The purpose of this study was to explore and describe the factors that motivate the Primary Health Care Nurses to render quality care in the Ekurhuleni Metropolitan Municipality Health Care Facilities (in the Northern Region). The Ekurhuleni Metropolitan Municipality is located in Gauteng, South Africa. To achieve this, a quantitative, descriptive research study was undertaken. A purposive and voluntary sample of (n=54) Primary Health Care Nurses with two or more years’ experience of working in the Ekurhuleni Metropolitan Municipality, in the Northern Region, participated in the study. Data was collected using structured questionnaires. Findings from the study indicated those factors that enhance the motivation of the Primary Health Care Nurses and those factors which may demotivate them. The findings further revealed the need for greater motivation for the Primary Health Care Nurses. Based on the study results, guidelines and recommendations were formulated according to the manner in which these nurses’ motivation may be implemented and improved / Health Studies / M. A. (Health Studies)

Thesis (M.A. (Clinical Psychology)) -- University of Limpopo, 2020 / The integration of mental health care (MHC) into primary health care (PHC) has been identified as a practical intervention to: increase accessibility to mental health care; reduce stigma and discrimination against people living with mental illnesses; improve the management of chronic mental illness; and, to reduce the burden of comorbidity of mental illnesses with other chronic illnesses. In the South African context, integrating MHC into PHC also seeks to respond to numerous legislative reforms, with the aim of providing comprehensive health care, particularly to previously disadvantaged populations. The aim of the present study was to explore the perceptions of facility managers in the Tshwane District (Gauteng Province) towards the integration of mental health into PHC. Fifteen participants from the Tshwane district facilities participated in the study. The participants were selected through a non-probability purposive sampling method. Data was collected through in-depth interviews using a semi-structured questionnaire, and analysed using the thematic coding approach. Significant findings suggested that the major hindrances to the realisation of the policy objectives may be due to: the lack of rehabilitation and psychotherapeutic services; insufficient skill and knowledge of mental health on the part of staff; insufficient or unsuitable practice space in the facilities; and, poor cooperation between South African Police Services, Emergency Medical Services and Primary Health Care. Inter-facility communication, district implementation support and policy knowledge has notably increased over the years and were deemed to be amongst the biggest enablers.

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The independence of the health and social care agencies makes the coordinated delivery of inter-related and inter-dependent services very difficult. Collaboration in health and social care has been a goal of policy makers for many decades, but it has not been achieved to the degree or to the extent of the aspiration. This thesis examines collaboration in the context of the NHS and Community Care Act 1990, which marked a new stage in the development of community care policy and in collaborative working between health and social services. The thesis takes the form of a case study set in Sunderland during 1990-1994, from the passing of the Act to the first anniversary of the implementation of its community care elements. It considers firstly, collaboration at a strategic planning level between Sunderland Health Authority and the Local Authority Social Services Department in the development and implementation of community care policy; secondly, the evaluation of a collaborative project at an operational level, in the attachment of a social worker to a general medical practice; and thirdly, the evaluation of a project which tried to strengthen collaborative working within the health service, among district nurses, health visitors and general practitioners. The thesis sets these three pieces of work in a number of contexts: the political setting of the NHS and Community Care Act and the changes it introduced; the literature of collaboration; and a description of Sunderland and its need for health and social care. The case study showed how difficult it is for organisations to work together. Relationships between individuals tended to be more collaborative than relationships between corporate bodies, but it is important to see the relationship between those individuals in the context of relationships between organisations. The study also found that for the success of joint projects to be sustainable and generalisable, collaboration needs to be present at all levels of the organisations. The thesis also showed that there is as much need for collaboration within the health service as between the health and social services. The thesis used as a measure a framework of factors which promote collaboration, and found that many elements were lacking in Sunderland. However, in the real world it is necessary to settle for a notion of "pragmatic collaboration" in which joint working is possible even when full collaboration is absent.

Objective: To explore the role of interprofessional collaboration in the delivery of team-based tobacco dependence treatments within primary care. Methods: A narrative review of the literature was completed to examine FHT team functioning in Ontario, followed by a single, multi-site qualitative exploratory case study. Results: Interprofessional collaboration contributed to changes in tobacco dependence treatment through the initiation of system-wide change, cultivation of collective action, and supporting enhanced quality of smoking cessation care. Conclusion: Interprofessional collaboration can enhance the comprehensive delivery of evidence-based treatments for individuals trying to quit smoking. Supportive public policy, education for patients and providers, and evaluation research is needed to advance FHT functioning.

