Epidemiological studies have shown that vascular diseases and specifically venous diseases are the cause of lower leg ulcers, that venous diseases are the cause of 70% of lower leg ulcers in the United Kingdom and 70 to 90% of all ulcers in North America and England. In North America 10 to 15% of ulcers are the result of a combination of venous and arterial insufficiency. Two treatment modalities are available for venous lower leg ulcers: ¿ sustained compression and ¿ intermittent pneumatic compression. The aim of this study was to compare the usefulness and effectiveness of intermittent pneumatic and sustained compression with each other. To attain this objective: ¿ the profile of patients with venous lower leg ulcers was described. ¿ the effectiveness of sustained versus intermittent pneumatic compression modalities regarding wound healing were compared. ¿ the effectiveness of sustained versus intermittent pneumatic compression modalities regarding pain were compared. ¿ The factors that influence the feasibility of the two treatment modalities were identified. This study consisted of two components. In the first place a descriptive study was undertaken of the patients with venous lower leg ulcers who visited the out-patient department of a Tertiary hospital in the greater Bloemfontein area. The second component was an experimental study in which the effectiveness of the two treatment modalities were compared. The patients in the experimental study were allocated to the experimental and control groups by means of a random list. Patients in the experimental group were treated with intermittent pneumatic compression for twelve weeks, while those in the control group were treated with four-layer compression bandages for the same period. The study lasted for 27 months until the desired sample size was reached. Data confirmed the information available in the literature regarding venous lower leg ulcers. Outstanding characteristics of the profile were the majority of the patients were obese and hypertensive. The misuse of topical antimicrobic drugs became clear from the patientsâ history. It also appeared that many of the patients lacked knowledge of and insight into the causes and nature of venous lower leg ulcers, as well as their prevention and treatment. It became clear that the ulcers of more patients treated by means of sustained compression were healed than those with intermittent pneumatic compression. This difference in wound healing was, however, not statistically significant. The pain levels of the patients of both groups decreased with treatment between the first and last assessment. However, the difference between the pain levels of the experimental and control groups was not statistically significant. The most import factors that influence the feasibility of the two treatment modalities were the following: ¿ A shortage of nursing staff and doctors were experienced due to the labour intensity of the study; ¿ Communication problems (it was necessary to use an interpreter at times); ¿ A shortage of wound dressings and bandages due to unforeseen circumstances; ¿ The Department of Health under-estimated the cost implications of the treatment modalities; ¿ Intermittent pneumatic compression as a treatment modality was available only to patients in the greater Bloemfontein area. Volgehoue versus intermitterende pneumatiese kompressie as behandelingsmodaliteite in pasiënte met veneuse onderbeenulkusse 35 ¿ Sustained compression â patients from outside the greater Bloemfontein area missed a treatment session if they missed the ambulance that transported them to the hospital. ¿ Patients experienced transport problems due to high taxi fares and transport was not always readily available on public holidays or over weekends. ¿ The continuity of sustained compression had, in some cases, to be broken for some patients if the patient presented with clinical signs and symptoms of infection.

