Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Research indicates that human touch plays an integral role in an infant’s ability to thrive and grow, with a correlation existing between tactile stimulation and optimal physical, emotional, cognitive, and social development. The aim of this study was to explore the level of knowledge of first time mothers attending Mowbray Maternity Hospital (MMH) regarding the importance of tactile stimulation during infancy and early childhood. A descriptive, non-experimental, research design was employed, using a pilot tested structured questionnaire for data collection during face-to-face interviews conducted by the Principal Investigator. Questions were divided into four domains: knowledge about the impact of tactile stimulation on the bonding domain, the emotional domain, physical domain and the social domain of infants and children. The inclusion of one open-ended question allowed participants to suggest recommendations for improved knowledge and care. A sample of 41 participants, constituting 40% of the study population (N=101) was randomly selected from MMH. Prior ethical approval was obtained from the Human Research Ethics Committee of Stellenbosch University, and operational approval from the Western Cape Department of Health, and the Research Committee and Senior Management of MMH. Written informed consent was obtained from the study participants. The quantitative data was analysed using Statistica (Version 10) with the assistance of a statistician. The qualitative data yielded from the one open-ended question was analysed thematically and then quantified. The findings show that 90% (n=37) of the participants were knowledgeable about tactile stimulation strategies, 81% (n=33) knew about the impact of tactile stimulation on the bonding domain, 75% (n=31) on the emotional domain, 52% (n=21) on the physical domain and 43% (n=18) on the social domain. Although all participants had reported for out-patient antenatal care on four and more occasions, 73% (n=30) indicated that they had improved their knowledge regarding pregnancy, labour, birth, and parenting by reading magazines, 20% (n=8) reported that a health care worker had spoken to them about the benefits of tactile stimulation, and 15% (n=6) had received literature on the benefits of tactile stimulation. The open-ended question generated several findings which included suggestions to enhance healthcare by providing information and training about tactile stimulation and perinatal matters when attending antenatal clinic; by offering assistance with infant feeding during the postnatal period; and by improving the attitude and professional stance of health care workers. The study findings suggest that first time mothers at MMH are not adequately knowledgeable about the importance of tactile stimulation during infancy and early childhood. Grounded in the empirical findings and based on the suggestions offered by the participants, several recommendations, including improved information and training, were identified toward strengthening tactile stimulation knowledge and practice at both the parental and health care provider levels. / AFRIKAANSE OPSOMMING: Studies toon dat menslike aanraking ‘n belangrike rol in ‘n baba se algemene vermoëns om te groei speel, terwyl ‘n positiewe korrelasie tussen koestering en optimale fisiese, emosionele, kognitiewe en sosiale ontwikkeling bestaan. Die doel van hierdie studie was om vas te stel of moeders, wat vir die eerste keer geboorte geskenk het, en geskeduleer was om by Mowbray Kraamhospitaal geboorte te skenk, ingelig was aangaande die belangrikheid van streling tydens babaskap en die vroeë kinderjare. ‘n Beskrywende, nie-eksperimentele navorsingstudie is uitgevoer, deur van ‘n gestruktureerde, onderhoudsvraelys vir die insameling van data gebruik te maak. Vrae was opverdeeld in die volgende seksies: kennis rakende die impak van babastreling op die band tussen moeder en baba, kennis rakende die impak op die emosienele dimensie, en kennis rakende die impak van babastreling op die fisiese en sosiale dimensies van babas en kinders. Die ewekansige gekose studie-groep van een-enveertig deelneemers het 40% van die studie-populasie uitgemaak. Voorafgaande etiese en operationele toestemming is vanaf die Menslike Etiese Kommittee van die Universiteit van Stellenbosch, die Wes-Kaapse Departement van Gesondheid en vanaf die Navorsings kommittee en Bestuur van Mowbray Kraamhospitaal verkry. Geskrewe toestemming is voor aanvang van die een-tot-een onderhoude vanaf die deelneners verkry. Die kwantitiewe data is met die hulp van ‘n statistikus deur die gebruik van die sagteware, Statistica (Weergawe10) geanaliseer. Die kwalitiewe data wat na aanleiding van die oop-eindigende vraag verkry is, is tematies geanaliseer en gekwantifiseer. Die resultate het getoon dat meeste 90% (n=37) van die deelnemers met die algemene praktyke van babastrelingstrategië gedurende babaskap bekend was. Die persentasie vir deelnemers se kennis rakende die impak van babastreling op die band tussen moeder en baba was 81% (n=33), en vir kennis omtrent die emosienele dimensie 75% (n=31), die impak van babastreling op die fisiese 52% (n=21) en die sosiale 43% (n=18) dimensies van babas en kinders. Alhoewel alle deelneemers vir voorgeboorte kliniek gerapporteer het, het 73% (n=30), terugvoer dat hulle hulle kennis omtrent swangerskap, geboorte en ouerskap verbreed het deur tydskrifte te lees, 20% (n=8) van die deelnemers gerapporteer het dat ‘n gesondheidswerker met hulle omtrent die voordele van babastreling gepraat het, terwyl 15% (n=6) leesmaterial rakende die voordele van babstreling ontvang het. Die oop-eindigende vraag het verskeie bevindings opgelewer met voorstelle met betrekking tot die verbetering van gesondheidsorg en opleiding, opleiding aangaande die voorgeboortelike sorg wat hulle ontvang het en aangaande perinatale aangeleenthede en stimulasie van babas deur streling. Deelneemers het ook voorgestel dat verpleegsters hulp aan moeders behoort te verleen met die voeding van hul babas in die periode na geboorte en dat gesondheidsorgwerkers hulle professionaliteit en gesindhede jeens pasiënte behoort te verbeter. Ten slotte het die uitkomste van hierdie studie aangedui dat, moeders wat vir die eerste keer geboorte geskenk het by Mowbray Kraamhospitaal, onvoldoende kennis dra oor die belangrikheid van stimulasie van hulle babas en jong kinders deur streling. Gegrond in die empiriese bevindings en gebaseer op die voorstelle van deelnemers, is verskeie aanbevelings geïdentifiseer vir die moontlike verbetering van kennis rakende streling op die ouer- en gesondheidswerkervlakke.

