the study felt more secure to answer the questions on their experiences regarding compliances with the Batho Pele principles at home and this could be an important consideration when conducting patient satisfaction surveys. It was also clear that patients were more dissatisfied than health care personnel in most questions asked regarding their experience on the compliance with the Batho Pele principles in a PHC context. Recommendations were made in the light of what was contained in the study that can serve as a starting point to address identified shortcomings in nursing practice, nursing education and nursing research. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2011.

In this study the focus is on Batho Pele (a Sotho translation for 'people first'), an initiative to get people that work in the public services to be service orientated and to strive for excellence towards continuous service delivery improvement (SA, 2004a:8). Batho Pele consist of a framework with two primary functions that apply to this study; service delivery to people as the customers (patients in this study) and the possibility to hold individual public servants (health care personnel in this study) accountable for poor service delivery. This, in fact, implies that poor performance lead to poor service delivery; thus, compliance with the Batho Pele principles plays a pivotal role to improve quality health care service delivery. The purpose of the study was to make recommendations to enhance the current compliance with the Batho Pele principles in a Primary Health Care (PHC) context that would positively improve quality care and patient satisfaction. A non–experimental, quantitative, descriptive study was undertaken within the philosophical framework of the Batho Pele principles as well as the Patients‘ Right Charter. All participants completed a structured questionnaire to determine the level of compliance with the Batho Pele principles as experienced by the patients and viewed by the health care personnel in a PHC context. The data collected, was analysed using descriptive statistics. Four PHC clinics were involved, situated at Umzinyathi District Health in the Kwazulu Natal (KZN) Province of South Africa. The study included two patient–population samples, based on convenience; the participants that visited the clinics (n=132) and the participants visited by the researcher at home (n=101). Fifty– six (n=56) health care personnel who voluntary agreed to participate in the study were an all–inclusive sample. The findings revealed that the patients in the study felt more secure to answer the questions on their experiences regarding compliances with the Batho Pele principles at home and this could be an important consideration when conducting patient satisfaction surveys. It was also clear that patients were more dissatisfied than health care personnel in most questions asked regarding their experience on the compliance with the Batho Pele principles in a PHC context. Recommendations were made in the light of what was contained in the study that can serve as a starting point to address identified shortcomings in nursing practice, nursing education and nursing research. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2011.