There is a human tendency to make judgements about those one is working with, as well as about oneself. Performance appraisal seems to be both inevitable and universal. With its absence, people tend to judge the work performance of subordinates naturally, informally and arbitrarily. A qualitative study was undertaken to explore and describe the experiences and expectations of registered nurses in Lesotho regarding performance appraisal. Recommendations are made according to the results of the study and these will assist the NGOs which were part of this study and the Ministry of Health and Social Welfare in Lesotho in the planning and implementing of the performance appraisals of registered nurses. Six phenomenological focus group interviews were conducted within the selected institutions to ascertain the participantsâ experiences and expectations in relation to performance appraisal. The meaning of these experiences and expectations was also explored. Basic steps in qualitative analysis as outlined by Ulin, Robinson, Tolly, & McNeill (2002) were used to analyse the data. The participants reported various experiences regarding performance appraisal. They reported experiences such as an increase in motivation and performance, receiving training, gaining insight into their own performance and being able to refer problems to supervisors as a result of performance appraisal. There were also feelings of dissatisfaction such as performance appraisal being seen as a threat, a lack of commitment, poor appraisal skills, unreliable instruments, no benefits, unclear purpose and the poor administration of performance appraisals. They also expressed their expectations regarding performance appraisal. Most of them would like the organisations to clarify the purposes of performance appraisals and their involvement in them. Both appraisers and appraisees should be trained in performance appraisal. The instruments should be reviewed, consistency in the appraisal process should be ensured and organisational decisions should be based on the results of the appraisal. The poor attitude and weak appraisal skills, inconsistencies in the appraisal process, the unclear purpose, the inability of appraisers to provide feedback and do follow-up, and also organisational decisions such as salary increments not based on the results of appraisal, were a concern across all the focus group interviews. Recommendations were made in view of both the experiences and expectations of these registered nurses. The organisation should define and clarify the purpose and the relationship between appraisal, performance and rewards, the results of the performance appraisal should be analysed and used for making organisational decisions. The full involvement of appraisees, the training of both appraisees and appraisers, more frequent appraisals throughout the year, the development and availability of standards of nursing care, the review and development of appraisal instruments, and further research are needed.

The Choice on Termination Act , No 92 of 1996 determine the circumstances in which and conditions under which the pregnancy of a woman may be terminated; believing that termination of pregnancy is not a form of contraception or population control. The act however grand women permission to terminated their pregnancies during the first 12 weeks of the gestation period, solely on her request and without reason. According to the statistics of termination of pregnancy of the Department of Health in the Free State an enormous increase in termination of pregnancies were noted after the implementation of the Act, No 92 of 1996. The believe for the practice of termination of pregnancies was that it should be done only according to the provisions of the Act, and under no circumstances as a form of contraception or to rid unwanted pregnancies. The enormous increase in the statistics of termination of pregnancies might therefore be seen as a consequence of unwanted pregnancies. The researcher thus decided due to this observation to launch an investigation to clarify the reasons leading to the increase in termination of pregnancies. The aim of the study was to identify the reasons for the high incidence of termination of pregnancies in the Free State. The objectives of the study was to identify: 1) the possible reasons for unwanted pregnancies 2) the possible reasons for termination of pregnancies. The researcher used a descriptive design as it provided an accurate portrayal of the characteristics of a paticular group in a real life situation. Data was obtained by individual structured interviews directed by the researcher by using a questionnaire. The participants in the study consisted only of clients visiting the termination clinics requesting a termination. The data was obtained in three of the institutions in the Free State rendering termination services. The instutions was selected purposively, though the participants were conveniently selected. The data-analysis was conducted by the Biostatistics department at the University of the Free State. Explanatory data, namely frequencies and percentages for categorical variables and medians and percentages for continuous variables, have been determined. The coding of the questionnaires was done by the researcher and the data was presented by using tables and figures. The researcherâs conclusion is thus that women whom request termination of pregnancies use their terminations as a form of contraception, which is forbidden by the Act, No 92 of 1996. The majority of the participants in this study however named socioeconomic reasons for their decision to have a termination. The prevention of pregnancy might decrease requests for termination of pregnancies. According to the data-analysis and conclusions, recommendations were made to increase the incidence of termination of pregnancies. Specific recommendations regarding the following aspects of the research findings were made: 1) sexual education, 2) the effective use of contraception, 3) the prevention of termination of pregnancies, 3) support of parents and family in the decision to have a termination, and 4) counselling. Recommendations regarding ongoing research according to the data-analysis and conclusions were made and focuses primarily on counselling, repeated termination of pregnancies and the psychological condition of women whom request termination of pregnancies.

