The purpose of the study was to come up with recommendations that would improve condom use in men in the Dikgatlong Sub-district in the Northern Cape Province of South Africa. Although condom use in this province followed the national tendency in South Africa of an increase in condom use amongst men of all age groups, men from the Northern Cape had the lowest prevalence of condom use amongst men in South Africa. The research methodology used was qualitative, descriptive and consensus seeking in design. The nominal group technique was used to collect data from men who were recruited from the primary health care facilities and from schools in the Dikgatlong Sub-district. An exploratory study was conducted to test the relevance and the clarity of the question. The study consisted of two nominal groups of older men (49 years and above) and two nominal groups of younger men (18-24 years). Atrained facilitator from the University of the Free State conducted the nominal group discussions. This structured interview technique allowed prioritizing recommendations proposed by participants as to how to improve condom use amongst men in the Dikgatlong Sub-district. Data obtained during the interviews was analysed according to the steps proposed by van Breda and categories and themes identified according to the steps proposed by Tesch. The categories identified were client education, quality assurance, attitude, communication and availability of condoms. The category, client education was further divided into the following themes: content, strategy, responsibility and target group. The category, quality assurance had two themes namely, manufacturing and cost. Whereas the category attitude had one theme namely, change. The category communication had one theme namely, interpersonal. The last availibility category had also one theme namely, sites. Trustworthiness of the data was supported by upholding the criteria of credibility, transferability, confirmability and dependability. Recommendations from the study were ordered according to the identified categories and themes. Briefly the results indicated that parents, community leaders, educators and the Department of Health in collaboration with other governmental departments have role to play in encouranging the sexual behavioural change in men. Policies and guidelines regarding the use and distribution of condoms were found to be available and should reach the community. The results of the study will be forwarded to the Department of Health in the Northern Cape and the implementation of these recommendations will be in their hands.

Midwives, in the absence of medical practitioners are the most readily available health professionals to render care in Primary and Community Health Care settings. After obtaining a qualification in Advanced Midwifery and Neonatology, midwives should be placed and utilized in areas where they can use their competencies for the benefit of the mother and the baby. The aim of this study was to describe the practice of advanced midwives including their placement and utilization. A non-experimental and descriptive design was used. After a thorough literature analsis as well as a focus group discussion was done, a questionnaire for data collection was compiled. The data was collected after approval was obtained from the relevant roleplayers as well as from the Ethics Committee of the Faculty of Health Science from the local University. The population consisted of all (178) practicing advanced midwives who trained at the University of the Free State during 1995-2007. No sampling was done and 178 questionnaires were distributed to the practicing advanced midwives. Sixty nine questionnaires were returned (39% return rate) and analysed. The findings indicated that only 13 (n=13, 19%) of advanced midwives were placed and utilized correctly. Advanced midwives that were not placed and utilized correctly expressed a loss of self-confidence, lack of support and a lack of recognition. They also reported an inability to demonstrate their expertise in practice due to inappropriate placement and utilization. Nurse academics and Advanced midwifery Practitioners should publish research articles in Health Sciences Journals to make their competencies known. That might ensure that they are recognized by their colleagues and given the opportunity to practice what they have trained for.