Thesis (NCur (Nursing Science))--University of Stellenbosch, 2008. / The current shortage of nurses has reached crisis proportions in South Africa and the effects of decreased numbers of health professionals are enormous. This results in far-reaching consequences for the health industry. An increased use of less-skilled personnel, in an attempt to meet the health care needs, impacts negatively on quality care. Personnel are often utilised outside their scope of practice, creating a high-risk therapeutic environment for the patients and health care workers alike. Consequently, the nursing managers and employers of nurses are currently faced with major challenges in ensuring that the nurses practise their profession within a safe and healthy environment, and within the legal and ethical framework of the nursing profession. For the purpose of this study the researcher decided to explore legal and ethical aspects influencing the clinical practice of the nurse. Specific objectives were set for the study. • Are nurses functioning outside their scope of practice? • Do nurses exercise their nursing right? • Do nurses function within ethical and legal guidelines? • Do caregivers function as nurses? • Do nurses still believe in the nursing philosophy? • Are nurses exploited in their area of work? • How much overtime do nurses work? These objectives were met through an in-depth explorative descriptive research design with a quantitative approach to explore legal and ethical aspects in the nursing practice. A stratified sample was drawn of all categories of nurses in selected private hospitals in the Western Cape Metropolitan area. Through the use of a questionnaire, data was collected personally by the researcher. Data analysis techniques that were used were based on descriptive and explorative procedures. Data was compressed in frequencies, percentages, means and standard deviations. The Chi-square test was applied. Findings include the following: • 53% of enrolled nursing assistants do not function under indirect supervision. • 40% of caregivers assist nurses with interventional nursing care. • Nurses still believe in the philosophy of the nursing profession. • The nurse’s rights are in contradiction with the patient’s rights (p = 0.08). • Nurses feel exploited in certain areas of work, depending on their qualifications. • Nurses do recommend the profession (p = 0.043). • Enrolled nursing assistants do not respect other religions (p = 0.04). • Nurses feel free to discuss the patient’s progress with the doctor depending on the nurses’ years of experience (p = 0.03). • 23% of nurses love to care for their patients. Recommendations were made based on the findings. • The patient approach should be respectful, not judgemental, accepting the patient’s right to self-autonomy. • Nurses should realise their autonomous role in addressing concerns. • A staff mix should be utilised that facilitates safe and professional nursing care. • Unfavourable or unsociable working conditions in some units such as the theatre should be addressed. • Managers should match the work load with a proper skills mix and competency. • Nursing practice should take place within the professional and statutory scope of practice of the nurse. • Nurses should keep up to date with knowledge through continuous professional development. • Caregivers should be regulated, installing the nursing philosophy and ethics into their practice.

Thesis (MCur (Nursing Science))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Every patient comes to a hospital with the expectation of getting quality care. It is not always within the ability of nursing personnel to give quality care in the work situation. Guided by the research question “What are the factors influencing the quality of nursing care in district hospitals in the West Coast Winelands Region of the Western Cape?” a scientific investigation was undertaken. The goal of this study was to identify the factors which influence the quality of nursing care in the eight (8) district hospitals of the West Coast Winelands Region of the Western Cape. The objectives set for the study were:  to determine whether staffing is adequate for all activities;  to evaluate what the perceptions of the nursing staff is about their current working situation;  to determine what the effect of the absence of full time doctors are on the management of patient care;  to evaluate whether adequate equipment is available for the execution of nursing care and to evaluate whether adequate provisions for the execution of nursing care is done. A descriptive non-experimental design with a quantitative approach was applied. The population for this study was all the nursing staff available at the time of data collection, working in the eight district hospitals of the West Coast Winelands Region. A structured questionnaire was used to collect the data. The final sample of nursing staff was N= 280 of a total population of 340 – all the members were invited to participate. Reliability and validity were assured by means of a pilot study and the use of experts in nursing research, methodology and statistics. Data were collected personally by the researcher. Ethical approval was obtained from Stellenbosch University and various health authorities. Informed written consent was obtained from the participants. The data was analyzed with the support of the statistician; it was expressed in frequencies, tables and histograms. Comparisons between variables were made using either ANOVA (Analysis of variance) techniques or cross-tabulations with the Chi-square test. The 95% confidence interval was applied to determine whether there was an association between the various variables. The analysis shows that participants of the separate wards hospitals N=142 (90%) and the mixed wards type hospitals N=113 (95%) disagree that staff provision (numbers) is adequate. From the analysis it is clear that the patient documentation is not up to standard. A statistical significant correlation between hospital type and adequate time for the completion of written records (Chisquare Test p=0.00) was shown. Management N=13 (100%), registered nurses N=80 (86%), enrolled nurses N=63 (86%) and nursing assistants N= 81 (83%) disagree that it is not necessary to act beyond their scope of practice. The following recommendations were made: Safe staffing levels have to be determined; qualify staff with the necessary skills; where unit managers are still lacking, they have to be appointed; to