High school adolescent's suicidal behaviour caused a concern to the Umzimkulu community and the multi - disciplinary team in the local Psychiatric institution during the years 1997 - 1999 . The purpose the study was to identify and describe the charactics of adolescents who committed suicide. Rutter's (1995) model of risk. resilience and recovery has been used as a theoretical frame work for the study. A descriptive, exploratory case study design is most suitable for the incidence of suicide at Umzimkulu District .The case study approach was best suited as it assists in an indepth study focussing on contemporary phenomena with sum real life contexts . The distinctive need for the case study design arises out the desire to understand complex psycho-social phenomena of adolescent suicide (Yin, 1989).Each adolescent who committed suicide over the last two years in Umzimkulu District will form a case . All data about the particular person will be the case description Adolescents who committed suicide were identified from the records at the police intelligence office of Umzimkulu Police Station. Parents, identified friends, teachers and health workers who had known the adolescents. Semi structured interviews with open ended questions were used. Interview schedules for teachers, parents and close friends differed slightly. A tape recorder for later transcription was utilised. To analyse the data, Ruttter's model was utilised to do cross case analysis. Results according to Rutter's model, were that, due to inconstant support received by the adolescents, high levels of stress in early child hood, had left them insuffiently resilient to with stand the problems they encountered during adolescence. / Thesis (M.Cur.)-University of Natal, Durban, 2001.

The study was designed to examine and describe mental health care provided by the nurses in the primary health care settings of Swaziland. The study sought to answer one main questions namely: • what was the nature of mental health care provided by nurses in the primary health care clinics? A sample of 31 primary health care clinic nurses was used to generate data for the study. The sample consisted of registered nurses with only one having a mental health qualification. The study used both qualitative and quantitative methods for data collection. Data analysis involved simple frequency and percentage counts using SPSSmanual as well as descriptive narratives using NVIVO computer analysis methods. Findings revealed that mental health care in the primary health care clinics was mainly traditional involving immunizations, family planning and antenatal services, Limited mental health care was provided by the only mental health nurse involved in the study, Nurses stated that the care they provided was in line with their job descriptions, The study concluded that the mental health care provided at the primary health care clinics was based on the traditional approach that did no encompass mental health care, Recommendations made were related to the promotion of the integration of mental health care into the services provided in the primary health care scttings with nurses being prepared for the role. / Thesis (M.Cur.)-University of Natal, Durban, 2000.

Introduction: the number of orphans world wide including Malawi, has increased greatly due to the Acquired Immune-Deficiency Syndrome (AIDS). The increased number of orphans has led to the development of community based strategies for continuity of care to orphans. People in various communities offer themselves as volunteers to care for the orphans with an aim to providing the best care possible. Due to the increased number of orphans, the caretakers are challenged in the provision of care, to promote the health status of the children. Purpose: The purpose of the study was to determine the knowledge and health information needs of caretakers in orphan care at the Mphatso day care centre in Lilongwe, Malawi. Methodology: A descriptive qualitative approach was used to determine the knowledge and health information needs of caretakers of orphans. Using a descriptive qualitative research method, the researcher interviewed eight participants working as volunteers at Mphatso Orphan Day Care Centre in Lilongwe, Malawi. Data analysis: In the study, a general content analysis approach was used. In this approach, the audio taped data were transcribed verbatim and translated from Chichewa to English soon after data collection prior to the next day of interview. Transcribing verbatim was done by listening to the tape recorded interviews several times until all the data were captured. Data were thereafter, displayed, reduced and organized into categories and sub categories. Results: Results generated from the study revealed that the caretakers benefit from training prior to the adoption of the caring role. The caretakers were also knowledgeable about the health challenges of the orphans, the concept of caring and health information needs that can help them provide the best care possible to the orphans. Conclusion: Children are facing the tragedy oflosing one or both parents to AIDS. Ifone parent is infected with HIV, there is a high probability that the other parent is also infected and so the entire family faces the threat of illness and later on death. Despite the death of these parents, the children left behind require the continuity of care. Volunteers shoulder the responsibility of caring for the children left by the deceased families. As such, there is need to support those who have dedicated their time to the orphans. Apart from material and financial resources, there is need to support the caretakers of orphans in institutions of care with health information relevant to orphan care. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