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Academic performance appears to be a problem, not only at nursing colleges, but at all academic institutions. An overloaded curriculum, a heavy workload, crowded classes, lack of equipment and scarce resources, amongst others, seem to be the problem. The study was conducted to determine the factors that influence studentsâ academic performance at a nursing college. A qualitative, explorative, descriptive and contextual design was used. Two samples, namely tutors and student nurses in the first year of their four-year diploma programme, were obtained. Both groups were English-speaking and available at the time of the study. Two questions were posed to the target groups. Firstly: âWhat are the factors that influence academic performance at the college?â Secondly: âWhat can be done to improve the academic performance of the students at the college?â Informed consent was obtained after the purpose of the study had been explained to the participants. Consent to conduct the study was also obtained from the Head of the Department of the Free State Department of Health. The eight steps identified by Tesch (1990), as cited in Botma, Greeff, Mulaudzi and Wright (2010: 224), was used during the process of data analysis. The researcher then did a literature review to support the outcome. During focus-group interviews, tutors indicated that the type of students selected for training was not committed enough to become competent professional nurses. Some of the tutors were concerned that students only applied to the nursing college to receive bursaries. The bursaries were then misappropriatedfor personal use, instead of being used for their studies. According to tutors, students only applied for training because they had not been admitted at other institutions which offeredthe courses of their choice. Tutors also complained that, due to administrative responsibilities, they lacked the time to accompany students in the clinical areas. The students identified several factors. They mentioned, for example, that the transition from high school to college and the resultant workloadhad a negative impact on their studies. More freedom at the college and the fact that they no longer studied under the strict supervision of their parents, were also mentioned as factors. Furthermore, it seemed that the study methods that were successful at high school did not have the same effect at college. Students also complained about the appalling living conditions at the nursesâ home. Poor hygienic conditions and unbearable noise levels, the lack of security, and a feeling of not being safe were mentioned. The lack of confidentiality when they consulted the student counsellor also added to studentsâ dissatisfaction. A concern was that confidential information would later be disclosed to other students and tutors. Finally, the researcherâs recommendations were to address the most important factors, such as the management of bursaries and accommodation of students and to ensure that a strategic plan would be developed to improve academic performance.

In the South African Military Health Service (SAMHS) clinical supervision is the responsibility of both the nurse educator and the professional nurse. However, the insufficiency of clinical departments in the military service triggered the researcherâs interest in how clinical supervision is experienced by the different nursing categories. The objectives of the study were to determine the views of nurse educators, professional nurses, nursing students and pupil enrolled nurses with regard to clinical supervision in the SAMHS and to formulate recommendations for improving clinical supervision based on the results. The following research question was evaluated: How do the different categories of nurses view clinical supervision in the South African Military Health Services? The research methodology constituted a non-experimental descriptive exploratory design with a quantitative approach. Self-administered questionnaires were used for data collection. The population comprised of nurse educators, professional nurses, nursing students and pupil enrolled nurses employed in the SAMHS. A random sampling technique was used and all students available at the time of data collection were included in the study. The final sample of nursing students and pupil enrolled nurses was n=148 (56%:264) of a total population of 264 students and the sample size of nurse educators and professional nurses was n=136 (20%:691). Prior to commencement of the research, approval for conducting the study was obtained from the Ethics Committee of the Faculty of Health Sciences at the University of the Free State (UFS), the Military Health Ethics Committee, the Chief Executive Officers of the various military hospitals, the Commanding Officer of the SAMHS nursing colleges, the Officers in Charge of each nursing college as well as the respondents who participated in the study. Data for the study was collected in a four-week period, the first of which took place at 3 Military Hospital. The second week saw data collection at 2 Military Hospital and the nursing college in Cape Town. The last two weeks were spent at 1 Military Hospital and the nursing college in Thaba Tshwane. The ethical principles stated in the proposal were strictly adhered to as the research involved human respondents. The respondents were asked to complete questionnaires voluntarily and they were assured that their participation and the information they provided would not be used against them. They were also assured of their right to confidentiality and anonymity. Anonymity was preserved by not revealing any of the names of the respondents who took part in the research study. Confidentiality was ensured by denying unauthorised access to data. Respondents were informed of their right to withdraw from the study at any stage. Each complete questionnaire was coded, before a biostatistician of the UFSâs Department of Biostatistics assisted with the data analysis. Descriptive statistics measures such as frequency and percentage distributions were obtained. A conceptual framework of three dimensions, namely the clinical supervision prerequisites, the core of clinical supervision and the outcomes of clinical supervision were used to guide the discussion in Chapter 2 on clinical supervision. Certain recommendations were made. Some of these included that clinical supervision should be given priority and that the appointment of clinical mentors and preceptors and the establishment of clinical departments in the SAMHS should be investigated. Nurse educators and professional nurses should be jointly responsible for clinical teaching and support of students in the clinical learning environment. Furthermore, it is recommended that nurse educators should provide professional nurses with a structured clinical supervision programme and that formal written contracts between nurse educators and students be drawn up. The supernumerary status of students needs to be maintained, and, lastly, the nurse-educator student ratio needs to be adjusted.

