Submitted in fulfillment of requirements for the Degree of Master of Health Sciences: Nursing, Durban University of Technology, Durban, South Africa, 2016. / Introduction Through centuries the birth of a baby has been considered as a deeply felt spiritual experience. Childbirth is not merely a physiological experience; it also embraces social, emotional, psychological, spiritual and religious aspects. In most Western societies the sacred moment of birth dissipates within the context of a pressured hospital environment. Whilst literature and empirical research has proliferated on midwifery very little has been done to explore how women experience childbirth personally and more importantly how spirituality interfaces within the context of the childbirth experience and midwifery care. There is a growing body of literature on spiritually sensitive care. However, there remained a need to inquire about mother’s personal experience and how spirituality interfaces with the childbirth experience in the hospital context. Problem statement Whilst empirical research in the field of midwifery, has grown, research pertaining to the spiritual aspects related to women’s diverse spiritual needs during childbirth is sparse (Crowther and Hall 2015). Furthermore little attention has been paid to issues relating to how women experienced childbirth in the public sector, and how religion and spirituality influence and impact on childbirth. It is against this background that the current study was conceived. Purpose of the Study The purpose of this study was to explore and describe the experience of childbirth amongst women from diverse spiritual or religious backgrounds viz. Christianity, Islam, African Traditional Religion and Hinduism, at public hospitals in the uMgungundlovu District of KwaZulu-Natal. Methodology A qualitative, explorative, descriptive and contextual study design was used. A total sample of twenty-two postnatal mothers from the following common spiritual backgrounds in South Africa viz. Christianity, Islam, African Traditional Religion and Hinduism were purposively chosen. Data was collected until saturation. Participants were selected from three public hospitals in the uMgungundlovu District of KwaZulu-Natal. Data was collected by means of semi-structured interviews conducted six weeks post-delivery at the six-week health check, but within three months of delivery. Interviews were transcribed manually; the data was analysed through thematic analysis. Findings The main themes drawn from the data reflected that childbirth was a deeply personal and meaningful experience. It was seen as a spiritual experience and spirituality was seen as a vital support system in enabling mothers to cope better with pain and other challenges. Emotional and comfort needs were also identified by mothers as being very important to cope with pain and an easier delivery. The presence of midwives and the need for partner and family support were also seen to be important. More importantly the study found that their spirituality and spiritually based activities and rituals were an important aspect of the overall birth experience. The study found a diverse range of spiritual practices and rituals that were salient across all the spiritual worldviews during childbirth and post-delivery. It also found that mothers often resorted to alternate and traditional therapies to help cope with labour and delivery all of which have salience to midwifery practice that is both respectful and sensitive to the diverse worldviews of mothers. Conclusion Collectively the data reflected that childbirth was a holistic experience that cannot be separated also from partner, family and medical support. Whilst traditionally effective midwifery practice may have been so to focus on primarily physical care, the study found that the physical component is interrelated with the psychological, social and cultural aspects as well. Hence effective and ethical midwifery practice is inseparable from these facets but most importantly inseparable from the spiritual worldviews that most mothers follow and ascribe to. Contemporary education needs to recognize the current move towards spiritual care and provide knowledge and skill to deal with patients from diverse spiritual backgrounds. Finally it needs to recognize as this study has found, that childbirth is a multifaceted experience which is spiritual in nature. Viewed in this way both midwives and the management of public hospitals should then make every effort to create spiritually sensitive care during the childbirth experience. / M