Florence Nightingale was 206 years ago of opinion that Nursing is not a household sercide or charity service and that nurses should be educated Nursing today is acknowledged as a profession and the aim of Nursing Education, as formulated by the South African Nursing Council (SANC) is that student nurses should be holistically developed. In contrast to 20 years ago, professional nurses today have to function autonomously, scientifically, within legal and ethical frameworks as well as cultural congruently. It is no more expected from professional nurses to only act on doctorsâ prescriptions, to perform technical procedures or to only observe patients and record information. They have to practice as independent practitioners. In accordance to SANC requirements, students are educated in the science and art of Nursing, other related sciences as well as Ethics and Professional Practice (Björkstrom, et al., 2006:505; Davis, Tschudin & de Raeve, 2006:21; Jormsri, Kunaviktikul, Ketefian & Chaowalit, 2005, intyds; Gastmans, 2002:intyds; Taft, 2000:intyds; Hussey, 1996:251) When students apply for registration with SANC after they have completed their studies, they actually declare that they comply with the autonomy, responsibility, values and norms of Nursing and are prepared to practice accordingly. This implies that they declare that they have developed a professional identity. Development of professional identity is an ongoing process and has to be addressed, amongst others, in the teaching of Ethos and Professional Practice. The aim of this study was to understand what the nature of Professional Practice is and to assess the process of teaching of Ethos and Professional Practice at national level. The research was explorative, descriptive and explainatory in nature and both quantitative techniques and qualitative techniques were used for gathering of data. Data gathering was done in different phases, namely analysis of disciplinary hearings, focus groups, literature analysis as well as telephone interviews. The results indicate that the majority of nursing institutions teach the content appriopriate to SANCâs guidelines. These guidelines were drafted in 1985 and is currently being revised. The profile of the students who are entering Nursing has changed. It is therefore a concern that traditional teaching techniques, such as lectures, class room discussions as well as written assessment are still mostly used in teaching Ethos and Professional Practice. These techniques do not improve development of professional identity. The time allocated to the teaching of [Ethos and] Professional Practice is problematic if the development of professional identity is required. Teaching and following-up of students with regard to [Ethos and] Professional Practice in the clinical setting was found to be insufficient. Taking this into account as well as the fact that there are not sufficient positive role models present, make it impossible for students to develop a professional identity. Students who do not develop a professional identity have a greater risk of unprofessional conduct. A framework, aimed at teaching [Ethos and] Professional Practice in order to develop a professional identity was compiled. This aimes to enhance professional conduct.

Research that involves human subjects requires effective ethical consideration to protect their rights. Thorough explanation of the study and the procedures involved should be made clear and the researcher ensures that everything is understood by the respondents.

The aim of this research was to assess the problems that undergraduate nursing students of the University of the Free State encounter during placement in primary health care (PHC) clinics, which have a negative influence on their learning experience. The need for such research became evident from anecdotal feedback and the fact that primary health care is the core of the existing curriculum. A qualitative, explorative and descriptive research design was used, firstly to examine the problems experienced by the participating triad (PHC nurse practitioners, facilitators of the academic nursing school and the students) during the placement of students in PHC clinics. Secondly, the participating triad were requested to offer suggestions to improve or optimise the learning experience of future students in PHC practice. Data was collected mainly by means of nominal group technique (NGT) interviews and documentary analysis. Diverse problems and suggestions were offered. The same five categories were identified in the data of all groups, namely learning environment, professional socialisation, learning opportunities, culture sensitivity and management. However, the priority sequence of the categories as determined by the participating triad differed. The above sequence (from the highest to the lowest) was for the âproblemsâ, but for the âsuggestionsâ it was learning opportunities, learning environment, culture sensitivity, professional socialisation and management. The identified main problems were, among others, lack of support and ineffective communication. Lack of support is closely associated with negative attitudes and inadequate knowledge. Communication among institutions, within institutions and among colleagues must improve. Recommendations were aimed at improving communication with and supporting various role players. Not only must the students be supported, but those who guide them in the practice setting. The training of nursing students must take place within a partnership in which all the partners play an equally important role and discharge their responsibilities with insight and accountability.

