In South Africa professional nurses undergo training which gives them different levels of skills. It is difficult for professional nurses to render comprehensive primary health care services without specific knowledge and skills. Some lack skills in preventative and promotive health care delivery; others are not trained to take care of a pregnant woman or a baby after delivery, or of a mental health patient; while yet others are only curatively oriented. It is possible that they do not recognise their own limitations and are not aware of the skills needed to render comprehensive primary health care services. Their perceptions could influence their practice and severely affect the quality of health services. The aim of this research was to explore and describe the perceptions that professional nurses working in primary health care clinics have of the skills required to render quality comprehensive primary health care services, and the perceptions they have of their own level of skills to render quality comprehensive primary health care services, as well as to formulate guidelines for the facilitation of trained professional nurses to truly render quality comprehensive primary health care services. A qualitative design was followed. Permission was obtained from the Potchefstroom District Health Manager to conduct this research. Purposive voluntary sampling was used to identify the three samples who complied with the set selection criteria. Data collection was done by means of semi-structured interviews. Experts in qualitative research evaluated the semi-structured interview schedule. A trial run was done and the interview schedule was then finalised to conduct the interviews. The interviews were recorded on audiotape and then transcribed. The interviewer made field notes to serve as an analytical basis for the collected data. Data was collected until data saturation was achieved. Data analysis was done by means of open coding. A co-coder was appointed and two consensus meetings took place. The findings indicated that professional nurses perceive the skills required to render quality comprehensive primary health care services as the ability to assess, diagnose and manage patients, as well as specific skills acquired during the various nurse training programmes. The more comprehensively trained, the more competent they feel. The less comprehensively trained, the more negative they experience their work. They view their own level of skills as ranging from adequate to lacking and inadequate, depending on their training. They feel that it is impo~ant to develop skills ranging from computer skills to the full range of skills. The conclusions drawn are that the professional nurses with different training and levels of skills are well aware of the skills required to re.nder comprehensive primary health care services. They maintain that trained professional nurses need qualifications in General Nursing, Midwifery, Community Nursing, Psychiatric Nursing and Clinical Nursing Science, and Health Assessment, Treatment and Care. The professional nurses with all five qualifications feel confident and enjoy their work, whereas those who are not fully trained lack certain skills and experience negative feelings working in the primary health care clinics. Recommendations are made for nursing education, nursing research and nursing practice with specific reference to the formulation of guidelines for the facilitation of trained professional nurses to truly render comprehensive primary health care services, with a focus on quality control, orientation, mentoring, planning of training, support systems, and consultancy. / Thesis (M.Cur.)--Potchefstroom University for Christian Higher Education, 2003

Worldwide, patients who visit health-care facilities generally have to wait very long to be attended by physicians and professional nurses. In South Africa, the Cape Triage Score system was implemented with great success in Emergency departments in the Cape Metropole. In primary health-care clinics the concern is that patients have to wait too long for service delivery, even if they are very ill and need hospitalisation. In this research study the role of triage in reducing waiting times in primary health-care clinics was examined. The Cape Triage Score system that was used in Emergency departments in the private sector and also in public hospitals was adapted for a pilot intervention study. This was done to determine if the utilisation of this system can reduce the waiting times of patients visiting primary health-care clinics. The researcher utilised a quantitative design with an intervention, after measuring the baseline waiting time. The strategies applied included an exploratory, descriptive and contextual strategy. The study was carried out in three steps according to the objectives set for the study. Firstly, the baseline assessment of the