Submitted in fulfilment of the requirements of the Master's Degree in Technology: Radiography, Durban University of Technology, 2013. / ABSTRACT Escalating current healthcare needs coupled with the dire shortage of radiologists created a climate in countries abroad to extend the role of the radiographer (Williams 2006). The South African radiography profession demonstrates similar if not worse challenges within the radiology services (Gqweta 2012). The human resource needs in the healthcare sector creates a gap in the provision of radiology services (Brandt et al 2007). Often under these circumstances radiographers are asked by emergency department's personnel to comment on radiographic appearances (Hardy and Snaith 2007). Radiographers do provide opinions in order to facilitate patient management (Gqweta 2012). Since the chest x-ray is the most commonly performed x-ray examination in x-ray departments (Manning, Leach and Bunting, 2000), it is assumed that most requests for an opinion may be directed for the clarification of this x-ray examination. Therefore radiographers need to have an in-depth understanding of the knowledge and skills related to the identification of patterns on chest images. The aim of the study was to establish and describe the current chest image interpretation skills, knowledge and perceptions of diagnostic radiographers in eThekwini Health District of KwaZulu-Natal (KZN) with regard to image interpretation. METHOD: A quantitative study using a descriptive design with a qualitative aspect using an interpretive design was employed. A simple random sample of hospitals within the eThekwini health district that have x-ray departments was drawn. All diagnostic radiographers that met the inclusion criteria from within these hospitals were invited to partake in the study and all were registered with the Health Profession Council of South Africa (HPCSA). A questionnaire was utilised to collect data on the perceptions and knowledge of diagnostic radiographers on radiographic appearances. A reporting template was provided for the respondents to report on ten (10) chest images and to standardise responses . Accuracy , specificity and sensitivity measurements were utilised to determine the image interpretation knowledge and skills of radiographers without formal training on image interpretation. The SPSS (Statistical Package for the Social Sciences) version 21 was utilised for the raw data capture and analysis. RESULTS Forty two (42) radiographers participated in the study. Almost half (46%) of the respondents were chief radiographers and twenty four point four percent (24.4%) of the respondents were senior radiographers . X-ray department managers and community service radiographers each had twelve (12%) percent representation. The majority of the respondents frequently performed chest x-rays. Furthermore they regularly observe Pulmonary Tuberculosis (PTB) abnormal patterns more than those of pneumonia and lung cancer on chest radiographs. The respondents indicated that there is a need for them to extend their roles to include image interpretation. This will ensure that radiographers are responsive to current health care needs perpetuated by the absence of radiologists and the ever rapidly increasing population. The majority of the respondents were able to identify abnormal appearances on the radiographs (high sensitivity). However there was a proportional decrease on the identification and recognition of the normal appearances (specificity). There was no respondent that obtained a mark of eighty (80%) on the image interpretation knowledge assessment section. CONCLUSION Radiographers are able to identify abnormal patterns on chest images. However they are unable to adequately exclude an abnormality (low specificity). Furthermore they lack the ability to adequately describe abnormal radiographic/radio logical appearances. The image interpretation knowledge base of radiographers is limited and specific. Therefore there is a need for an intensive education and training for prospective reporting radiographers.

Submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Objective: The majority of information available on chiropractic patients originates from private practices in developed countries. However, recently reports describing chiropractic patients in South Africa have emerged, reporting on private practices and teaching clinics. Therefore, the overall purpose of this study was to determine the characteristics of patients presenting to a public chiropractic facility at the Kimberley Hospital Complex (KHC) in South Africa; and compare to the local and international private practices and teaching clinics. Methods: The period prevalence was three months in which information was extrapolated from patient files of the patients that presented to the KHC Chiropractic Clinic (KHCCC). Information that was collected included demographic data, common presenting complaints, patient history and common management protocols. Results: Data for 157 patients were recorded. The mean age of patients was 47.5 years, majority of the patients were female (70%), comprised of coloured and black patients (85%), where the greater part had a primary education level. Less than half the patients were employed in manual type of occupation, whilst almost one quarter of the patients were pensioners. By far, the greatest reason that patients visited chiropractors within the public health care sector at the KHCCC in South Africa was for chronic musculoskeletal complaints (68%). Majority presented with spinal complaints of the lower back (n=144), the most common diagnosis made was sacroiliac syndrome (48%). X-rays were the most common special investigation requested by KHCCC. The most common co-morbidities reported were hypertension, followed by diabetes and allergies. More than half the sample had undergone previous surgery. Thirty seven percent of patients received treatment for fewer than six visits. Contraindications to chiropractic treatment were indicated in only three patients. The treatment protocols that were predominantly used at the KHCCC were joint manipulation, followed by dry needling, kinesiotape and soft tissue therapy. Two thirds of all patients that were referred to the KHCCC were referred from within the medical profession. With regards to the chiropractic patients globally, similarities respect to patients in the public sector in South Africa to all sectors both locally and internationally, include factors such as majority female patients, top five anatomical locations of complaint, common usage of x-rays as a special investigation, similarities with co-morbidities including cardiovascular and endocrine, the repeated number of visits for the same complaint and manipulation remained treatment of choice. Conclusion: Although this was purely a demographic and descriptive study in nature, it gave a better understanding of patients that presented to a public hospital in a developing country like South Africa. With this demographic and descriptive information obtained in this study, it confirmed that although there is a unique population utilising chiropractic services within the public sector of South Africa, meaningful similarities have been found between patients in the different sectors in South Africa and internationally.