The purpose of this study was to identify the problems that study leaders from the School of Nursing, at the University of the Free State encountered with giving study guidance to students and thereafter to develop strategies to improve study guidance. The implementation of these strategies would then improve the through put of postgraduate students. A qualitative, descriptive study design was used and information was gathered through the nominal group technique. The findings were that study leaders experienced a deficit in their training as study leaders, as well as a deficit in experience of providing study guidance. Study leaders also experienced uncertainty with regard to administrative procedures and a challenge to stay abreast of the development regarding research methodologies as well as development concerning the different sub-disciplines. A high workload was also identified as being problematic. Further problems experienced were studentsâ deficit regarding skills needed to complete research studies. Students also do not keep appointments and reacted negatively on feedback that were given to them. It is recommended that study leaders receive training with regard to giving of study guidance. Other strategies that were formulated are that study leaders be exposed to group study guidance before they embark on giving individual study guidance. Group study guidance can also diminish study leadersâ workload. New study leaders can also initially be allocated as co-study leaders to provide them with experience . With regard to the students, it is suggested that a contract should be implemented at the commencement of their studies. Such a contract could address what is expected from the students as well as the study leaders; it can guide the study guidance process and may diminish possible conflict. The lack of identified skills of the students can be addressed by implementing a more strict selection process and implementation of a pre-study module. If other skills deficits are identified during the study guidance process, it should be addressed either by the study leader or by referring the students to applicable resources. More emphasis should also be directed towards the development of research skills in undergraduate programs. Some of the identified study guidance problems in this study are universal, while others were unique to the specific institution and situation. Some of the proposed strategies, such as training of study leader are universal, while others such as administrative issues are specific to the institution.

High fidelity simulation is an innovative learning strategy that supports students in developing their critical thinking and clinical judgement abilities. This strategy is used in the School of Nursing at the University of the Free State (UFS) to enhance the acquisition of basic and advanced competencies of students. It was implemented for use in 2009 and is thus regarded as a new practice at the School. It was essential to determine the effectiveness of this strategy. A qualitative, descriptive and exploratory design was used to explore the learning experience of third-year Baccalaureate nursing students on high fidelity simulation (HFS). After the students were exposed to the HFS, they were invited to participate in focus group interviews. Fourteen of the 35 third-year students chose to participate. The inclusion criteria specified that the students should be registered for both their third-year nursing theory and their clinical modules and should have been exposed to the two high fidelity simulation sessions that had been presented. The focus group interviews were audio-recorded and transcribed. For triangulation purposes, data collected by means of the module evaluation questionnaire completed at the end of the semester was also used. Teschâs method was used to code the data and NVivo software implemented to simplify the process. The students described their learning experience as positive and highlighted the advantage and value of HFS as a learning strategy. They entered the learning environment anticipating that they would learn new things. Several emotions were experienced during all the phases of the simulation. They experienced fear before commencing the simulation scenario. This emotion developed into astonishment, alertness and anxiety during the simulation, but changed into self-confidence. The complexity of the simulated situation caused anxiety within the students since they were unsure of how to care for the patient. The students felt excited and stimulated after participating in the facilitated reflection session. The high-technological features of the human patient simulator, the convincing nature of the environment and the interaction within the team led the students to experience the simulation as real. Although authentic, the high fidelity simulation posed less risk than real patient care since students were permitted to make mistakes and learn from these. The students felt that they were able to integrate their theoretical knowledge with nursing practice. This integration occurred during the facilitated reflection session. The self- and peer assessment strategies to which they were exposed assisted the students in identifying gaps in their knowledge. An improvement in critical thinking and clinical judgement abilities was the result of the effective theory and practice integration that occurred. This led to an increase in self-confidence and the belief that the skills acquired during the high fidelity simulation session were transferrable to real instances of patient care. It was evident that proper preparation before the simulation is essential to ensure an optimal learning experience. The students also realised that they should have been better prepared on the subject matter, since this would have enabled them to meet the needs of the human patient simulator more effectively. It can be concluded that the HFS experiential learning opportunity that the third-year students were exposed to assisted them in integrating their nursing theory with practice. Repeated exposure to HFS learning experiences, commencing during their first year of study, might enable nursing students to develop their critical thinking and clinical reasoning skills and, together with patient contact instances, develop their clinical judgement abilities. This will prepare them, as registered nurses, to render safe and effective care to their patients.