current waiting times in two PHC clinics in a sub-district of the North West Province was done. A waiting-time survey checklist was used to determine the baseline waiting time of patients visiting primary health-care clinics. These waiting-time survey checklists consisted of a few components that assessed different aspects of waiting time. The second objective was to explore and describe literature in order to understand primary health-care waiting times, triage and related constructs. The third objective was to pilot an adapted Cape Triage Score system to determine if the intervention contributed to reducing waiting times for patients visiting primary health-care clinics. Data was analysed according to Cohen’s effect sizes. The comparison between the baseline waiting times and pilot intervention waiting-time assessment was done according to Cohen’s effect sizes. The analysis of the data indicated a practical significance for the component where the pilot Cape Triage Score system was applied, as patients were referred to the physician and professional nurse according to the severity of their condition. The outcome of the study indicated no reduction in the overall waiting time of patients visiting primary health-care clinics due to the different components of the waiting-time survey checklist. Finally, the research was evaluated, limitations were identified and recommendations were stipulated for nursing practice, education, research and policy. / MCur, North-West University, Potchefstroom Campus, 2014

In South Africa professional nurses undergo training which gives them different levels of skills. It is difficult for professional nurses to render comprehensive primary health care services without specific knowledge and skills. Some lack skills in preventative and promotive health care delivery; others are not trained to take care of a pregnant woman or a baby after delivery, or of a mental health patient; while yet others are only curatively oriented. It is possible that they do not recognise their own limitations and are not aware of the skills needed to render comprehensive primary health care services. Their perceptions could influence their practice and severely affect the quality of health services. The aim of this research was to explore and describe the perceptions that professional nurses working in primary health care clinics have of the skills required to render quality comprehensive primary health care services, and the perceptions they have of their own level of skills to render quality comprehensive primary health care services, as well as to formulate guidelines for the facilitation of trained professional nurses to truly render quality comprehensive primary health care services. A qualitative design was followed. Permission was obtained from the Potchefstroom District Health Manager to conduct this research. Purposive voluntary sampling was used to identify the three samples who complied with the set selection criteria. Data collection was done by means of semi-structured interviews. Experts in qualitative research evaluated the semi-structured interview schedule. A trial run was done and the interview schedule was then finalised to conduct the interviews. The interviews were recorded on audiotape and then transcribed. The interviewer made field notes to serve as an analytical basis for the collected data. Data was collected until data saturation was achieved. Data analysis was done by means of open coding. A co-coder was appointed and two consensus meetings took place. The findings indicated that professional nurses perceive the skills required to render quality comprehensive primary health care services as the ability to assess, diagnose and manage patients, as well as specific skills acquired during the various nurse training programmes. The more comprehensively trained, the more competent they feel. The less comprehensively trained, the more negative they experience their work. They view their own level of skills as ranging from adequate to lacking and inadequate, depending on their training. They feel that it is impo~ant to develop skills ranging from computer skills to the full range of skills. The conclusions drawn are that the professional nurses with different training and levels of skills are well aware of the skills required to re.nder comprehensive primary health care services. They maintain that trained professional nurses need qualifications in General Nursing, Midwifery, Community Nursing, Psychiatric Nursing and Clinical Nursing Science, and Health Assessment, Treatment and Care. The professional nurses with all five qualifications feel confident and enjoy their work, whereas those who are not fully trained lack certain skills and experience negative feelings working in the primary health care clinics. Recommendations are made for nursing education, nursing research and nursing practice with specific reference to the formulation of guidelines for the facilitation of trained professional nurses to truly render comprehensive primary health care services, with a focus on quality control, orientation, mentoring, planning of training, support systems, and consultancy. / Thesis (M.Cur.)--Potchefstroom University for Christian Higher Education, 2003