Submitted in fulfillment of the requirements for the Degree of Master of Technology Hospitality and Tourism, Durban University of Technology, Durban, South Africa, 2014. / It has been accepted that health care within provincial hospitals has deteriorated. For most it has become routine to visit provincial hospitals and wait for majority of the day for basic treatment. Service delivery in provincial health care are confronted with challenges such as staff shortages, inadequate medical supplies and reduced budgets. The media contributes with letters and articles about poor patient treatment, the increase in deaths and diseases due to poor service delivery and weak hospital management. However, with the growing rate of poverty and unemployment, resources have become scarcer hence, adding to an already crippling economy. The rationale behind this research is to evaluate the role of hospitality within a Provincial Hospital in the southern area of Durban KZN that’s offering treatment to patients with more than just basic health care. And to establish a more effective and efficient delivery of services offered with scarce resources which enhances patient encounters within a provincial hospital. The aim of this research is to evaluate the current legislation around provincial hospitals for the efficient and effective practise of hospitality. In the form of a literature review a theoretical perspective was formulated around the study and an operational chapter detailing the Provincial Hospital in the southern area of Durban, KZN. The rationale was tested by research in the form of questionnaires and interviews with the Provincial Hospital. A target sample was selected with managers, senior management and patients. The major findings may be gravitated towards serious service delivery issues. The Provincial Hospital should therefore, consider the introduction of a hospitality approach in its attempts to improve the delivery of patient care. The study also found that hospitality management influences may improve employee output which impacts on the delivery of patient care. / M

Submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Objective: The majority of information available on chiropractic patients originates from private practices in developed countries. However, recently reports describing chiropractic patients in South Africa have emerged, reporting on private practices and teaching clinics. Therefore, the overall purpose of this study was to determine the characteristics of patients presenting to a public chiropractic facility at the Kimberley Hospital Complex (KHC) in South Africa; and compare to the local and international private practices and teaching clinics. Methods: The period prevalence was three months in which information was extrapolated from patient files of the patients that presented to the KHC Chiropractic Clinic (KHCCC). Information that was collected included demographic data, common presenting complaints, patient history and common management protocols. Results: Data for 157 patients were recorded. The mean age of patients was 47.5 years, majority of the patients were female (70%), comprised of coloured and black patients (85%), where the greater part had a primary education level. Less than half the patients were employed in manual type of occupation, whilst almost one quarter of the patients were pensioners. By far, the greatest reason that patients visited chiropractors within the public health care sector at the KHCCC in South Africa was for chronic musculoskeletal complaints (68%). Majority presented with spinal complaints of the lower back (n=144), the most common diagnosis made was sacroiliac syndrome (48%). X-rays were the most common special investigation requested by KHCCC. The most common co-morbidities reported were hypertension, followed by diabetes and allergies. More than half the sample had undergone previous surgery. Thirty seven percent of patients received treatment for fewer than six visits. Contraindications to chiropractic treatment were indicated in only three patients. The treatment protocols that were predominantly used at the KHCCC were joint manipulation, followed by dry needling, kinesiotape and soft tissue therapy. Two thirds of all patients that were referred to the KHCCC were referred from within the medical profession. With regards to the chiropractic patients globally, similarities respect to patients in the public sector in South Africa to all sectors both locally and internationally, include factors such as majority female patients, top five anatomical locations of complaint, common usage of x-rays as a special investigation, similarities with co-morbidities including cardiovascular and endocrine, the repeated number of visits for the same complaint and manipulation remained treatment of choice. Conclusion: Although this was purely a demographic and descriptive study in nature, it gave a better understanding of patients that presented to a public hospital in a developing country like South Africa. With this demographic and descriptive information obtained in this study, it confirmed that although there is a unique population utilising chiropractic services within the public sector of South Africa, meaningful similarities have been found between patients in the different sectors in South Africa and internationally.

