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Cognitive behaviour therapy is a well-documented first-line treatment for mild to moderate depression. Primary healthcare providers have encountered several barriers when trying to provide CBT in an office-based setting and as such, adoption of this evidence-based treatment has been suboptimal. Primary healthcare nurse practitioners (PHC NPs) have an in-depth knowledge of advanced nursing practice, and are responsible for the assessment, diagnosis and management of patients with acute and chronic conditions, such as depression. PHC NPs are also ideally situated in the health care system to deliver CBT to their patients. The objectives of this project were to develop a format for the delivery of brief CBT methods that was feasible in the PHC setting, increase PHC providers’ confidence to implement CBT and ultimately increase their adoption of CBT

Bakgrund: Kommunikationen är ett viktigt redskap för sjuksköterskor och inte minst vid telefonrådgivningen som utvecklats under de senaste årtiondena. Syftet med föreliggande studie var att beskriva distriktssköterskornas erfarenheter och reflektioner av telefonrådgivning inom primärvården. Metod: Studien var av kvalitativ ansats med en deskriptiv design. Nio distriktssköterskor intervjuades med hjälp av en semistrukturerad intervjuguide. Kvalitativ innehållsanalys användes som dataanalys. Resultat: Distriktssköterskorna ansåg telefonrådgivning som utmanande då det var många olika patienter, i olika åldrar och med olika vårdbehov som ringde telefonrådgivningen. Arbetet med telefonrådgivning beskrev informanterna som stimulerande då de via telefon hade möjlighet att hjälpa många patienter med enkla medel. Distriktssköterskorna upplevde även arbetet som stressigt vissa dagar. Distriktssköterskorna beskrev att bristen på visualisering i samband med att bedöma vårdbehovet hos patienten som det svåraste med telefonrådgivning. Flera svårigheter som distriktssköterskorna beskrev var att ställa rätt frågor samt svårigheterna med att hantera missnöjda patienter. Informanterna beskrev att de inte endast hade patientens önskemål att tillgodose utan även krav från hälsocentralen då det var brist på tider att boka samt att de fördelade arbetet på hälsocentralen via telefonrådgivningen. Informanterna beskrev arbetet med telefonrådgivning som betydelsefull då det var vägen in på hälsocentralen för patienterna. Slutsats: Distriktssköterskorna beskrev arbetet med telefonrådgivning inom primärvården som utmanande och svårt med begränsade möjligheter att tillgodose allas behov. Distriktssköterskorna som arbetade med telefonrådgivning inom primärvården upplevde liknande svårigheter som sjuksköterskorna på call-centers. Det svåraste distriktssköterskorna upplevde med telefonrådgivning var att de inte fysiskt såg patienten. Distriktssköterskorna upplevde även telefonrådgivningen som betydelsefull och stimulerande. / Background: Communication is an essential tool for nurses, especially when working with the telephone advice nursing (from here on mentioned as telenursing) that has been developed in recent decades. The aim of the present study was to describe the primary healthcare nurse´s experiences and reflections of telenursing in primary healthcare. Method: The present study was of qualitative approach with a descriptive design. Nine primary healthcare nurses was interviewed using a semi-structured interview guide. Qualitative content analysis was used as data analysis. Results: Primary healthcare nurses experienced telenursing as challenging because there were many different patients of different ages and with different health needs who contacted the telenursing. The informants described working with telenursing as stimulating because they easily were able to help many patients. Primary healthcare nurses also experienced the work stressful. The most difficult thing with telenursing described the primary healthcare nurses as the lack of visualization when assessing the need of care. Other difficulties the primary healthcare nurses described were difficulties in dealing with dissatisfied patients and to ask the right questions. The informants described they were not only the patient's wishes to meet. The primary healthcare center made demands of the primary healthcare nurses when it was lack of doctors’ appointments and because the nurses distributed the work on the healthcare center by the telenursing. The informants described the telenursing important because that is the only way for the patient to get an appointment at the healthcare center. Conclusion: The primary healthcare nurses described working with telenursing in primary healthcare as challenging and difficult with limited opportunities to ensure everyone is satisfied. The primary healthcare nurses working with telenursing in primary healthcare experienced similar difficulties as nurses at the call-centers did. The most difficult thing the primary healthcare nurses experienced with telenursing was that they did not met the patient physically. Primary healthcare nurses also experienced telenursing as important and stimulating.