Worldwide, patients who visit health-care facilities generally have to wait very long to be attended by physicians and professional nurses. In South Africa, the Cape Triage Score system was implemented with great success in Emergency departments in the Cape Metropole. In primary health-care clinics the concern is that patients have to wait too long for service delivery, even if they are very ill and need hospitalisation. In this research study the role of triage in reducing waiting times in primary health-care clinics was examined. The Cape Triage Score system that was used in Emergency departments in the private sector and also in public hospitals was adapted for a pilot intervention study. This was done to determine if the utilisation of this system can reduce the waiting times of patients visiting primary health-care clinics. The researcher utilised a quantitative design with an intervention, after measuring the baseline waiting time. The strategies applied included an exploratory, descriptive and contextual strategy. The study was carried out in three steps according to the objectives set for the study. Firstly, the baseline assessment of the current waiting times in two PHC clinics in a sub-district of the North West Province was done. A waiting-time survey checklist was used to determine the baseline waiting time of patients visiting primary health-care clinics. These waiting-time survey checklists consisted of a few components that assessed different aspects of waiting time. The second objective was to explore and describe literature in order to understand primary health-care waiting times, triage and related constructs. The third objective was to pilot an adapted Cape Triage Score system to determine if the intervention contributed to reducing waiting times for patients visiting primary health-care clinics. Data was analysed according to Cohen’s effect sizes. The comparison between the baseline waiting times and pilot intervention waiting-time assessment was done according to Cohen’s effect sizes. The analysis of the data indicated a practical significance for the component where the pilot Cape Triage Score system was applied, as patients were referred to the physician and professional nurse according to the severity of their condition. The outcome of the study indicated no reduction in the overall waiting time of patients visiting primary health-care clinics due to the different components of the waiting-time survey checklist. Finally, the research was evaluated, limitations were identified and recommendations were stipulated for nursing practice, education, research and policy. / MCur, North-West University, Potchefstroom Campus, 2014

In a descriptive survey, the accessibility of primary healthcare services in Molemole was explored and factors impacting on accessibility were identified. The research sample consisted of 134 community members who visited one of five clinics (one a mobile clinic) in Molemole. Questionnaires, information lists, observations and field notes were used as research instruments. Ethical principles were adhered to, and validity and reliability maintained. Findings indicated that geographical, financial and cultural accessibility were satisfactory. Functional accessibility seemed problematic. The main reasons for dissatisfaction were attitudes, shortages of staff, unavailability of treatment, dysfunctional hours and fragmented services. Recommendations included optimal utilisation of staff and resources, improvements on infrastructure and support systems, community involvement in decision-making, as well as reassessing service point locations and policies on medications, supplies and equipment. / Health Studies / M. A. (Health Studies)

Text in Afrikaans / Summaries in Afrikaans and English / VIGS is 'n gesondheidsprobleem wat 'n impak uitoefen op alle gebiede in die samelewing. Voorkoming is die enigste vorm van bekamping. As gevolg hiervan, word VIGS-voorkoming binne die funksies van primere gesondheidsorg geplaas. Die persoon wat die funksies van primere gesondheidsorg uitoefen, is die gemeenskapsgesondheidswerker. Binne hierdie raamwerk is die terme primere gesondheidsorg, gemeenskapsgesondheidswerker en VIGS bespreek en die onderlinge interaksie is aangetoon. Die opleiding wat die gemeenskapsgesondheidswerker op VIGS-gebied ondergaan, is meegemaak. Die prioriteite wat op nasionale, provinsiale en plaaslike vlak bestaan is deur middel van onderhoude nagevors. Die effektiwiteit van die VIGS-voorkomingsboodskap soos oorgedra deur die