make personnel development possible for staff; continuous auditing of patient documentation. It is necessary that there is always adequate equipment and consumables. More training is necessary for the effective and efficient implementation of the Batho Pele principles. / AFRIKAANSE OPSOMMING: Elke pasiënt kom na ‘n hospitaal met die verwagting om kwaliteit verpleegsorg te ontvang. Dit is nie altyd binne die vermoë van die verpleegpersoneel om sodanige diens te kan lewer nie. “Watter faktore het ‘n invloed op die lewering van gehalteverpleegsorg in die distrikhospitale van die Weskus Wynlandstreek in die Wes Kaap? het die wetenskaplike ondersoek gelei. Die doel van die studie is om die faktore te identifiseer wat ‘n invloed het op die lewering van gehalteverpleegsorg in die ag (8) distrikhospitale van die Weskus Wynlandstreek in die Wes Kaap. Die doelwitte van die studie is:  om te bepaal of personeelvoorsiening voldoende is vir al die aktiwiteite;  om te evalueer wat die persepsies is van die verpleegpersoneel betreffende hulle huidige werksituasie,  om te bepaal watter effek die afwesigheid van voltydse geneeshere het op pasiënte sorg;  om te evalueer of toerusting voldoende is vir pasiënte sorg;  om te evalueer of daar voldoende voorsiening gemaak is vir die lewering van pasiënte sorg. ‘n Beskrywende, nie-eksperimentele ontwerp as metodologie is gebruik met ‘n kwantitatiewe benadering. Die bevolking betreffende die studie was alle verpleegpersoneel, werksaam tydens die insameling van die data in die ag distrikhospitale van die Weskus Wynlandstreek. ‘n Gestruktureerde vraelys was gebruik om die data te versamel. Die finale steekproef van die verpleegpersoneel was 280 uit die totale bevolking van 340. Betroubaarheid en geldigheid is verseker deur middel van ‘n loodstudie, en deur gebruik te maak van kenners betreffende verpleegnavorsing, metodologie en statistieke. Data is persoonlik deur die navorser ingesamel. Etiese goedkeuring was verkry vanaf die Universiteit van Stellenbosch en die verskeie gesondheidsowerhede. Ingeligde, skriftelike toestemming is van elke deelnemer verkry. Data is ontleed met die ondersteuning van die statistikus en is uitgedruk in die vorm van frekwensies, tabelle en histogramme. Vergelykings tussen die veranderlikes was gedoen deur gebruik te maak van ANOVA (analise met betrekking tot variansie) en kruis-tabulerings met die Chi-kwadraat toets. 95% Betroubaarheidsinterval is toegepas om te bepaal of daar ‘n assosiasie was tussen die onderskeie veranderlikes. Die analise het getoon dat deelnemers betreffende die hospitale met aparte afdelings N=142 (90%) en die gemengde sale hospitale N=113 (95%) verskil, betreffende die stelling dat daar voldoende personeelgetalle is. Dokumentasie is volgens die analise nie op standaard nie. ‘n Statistiese betekenisvolle korrelasie is verkry met betrekking tot die hospitaal tipe en voldoende tyd betreffende volledige geskrewe dokumentasie (Chi-kwadraat Toets p=0.00). Verpleegbestuur N=13 (100%), geregistreerde verpleegkundiges N=80 (86%), stafverpleegsters N=63 (86%) en verpleegassistente N=81 (83%) het verskil met die stelling dat dit nie nodig is om buite bestek van hul praktyk te werk nie. Die volgende aanbevelings is gemaak: die bepaling van veilige personeel vlakke moet gedoen word; voldoende personeel moet gekwalifiseer word met die nodige vaardighede. Eenheidsbestuurders moet aangestel word waar dit ontbreek; personeelontwikkeling moet moontlik wees en deurlopende oudits van dokumentasie moet plaasvind. Voldoende toerusting en voorraad is nodig om kwaliteit verpleegsorg moontlik te maak. Verdere opleiding in die beginsels van Batho Pele is nodig ten einde effektiewe en doeltreffende implementering daarvan moontlik te maak.

Thesis (MCur)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: Nationally and internationally emphasis is placed on quality care in health services. The researcher identified a need to evaluate a component of primary health care service in the Northern province. A study based on the combination of qualitative and quantitative methods was conducted to formulate and evaluate structure, process and outcome standards for selected clinics in the Northern Province. The most important results are: • The standard relating to the structure was suboptimal. Physical and human resources are of critical importance to the rendering of quality patient care. However this did not comply with the pre-set standard norm of 80%. • Process standards focused on physical examination of patients taking into account the age of the client and the systems involved. Substandard care was found in all these aspects. • Outcome standards determined by the patient questionnaire also revealed negative findings. Recommendations include the development of a quality improvement model for the Northern Province Health Services, formulation of standards for all disciplines of health care, annual evaluation of patient care and the institution of a formal staff development programme. Key words: quality care, formulation of standards, structure, process, outcome / AFRIKAANSE OPSOMMING: Nasionaal en internasionaal word die belang van gehaltesorg in gesondheidsdienste beklemtoon. Die navorser het enbehoefte ge'identifiseer om en component van prirnerre gesondheidsorgdienste in die Noordelike provinsie te evalueer. en Kombinasie van kwalitatiewe en kwantitatiewe metodes is gebruik om struktuur-, proses en uitkomsstandaarde in geselekteerde klinieke in die Noordelike provinsie te formuleer en evalueer. Die belangrikste resultate was: • Die standard ten opsigte van die standard was suboptimal. Fisiese en menslike hulpbronne is van kritiese belang vir gesondheidsdienslewering. Die standaard hiervan het nie voldoen aan die voorafbepaalde norm van 80% wat gestel is nie. • Prosesstandaarde het op fisiese ondersoek van die pasiente gefokus met inagneming van die ouderdom van die klient en die simptome waarmee pasiente presenter. Sub-standaardsorg is ten opsigte van al hierdie aspekte gevind. • Uitkomsstandaarde is deur middel van en pasientevraelys gemeet en he took negatiewe bevindinge opgelewer. Aanbevelings sluit in die ontwikkeling van engehalteversekeringsmodel vir die Noordelike Provinsie se gesondheidsdienste, die formulering van standaarde vir aile dissiplines van gesondheidsorg, jaarlikse evaluering van pasientesorq en die instelling van enformele personeelontwikkelingsprogram. Kernwoorde: Gehaltesorg, formulering van standaarde, struktuur, proses, uitkomsstandaarde.