Nursing as a profession is currently facing a multitude of difficulties and adversaries. Some of the difficulties and adversaries are poor planning within the managerial top structure of the profession, general negative opinion of the nursing profession, managed patient care by medical schemes, privatisation of hospital care and an ever changing patient profile. These factors lead to the professional nurses of today feeling overwhelmed and frustrated, who will easily leave the profession causing high rate of turnover and a loss of talent and expertise. During the course of this study the current situation within a specific private hospital was evaluated by using the Nominal Group Technique. Characteristics of a negative and a positive work environment were specified and the advantages of creating and maintaining a positive work environment were emphasised. The recommendations gathered during the nominal group sessions were categorised and prioritised to ascertain the most important and critical factors that could improve the work environment of the professional nurses. Strategies were formulated based on the recommendations generated by the professional nurses themselves to improve their work environment. These strategies could be used by the management of the hospital to improve the work environment of the professional nurses to be able to retain the existing staff and recruit interested candidates to fill the vacant positions. The hierarchical needs theory of Maslow was used during the study to indicate the importance of creating and sustaining a positive work environment for the professional nurse by first concentrating on the attainment of the lower order needs. Once the lower order needs are met, the higher order needs will become priority and once that is met, self-actualisation and fulfilment of the professional nurses will follow. Fulfilled staff working in a motivating, positive work environment will not think of leaving the profession and will deliver good quality nursing care leaving the patients feeling satisfied and well cared for.

Introduction and background: Dynamic environmental challenges compel different organizations such as the health sector to focus on innovative changes to address difficult health care challenges. The aim of the study was to develop a framework to support the fostering of intrapreneurship within unit/operational nurse managers working in three public hospitals situated in Mangaung, Free State.The objectives of the study were to analyse the concept of intrapreneurship using Walker and Avantâs framework for concept analysis; to explore the conduciveness towards intrapreneurship of unit/operational managers within the hospital working environment, to explore the intrapreneurial characteristics of unit/operational nurse managers as well as their understanding and view of intrapreneurship within the hospital working environment. Methodology: A convergent parallel mixed method design that included a concept analysis, exploratory qualitative research methodology in the form of focus groups and the application of a quantitative-type descriptive survey using Hillâs Intrapreneurial Index questionnaire III (2003) were used. Reliability was determined through the use of a pilot case study, split-half and test-retest reliability. An exploratory pilot study lead to the adaptation of a number of concepts in the survey to suit the population better. Purposive sampling was used to select participants for the qualitative data collection process that included five focus groups managed by an expert facilitator. In the quantitative data collection process, all members of the population (N=104) had a chance to participate. Ethical clearance was obtained from the Faculty of Health Sciences, University of the Free State. The ethical principles of beneficence, respect for human dignity, and justice were considered. Participation in the study was voluntary, participants were informed of the risks and benefits of the study and homogeneity of the group was maintained at all times. Findings: The concept analysis process underlined the complexity of the multifaceted concept of intrapreneurship and highlighted critical attributes such as innovation, creativity and risk-taking. The majority of the antecedents were located within the organization whilst the consequences highlighted innovative ventures, the identification of opportunities and improved performance. A total of 42 participants attended the focus group sessions with 8 to 9 participants per group. The participants were mostly women (89.7%) and between 50-59 years (55.3%). The focus group discussions yielded a number of interesting results. Participants considered the concept to relate to a business venture, innovation, involvement and of being valued. Factors that were considered conducive to intrapreneurship included for example training and development, planning, quality improvement initiatives and a business focus in the organization. They considered the infrastructure, limited resources, poor security, communication, limited respect for rights and lack of incentives as detriemental to intrapreneurship. Within the quantitative data