gemeenskapsgesondheidswerker is tydens 'n inligtingsessie van hoerskoolleerlinge bepaal. Gevolgtrekkings en aanbevelings is in elk van bogenoemde gevalle gemaak. VIGS-voorkomingsinisiatiewe is nog in die kinderskoene in Suid-Afrika, maar het 'n belangrike rol te speel. / AIDS is a health problem that impacts on all societal spheres. Prevention is the only form of combat. Therefore, AIDS prevention falls within the functions of primary health care. The person performing these functions is the community health worker. Within this framework the terms primary health care, community health worker and AIDS were discussed and their interrelatedness illustrated. A session during which community health workers received training in aspects of AIDS was attended. Priorities existing at national, provincial and local levels were researched through interviews. The effectiveness of the community health worker in spreading the AIDS prevention message was determined during an information session for secondary school pupils. Conclusions and recommendations were made in each of these cases. AIDS prevention initiatives are still in its infancy in South Africa, but has an important role to play. / Health Studies / M.A. (Ontwikkelingsadministrasie)

Background: Although immunisation services are provided free at all public health facilities in South Africa, immunisation coverage remains variable and disease outbreaks still occur. The coverage rate in the Overberg district is recorded as 75.8%, below the national target of 90% (Western Cape Government Provincial Treasury 2013:2). The researcher wanted to understand what the barriers to accessing immunisation services were and how this might relate to other primary health care services. Methods: The researcher visited 22 households and interviewed nine mothers who had brought their children to Zwelihle Clinic to be immunised and nine community health workers servicing the Zwelihle community in the Overberg district, Western Cape Province. Findings: A key finding is that the data does not reflect the actual situation – children in the community either are immunised at other facilities or have left the catchment area, hence strong relationships between the facility and the community and an electronic patient tracking system become important. Findings impacting access to services include the attitude of administrative staff, waiting times and the impact of migratory communities. Recommendations are made to improve the quality of data, provide training to administrative staff, improve patient education, reduce waiting times and improve the relationship between the clinic and the community in order to better track patient migration / Health Studies / M.A. (Public Health)

Submitted in fulfilment of the requirements for the Degree in Master of Technology: Nursing, Durban University of Technology, 2012. / Background : Work Integrated Learning is an educational approach that aligns academic and workplace practices for the mutual benefit of students and workplaces. Work Integrated Learning like in any other nursing course is essential in primary health care as required by the South African Nursing Council. In the clinical setting, students develop clinical and diagnostic reasoning; they also learn how to make the appropriate clinical decisions which they need as qualified primary health care practitioners. This is achieved through instruction and guidance by lecturers, mentors and clinical staff. However it has been noted that the clinical learning environment confronts students with challenges that are absent from the classroom situation. So this study seeks to explore and describe the experiences of post basic nursing students in primary health care clinics so as to address the challenges that are faced within the clinical settings. Aim of the study The aim of the study was to explore and describe primary health care post basic nursing students’ experiences during clinical placements. Methodology : A descriptive exploratory qualitative approach was used to guide the study. In-depth interviews were conducted with ten primary health care post basic nursing students who were allocated for Work Integrated Learning at the clinics in District A and District B in 2011. The main research question for this study was asked: ‘What are the experiences of primary health care post basic nursing students regarding Work Integrated Learning?’ Results : The findings of this study revealed that Work Integrated Learning is vital for the development of clinical skills amongst primary health care post basic nursing students. However, shortage of staff, inadequate material/ non-human resources, lack of supervision in the clinical facilities, distant clinical facilities and insufficient practice in the clinical skills laboratory were identified as challenges that students experience during Work Integrated Learning placement.

