Globally tobacco use and exposure to tobacco smoke represent some of the greatest risk factors for mortality. Best practice guidelines and standards of practice support nurses' provision of smoking cessation interventions. Nurses employed in primary health care settings interact with large numbers of people who smoke, and have the potential to significantly reduce tobacco use in the population. Evidence shows that nurses do not consistently implement smoking cessation interventions. The purpose of this cross-sectional study was to describe nurses' perceptions of factors that influence their intentions related to providing smoking cessation interventions in primary health care settings. A conceptual framework derived from the Theory of Planned Behavior and relevant empirical literature guided the study. A questionnaire measuring the concepts of interest was mailed to a random sample of Registered Nurses and Nurse Practitioners in Ontario. Responses of 237 eligible participants were available for analysis. Multiple regression analyses were used to examine the hypothesized relationships between nurses' attitudes, subjective norms and perceived behavioural control, and their intention to implement smoking cessation interventions, and the association between intention and practice related to smoking cessation. The Theory of Planned Behavior concepts explained up to 48.5% of variance in behavioural intention. Perceived behavioural control was most strongly associated with intention to provide smoking cessation interventions. Behavioural intention was correlated with smoking cessation practice. Analysis of responses to open-ended questions identified factors that facilitated (wish to improve patients' health, organizational support, access to resources, a perception of patient readiness to quit, and training in smoking cessation) and hindered (lack of time, lack of patient readiness, lack of support and resources, and lack of knowledge) nurses' provision of smoking cessation interventions. Overall, the study results suggest that nursing intention to engage in smoking cessation practices in primary health care settings was associated with organizational factors. Further research is required to explore how primary health care organizations can support nurses so that they fully realize their role in reducing the impact of tobacco use on the health of the people in Ontario.

<p>The study aims to assess the readiness of professional nurses in Khayelitsha health sub district to render mental health care services as stipulated in the Healthcare 2010 Plans for the western Cape. The Main objectives are to assess the readiness of professional nurses in the Khayelitsha health sub district to render mental health care services after de institutionalisation of mentally ill persons in terms of skills and resources, as well as to explore feelings and perceptions of professional nurses regarding the Healthcare 2010 plans for the Western Cape with refernce to mental health.</p>

Despite the effectiveness of brief lifestyle interventions delivered in primary health care (PHC), implementation in routine practice remains suboptimal. Previous research suggests that there are many barriers to PHC clinicians addressing lifestyle risk factors, however few studies have identified the importance of various factors and how they shape practices. This thesis aimed to develop and describe a theoretical model to explain the lifestyle risk factor management practices of PHC clinicians and to identify critical leverage points for intervention. The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in NSW, Australia, involving 48 PHC providers working outside of general practice. Grounded theory principles were used to inductively develop a model, involving three main stages of analysis: 1) an initial model was developed based on quantitative analysis of clinician survey and audit data, and qualitative analysis of a purposeful sample of participant interviews (n=18) and journal notes; 2) the model was then refined through additional qualitative analysis of participant interviews (n=30) and journal notes; and 3) the usefulness of the model was examined through a mixed methods and case study analysis. The model suggests that implementation of lifestyle risk factor management reflects clinicians??? beliefs about commitment and capacity. Commitment represents the priority placed on risk factor management and reflects beliefs about role congruence, client receptiveness and the likely impact of intervening. Capacity beliefs reflect clinician views about self efficacy, role support and the fit between risk factor management and ways of working. The model suggests that clinicians formulate different intervention expectations based on these beliefs and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians??? appraisal of the overall benefits and costs of addressing lifestyle issues acts to positively reinforce or to diminish their commitment to implementing these practices. The model extends previous research by outlining a process by which clinicians??? perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices.

Thesis (MCur(Advanced Community Nursing)--Faculty of Health Sciences)-University of Pretoria, 2008. / Summary in English. Includes bibliographical references. Mode of access: World Wide Web.

Thesis (MCur.(Advanced Community Nursing)--Faculty of Health Sciences)-University of Pretoria, 2008. / Summary in English. Includes bibliographical references.

Thesis (Ph.D.) - University of St Andrews, April 2008.

Thesis (Ph.D.) - University of St Andrews, November 2008.

Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2010. / Full text also available online. Scroll down for electronic link.

Thesis (MFamMed)--Stellenbosch University, 2015. / Introduction Since 1994 the South African health care system has been undergoing considerable transformation as new health challenges emerges locally and globally. Limpopo and Mopani primary healthcare in particular is not an exception. The information on the reasons for encounter and diagnosis in primary care will create an opportunity to focus on proper planning for the delivery of quality health care that is relevant to the people, socially justifiable and cost effective. The study aimed to determine the range and prevalence of reasons for encounter and diagnoses found among patients attending primary care facilities in Limpopo. Methods Design: A prospective cross-sectional survey Setting: Primary health care centers, clinics and mobile clinics in Mopani district of Limpopo Province, South Africa. Selection of facilities, primary care providers and patients: Patient encounters were obtained from twenty-nine randomnly selected primary care facilities by trained primary care practitioners with data collection sheets. Data collection: The data collection days were spread across all days of the week and across the whole period from July 2009 to March 2010. Analysis: The international classification of primary care (ICPC-2) was used to code and analyse the data. Results A total of 6,666 patient encounters were recorded. Females 4598 (69%), accounted for more than two thirds of all contacts and children aged 0-4 years were the largest age group. Overall the commonest reasons for encounter were cough (13.0%), repeat family planning (8.4%) and headaches (5.7%). The commonest diagnoses were cough/upper respiratory tract infection (16.9%), hypertension (5.7%) and HIV/AIDS (2.6%). The top 20 reasons for encounter (RFE) and diagnoses are presented for all patients, men and women as well as children < 5 years. Conclusion Primary care nurse practitioners, clinical associates and general medical practitioners need to be competent to assess and manage the common RFE and diagnoses in order to deliver comprehensive health care at the primary level. / AFRIKAANSE OPSOMMING: Nie beskikbaar