Mount Cameroon is one of Africaâs largest and most active volcanoes, the last eruption occurring in 1999-2000. Communities in close proximity to this mountain were and could again be adversely affected by such volcanic eruptions. The goal of the study was to develop a community health adaptable model for the management of health care related hazards â not only for this community, but also for others within Cameroon and Africa. An exploratory qualitative approach to data collection and analysis was used in order to gain insight into what would be acceptable to the community. Purposive sampling was used to identify three groups of community members and a group of health care workers who have lived through a previous eruption (who turned out to be nurses and nursesâ aids only). Data was transcribed, notes made among researcher and assistants and cross-matched to arrive at occurring themes. The significance attached to the mountain and its eruptions, management strategies from the perspective of the community members and an identification of what matters most in this regard were elicited. An analysis of documented evidence from local resources focused on the realities of such a hazard, prevention and mitigation measures, as well as adaptable methods that could inform the model. The exploration of international relevant strategies in managing natural disasters in general, and volcanic disasters in particular, as well as a literature review, was conducted. The findings were triangulated to inform the development of an adaptable model. After an exploratory pilot study (pretest), using members of another community that was affected to some extent during the 1999-2000 eruption, two participant focus group discussions were held with each of three groups of community members. These included a group of elders, men and women. The findings indicated that community members regarded the mountain as a god to be appeased. Thus, some of the cultural practices exposed the community even further to hazards related to a volcanic eruption. They emphasised the protection of women and children, had some traditional health care actions in place, respected the local council for its important role, but thought that their role was marred by limitations such as infrastructure and resources. They were concerned about any evacuation process and confirmed previous negative experiences in this regard. Focus group discussions with a group of health workers indicated a slightly more scientific view of the eruptions and emphasised the livelihood value of the fertile soil surrounding the mountain. The group expressed concerns regarding cultural practices and the severe lack of health care infrastructure and resources, and expressed limited management strategies to deal with a health hazard of such magnitude. Documented evidence and literature was limited, but it was found that within Africa, concerns were similar. Management strategies were linked to a number of government departmentsâ involvement and scientific research and monitoring done by academic institutions or other facilities. Internationally, a number of directive frameworks exist but the need for an in-country framework, incorporating the needs of local communities, is emphasised in some models and approaches. Triangulation of focus group results, and an analysis of local and national documented evidence and international literature, indicated that a critical need exists to focus on the communityâs intricate relationship with the mountain (inclusive of cultural and religious practices), the involvement of community members as critical role-players, the enhancement of health care services, the development of the knowledge and skills of health care workers, and addressing or even simplifying the complex nature and directives on national level to deal with such emergency situations. These five major focus areas form the basic tenets of a community adaptable model that values being, belonging and becoming. In this way, community members are active participants in assessment, planning, implementation and evaluation.

The aim of this study was to develop a framework to expand public health care services to HIV exposed and HIV positive children in the Free State. The objectives set in order to meet the aim were to identify strategies to expand health care services to these children and to then develop a framework to expand health care services to them within the Free State public health sector. The study consisted of various component projects, depicted as phases. The researcher conducted two components, Phase 1b and Phase 2 which links to the fore mentioned objectives of the study. A colleague, conducting research as Master student, conducted Phase 1a of the study, describing health care services rendered to HIV exposed and HIV positive children in the Free State public health sector. The researcher was intimately involved in Phase 1a, as she was acting as co-study leader. Health policy research was used, which is a type of health systems research, in an effort to inform higher levels of health on policy choices. Health managers were therefore active stakeholders in the development of the framework. The identification of strategies to expand health care services to HIV exposed and HIV positive children were one such activity where stakeholders assisted in the development of the framework. The Nominal Group Technique was used to identify mentioned strategies. A draft framework was developed using the Theory-of-Change Logic model as theoretical underpinning of the framework, with the empirical foundation being based on triangulated data obtained from literature findings, Phase1a and Phase 1b of the study. During a workshop with stakeholders, the framework was finalized, providing stakeholders the opportunity to validate the identified problem, namely that of fragmented care being delivered to HIV exposed and HIV positive children, due to over-verticalisation of programs. The validation of the framework was completed by confirming the desired results, possible influential factors that could impact on the results, as well as strategies that could be followed to expand health care services to fore mentioned children. Since health policy research only informs policy choices, the extent to which the framework will actually inform policy is in the hands of the Free State Department of Health.