Thesis (DPhil (Psychology))—University of Stellenbosch, 2010. / ENGLISH ABSTRACT: This dissertation examines how nurses in primary health care in South Africa make use of guidelines. Primary level health care is reliant primarily on nurses, who are under-resourced and often overwhelmed by the complex needs of their clients in the context of the TB and HIV/AIDS epidemic. Despite various continuing education strategies to promote current and evidence-based practice, there are many barriers to providing optimal care. Clinical practice guidelines using best evidence are an important tool for updating health professionals in current practice, particularly at primary care level, where busy practitioners often do not have time or sufficient access to the best evidence. Despite this, we know little of the practitioners’ experiences of guideline use. This study describes experiences of nurses in implementing clinical practice guidelines in the delivery of health care in selected primary level contexts in the Free State Province. The primary research question for this study was “What are the experiences of nurses in using guidelines in primary health care facilities?” A qualitative research approach, drawing on a psychoanalytic framework, was adopted. Three linked studies were conducted, utilising secondary data analysis of transcripts collected during the PALSA (Practical approach to Lung Health in South Africa) RCT study (sub-study 1), document description and review of guidelines used in primary care settings (sub-study 2), observation of nurses in practice and during patient consultations, and focus group discussions with nurses in primary health care facilities (sub-study 3). After the introduction of new format guidelines with onsite training and access to good support and updates, nurses reported feeling more confident, as the guidelines were explicit and gave them clear direction as to when a patient would need referral to the medical practitioner. When the guidelines were followed, and the patient responded positively to an intervention, this gave nurses a sense of credibility and validated their role as primary level health care providers. Guidelines available in the primary care clinics covered a wide variety of clinical conditions, were inconsistent, often outdated and even contradictory. A detailed comparison of two selected guidelines, the South African TB control guidelines and the PALSA PLUS guidelines, both in everyday use in the Free State province, shows that the preferences expressed by the nurses in sub-study 1 are evident in the layout, colour, and user-friendliness of the PALSA PLUS guideline. Nurses in the Free State province do use guidelines, but not consistently. Nurses make clinical judgments and decisions based on experience, alternative knowledges and intuitive responses, in consultation with colleagues and through the use of guidelines. Very few guidelines were used regularly, and each nurse had her preferences for a limited number of guidelines which she found useful. There is a clear need for integrated approaches to the information needs and support of nurses and nurse practitioners at primary care level. Guidelines play a role in promoting learning, changing professional practice and strengthening health care delivery by nurse practitioners at primary level. They can also be thought of as a strategy the health care system uses to defend against the possibility of its health professionals not meeting its expectations of providing quality care. Guidelines may contain anxiety and improve the quality of care, or compromise practice through the imposition of controls. The use of guidelines in primary care settings facilitates decision making, may contain practitioner anxiety and improve the quality of care, yet guidelines pose challenges to creative discernment of the patient’s symptoms in relation to his/her personal circumstances and may impact on the personalised holistic care approach which characterises the essence of nursing. Today’s primary care nurse and nurse practitioner needs to be a competent clinician, compassionate carer, and confident co-ordinator – the overlapping roles of caring, diagnosing and treating and managing. The challenge for the nurse in primary care is to combine her traditional caring and co-ordination role into a role which encompasses curing, caring and co-ordination, a new, yet critically important identity for the 21st century nurse. / AFRIKAANSE OPSOMMING: Die proefskrif ondersoek hoe