Philosophiae Doctor - PhD / The unacceptable high rate of maternal and neonatal deaths in Nigeria has been persistently unabated. Therefore, the present quality of maternal care evident by the magnitude of severe maternal/neonatal morbidity and mortality in this region makes designing of a model that will serve as a framework for provision of quality maternity care to women and their new-born a worthwhile study. The global report of deaths related to pregnancy and childbirth documented 600,000 maternal deaths annually. Developing countries, including Nigeria, have the highest burden of maternal and neonatal deaths resulting from complications related to pregnancy and childbirth. There has been no improvement in Nigeria as far as maternal and neonatal deaths are concerned. In Nigeria, the maternal mortality ratio in 2008 was recorded as 545/100,000 live births, and 576/100,000 live births in 2013. Women and children from low socioeconomic background are the vulnerable groups. The peculiarity of their vulnerability predisposes them to finding quicker and cheaper avenues to seek health care. The Primary Health Care (PHC) maternity facilities are to serve this large population of women and their babies at grassroots level. Few studies have been done to measure quality of antenatal and delivery care separately at higher level of care with resultant subjective findings and conclusions. Each of these aspects of maternity is a part of the whole and not the whole. Currently, there is gross dearth of literature regarding quality of maternity services at the disposal of the vulnerable women, who are likely to utilize the PHC facilities. The measurement of the quality of the existing maternity services at primary level is imperative for designing a more effective model capable of improving quality of services at this level. This study sought to develop a quality service improvement model for primary level-based maternity following rigorous analysis of the quality of its structure, the process and the outcome as proposed by Donabedian. The specific objectives of the study were to describe the status of infrastructures, equipment, instruments, medications; investigate the degree to which the services rendered are timely, appropriate, satisfactory and consistent with current professional knowledge; investigate the degree to which services rendered in the facilities are satisfactory to the women and uphold their basic reproductive rights; measure clients’ return rates for maternity-related services in the facilities; and to develop a validated model to guide provision of quality maternity care in PHC facilities. Using a theory-generating approach, the study was conducted in two distinct phases. The first phase focused on analysis of the existing maternity services at PHC level, while the second phase concentrate on model development. The first phase, which is an embedded mixed-methods approach, utilized validated clients’ questionnaire, health workers’ questionnaire, observation checklist, focused group discussions, and in-depth interviews for data collection. A multistage sampling method was used for sample size selection. Five local government areas (LGAs) in Ibadan were selected purposively. Similarly, all the facilities that offer maternity care in each LGA were purposively selected. Postnatal women, health workers in each facility, medical officers of health (MOHs) and heads of facilities were the participants in the study. A total of 755 postnatal women who participated in the surveys were recruited from the sample frames (attendance registers) using systematic random sampling. A validated structured questionnaire was utilized to elicit information on their experiences with their chosen places of antenatal and childbirth care from pregnancy to puerperium. Similarly, the 130 health workers who participated in the surveys were recruited from the sample frames (duty rosters) using systematic random sampling. A validated structured questionnaire was utilized to elicit information on their competences, attitudes and the midwifery practice in their respective facilities. In addition to the quantitative surveys, focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted for some postnatal women and four MOHs/heads of group of facilities. The participants for the FGDs and the IDIs were conveniently and purposively selected, respectively. FGD guide and IDI guide were used to guide the interviewers. The study was approved by the Faculty Board Research and Ethics Committees, the Senate Research Committee of University of the Western Cape and Oyo State Research Ethical Review Committee in Nigeria. Informed consent was obtained from each study participant. Autonomy, anonymity, and confidentiality of information provided by the participants were ensured. Nobody was coerced to participate in the study. The data collected with the aid of observation checklist and questionnaire from the selected PHC, health workers and client (postnatal women) were analyzed using descriptive statistics (frequency/percentage distributions); while association between variables of interest and difference in mean values were done using chi-square and t-test statistics, respectively. The second phase of the study focused on model development, and was done in line with a theory- generating research process in the literature supported by McKenna & Slevin, (2008) and Chinn& Kramer (2014). The developed model was tested for its appropriateness, adequacy, accuracy and whether it represents reality, for it to be assumed effective in achieving the goal if applied in midwifery practice at primary level.Client-participants were between 15 and 44 years; their mean age ± standard deviation was 28 ±5.3. The health workers were between 20 and 58 years; mean age ± standard deviation being 41 ±10. Out of the 730 client-participants, 92.1 % were married. None of the women had access to preconception counselling in any health facility. A total of 92.6 % of the women received prenatal care under the existing traditional model of antenatal care (ANC), out of which 22.6 %registered for ANC in two different facilities for various reasons. Although there was gross shortage of manpower in all the facilities, the percentage of nurses/midwives was fewer than that of the community health extension workers (CHEWs) and health assistants (HAs), while only one medical doctor was employed to cover all the different types of facilities in each local government area . There was a questionable staff level of competence reported in the study. Evidence of training in life-saving skill (LSS), post-abortion care (PAC) and safe motherhood was rare among the health worker participants. Among health workers who had witnessed vaginal laceration and those who claimed to have performed episiotomy on women, 30.2% and 32.6 % would depend on other health workers for repair of the vaginal traumas, respectively. Partograph was not in use for management of progress of labour by any health worker in any of the facilities. Both quantitative and qualitative data analysis showed evidences of abuse of women’s rights to timely, quality and respectful maternity care and risky practices by the health workers. The conditions of the buildings used for PHC centres and the beds were not satisfactory. There was gross inadequacy of essential and basic items needed to provide standard and quality care across all the facilities, while significant proportion of the available equipment/instruments were obsolete, dirty, rusty and faulty. The infection prevention and control practices were sub- standard. Inadequate funding by respective local government authorities was implicated for the poor conditions of infrastructures, equipment/instruments, staff recruitments and consequent shortage of manpower. Low level of patients’ satisfaction, evidenced by verbal expression, percentage difference between antenatal registration and childbirth record, immunization clinic visits and childbirth record in each facility, was reported. Therefore, fixing the deplorable and/or non-commodious building infrastructures to meet the required standard, provision of facilities and items needed for quality care and infection prevention, recruitment of skilled qualified health professionals, establishing a new Primary Health Board in the state to provide efficient funding and effective monitoring systems were recommended, based on the findings of the study. Lastly, the implementation of the newly developed model is strongly recommended in order to improve women’s and new-born’s health. / Centre for Teaching and Learning Scholarship, School of Nursing, University of the Western Cape