ABSTRAKT   BAKGRUND Att inte se patienten men samtidigt ge säkra, goda och evidensbaserade råd och bedöma rätt vårdnivå är en stor utmaning för distriktssköterskan i telefonrådgivning. Att arbeta med telefonrådgivning är en stor del av distriktssköterskans arbete på en vårdcentral. SYFTE Syftet med studien var att beskriva distriktssköterskans upplevelser av att arbeta med telefonrådgivning. METOD Kvalitativ induktiv ansats har använts med semistrukturerade intervjuer genomfördes med tio distriktssköterskor och en kvalitativ latent innehållsanalys användes för att analysera textmassa. RESULTAT Resultatet bygger på ett tema och fem kategorier. Temat är; Svårt att möta allas behov med begränsade möjligheter men också utmanande och Kategorierna är; Det svåra arbetet med telefonrådgivning, När resurser saknas är det svårt att arbeta med telefonrådgivning, Att känna sig utsatt tar energi, Olika faktorer för ett bra arbete i telefonrådgivning och Ett arbete som är en utmaning. Resultatet visar att arbeta med telefonrådgivning på en vårdcentral upplevs som svårt när distriktssköterskan och patienten inte förstår varandra och det är svårt att alltid känna att de fattat rätt beslut. Det upplevs svårt att arbeta med telefonrådgivning och endast ha fyra till fem min/samtal och det är svårt att bedöma vård när läkartider inte finns. Distriktssköterskorna upplever att arbeta med telefonrådgivning är en stor utmaning KONKLUSION Att arbeta som distriktssköterska i telefonrådgivning mot primärvården är en utmaning. Att inte se patienten kan göra det svårt att fatta beslut. Att inte patienten kommer fram till sin vårdcentral skapar ett vårdlidande för patienten.

Magister Commercii (Information Management) - MCom(IM) / In the past, the Western Cape Department of Health had no formal or technologically enabled system for patient administration. This resulted in an administrative burden, increased waiting times for patients and doctors who needed results back from other sections, and missing patient files within the community health institutions such as clinics and hospitals. The Primary Healthcare Information System (PHCIS) was developed to solve this problem. However, it was later discovered that even though the PHCIS had been installed across the Western Cape clinics, there was a limited adoption and use of the PHCIS. Hence, the aim of this study was to investigate the factors that hinder the adoption and use of PHCIS by healthcare workers in the public healthcare clinics in the Khayelitsha sub-district in the Western Cape Province

This thesis is an account of praxis: it examines Playback conceptually, and portrays a programme of practical work exploring the experience of workplace audiences of five Playback Theatre performances, delivered from 2002-2005. The aim of the performances was to assist multi-disciplinary teams of staff in community health centres in Auckland New Zealand to communicate and work together with more understanding of each other. The thesis describes Playback as a way not only to elicit complex narratives which allow for diverse points of view to be expressed, but also as an aesthetic reworking of these narratives using action, music, dance, gesture and speech, in ways which have been influenced by 20th century avant-garde forms such as surrealism, dada, collage, jazz and poetry. Unlike some forms of theatre, Playback calls on elements of ritual and group method, in that it relies on audience members taking an active part in the performance by contributing narratives from their own lives. The thesis interrogates the notion of audience in theatre, using the words audience, spectator, spectactor, participant, public and polis, and specifically investigates two moments of the theatre as polis, in the French and Russian revolutions, when the potential of theatre to engage with the widest cross-section of the nation led to influential experiments and innovations in theatrical practice, each of which influenced the succeeding century. Some Playback discourse and practice is found to contain simplistic, even nostalgic, concepts of personal narrative, and the potential for performers’ interpretations in Playback to reinscribe social privilege is noted. In spite of its simple structure, Playback demands extremely complex skills from all the performers, not only the facilitator. In addition, the complex setting of the practical work encompasses both local NZ health initiatives and developments in global health. The work in each Healthcare Centre is described in a complete chapter: each containing details of the Centre and the Playback, seen through the findings of the patient focus groups, through comments made in interviews by the staff and through the researcher’s observation and experience. In all three Centres, existential and emancipatory metanarratives surfaced in the performances and in interviews. Professionalism was seen as meaning different things: at Ngākau it was a measure by which people were found to be unsatisfactory; at Oranga, it referred to applying the lessons of the Playback to one’s own practice; while at Pātaka, professionalism was evident in narratives of self care, dedication and seeking clarification and support from peers. While the study revealed limitations of Playback, it also pointed to some unique contributions this form of improvisational theatre can make to a programme of staff or group development. In particular, Playback can open up spaces, people and topics, for non-dogmatic, pluralistic, embodied thinking and reflection, leading people to more nuanced understandings of themselves and each other, and can even affect attitudes and behaviours.

