Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Healthcare organizations have implemented numerous safety initiatives to address errors due to the impact on the patient, families, healthcare provider and the organization as highlighted in the Institute of Medicine report. However, error identification, reporting and management remain a challenge. Nurses have been identified as the healthcare provider with the greatest potential for errors. Supportive work environments are needed to provide optimal care to the nurse who makes an error; which may be minor to severe repercussions. The patient is identified as the first victim and the nurse who makes the error as the second victim. How nurse errors are reported, managed and disclosed is dependent on the response of leaders and peers which may be in a shame and blame or just culture approach. The aim of the study was to assess error management in nursing amongst registered nurses working in a tertiary hospital in Saudi Arabia. The objectives were to identify the occurrence of nursing related errors, determine the current process of reporting nursing errors, describe the management of nursing errors and explore the factors impacting on the management of nursing errors. The research methodology for this study was a descriptive, quantitative approach which is applicable when exploring the unknown. Ethical approval was obtained from the Ethics Board, University of Stellenbosch and the Institutional Review Board, King Faisal Specialist Hospital and Research Centre (General Organization) -Jeddah (KFSH&RC-J). The population was registered nurses working in KFSH&RC-J and assigned to the job descriptions of Staff Nurse 1&2, Clinical Nurse Coordinators and Assistant/Head nurses. Sample was selected using proportional allocation for nationality and simple random selection for nursing specialty; 215 RNs from these three groups. Data was collected using a questionnaire developed by the researcher and analysis completed using SPSS and regression analysis to identify factors which influences the reporting and management of errors. Data was presented in the form of frequency tables and graphs using the EXCEL program to analyze the data. The main findings of the study; there was significant difference in nurse leaders and professional nurses ability to identify nursing errors; questioning of the practice of peers, views of a non-punitive environment and the ability to differentiate between error and negligence. The nurse executive was positively associated with the average positive responses received. RNs of Middle Eastern nationality and the Adult nursing division were found to be slightly more negative in their perceptions about error reporting and management than other respondents. Improvements are needed in the processes of error reporting and management which include education; leadership development, underreporting of errors, feedback and communication, nurse manager support and disclosure of errors. Recommendations are the implementation of the Just Culture principles within the organization and leadership development to address error reporting and management. The need to develop a national database for error reporting in Saudi Arabia is recommended. Nursing errors occurred in one tertiary hospital in Saudi Arabia and an on-line system is available to report errors. However, nurses do not report errors as they fear being blamed and shamed. The process of error management within the organization has not been clearly defined. / AFRIKAANSE OPSOMMING: Gesondheidsorganisasies het talle veiligheids inisiatiewe geïmplementeer om foute aan te spreek weens die invloed wat dit het op die pasiënt, families, die gesondheidsverskaffer en die organisasie soos uitgelig in die Mediese Verslag van die Instituut. Nietemin, die identifisering van foute, verslaggewing en bestuur bly ’n uitdaging. Verpleegsters is geïdentifiseer as die gesondheidsverskaffers wat oor die grootste potensiaal beskik om foute te begaan. Ondersteunende werkomgewings word benodig om optimale sorg aan die verpleegster te verskaf wat ’n fout van ’n mindere aard tot die met ernstige gevolge begaan. Die pasiënt word geïdentifiseer as die eerste slagoffer en die verpleegster wat die fout begaan as die tweede slagoffer. Die manier hoedat verpleegfoute gerapporteer, bestuur en openbaar gemaak word, is afhanklik van die reaksies van leiers en portuurgroepe wat ’n skaamte- en blameerbenadering of “just culture”-benadering kan wees. Die doel van die studie was om die hantering van verpleegfoute tussen geregistreerde vepleegkundiges wat in n tersiêre hospital in Saudi werk te ondersoek. Die doelwitte is om die voorkoms van verpleegverwante foute te identifiseer, die huidige proses van verslaggewing van verpleegfoute te bepaal, die bestuur van verpleegfoute te beskryf en die faktore te ondersoek wat ’n impak het op die bestuur van verpleegfoute. Die navorsingsmetodologie vir hierdie studie is ’n beskrywende, kwantitatiewe benadering wat van toepassing is wanneer die onbekende ondersoek word. Etiese goedkeuring is verkry van die Etiese Raad aan die Universiteit Stellenbosch en die Institusionele Beoordelingsraad, King Faisal Specialist Hospitaal en Navorsingssentrum (Algemene Organisasie) – Jeddah (KFSH & RC-J). Die teikengroep is geregistreerde verpleegsters wat werk in KFSH & RC-J aan wie die posbeskrywing van stafverpleegster 1 & 2 toegeken is, Kliniese Verpleegkoördineerders en Assistent/Hoofverpleegsters. Die steekproef is geselekteer deur gebruik te maak van proporsionele toekenning vir nasionaliteit en ’n eenvoudige ewekansige steekproef vir verpleegspesialiteit; 215 geregistreerde verpleegsters van hierdie drie groepe. Data is gekollekteer deur gebruik te maak van ’n vraelys wat deur die navorser ontwikkel is en die analise is voltooi deur gebruik te maak van SPSS en regressie-analise om faktore te identifiseer wat verslaggewing en bestuur van foute beïnvloed. Data is aangebied in die vorm van frekwensie-tabelle en grafieke deur gebruik te maak van die EXCEL-program om die data te analiseer. Die vernaamste bevindinge van die studie is dat daar beduidende verskille tussen verpleegleiers en professionele verpleegsters se vermoë is om verpleegfoute te identifiseer; bevraagtekening van die praktyke van portuurgroepe; beskouinge van nie-strafgerigte omgewing en die vermoë om te onderskei tussen foute en nalatigheid. Die verpleegeksekuteur is positief geassosieer met die gemiddelde positiewe response wat ontvang is. Geregistreerde verpleegsters van Midde-Oostelike nasionaliteit en die Volwasse Verpleegafdeling is gevind om effens meer negatief te wees in hulle persepsies van fouteverslaggewing en bestuur, as ander respondente. Verbeterings is nodig in die prosesse van verslaggewing van foute en bestuur daarvan wat opvoeding daarvan insluit; leierskapontwikkeling, onderverslaggewing van foute, terugvoer en kommunikasie, ondersteuning van verpleegbestuur en bekendmaking van foute. Aanbevelings is die implementering van die “Just”-kultuur beginsels binne die organisasie en leierskap ontwikkeling om die verslag van foute en bestuur aan te spreek. Die behoefte om ’n nasionale databasis te ontwikkel vir die verslag van foute in Saoedi-Arabië word aanbeveel. Verpleegfoute het in een tersiêre hospitaal in Saoedi-Arabië plaasgevind en ’n aanlyn sisteem is beskikbaar gestel om foute te rapporteer. Nietemin, verpleegsters rapporteer nie foute nie, want hulle vrees om geblameer te word en beskaamd te staan. Hierdie proses van foutebestuur binne die organisasie is nog nie duidelik gedefinieer nie.