verpleegsters in primêre gesondheidsorg in Suid-Afrika van riglyne gebruik maak. Primêre vlak gesondheidsorg steun hoofsaaklik op verpleegsters, alhoewel hulle verswelg word deur die komplekse behoeftes van hul kliënte in die konteks van die TB en HIV/AIDS epidemie. Ten spyte van verskeie volgehoue onderrigstrategieë om die huidige en bewese basiese te bevorder, is daar verskeie struikelblokke om optimale versorging te voorsien. Kliniese praktyk riglyne voorsien die beste bewyse en is 'n belangrike hulpmiddel om praktiserende professionele gesondheidswerkers, veral op die vlak van primêre gesondheidsorg, op hoogte van sake te hou. Besige programme en onvoldoende toegang tot hierdie riglyne weerhou dikwels die gesondheidswerkers van bestaande inligting. Dit is egter onbekend wat gesondheidswerkers se ondervinding en gebruik van riglyne is. Die studie beskryf versorgers se ervaring van die implementering van kliniese praktyk riglyne vir gesondheidsorg in primêre vlak kontekste in die Vrystaatprovinsie. 'n Kwalitatiewe navorsingsbenadering wat steun op 'n psigoanalitiese raamwerk, is gebruik. Drie verbandhoudende studies is gedoen wat sekondêre data analise transkripsies gebruik het wat verkry is gedurende die PALSA (Practical Approach to Lung Health in South Africa): RCT (Willekeurig Gekontroleerde Toets) studie (sub-studie 1), beskrywing van dokumentasie en oorsig van riglyne wat in primêre vlak ontwikkeling gebruik is (sub-studie 2), en observasie van verpleegsters in die praktyk en gedurende konsultasies met pasiënte, en fokusgroep besprekings met verpleegsters in primêre vlak gesondheidsorg fasiliteite (sub-studie 3). Na die bekendstelling van 'n nuwe formaat riglyne vir indiensopleiding en toegang tot goeie ondersteuning, het die verpleegsters meer selfversekerd gevoel omdat die riglyne duideliker was en aan hulle 'n beter aanduiding gegee het wanneer 'n pasiënt verwysing na 'n mediese praktisyn benodig het. Wanneer die riglyne gevolg is en die pasiënt positief op behandeling gereageer het, het dit aan hulle 'n gevoel van agting en deug vir hulle rol in primêre vlak gesondheidsorg gegee het. Beskikbare riglyne in primêre sorg klinieke dek 'n wye verskeidenheid kliniese kondisies, is onsamehangend, dikwels verouderd en selfs soms weersprekend. 'n Gedetailleerde vergelyking is tussen twee geselekteerde riglyne gedoen: die Suid-Afrikaanse TB kontrole riglyne en die PALSA PLUS riglyne. Beide word daagliks in die Vrystaatprovinsie gebruik. Die verpleegsters in sub-studie 1 het a.g.v. die uitleg, kleur en gebruikersvriendelikheid die PALSA PLUS riglyne verkies. Verpleegsters in die Vrystaat gebruik wel riglyne maar nie op 'n gereelde grondslag nie. Hulle maak eerder kliniese keuses en besluite gebaseer op ondervinding, alternatiewe kennis en intuïtiewe gevoel, in konsultasie met kollegas en na bestudering van die riglyne. Baie min riglyne is gereeld gebruik, en elke verpleegster het haar voorkeure vir 'n beperkte aantal riglyne wat sy bruikbaar vind. Daar is 'n duidelike behoefte aan 'n geïntegreerde benadering tot die informasiebehoeftes en ondersteuning aan verpleegsters en praktisyns op primêre sorg vlak. Riglyne speel 'n belangrike rol in die bevordering van onderrig, verandering van professionele praktyke en die versterking van gesondheidsorg wat deur verpleegsters in primêre vlak gesondheidsorg gelewer kan word. Dit kan ook gesien word as 'n strategie wat die gesondheidsorgsisteem kan gebruik om te verseker dat gesondheidswerkers kwaliteit diens lewer. Riglyne kan moontlik angstigheid beperk en verhoogde versorgingskwaliteit bring, of dit kan gesondheidsorg benadeel deur die afdwing van kontrolemaatreëls. Die gebruik van riglyne in primêre sorg fasiliteer besluitneming, en mag dalk angstigheid by die praktisyn beperk, wat dan die kwaliteit van versorging kan verhoog. Riglyne bied uitdagings aan die kreatiewe oordeelsvermoë om die pasiënt se simptome te sien binne die konteks van sy/haar omstandighede en mag 'n impak hê op persoonlike holistiese versorging wat die aard en kern van verpleging is. Die huidige primêre sorg verplegingspraktisyn moet 'n bekwame klinikus, ontfermende versorger en betroubare koördineerder wees – met oorvleuelende rolle van versorging, diagnosering en behandeling, en bestuur. Die uitdaging vir die verpleegster in primêre sorg is om die tradisionele versorging en koördinering te kombineer tot 'n omvattende rol van genesing, versorging en koördinasie; 'n nuwe, maar krities-belangrike identiteit vir die 21ste-eeuse versorger.