HIV is major public problem in the world and in Sub-Saharan Region in particular. The literature has shown that mental disorders and particularly depression are common among people living with HIV/AIDS, but that little is known about the prevalence of depression and factors associated with it, among people living with HIV/AIDS in Rwanda. A descriptive, cross-sectional study was done to assess the prevalence of depression, the clinical profile and the factors associated with depression among people living with HIV and attending a primary health care centre in Kigali-Rwanda. This study was informed by the stress and vulnerability framework. A questionnaire was used to collect socio-demographic and HIV related medical information, while depression was assessed using the Beck Depression Inventory Scale, with a cut off of less than 10 for no depression and above 10 scoring positive for depression. Respondents were randomly selected from the patient appointment list for patients who were scheduled during the period of data collection and according to the sample selection criteria. The sample consisted of 96 people living with HIV. Permission to conduct the study was requested and obtained from the University of Kwazulu-Natal Ethics Committee, from the CNLS Research and Ethics Committee in Rwanda and from the management of the health care centre to consult patients' files. Data was analyzed using the Statistical Package for the Social Sciences (SPSS for window, 15). Descriptive data was analyzed by means of frequencies, mean and standard deviation. Cross tabulation using Pearson' chi-square test was performed to test the association between sociodemographic factors and HIV related medical information and depression for categorical variables, while t-test for independent simple test was performed for continuous variable. Multi logistic regression analysis was performed to test further association between the above mentioned factors with depression, while controlling for confounders. The results were presented by means of tables, histograms and graphs. The findings of the study revealed that depression is very high among HIV-infected patients attending a primary health care centre in Kigali, with a prevalence of 41.7%. The most frequent depressive symptoms presented were pessimism, fatigability, sad mood; lack of satisfaction, somatic preoccupation, loss of libido, crying spells, work inhibition, irritability, social v withdrawal and loss of appetite. The majority of respondents scored mild to moderate depression, whereas few had moderate to severe depression and only very few scored severe depression. Having considered all other socio-demographic and HIV related medical factors that were studied, being a female, having presented many HIV-related symptoms in the month prior to data collection, and having less than 250 CD4 counts were statistically associated with depression. On the other hand, having high social and family support was a protector factor to depression. Although the results of this study are not generalizable to the Rwandan population living with HIV, they underscore the importance of integrating mental health in HIV/AIDS services for the care of those who present mental problems related to HIV such as depression. / Thesis (MN)-University of KwaZulu-Natal, Durban, 2010.

The purpose of this study was to describe current tube feeding knowledge and practices to target appropriate quality improvement interventions. This study was important because literature has demonstrated gaps in nurses' knowledge and practice in this area. The Synergy model of patient care was used as a conceptual basis for this study. Two data collection methods were used. A quantitative descriptive survey of nurses, using a questionnaire to collect information about knowledge and practice was undertaken concurrently with a retrospective review of case files between June and July, 2010. Ethical approval was sought from the relevant authorities. The whole population of nurses available was used, and a sample of 51 nurses that met the inclusion criteria responded to the questionnaire (100% response rate). A total of 78 eligible case files were reviewed using a checklist. SPSS Version 15 was used to analyse the data. The findings revealed that most nurses (98%) had received tube feeding training while at college. However, nearly the same number of nurses (96%) reported having received no in-service training on tube feeding. The findings showed variability in the levels of knowledge. Furthermore, the use of outdated method, to confirm proper tube placement was reported. The majority of respondents reported that they document the care given, but this was not evident in the review of the case files. Environmental aspects such as tube/feed shortage, lack of guidelines and patients/ guardian refusal of tube feeding were reported as common problems affecting nurses' practice. The standards for tube feeding suggested from literature are not attained. The characteristics of a nurse and the environment of care have an implication in tube feeding practices and can ultimately help to eliminate the gap in practice. The nurses' current knowledge and practice is a cause for concern. Recommendations include education, evidence based protocols and other efforts to improve tube feeding practice. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