The purpose of the study was to describe patientsâ experience of nursing care as an indicator of the quality of nursing care that they received. Patients evaluate the quality of nursing care according to their own experience and perceptions. A qualitative, phenomenological and contextual research was done to explore and describe fifteen patientsâ experiences of nursing care. Data collection was done by means of in-depth interviews. In this study a positive experience of nursing care experience by the patients indicated patient satisfaction and therefore that quality nursing care was rendered. Negative experiences indicate that the patients were not satisfied with the nursing care and therefore quality nursing care was not rendered. The data was analysed according to the steps described by Tesch. The following characteristics that describe quality nursing care were identified: applicability, professional knowledge and competence, therapeutic environment, acceptability, accessibility and patient satisfaction. The respondents experienced the professional behaviour of nurses as well as their dedication in doing nursing procedures as positive. Communication and pain management that forms part of professional behaviour, were negatively experienced by most of the respondents. Accessibility was also positively experienced by the majority of the respondents. The therapeutic environment as part of quality care was experienced as both positive and negative by an equal number of respondents. Acceptability of nursing care was experienced as positive, meaning that quality nursing care was rendered. Respondents experienced applicability negatively due to the fact that they experienced that the personnel was short staffed. Respondents experienced that this lead to a high working load. The majority of respondents experienced patient satisfaction. It is indicated through this study that the experience of the patient of the most important role player in health care, the patient, could differ from the information obtained through questionnaires or surveys. This finding should not merely be ignored if rendering of quality care is an important focus of a company or department.

The aim of this study was to investigate reported needle stick injuries amongst health care workers in regional hospitals in the Free State Province during the time period January 2006-September 2007. Needle stick injuries were defined as any injury caused by different types of needle devices, irrespective of the purpose of use. A quantitative, non-experimental, descriptive and retrospective design was used. Data was collected through an interview using a questionnaire. The total population interviewed was 100 health care workers, namely doctors; professional nurses; staff nurses; auxiliary nurses and general assistants. Descriptive statistics, namely frequencies and percentages for categorical data, medians and percentiles for continuous data were calculated and compared by means of 95% confidence intervals for all categories of health care workers. The results of the study indicated that health care workers are at risk of sustaining needle stick injuries in the course of their work. The reported causes of the needle stick injuries were issues related to policy non-compliance, coupled with the use of unsafe needle devices. Ninety-nine health care workers (91.92%) were aware of the needle stick injury policy, eighty health care workers had in-service training (80%) on the prevention and eighty-three health care workers had in-service training on the management of needle stick injuries (83%). Fifty general assistants (50%) reported needle stick injuries due to wrong disposal of used needles. Injection needles (47%) accounted for the majority of needle stick injuries. A total of eighty health care workers (80%) reported two to six times occurrences of needle stick injuries. The peak time of needle stick injuries reported was between 07:00-10:00 for all health care workers, except for doctors. Less needle stick injuries were reported between 19:00-23:00 (8.42%:n=8/95) and between 23:00-06:00 (6.32%:n=6/95). Health care workers (85%:n=85) received post exposure prophylaxis (PEP) within two hours post needle stick injuries. The findings indicated that there is a need to address the needle stick injury âpolicy implementationâ and âreviewâ to include updated exposure prevention strategies. Continuous training of health care workers and evaluation of such interventions should be done to reduce the exposure to needle stick injuries. Policy compliance needs Management support and a team approach.