Thesis (PhD)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: The South African primary health care (PHC)system is in a period of transition. This, and the growing HIV epidemic, place tremendous strain on PHCworkers in public health services. Staff morale is low and this results in turnover and poor quality of care. Therefore, staff need to be supported, so that they are better equipped to provide quality care for patients. This dissertation describes a process of action research that aimed to explore possibilities for staff-support interventions to health teams in the public PHCsector. Data were collected through in-depth interviews, group interviews, focus group discussions and consultation sessions, with health staff and middle managers. Data were analysed using a grounded theory approach, with the assistance of the Atlas.ti 4.1 software package.The interpretation of data was informed by psychoanalytic and open systems theories. Four cycles of action research were conducted. The first action stage involved a qualitative assessment of the nature of stressors in the PHC system. The second action stage describes the experiences of two staff teams from a health prevention clinic and a day hospital (curative service) as they prepared to merge and integrate aspects of service delivery. In the third action stage the research team explored the feasibility of a short programme aimed at building capacity amongst middle and facility level managers to act as containers for staff stresses. However, due to external factors the programme was not completed. The final action stage describes interviews with selected participants to reflect on the effects of the current action research process on them and their work. The current research suggests that a psychodynamic approach may be a useful component of action research in health settings. This approach makes room for interpretation of unconscious processes in the stress experiences of health workers, and has the potential to move health staff and management to alternative modes of functioning and coping. / AFRIKAANSE OPSOMMING: Primêre gesondheidsdienste in Suid Afrika is tans in 'n proses van transisie. Die toenemende druk wat die VIGS-epidemie op gesondheidsdienste plaas, maak dit eweneens moeilik vir gesondheidswerkersom aan te pas by 'n gedurig-veranderende stelsel. Dit bring mee dat moraal laag is, baie werkers die publieke sektor verlaat en gehalte van dienslewering verswak. Hierdie situasie noodsaak dat programme ontwikkel moet word om gesondheidswerkerste ondersteun in hul werk, sodat hulle beter toegerus is om kwaliteit sorg aan pasiënte te verleen. Hierdie proefskrif beskryf aksienavorsing wat gedoen is met die doelom ondersteuningsprogramme vir gesondheidswerkers en hulpwerkers in openbare primêre gesondheidsdienste te ontwikkel. Individuele en in-groepsverband in-diepte onderhoude, asook fokusgroepbesprekings en konsultasies met gesondheidswerkers en middelvlak-bestuurders is gevoer om data in te samel. Data-ontleding was gedoen volgens die gegronde teorie aanslag en die Atlas.ti 4.1 sagteware pakket Is vir hierdie doel gebruik. Teorieë van psigoanalise en oop stelsels is deurgans geraadpleeg met die interpretasie van bevindinge. Die navorsingsproses bestaan uit vier siklusse van aksienavorsing. In die eerste navorsingsiklus is ~ie aard van stress in the publieke primêre gesondheidstelsel ondersoek. Die tweede siklus behels 'n beskrywing van die ervaringe van twee personeelgroepe soos hulle gereed gemaak het om aspekte van hulonderskeie dienslewering te integreer met die oprigting van 'n gemeenskaplike gesondheidsentrum. Die derde siklus beskryf die implementering van 'n kort program wat gerig is daarop om middel-vlak en diens-bestuurdersvaardighede aan te leer om personeel beter te ondersteun. Eksterne invloede het meegebring dat hierdie opleidingsprogram nie ten volle uitgevoer kon word nie. In die finale siklus is onderhoude met geselekteerde deelnemers gevoer om te bepaal hoe deelname aan die aksienavorsingsproses hulle in hul persoonlike hoedanigheid asook In die uitvoering van hul pligte beïnvloed het. Die huidige navorsing stel voor dat die psigodinamiese benadering 'n gepaste komponent van aksienavorsing in publieke gesondheidsomgewingskan wees, omdat hierdie benadering Insig kan verleen tot die onbewuste prosesse wat gesondheidswerkersse belewenis van stres beïnvloed, en verder ook die potensiaal het om gesondheidswerkers en bestuurders tot alternatiewe funksionering en hantering van stres te motiveer.