Emergency department overcrowding is a growing problem worldwide including Rwanda. Literature shows that this problem has an impact on the functioning of the health care system and the quality of care provided. Research Methodology. This study aimed at exploring the phenomenon of overcrowding in ED/CHUK. Fifty one self-administered questionnaires were distributed to 40 ED nurses; these comprised three questions related to demographic data and 48 questions related to overcrowding. Correlation between overcrowding and causes and overcrowding with outcomes was explored and the pearson's test demonstrated that there is no linear correlation between these variables. Results. Findings from the demographic data demonstrated that the majority (92%) of ED nurse's were young (aged between 20 to 35 years). The majority (74%) of ED nurses had less than one to three years of experience in ED. With regard to overcrowding characteristics; nurses reported that the patient's waiting time for a physician varied between less than 30 min to more than 180 min; ED beds occupancy varied between 1 hour to more than 24 hours; patients were placed in the ED hallways for 1 hour to more than 24 hours; waiting room occupancy varied between less than 1 hour to more than 24 hours. Nurses attributed overcrowding to a variety of causes, including; a lack of inpatients beds (95%), large volume of trauma patients (87%), patients with no urgent condition (66), inappropriate referral of chronic cases (61 %), space limitation in emergency department (76%) and insufficient acuity ED beds (74%). Perceived outcomes (impact) were also multiples including, boarding patient in ED (92%), increased stress among nurses (79%), stress among physicians (60%), and risk of poor outcomes (60%), staff dissatisfaction (58%), violence between health care providers and patients (60%) and increased patient waiting time (58%). Regarding the undertaken interventions to reduce ED overcrowding, 100% of respondent asserted that there was some sporadic interventions, but not consistent. Recommendations: Like in other countries ED/CHUK overcrowding is a complex problem that needs to be addressed by all stakeholders: CHUK managers, hospital staff, ED staff, Rwandan district hospitals and Ministry of health. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2008.

It has been reported for over the last decade that the quality of nursing care provided towards patients has decreased tremendously. The literature shows the impact of poor quality nursing to patients and assumes the influence of nurses’ perceptions of quality nursing care on its delivery. However, studies about such perceptions are still few in Rwanda. Aim: The purpose of this study was to explore the perceptions of quality nursing care among nurses working in two district hospitals in Rwanda. Methodology: A non-experimental exploratory descriptive design which was quantitative in nature was used. A self-report questionnaire comprised items related to socio-demographic characteristics of participants, perceptions of quality nursing care, nurses’ role in continuous quality improvement and factors affecting the delivery of quality nursing care. The sample was obtained through a purposive non-probability sampling of the nurses (n=150) who were available during data collection from 16 to 28 October 2011, with a return rate of 110 (73%) of completed questionnaires. Results: The findings from demographic data indicated that many of nurses were young, with 48.2% falling into the 20 to 30 year old bracket and the majority of the participants (83.3%) were enrolled nurses. Many of the participants were new to the nursing profession, with 47.2% falling into the 6 months-5 years working experience bracket. This study suggests that nurses had an appropriate perception of quality nursing care, as evidenced by the mean score of 4.183 (SD: .5741), related to nurses’ understanding of quality nursing care with mean score of 4.137 (SD: .5763) for the perceptions of the delivery of quality nursing care. The role played by nurses in continuous quality improvement was evident, but it was constrained by the factors related their nursing practice environment, including: shortage of nurses, lack of time, heavier workloads, and few opportunities for advancement. Conclusion: In summary, this study provided insights into nurses’ perceptions of quality nursing care, and their current ongoing endeavours to provide quality improvement in spite of challenges in their workforce environment. This study has described the challenges which interfere with the delivery of quality nursing care that need to be addressed so that patients may benefit from evidence-based care. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