Thesis (MCur)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: Nurses are being held responsible and accountable for the quality of nursing care, which includes quality infection control nursing, they provide. This change in accountability has been brought about by the need to reduce the ever escalating costs of health care. During the 1980's, health care services created a demand for high-quality, efficient, cost-effective and competitively priced health services. In order to provide these services, health care organisations are forced to consider new strategies. This is a process that produces outcomes. Quality improvement methods, which include infection control, help organisations to produce these outcomes. Donabedian (1980) defined high-quality care as "that kind of care which is expected to maximise an inclusive measure of patient welfare, after one has taken account of the balance of expected gains and losses that attend the process of care in all its parts" (Grossman, 1998: 43). Quality improvement in infection control relates to the activities employed to improve the performance of a process, and includes the process of planning and control. Management is responsible and accountable for providing resources In order to implement quality infection control nursing care. The purpose of the study was to identify factors influencing the implementation of an effective infection control process in aNICU. An exploratory and descriptive design with a qualitative orientation was implemented. It consisted of a narrative and a literature study by means of which factors have been identified to influence the implementation of an infection control process in a NICU. The case study design, an indepth analysis of a single unit of study, was utilised in this study as part of the data-gathering process. Recommendctions were made on the macro, meso and micro levels, which included quality circles, hand hygiene and antibiotic usage, in-service education, recognition of personnel, mission statement and the infection control manual. The shortage of human and physical resources in nursing is a global problem. In S.A. there has been no previous study to emphasise the importance of an effective infection control process, and therefore no solutions to the problem have been suggested. The Japanese view with regard to quality circles is recommended. / AFRIKAANSE OPSOMMING: Verpleegkundiges is verantwoordelik en aanspreeklik vir die gehalte van verpleging wat gelewer word, insluitende gehalte infeksiebeheer verpleging. Hierdie verandering in aanspreeklikheid het voortgespruit uit die behoefte om die voortdurende styging in gesondheidskoste te verminder. Gedurende die 1980s, het 'n aanvraag vir hoë gehalte, kosteeffektiewe en kompeterende gesondheidsorgdienste ontstaan. Gesondheidsorg dienste moes nuwe strategieë oorweeg om in hierdie dienste te kan voorsien. Uitkomste word op hierdie proses gebaseer. Om hierdie uitkomste te bereik, behoort organisasies gehalteverbetering metodes, wat infeksie beheer insluit, te implemeteer. Donabedian (1980) definieer hoë gehalte as "that kind of care which is expected to maximise an inclusive measure of patient welfare, after one has taken account of the balance of expected gains and losses that attend the process of care in all its parts" (Grossman, 1998: 43). Gehalteverbetering in infeksiebeheer , verwys na die aktiwitieite wat geimplementeer word om die uitvoer van In proses te verbeter, insluitende beplanning en beheer. Bestuur is verantwoordelik en aanspreeklik vir die voorsiening van hulpbronne, om gehalte infeksiebeheer verpleegsorg te implementeer. Die doel van die studie was om faktore wat die implementering van 'n effektiewe infeksie beheer proses in 'n NICU beinvloed, te identifiseer. In Verkennende en beskrywende ontwerp, met 'n kwalitatiewe orientering, is geimplementeer. Dit het bestaan uit In narratief en In literatuur studie, waardeur faktore wat die implementering van In effektiewe infeksie beheer proses in 'n NICU beinvloed, geidentifiseer word. Die gevallestudie ontwerp, wat 'n in-diepte ondersoek van In enkele eenheid van studie is, is in hierdie studie gebruik as deel van die data-insamelings proses. Aanbevelings is gemaak of makro, meso en mikro vlak, en sluit in gehalte sirkels, handhigiëne en antibiotika gebruik, indiensopleiding, erkenning van personeel, In missieverklarin~ en ten opsigte van die infeksiebeheerhand- leiding in. Die tekort aan menslike en fisiese hulpbronne in verpleging is I n globale probleem. Aangesien daar nog nie voorheen In studie in S.A. gedoen is om die belang van I n effektiewe infeksiebeheerproses te beklemtoon nie, is daar nog nooit oplossings vir die probleem voorgestel nie. Die Japanese siening van gehalte sirkels word aanbeveel.

Thesis (MCur)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: No clear description exists in S.A. of the role and functions of a forensic psychiatric nurse. The researcher conducted a research project based on more than 20 years of practice experience to define and describe the role and functions of the forensic nurse practitioner. A non-experimental descriptive study was done. Questionnaires and checklists were compiled to determine the perceptions of forensic psychiatric patients/clients (n =24) and nursing staff (n = 15) .The nursing activities in a selected forensic psychiatric unit was evaluated through nonparticipative observation. Results indicated that: • Patients experienced their environment as isolated and has a need for better support by the nursing staff; • Nursing staff indicated their need for more specific training in forensic psychiatric nursing; and • A need exists for specific protocols and procedures to guide his/her practice. The recommendations are made that: • A special training program for forensic psychiatric nursing needs to be planned and implemented; and • Procedures and guidelines must be established to guide the practice of the nurse practitioner. / AFRIKAANSE OPSOMMING: Daar bestaan in S.A. geen duidelike omskrywing van die rol en funksies van die forensiese psigiatriese verpleegkundige nie. Die navorser het gegrond op meer as 20 jaar praktykervaring 'n navorsingsprojek gedoen om die rol en funksies van die verpleegpraktisyn te definieer en te omskryf. 'n Nie-eksperimentele, beskrywende studie is gedoen. Vraelyste en kontrolelyste is opgestel om die persepsies van forensiese psigiatriese pasiënte/kliënte (n=24) en verpleegpersoneel (n=15) te bepaal. Die verpleegaktiwiteite in 'n geselekteerde forensiese psigiatriese eenheid is deur nie-deelnemende observasie geëvalueer. Resultate het daarop gedui dat: • Pasiënte hulle omgewing as geïsoleerd ervaar en het 'n behoefte aan beter ondersteuning deur die verpleegpersoneel; • Verpleegpersoneel het aangedui dat hulle 'n behoefte het aan spesifieke opleiding in forensiese psigiatriese verpJeging;en • Daar 'n behoefte is aan spesifieke protokolle en prosedures om sy/haar praktyk te rig . Die aanbevelings word gemaak dat: • 'n Spesiale opleidingsprogram vir forensiese psigiatriese verpleging beplan en geïmplementeer word; en • Prosedures en riglyne daargestel moet word om die praktyk van die verpleegpraktisyn te rig.

Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Background & rationale: South Africa is faced with the major challenge of HIV/AIDS. Every South African has a vital role to play in managing this public health problem. One of the best ways of managing it is by informing and educating the communities about HIV/AIDS, as the communities lack knowledge about it. Problem statement: Due to the increase in the number of patients infected with HIV/AIDS, an informal caregiver’s programme was introduced to ensure that patients are better cared for at home, in a familiar environment and by their family members. Purpose and objectives: The purpose of the study was to evaluate the effect of an informal caregiver’s programme on the care of patients with HIV/AIDS. The objectives included evaluating the effect of care, physically, socially, spiritually, emotionally, information and educational support given. Methodology: A phenomenological research design was applied to evaluate the effects of an informal caregiver’s programme implemented for the care of patients infected with HIV/AIDS at Mfuleni Township in the Cape Metropolitan area. Population and sampling: The population of this study were HIV/AIDS infected patients who were participating in the informal caregiver’s programme. Ten of these patients, who gave consent, participated in the study. Reliability, validity & pilot study: The trustworthiness of this study was assured with the use of Lincoln and Guba criteria of credibility, transferability, dependability and conformability. A pre-test study was also completed. Ethical considerations: Ethical approval was obtained from the Stellenbosch University and the required consent from the individual participants. Data collection, analysis and results: Data was collected through an interview using an interview schedule based on the objectives. Data was analysed and the findings show that the care given to patients infected by HIV/AIDS at home through an informal caregiver’s programme has a positive outcome. Recommendations and conclusion: On the spot training of participants and their family members is recommended. The community health workers form a very strong support base for the participants. / AFRIKAANSE OPSOMMING: Agtergrond en rasionaal: Suid-Afrika kom te staan voor ’n reuse uitdaging t.o.v. HIV/VIGS. Elke Suid-Afrikaner het ’n belangrike rol te speel in die beheer van hierdie openbare gesondheidsprobleem. Een van die beste maniere om dit te beheer, is om gemeenskappe in te lig en op te voed aangaande MIV/VIGS, aangesien daar ’n gebrek aan kennis hieromtrent is. Probleemstelling: Weens die toename in die aantal pasiënte wat deur MIV/VIGS geaffekteer word, is ’n informele versorgingsprogram daarop ingestel om te verseker dat pasiënte beter tuis versorg word in ’n bekende omgewing en deur hul familielede. Doel en doelwitte: Die doel van hierdie studie was om die effek van ’n informele versorgingsprogram in die versorging van pasiënte met MIV/VIGS te evalueer. Die doelwitte is uiteengesit om die effek van die versorging wat gegee is, te evalueer met verwysing na die fisiese, sosiale, geestelike, emosionele, inligting en opvoedingsondersteuning te evalueer. Metodologie: ’n Fenomenologiese navorsingsontwerp is toegepas om die effekte te evalueer van ’n informele versorgingsprogram wat geïmplementeer is vir die versorging van pasiënte wat deur MIV/VIGS geaffekteer is in die Mfuleni woonbuurt in die Kaapse Metropolitaanse area te evalueer. Bevolking en steekproef: Die bevolking van hierdie studie is MIV/VIGS geaffekteerde pasiënte wat deelgeneem het aan die informele versorger se program. Tien van hierdie pasiënte wat toestemming verleen het, het deelgeneem aan hierdie studie. Betroubaarhied, geldigheid en loodsondersoek: Die betroubaarheid van hierdie studie is verseker deur die gebruik van Lincoln en Guba se kriteria van geloofwaardigheid, oordraagbaarheid, afhanklikheid en ooreenstemmigheid. ’n Aanvoortoets is ook voltooi. Etiese oorwegings: Etiese goedkeuring is van die Stellenbosch Universiteit en die vereiste toestemming van die individuele deelnemers verkry. Dataversameling, analise en uitslae: Data is ingesamel deur gebruik te maak van ’n onderhoudskedule wat gebaseer is op die doewitte. Data is geanaliseer en die bevindinge het bewys dat versorging wat by die huis deur ’n informele versorgingsprogram aan pasiënte gegee word wat met MIV/VIGS geaffekteer is, ’n positiewe uitkoms het. Aanbevelings en gevolgtrekkings: Op-die-plekopleiding van HIV geïnfekteerde pasiente en hul familielede word aanbeveel. Die gemeenskap se gesondheidswerkers bied ’n sterk ondersteuningsbasis aan die deelnemers.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The Joint Commission International Accreditation (JCIA) has included a patient safety goal as part of the standards for the accreditation of hospitals. Goal number six states the need to “reduce the risk of patient harm resulting from falls”. An acute care hospital setting in Abu Dhabi, United Arab Emirates had implemented a multifaceted, multidisciplinary fall prevention programme (FPP) in preparation for accreditation by the JCIA. The achievement of the above goal is dependent on compliance with JCIA standard requirements and the hospital’s FPP. This study was undertaken to identify the factors preventing the successful implementation of the existing FPP in an acute care setting. The FPP is recognised to be in its development stages and therefore has opportunities for improvement for better patient safety outcomes, more so by reducing the incidence of falls and the severity of injuries from falls. Literature studies by Gowdy and Godfrey (2003:365) and Hathaway, Walsh, Lacey and Saenger (2001:172) suggests that the most successful approach to reducing falls and the severity of injuries from falls among patients in an acute care setting is that of a multifaceted, multidisciplinary approach. The nurses, who were primarily responsible for completing the initial fall risk assessment, expressed feelings of being overwhelmed by more safety standards being required for the JCIA. Patients with a high risk for falls were not referred to the physicians and physical therapists, nor were they referred to the clinical pharmacists for the review of high-risk medications. In addition, fall risk assessments were sometimes not done in the afternoon and during the night shift. The existing programme also did not consider bedbound, long-term patients, who require less frequent assessment. There furthermore was observer evidence to suggest that the existing FPP was not being implemented correctly. The aim of this study was to describe factors preventing the successful implementation of the existing FPP. The objectives were to identify areas being implemented successfully, to identify any barriers to successful implementation and to identify aspects of the existing FPP that may need revision. A quantitative