This thesis is an account of praxis: it examines Playback conceptually, and portrays a programme of practical work exploring the experience of workplace audiences of five Playback Theatre performances, delivered from 2002-2005. The aim of the performances was to assist multi-disciplinary teams of staff in community health centres in Auckland New Zealand to communicate and work together with more understanding of each other. The thesis describes Playback as a way not only to elicit complex narratives which allow for diverse points of view to be expressed, but also as an aesthetic reworking of these narratives using action, music, dance, gesture and speech, in ways which have been influenced by 20th century avant-garde forms such as surrealism, dada, collage, jazz and poetry. Unlike some forms of theatre, Playback calls on elements of ritual and group method, in that it relies on audience members taking an active part in the performance by contributing narratives from their own lives. The thesis interrogates the notion of audience in theatre, using the words audience, spectator, spectactor, participant, public and polis, and specifically investigates two moments of the theatre as polis, in the French and Russian revolutions, when the potential of theatre to engage with the widest cross-section of the nation led to influential experiments and innovations in theatrical practice, each of which influenced the succeeding century. Some Playback discourse and practice is found to contain simplistic, even nostalgic, concepts of personal narrative, and the potential for performers’ interpretations in Playback to reinscribe social privilege is noted. In spite of its simple structure, Playback demands extremely complex skills from all the performers, not only the facilitator. In addition, the complex setting of the practical work encompasses both local NZ health initiatives and developments in global health. The work in each Healthcare Centre is described in a complete chapter: each containing details of the Centre and the Playback, seen through the findings of the patient focus groups, through comments made in interviews by the staff and through the researcher’s observation and experience. In all three Centres, existential and emancipatory metanarratives surfaced in the performances and in interviews. Professionalism was seen as meaning different things: at Ngākau it was a measure by which people were found to be unsatisfactory; at Oranga, it referred to applying the lessons of the Playback to one’s own practice; while at Pātaka, professionalism was evident in narratives of self care, dedication and seeking clarification and support from peers. While the study revealed limitations of Playback, it also pointed to some unique contributions this form of improvisational theatre can make to a programme of staff or group development. In particular, Playback can open up spaces, people and topics, for non-dogmatic, pluralistic, embodied thinking and reflection, leading people to more nuanced understandings of themselves and each other, and can even affect attitudes and behaviours.