Aim: The aim of this study was to investigate the educational shortcomings as evident in the literature reviewed with the intention of developing intervention/s thus contributing to practice, management, research and education. Background: Literature identifies many limitations in psychosocial support to families of patients in ICU. Little is known about the continued educational support the ICU nurses receive, formally and informally, to empower them to provide psychosocial support to the families of ICU patients. Methodology: The mixed method (concurrent triangulation design), was adopted using the survey for both the quantitative and qualitative approach. In-depth interviews, conversations, participative observation and the review of documents were used to collect data. Collection of data occurred simultaneously. A research instrument and guide were used to obtain quantitative and qualitative data respectively. Setting: Purposive sampling was used for the selection of hospitals within which the chosen ICUs were located and the educational institutions which provided the formal education and training to ICU nurses who worked in these hospitals. Participants: The qualitative arm involved interviews with a purposively selected sample of critical care nurses. Saturation was reached after nine interviews. A sample size of 34 (n=34) was used in the quantitative arm of the study. Convenience sample was used. Data Analysis: A mixed method approach was adopted. The study applied a thematic analysis according to the qualitative analysis described by Creswell 2007. Descriptive statistics were used to summarize data and findings were presented in tables and graphs. The SPSS version 15.0 and STATA statistical package calculate non – parametric tests between selected study variables. Findings: The main themes derived from the qualitative analysis and confirmed by the statistical data demonstrated the manner in which continued education preparation was inadequate, the lack of specific clinical accompaniment, the lack of direction in terms of the philosophy of the units, ICU nurses being left on their own to obtain educational preparation. The results indicated that the lack of continued informal education at the unit and hospital level influenced the ICU nurses’ lack of implementation of psychosocial support to families of ICU patients. Statistical results and qualitative themes were converged and integrated during data analysis. Jamerson et al.’s (1996) model of family experience was used to contextualise the findings. Recommendations: Recommendations arising from the study were made for improvements in nursing practice, nursing management, nursing education and future nursing research. A practice checklist was formulated and expert opinion was sought using the Nominal Group Technique. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

Background: In South Africa there data is lacking on the health of the older population. This study aims to report on actions taken by general practitioners on abnormal blood pressure, blood glucose and osteoporosis screen identified by registered nurses, conducting home based visits to older clients. Methods An agency piloted the Comprehensive geriatric assessment (CGA) tool in an urban affluent population. In this cross sectional secondary study analysis, 465 participants aged 60 years and over had a nurse visit in their homes and a subsequent General Practitioner (GP) visit. The prevalence of specific geriatric problems was assessed as well as the frequency of initiated procedures by the GP. This study will focus on initiated actions by the General Practitioners in response to abnormal blood pressures, blood glucose, and osteoporosis screen. Results Frequency tables were utilised to identify prevalence of the abnormal blood pressures, blood glucose and osteoporosis screen. . Abnormal blood pressures were detected (230/465, 49%) of the subjects , the GP initiated actions on only 15/465 (3.2%) of clients. Abnormal blood sugars were detected 106/465 (23%) of the GP initiated actions on 23/465 (5%) of clients. Clinical risk factors for the development of osteoporosis were detected in 252 /465 (54%) subjects GP initiated actions on 11/465 (3%) Conclusion This study explored the relationships between comprehensive geriatric assessment and subsequent GP actions and found using the CGA in this population will be successful in identifying abnormal health findings which will enable intervention. However, due to challenges in the communications and marketing of this service, GP’s were not well informed of their role and did not act on majority of the abnormal findings detected by nurses / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

The focus of this study was on common psychiatric comorbidities of depression and anxiety in people with epilepsy (PWE). While international published data show that up to 60% of PWE suffer from depression and/or anxiety, most primary care (PHC) settings in developed countries display some oversight in this area. The study was conducted in Zambia, in three phases; which each culminated in submissions for publication in an internationally peer reviewed journal. Phase one involved chart review to establish the rate of detection of depression and/or anxiety in PWE at the outpatient clinic of Chainama Hills College Hospital. The detection rate was only 1%. This formed the basis for phase two where we developed a ten item screening tool for depression and/or anxiety for use by PHC workers in busy clinical settings. The tool was validated, its sensitivity and specificity were determined and the inter-rater reliability was also calculated. Phase three involved implementation of the tool validated screening tool. We measured the ability of PHC workers to use and interpret the screening tool in busy clinical settings. One month after training and implementing the use of the screening tool, a retrospective chart review was undertaken using the same tool that was employed in phase one chart review. There was a marked improvement when 120 files of PWE were reviewed as the percentage of screening for depression and anxiety increased from 1% to 49%. / Theses (Ph.D.)-University of KwaZulu-Natal, Durban, 2014.