collection process the response rate was 40% (n=42). Findings from the survey indicated a primarily low intrapreneurial intensity index. Five of the six intrapreneurial indexes as postulated by Hill scored low (leadership, policies, culture, structure and task) whilst only the employee index scored relatively high, indicating participantsâ self-valuing of own innovative vision, and courage to embrace change. Conclusion: The analysis and triangulation of data provided the conceptual data to develop a framework to support intrapreneurship in this context. The framework hinges on the external and internal environment â highlighting the positive and negative influences that come to play. The positive external environmental factors included environmental dynamicity and uncertainty as compared to negative factors such as limited organizational ownership and legislative obstacles. The internal environment outlines the importance of organizational wellbeing, organizational leadership, support and communication. Attributes within the intra-environment include innate, personal attributes of unit/operational managers, demographic and situational attributes. Recommendations from the study focussed on the enhanced teaching and learning of intrapreneurship principles and practices in the public hospital environment, the utilization of the intrapreneurship framework in nursing management programmes (formal and nonformal), the support of intrapreneurial activities at national and provincial level and the inculcation of a paradigm shift to embrace the intrapreneurial approach within health care services. The use of transformational leadership style and the capacity building of nursing teams seem to be pivotal in this process. Limitations: The small sample size in the quantitiatvie survey was a cause of concern, whilst the participantsâ limited knowledge and understanding of the concept of intrapreneurship may have influenced the meaningful identification of factors that hinder or foster intrapreneurship in the public hospital work environment â this might have lead to a focus on challenges they face from day-to-day. The current health care services context was seen to create uncertainty and fear of cutting positions. This may have resulted in insecurity amongst unit/operational nurse managers and their willingness to freely disclose matters of concern.

The aim of the study was to assess the injury profile of recruits during BMT at 3 SAI Bn Kimberley. The study objectives were to identify and describe the demography, socio-economic status and medical history of these recruits, as well as the type and mechanism of exercise-related injuries among them. The design involved a quantitative, non-experimental, descriptive design with a self-reported questionnaire as data collection technique. The demography of the recruits indicated a large majority of Blacks (83%) with very few Coloureds, Whites and Indians. The gender distribution was 46.9% (n=173) female and 53.1% male (n=196). Gender (P=2.351E-10) statistically contributed to injuries. Participants had significantly better socio-economic living standards than the average South African. The overall injury prevalence was reported as 25%, of which 19% were reported by female and 6% by male participants. Injury rates were the highest during weeks 3-4 of the BMT programme. Smoking, contraception use, amenorrhea and miscarriages prior to BMT were not found to be statistically significant injury risk factors. Being unfit was indicated as a statistically significant risk factor for injuries (P=0.0091). Having participated in sport (P=0.0296), and specifically in weightâbearing types of sport (P=0.0023), was found to have significantly reduced injuries. Females experienced higher stress levels which made a statistically significant (p=0.0034) contribution to injury prevalence. The most frequent sites of injury were the knee (40%), ankle (19%). lower leg (13%) and lower back (9%). Hydration and nutrition, as well as warm-up activities to prevent injuries were investigated. The biomechanical aspects that were reported, inter alia, indicated that the majority of the respondents had sustained injuries during activities which entailed running or falling, and most sustained muscle/tendon dislocation injuries during obstacle course training (P=0.0178). The questions regarding back-packs and external loads revealed that these did not have an impact on the prevalence of injuries. Environmental risk factor responses regarding the weather indicated that it was found very hot during training, but neither rain nor wind played a role in the injuries. The terrain mostly contributed to ligament injuries (P=0.0063) which occurred in the afternoon, especially in the middle of the training programme. The recommendations are aimed at establishing task teams to consider pre-enlistment fitness criteria, as well as remedial fitness training. Other recommendations deal with a balanced physical fitness programme, injury control programmes, and health promotion programmes. Attention is also paid to smoking, stress factors, communicable disease transmission; haemoglobin screening and the use of sun block.