descriptive approach was applied. The population was healthcare providers (HCPs), including both registered and practical nurses, physicians, physical therapists and pharmacists, working in an acute care setting in the United Arab Emirates. The respondents were 118 (86%) from a stratified sample of n = 137 (20%) from 684 HCPs. A specifically developed structured questionnaire was used for data collection. Reliability and validity were assured through the use of experts in questionnaire design and statistical consulting, in addition to pre-testing of the questionnaire. Ethical approval was obtained from the University of Stellenbosch Committee for Human Research and the Ethics Committee of the hospital where the study was undertaken. The respondents’ completion of the questionnaire served as voluntary consent to participate. The data were analysed and are presented in frequency tables. The mean and standard deviation were used for the statistical analysis. Correlational analyses were not done because of the descriptive approach to the study. It was considered most practical to focus on the professional groups and not on the variables, as the initial analysis indicated weak correlations. The results show those aspects of the FPP that were successfully implemented and those areas that need improvement if the JCIA requirements are to be met. Policy revision to include a clearly defined referral process for the high-risk patients, in addition to consistency of the environmental safety rounds and greater involvement and support of the unit managers/supervisors, will contribute to the greater success of the FPP. The hallmark of a successful FPP is staff education, which should be the key step in addressing the identified barriers. The human need for safety and the patient’s right to safe care and a safe environment must be integrated into staff orientation, and education and safety training programmes for all HCPs. Increased compliance may occur when HCPs are more aware of the hospital’s commitment to the patient’s right to safety. Compliance with JCIA standards and the FPP will contribute in the achievement of the accreditation. / AFRIKAANSE OPSOMMING: Die Joint Commission International Accreditation (JCIA) het ’n pasiëntveiligheidsdoelwit as deel van die standaarde vir die akkreditasie van hospitale ingesluit. Doelwit nommer ses lui: “verminder die risiko vir leed aan die pasiënt as gevolg van val”. ’n Akute sorg hospitaal in die Verenigde Arabiese Emirate het ’n veelvuldig gefasetteerde, multidissiplinêre program vir die voorkoming van val (fall prevention programme (FPP)) geïmplementeer ter voorbereiding vir akkreditasie deur die JCIA. Die bereiking van bogenoemde doelwit is afhanklik van nakoming van die standaardvereistes van die JCIA en die hospitaal se FPP. Hierdie studie is onderneem om die faktore wat die suksesvolle implementering van die bestaande FPP in die akute sorg omgewing verhinder, te identifiseer. Daar word erken dat die FPP nog in die ontwikkelingstadium is en dat daar dus geleenthede vir beter pasiëntveiligheidsuitkomstes is, veral deur die aantal valvoorvalle en die erns van beserings as gevolg van val te verminder. Literatuurstudies deur Gowdy en Godfrey (2003:365) en Hathaway, Walsh, Lacey en Saenger (2001:172) stel voor dat die suksesvolste benadering tot die vermindering van val en die erns van die gevolglike beserings onder pasiënte in ’n akute sorg omgewing ’n veelvuldig gefasetteerde, multidissiplinêre benadering behels. Verpleërs, wat die primêre verantwoordelikheid vir die voltooiing van die aanvanklike assessering van die risiko vir val het, het daarop gewys dat hulle oorweldig voel deur bykomende veiligheidstandaarde wat vir die JCIA vereis word. Pasiënte met ’n hoë risiko vir val is nie na die geneeshere en fisiese terapeute verwys nie, en ook nie na die kliniese aptekers vir die beoordeling van hoë-risiko medikasie nie. Assessering van die risiko vir val is soms ook nie in die middag en tydens die nagskof gedoen nie. Die bestaande program het ook nie bedlêende, langtermyn pasiënte wat minder gereelde assessering benodig, oorweeg nie. Daar is verder ook waargeneem dat die bestaande FPP nie korrek geïmplementeer word nie. Die doel van hierdie studie was om die faktore te beskryf wat die suksesvolle implementering van die bestaande FPP verhoed. Die doelwitte was om areas wat suksesvol geïmplementeer word, te identifiseer, sowel as hindernisse tot suksesvolle implementering en aspekte van die bestaande FPP wat hersiening benodig. ’n Kwantitatiewe beskrywende benadering is gebruik. Die populasie was gesondheidsorgverskaffers, insluitend beide geregistreerde en praktiese verpleërs, geneeshere, fisiese terapeute en aptekers wat in ’n akute sorg omgewing in die Verenigde Arabiese Emirate werk. Daar war 118 (86%) respondente uit ’n gestratifiseerde steekproef van n = 137 (20%) uit 684 gesondheidsorgverskaffers. ’n Spesiaal ontwikkelde, gestruktureerde vraelys is vir dataversameling gebruik. Betroubaarheid en geldigheid is verseker deur die gebruik van kundiges in vraelysontwerp en statistiese raadgewing, sowel as die vooraftoetsing van die vraelys. Etiese goedkeuring is van die Universiteit Stellenbosch se Komitee vir Menslike Navorsing, en die Etiekkomitee van die hospitaal waar die studie onderneem is, verkry. Die voltooiing van die vraelys deur die respondente het gedien as vrywillige toestemming om deel te neem. Die data is geanaliseer en in frekwensietabelle voorgesit. Die gemiddelde en standaardafwyking is vir die statistiese analises gebruik. Korrelasie-analises is as gevolg van die beskrywende benadering nie onderneem nie. Daar is besluit dat die mees praktiese benadering sou wees om op die professionele groeperinge te fokus en nie op die veranderlikes nie, aangesien die aanvanklike analise swak korrelasies aangedui het. Die resultate identifiseer daardie aspekte van die FPP wat die suksesvolste geïmplementeer is, sowel as dié gebiede wat verbetering benodig om aan die JCIA-vereistes te voldoen. Faktore wat sal bydra tot die groter sukses van die FPP is beleidshersiening wat ’n duidelik bepaalde verwysingsproses vir hoë-risiko pasiënte insluit, sowel as konsekwentheid in die omgewingsveiligheidsrondtes, en meer betrokkenheid en ondersteuning deur die eenheidsbestuurders/toesighouers Die waarmerk van ’n suksesvolle FPP is personeelopvoeding, wat die belangrikste stap in die aanspreek van die geïdentifiseerde hindernisse moet wees. Die menslike behoefte aan veiligheid en die pasiënt se reg op veilige sorg en ’n veilige omgewing moet in personeeloriëntering, personeelopvoeding- en veiligheidsopleidingsprogramme vir alle gesondheidsorgverskaffers ingesluit word. Verhoogde nakoming sou moontlik plaasvind indien gesondheidsorgverskaffers meer bewus was van die hospitaal se verbintenis tot die pasiënt se reg op veiligheid. Nakoming van JCIA-standaarde en die FPP sal bydra tot die verkryging van die akkreditasie.