Master of Public Health - MPH / Background: Drugs are essential components of the health system and their rational use is vital to delivering quality and efficient healthcare services. However, inappropriate prescribing is a common rational drug use problem globally, particularly in developing countries including Nigeria. Despite measures to address this problem, inappropriate drug use continues to be a major public health problem in Nigeria. Aim: This study assessed rational drug use (RDU), with a focus on rational prescribing and factors affecting it, among primary healthcare providers working in primary healthcare facilities of a LGA in Northwestern Nigeria. Methods: The study was a cross sectional descriptive study and it included retrospective review of patient encounters and interviews with prescribing healthcare providers in sampled health facilities. Stratified random sampling method was used to select 20 public primary healthcare facilities and 30 patient encounters were drawn by systematic random sampling from each facility. One hundred and sixty three prescribing healthcare providers in the health facilities were also included in the study. Adapted WHO's drug use study tools and a structured self-administered questionnaire were used to collect data. Data were analysed using Statistical Package for Social Sciences (SPSS Version 17) software and presented as contingency table with chi square test used to test for relationship between variables with statistical significance taken at p < 0.05. Ethical approval was obtained from the University of the Western Cape Research Ethics Committee and Kaduna State Ministry of Health, and permission from local stakeholders. Confidentiality of individual patients, healthcare providers and health facilities data was maintained. Results: The prescribing staff at the selected facilities were predominantly Nurses/Midwives and community health assistants with SCHEWs constituting the majority (60.8%). More than half (54.4%) of providers did not know about the concept of RDU. Similarly, the computed knowledge score of RDU revealed that the majority (74.4%) had poor knowledge of the concept. Knowledge was significantly associated with duration of service, providers' previous training in rational drug use and professional status (p<0.05), with the CHOs having better knowledge of RDU compared with other professional cadres. High antibiotic use (68.3% in retrospective review and 82.9% in survey) and injection use (9.5% in retrospective review and 12% in survey) were found in the study with significant proportions of providers admitting that all cases of URTI should receive antibiotics (72.3% ) and that patients could be prescribed injections if they requested for it (35.3%). The Standing Order was the main source of information for the majority (50.6%) of providers and it served as the major influence affecting prescribing practices. Conclusion: This study revealed a poor understanding and knowledge of RDU among healthcare providers. High antibiotic and injection use also reflected providers' poor attitude to rational prescribing of these commodities. To improve prescribing practices at the PHC level, adequate staff skill mix, including physicians should be established. Since RDU knowledge was associated with prior training, curriculum development towards RDU and opportunities for in-service training should be provided to build prescribers capacity, in addition to instituting a system of rational drug use monitoring. Further research into rational drug use among different cadres of PHC healthcare providers is also recommended.

Magister Pharmaceuticae - MPharm / Antibiotic resistance (ABR) is a global healthcare burden complicating the treatment of various infections. The infectious diseases burden is heavy in primary care. Urinary tract infections (UTIs) are common outpatient infections. Miscommunication in healthcare may lead to non-adherence, adverse events and fuel ABR. Labelling antibiotics should be explicit and understood by patients. Treatment of UTIs in primary care in the Western Cape is not well defined. This study’s aim is to describe the treatment of UTIs in primary care in the Cape Metropole of the Western Cape province.

Published Article / The aim of the study on which this article is based was to reflect on the learning experiences of students during integrated management of childhood illness (IMCI) training in an undergraduate programme. IMCI is a set of guidelines that was established by the World Health Organisation (WHO) for cost-effective quality care for children younger than five to prevent diseases and death (WHO, 2004). Skilled primary healthcare workers are required to provide quality care at first contact with these children. The IMCI package was presented as an integral part of the second-year module that focuses on primary healthcare. In order to improve the quality of health services and refocus the health system on primary health-care (South Africa Department of Health, 2010), students have to demonstrate that they have achieved competence. According to Killen (2000:188), competence is a holistic term and focuses on knowledge, skills and values instead of competencies, which refer to specific capabilities. Primary health-care workers who act competently will integrate foundational IMCI knowledge with skills and values as well as with the ability to verify their decisions (Killen, 2000:188). Aqualitative, exploratory and descriptive research design was used to investigate the IMCI learning experiences. Such experiences are one of the indications whether training has been successful and how it can be improved (Suski, 2004:222). Data was collected by means of nominal-group technique (NGT) interviews with second-year nursing students of the training school who complied with the criteria for inclusion. NGT interviews were used effectively to evaluate clinical interaction, education and training.The findings reflected the different emotions experienced during teaching and learning as having been positive, negative or neutral. The consideration of negative emotions will assist with the improvement of IMCI teaching and learning, but all these findings can be useful for other higher-education institutions that present or plan to present IMCI training.