Interactive version of the thesis is filed with the printed copy in the UNISA archives / The study investigated and described public hospitals in terms of management processes with reference to financial planning, organizing, leading and control in order to identify deficiencies in the financial management of public hospitals. The aim was to identify gaps in the management of financial processes and to provide guidelines and strategies to improve these. The purpose of the research was addressed within a quantitative approach applying exploratory and descriptive designs. A self-administered questionnaire was used to collect the data that fit the objectives of the research. The study population compassed all 27 public hospitals as study units in a specific geographic area, namely Mpumalanga Province with the following inclusion criteria: active patient capacity of 100 beds and more, which employ personnel such as (1) medical, (2) paramedical and (3) administrative and a working application of the BAS as financial accounting system since its interception in the year 2000. Nine public hospitals were randomly selected as the sample hospitals. Within the nine hospitals, four groups of staff were selected by means of stratified random sampling, namely management, health professionals, and financial and administrative staff. The number of staff selected within each hospital differed, from 15 to 50, amounting to a sample size of three hundred (n=300). A response rate of 66.66% v (n=182) was achieved. The sample consisted of 4 (2.27%) chief executive officers, 3 (1.70%) financial managers, 84 (47.72%) unit managers and 91 (50.00%) subordinates. The response rate of 66.66% in this study was an indication of the unavailability of the health care professionals (which include management, health professionals and financial and administrative staff) within the nine public hospitals. The major inferences drawn from this study are that the different health care professions have a poor perception of the scope of financial management in terms of financial needs, utilization of resources, the scope and function of leading and delegation, and applying appropriate financial control methods. / Health Studies / D. Litt. et Phil. (Health Services Management)

Interactive version of the thesis is filed with the printed copy in the UNISA archives / The study investigated and described public hospitals in terms of management processes with reference to financial planning, organizing, leading and control in order to identify deficiencies in the financial management of public hospitals. The aim was to identify gaps in the management of financial processes and to provide guidelines and strategies to improve these. The purpose of the research was addressed within a quantitative approach applying exploratory and descriptive designs. A self-administered questionnaire was used to collect the data that fit the objectives of the research. The study population compassed all 27 public hospitals as study units in a specific geographic area, namely Mpumalanga Province with the following inclusion criteria: active patient capacity of 100 beds and more, which employ personnel such as (1) medical, (2) paramedical and (3) administrative and a working application of the BAS as financial accounting system since its interception in the year 2000. Nine public hospitals were randomly selected as the sample hospitals. Within the nine hospitals, four groups of staff were selected by means of stratified random sampling, namely management, health professionals, and financial and administrative staff. The number of staff selected within each hospital differed, from 15 to 50, amounting to a sample size of three hundred (n=300). A response rate of 66.66% v (n=182) was achieved. The sample consisted of 4 (2.27%) chief executive officers, 3 (1.70%) financial managers, 84 (47.72%) unit managers and 91 (50.00%) subordinates. The response rate of 66.66% in this study was an indication of the unavailability of the health care professionals (which include management, health professionals and financial and administrative staff) within the nine public hospitals. The major inferences drawn from this study are that the different health care professions have a poor perception of the scope of financial management in terms of financial needs, utilization of resources, the scope and function of leading and delegation, and applying appropriate financial control methods. / Health Studies / D. Litt. et Phil. (Health Services Management)

Submitted in fulfillment of the requirements for the Degree Mast in Technology: Public Management, Durban University of Technology, Durban, South Africa, 2017. / The South African healthcare sector stands at the threshold of major restructuring in an attempt to address inadequacies as a result of fragmentation of health services in apartheid South Africa. The level of health services, particularly in rural areas, has decreased and has led to reduced quality and productivity of health services. For individuals residing in rural communities, access to health services can be arduous. Delivery of essential services has to meet the needs of marginalised people who live in remote areas. In light of the above, the department of health is faced with growing expectations from citizens to use resources efficiently and effectively and to ensure that healthcare is affordable and accessible to all. National Health Insurance (NHI) is intended to bring about reform that will improve service provision. The researcher undertook this study to explore healthcare challenges faced by South Africa and its people and how far progressive realisation of access to healthcare, as enshrined in the 1996 Constitution, is being implemented. A case study using a mixed method approach was adopted. The literature reviewed indicated that issues of remuneration, ageing infrastructure and general management challenges, including financial management, are among the challenges that continue to hamper the public health system in South Africa. In addition, the HIV/AIDS epidemic has created more demand for healthcare as many more people become sick. The Green Paper outlining the government’s broad policy proposals for NHI, released in August 2011, makes it clear that NHI is a long-term project that will be rolled out over 14 years. It aims to promote efficiency and equity to ensure that all South Africans have access to affordable, quality healthcare. The findings of this study are useful not only to the case study institution, but to all District Hospitals, especially the department of health and the public management sector and may assist in taking the NHI forward. / M