This thesis is based on an eighteen-month period of fieldwork with a group of general practitioners in the North East of England. Changing patterns in the practice of primary health care are examined alongside a detailed discussion of the role of the practice nurse in order to set general practice in its cultural and historical context. The thesis takes issue with the positioning of primary health care practitioners squarely within Kleinman's 'professional' sector. Within this context, three major themes relating to the primary health care setting are identified as being of major relevance to the enquiry 1. the use of narratives by patients and practitioners, both clinical and therapeutic 2. The role of the general practitioner and practice nurse in mediation between the patient and the secondary health care sector and the role of the practice nurse in mediation between the general practitioner and the patient3. the similarities in practice between healers in primary health care settings and ethnomedicine in traditional and developed societies These themes are illustrated by the use of fieldwork material and are discussed with reference to current anthropological theory concerning narrative, mediation, dialogics, the placebo effect and the practice of shamanism, as an example of ethnomedicine. On the basis of an examination of the similarities between primary care practitioners and ethnomedical practitioners, namely: quality of practitioner-patient relationship based on narrative understanding, shared cultural explanatory models, and shared mediatory role, this thesis concludes that a shared philosophy underlines the two, and that general practice is in itself a system of ethnomedicine practised within the Western context.

M.Cur. / Primary clinical nurses (PCNs), traditionally known as primary health care nurses (PHCNs) in South Africa, are expected to function as ‘frontline providers’ of clinical primary health care (PHC) services within the public PHC facilities (Department of Health (DoH), 1996: 8; DoH, 2001a: 23). This extended role of the registered nurse (as set out in section 38A of the Nursing Act, No. 50 of 1978) demands high quality clinical competencies. The purpose of the study is to describe guidelines to improve clinical competencies of learners within the context of a learning programme PHC: Clinical Nursing, Diagnosis, Treatment and Care (the programme) provided at a specific university in Gauteng where the study was conducted. The research objectives are to: o Explore and describe the perceptions of both clinical instructors and learners with regard to reasons for poor clinical competencies of learners of the programme. o Explore and describe the demographic profile of learners registered at the university in the 2003 academic year for the programme with regard to reasons for poor clinical competencies. o Explore and describe the correlation between scoring/rating of learners by different clinical evaluators during summative clinical evaluations of learners registered for the programme in the 2003 academic year at the university, in order to ensure inter-rater reliability with regard to reasons for poor clinical competencies. o Describe guidelines to improve clinical competencies of learners of the programme provided at a university in Gauteng, as informed by the research study findings. To achieve the purpose and objectives of the study, a mixed methodological design, qualitative and quantitative in nature, was used (Creswell, 1994: 184), utilising the sequential exploratory strategy (Creswell, 2003: 215). Other research strategies used are descriptive and contextual (Creswell, 1994: 145 & 175). Qualitative data were collected from purposively selected participants in separate focus group interviews of clinical instructors and learners. Analysis was done following Tesch’s method (1990). Trustworthiness was ensured using Lincoln and Guba’s method (1985). Ethical considerations were maintained throughout the study and consent was obtained from the participants. Quantitative data were collected using a summative clinical evaluation instrument (checklist) administered by clinical evaluators and a self-administered questionnaire for collecting a learner profile from a purposively selected sample of learners and clinical instructors, respectively. Statistics were analysed using a reliable computer program SPSS. Validity and reliability were ensured throughout the study. Data of correlated marks/scores revealed that there was no ecologically significant difference between the marking/scoring of learners by clinical evaluators during summative clinical evaluations of learners. Qualitative data yielded two main themes from the focus group interviews as challenges that participants perceived as reasons for poor clinical competencies of learners of the programme, viz: o Challenges within the PHC clinical practice field; o Challenges within the learning programme (university). Major categories and subcategories also emerged from the two themes. Interpretation of both quantitative and qualitative results was integrated and reported as similar findings from which the guidelines to improve clinical competencies of learners of the programme PHC: Clinical Nursing, Diagnosis, Treatment and Care were formulated. The guidelines focused on both the learning programme and the PHC clinical practice field.