Thesis (MCur)- -University of Stellenbosch, 2011 / ENGLISH ABSTRACT: It generally is a problem for persons with disabilities to have barrier free access to buildings, which is their constitutional right. It is however, not only the physical facility that causes barriers for persons with disabilities but also the attitudes of the able-bodied persons. The aim of the study was to explore what opinions the nurses and persons with disabilities held in two healthcare settings in Kimberley with reference to the nursing care provided to persons with disabilities. To the researcher, it was important to gather the opinions of the nursing staff on how they saw persons with disabilities, but also to hear what they thought the problem areas in caring for persons with disabilities were. On the other hand, it was equally important to understand the persons with disabilities’ perceptions of the hospitals, nursing and what they saw as solutions to the problems. The objectives of the study were: • To determine what the opinions and knowledge of nurses working in two healthcare services in Kimberley are regarding the nursing management of persons with disabilities. • To determine what the opinions of persons with disabilities are in healthcare settings in Kimberley, with reference to the nursing care provided for persons with disabilities. Data was collected in two phases namely Phase 1 amongst the nursing staff in the private and state hospital in Kimberley and Phase 2 amongst the persons with disabilities. A list of staff members which was obtained from the Human Resource office in both the private and state hospitals were sent to the statistician Prof Kidd and who prepared a randomised list which was used for the participants in the study. The same process was followed when a list of all the people who are members of the Association for Persons with Disabilities (APD) and with the help of the statistician a randomised list was compiled from which the participants in the study were chosen. The design of this research is an explorative, descriptive non-experimental study with a quantitative approach, utilizing a structured questionnaire with closed and open ended questions. In this study it was found that the nursing staff was aware of the problems and barriers persons with disabilities encounter. The nurses, however, were aware of their own shortcomings. For example, the nurses identified the lack of training to equip them to assist the persons with disabilities during nursing care, while persons with disabilities also saw this as a problem. By addressing this shortcoming, nurses would be able to provide more holistic care. Recommendations were made based on the findings regarding the facility, perceptions, caregivers, procedures, doctors and the training of the nurses. / AFRIKAANSE OPSOMMING: Om toegang te hê tot geboue wat hulle grondwetlike reg is, is vir die meeste mense met gestremdhede ‘n voortdurende stryd. Dit is egter dikwels nie net die fisiese ontoeganklikheid van die geboue wat dit vir die persone met gestremdhede onmoontlik maak om ‘n normale lewe te lei nie, maar die houding van verpleegpersoneel wat dikwels meer ontoeganklik is as die toegang tot die geboue. Die doel van die studie was om te bepaal wat die opinies die verpleegpersoneel sowel as persone met gestremdhede het ivm gesondheidsorg in die privaat en staatshospitale in Kimberley Dit was vir die navorser belangrik om te bepaal hoe die verpleegpersoneel mense met gestremdhede sien, maar ook om hulle opinies te hoor ivm die probleme wat hulle ondervind sowel as moontlike oplossings daarvoor. Aan die ander kant wou die navorser ook weet wat die opinie van mense met gestremdhede is van die hospitale wat hulle besoek. Doelwitte van die studie was: • Om die kennis van verpleegpersoneel in die staat sowel as privaathospitale te bepaal ivm die versorging van persone met gestremdhede.. • .Om die opinies van persone met gestremdhede te bepaal tov die verpleegsorg in die staat sowel as privaathospitale in Kimbelrey. Data is in twee fases versamel. In Fase 1 was die verpleegpersoneel in beide die staat sowel as die privaathospitaal ingesluit en in Fase 2 was die deelname van die persone met gestremdhede verkry. Nadat ‘n personeellys van die Menlike hullpbronafdeling van beide hospitale verkry is, is dit aan die statistikus, Prof Kidd gestuur is vir steekproefneming. .Die persone met gestremdhede is genader nadat ‘n lys van die Assosiasie vir persone met gestremdheide (APD) verkry is. Die lys is deur die statistikus herrangskik,en die personeel en persone met gestremdhede is gevra om deel te neem aan die studie na aanleiding van die orde op die lys, nadat hulle ingligting ontvang het en toestemming geteken het vir deelname aan die studie. Die studie is eksploratief, beskrywend en nie-eksperimenteel van aard met ‘n kwantitatiewe benadering. Gestruktureerde vraelyse wat oop en geslote –einde vrae bevat het, is gebruik.. In die studie is bevind dat die verpleegpersoneel bewus was van die leemtes in die versorging van persone met gestremdhede. Een van die leemtes wat geïdentifiseer is, was dat verpleegsters nie formele opleiding ontvang in die versorging van persone met gestremdhede nie. Die persone met gestremdhede het ook hierdie leemte identifiseer. Deur hierdie leemte aan te spreek behoort verpleegpersoneel ‘n meer holistiese versorging aan persone met gestremdhede te lewer. Aanbevelings wat gemaak is, is gebasseer op die bevindinge in die studie en sluit in: fasiliteitt, persepsies, versorgers, prosedures, dokters en die opleiding van verpleegsters.