Submitted in fulfillment of the requirements for the Master’s Degree in Health Sciences in Radiography, Durban University of Technology, Durban, South Africa, 2017. / Introduction Work related stressors are identified as the main reason for the decline in patient care in Radiography in public hospitals. Radiographers opt to leave the public sector because of stressful experiences. Research has shown that the scarcity of qualitative studies on the phenomenon makes it difficult to understand work related stress in relation to radiography as a profession. Aim of the study The aim of the study was to explore and describe work related stressors in Radiography at a public hospital in Gauteng, South Africa. Methodology This study was a qualitative, exploratory, descriptive study. An interview guide was used to elicit information from 10 participants through semi-structured interviews. All the interviews were one-on-one and were audio-recorded. The data were analysed through Tesch’s eight steps of thematic analysis. Findings The following three themes emerged during data analysis, namely: personal well-being of Radiographers; decline in quality patient care and impaired radiography service; and, environmental enablers. The findings of the study revealed that the participants’ general health was compromised by various factors pertaining to work related stress. Conclusion Interventions necessary for dealing with work related stressors are highlighted as a way of enabling improvement of the working environment conditions. The participants in the study felt that hiring more staff could alleviate their work related stressors. The study has shown that it is also imperative that staff and management are constantly communicating well. / M

The primary purpose of CTG is to detect early signs of intrapartum hypoxia and improve foetal outcomes. Intrapartum hypoxia remains the major cause of perinatal deaths mainly in monitored labours. This is attributed to the midwives’ lack of skills in the foetal implementation and interpretation of CTG. Midwives interpret foetal heart rate patterns erroneously hence they fail to detect early signs of severe foetal compromise. Accurate interpretation of CTG is the cornerstone for clinical decision during intra-partum foetal surveillance. Therefore, it is mandatory that midwives are competent in CTG. The purpose of the study was to explore and describe the perceptions of midwives in KwaZulu-Natal public hospitals regarding their level of competence related to the CTG. The purpose of the study was to explore and describe the perceptions of midwives in KwaZulu-Natal public hospitals regarding their level of competence related to the CTG. The objectives of this study were: -to explore and describe the perceptions of the midwives regarding their level of competence relating to cardiotocography. -to establish the levels of competence of midwives in relation to CTG. -to develop clinical guidelines that could be utilised by midwives in the implementation and interpretation of the cardiotocograph. The study utilised a quantitative non-experimental comparative descriptive research design. A self-developed and self-administered questionnaire was developed under the supervision of a statistician and was to collect data from a purposively selected sample of midwives who work in labour wards in Kwa-Zulu Natal public hospitals. A sample of 226 practicing midwives working in labour wards of the nine KZN public hospitals was selected using a non-probability convenience sampling method; only 125 responded. Data were collected on an excel spread sheet and analysed under the supervision of the statistician and research supervisor. The researcher assured of validity and reliability of the data collection method and data as well as of the data collection instrument. The findings revealed that the midwives in KZN public hospitals perceived themselves as being competent regarding CTG tasks; however they lack knowledge and skills in the implementation and interpretation of CTG. It was also evident that the midwives’ years of midwifery clinical experience, labour ward experience, possession of additional post basic midwifery qualification and the perceived level of competence related to CTG tasks number of years of the midwives did not influence their level of competence in the implementation and interpretation of CTG. Literature control supported these findings and there was consistency with that literature. Recommendations were made and clinical guidelines were developed to assist midwives with the assessment of foetal heart rate and the interpretation of the cardiotocograph results.