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Hypertension is on the increase among patients as found on the Routine Monthly Report (RMR) at Kayamandi Clinic. The staggering figures showed that the number of patients with hypertension between January 2009 until December 2009 was 5 754. It was further identified on the Routine Monthly Report (RMR) statistics that, more and more young adults between 18 and 40 years who are visiting the clinic for other health problems are diagnosed with hypertension and its complications. The incident rate of these young adults ranges between 151 and 340 per month. It is very alarming that some of them who are diagnosed with hypertension never return for further follow-up visits and are at risk of debilitating complications which are preventable in later life. The objectives of this study were to determine the knowledge young adult patients have of: • hypertension • the management of hypertension • the complications of hypertension. The study adopted a descriptive, exploratory design with a quantitative approach. The research question determines the research design or approach. In this case a broad overview is necessary of the knowledge young adults at Kayamandi Clinic have on the topic of hypertension. This then serves as a platform for further in-depth studies on this phenomenon. A yes/no scale was used to collect data. The questionnaire was designed in such a way that the participants could understand all the questions. The layout of the questionnaire was easy and the questions were straightforward. The questionnaires were written in English, Xhosa and Afrikaans. After the translation of the questionnaires, a second person scrutinized it for the correctness of the Xhosa translation. An interpreter assisted with the questionnaire in the Xhosa speaking community at the time of data collection, where a language barrier was anticipated. The Cronbach’s alpha test was used to test the reliability of the questionnaire. Informed consent was obtained from each participant. Permission was obtained from the University of Stellenbosch via the Health Research Ethical Committee ((HREC). Permission was also obtained from the Director: Department of Health, Western Cape Province and the authorities of the Cape Wine lands district. A statistician from the University of Stellenbosch was consulted regarding the data analysis and the interpretation of the data. Data was articulated in the form of frequency tables and histograms. The Spearman test was used to determine the correlation between variables. 10% of the participants used in the pilot study were from Cloetesville Clinic and 21% of the participants used for the main study were from Kayamandi Clinic, that is n=210 participants. The results of the study showed that for the n=172 participants that partook in the study, there was a correlation between complications and hypertension but no correlation on lifestyle management. Statistical associations were determined by using the Spearman test on a 95% confidence interval between various variables. The normal descriptive statistical analysis was completed. The implication of the results of this study is that high blood pressure can affect young and old people. Recommendations consist of on going health promotion and continuous education that include both old and young people. / AFRIKAANSE OPSOMMING: Hipertensie is aan die toeneem onder die pasiënte soos gevind in die maandelikse roetine-verslag.Die skokkende syfers soos gerapporteer in die maandelikse roetine-verslag,wys dat die aantal pasiënte met hipertensie by Kayamandi-kliniek van Januarie 2009 tot Desember 2009 was 5 754. Dit is verder geidentifiseer in die maandelikse roetine-verslag dat al hoe meer jong mense tussen die ouderdomsgroep van 18 to 40 jaar oud wat die kliniek vir ander siektetoestande besoek, met hipertensie en verwante komplikasies gediagnoseer word. Die voorkomssyfer van jongmense met hipertensie wissel tussen 151 tot 340 per maand. Dit is sorgwekkend dat sommige van die pasiënte nadat hulle met hipertensie gediagnoseer is, nie terugkeer na die kliniek vir verdere opvolgbesoeke nie en daardeur blootgestel word aan uitmêrgelende komplikasies in hul latere leeftyd wat voorkombaar is. Die doelwitte van die studie is om jong volwasse pasiënte se kennis vas te stel ten opsigte van: • hipertensie • die behandeling van hipertensie • die komplikasies van hipertensie. Die studie neem die vorm van ʼn beskrywende, verkennende ontwerp met ʼn kwantitatiewe benadering aan. Die navorsingsvraag bepaal die navorsingsontwerp of benaderring. In hierdie geval is ʼn breë oorsig nodig van die kennis van jong volwassenes by Kayamandi-kliniek oor die onderwerp aangaande hipertensie. Dit dien dan as basis vir verdere indringende studies rakende hierdie fenomeen. ʼn Ja/nee skaal is gebruik om data te versamel. Die vraelys is ontwerp op ʼn manier sodat die deelnemers dit kan verstaan. Die uitleg van die vraelys is eenvoudig en die vrae maklik. Die vraelys is geskryf in Engels,Xhosa en Afrikaans.Na die vertaling van die vraelys,is dit deur ʼn tweede person wat ook Xhosa magtig is nagegaan om die korrektheid van die vraelys te verseker. ʼn Tolk het gehelp met die vraelys ten tye van data-insamelling in die Xhosa- sprekende gemeenskap, waar taal ʼn moontlike probleem kon wees. Die Cronbach alpha- toets was gedoen om die betroubaarheid van die vraelys te toets. Ingeligte toestemming was verkry van elke deelnemer. Toestemming was verkry van die Universiteit deur middel van die Gesondheids Navorsings Etiese Kommitee (GNEK). Toestemming was ook verkry van die Direkteur: Departement van Gesondheid, Wes Kaap Provinsie en die owerhede van die Kaap Wynland streek. ʼn Statistiekus van die Universiteit van Stellenbosch was geraadpleeg aangaande die data analise. Data was geartikuleer in die vorm van frekwensies in tabelle en histogramme. Die Spearman-toets is gebruik om die korrelasie tussen variante vas te stel .10% van die deelnemers wat vir die loodprojek gebruik is, is van Cloetesville-kliniek. 21% van die deelnemers wat vir die hoofstudie gebruik is, is van die Kayamandi-kliniek , dus ʼn total van n=210 deelnemers. Die studie het bewys dat vir n=172 deelnemers wat aan die studie deelgeneem het, daar ʼn korrelasie tussen die komplikasies en die hipertensie toestand is, maar geen korrelasie met leefstylgewoontes is gevind nie. Statistiese assosiasies is bepaal deur gebruik te maak van die Spearman-toets op ʼn 95%-interval tussen verskeie variante. Die normale, beskrywende statistiese analise is voltooi. Die implikasie van die resultate van die studie, is dat hoë bloeddruk jonk en ouer mense affekteer. Aanbevelings dui op aanhoudende gesondheids promosies en voortdurende opvoeding wat jonk en ouer persone insluit.