Thesis (MA)--Stellenbosch University, 2010. / ENGLISH ABSTRACT: Hypertensive disorders are one of the leading causes of maternal morbidity and mortality in South Africa. The morbidity and mortality rate can be decreased by early detection and management of hypertensive disorders at primary health care Level. The midwives should therefore be knowledgeable and competent in the assessment and diagnosis of pregnant women who are at risk of developing a hypertensive disorder, and be able to manage the problem. The purpose of the study was to investigate scientifically the knowledge of the registered midwives managing hypertensive disorders in pregnancy working at primary health care level in the Eastern Cape. The objectives set for the study were to investigate the knowledge of the registered midwives in the following areas: • Knowledge about hypertensive disorders • Assessment • Diagnosis • Management A descriptive correlational research design was applied with a quantitative approach to investigate scientifically the knowledge of the registered midwives managing hypertensive disorders in pregnancy. The target population included all the registered midwives working permanently in primary health care clinics in the Buffalo City Local Service Area. A stratified random sample of n=43 (44%) of a population of N=98 clinics both in rural and urban were selected together with a sample of n=101(44%) of N=228 registered midwives working in these clinics. A questionnaire consisting of predominantly closed questions was used for the collection of data, collected personally by the researcher. Ethical approval was obtained from Stellenbosch University, Department of Health and individual informed consent. A pilot study, which did not form part of the study, was conducted to test the questionnaire at the clinics. A 10% (n=10) sample of the registered midwives of 4 clinics participated in the pilot study. The validity and reliability was assured through the pilot study, the use of a statistician, as well as experts in midwifery, nursing and a research methodologist. The data was analysed and presented in tables and histograms. Statistical correlational tests were done to determine any correlations between the variables. Findings obtained show that inadequate knowledge exists among participants with specific reference to knowledge, assessment, diagnosis and management about hypertensive disorders. A statistical correlation was shown between the presence of doctors and the knowledge of the midwives using the Mann-Whitney statistical test (p=0.04). In clinics where there are no doctors’ visits, the knowledge of the staff was higher (0.691), than the total knowledge mean score (0.666). Where doctors are regularly visiting the clinics the mean knowledge score is lower (0.656). These results show that where midwives do not have any additional support as when there are doctors present, individual effort is made to keep up to date as they are practising as independent practitioners. Recommendations are based on the scientific evidence which emphasis further education in advanced midwifery, workshops, conferences, updating their knowledge and weekly in-service training, introduction of a quality assurance and patient education programmes. In conclusion empowering the midwives with the required knowledge about hypertensive disorders will contribute towards decreasing the mortality and morbidity rates. / AFRIKAANSE OPSOMMING: Siektetoestande gekoppel aan hipertensie is een van die vernaamste oorsake van sieklikheid en moedersterftes in Suid-Afrika. Die siektetoestand en sterftekoers kan afneem deur vroeë opsporing en bestuur van hipertensietoestande op primêre gesondheidsorgvlak. Die kraampersoneel behoort dus kundig en bekwaam te wees tydens die assessering en diagnose van swanger vroue wat die risiko loop om ’n toestand van hipertensie te ontwikkel en daartoe in staat te wees om die probleem te kan hanteer. Die doel van die studie is om die kennis van geregistreerde vroedvroue wetenskaplike te ondersoek wat hipertensiewe toestande tydens swangerskap hanteer op Primêre Gesondheidssorgvlak in die Oos-Kaap. Die doelstellings wat uiteengesit is vir die studie, is om die kennis van geregistreerde kraampersoneel in die volgende areas te ondersoek: • Kennis van hipertensiewe toestande • Assessering • Diagnose • Hantering. ’n Beskrywende korrelerende navorsingsontwerp is toegepas met ’n kwantitatiewe benadering om die kennis van die geregistreerde kraampersoneel wat hipertensiewe versteurings in swangerskappe hanteer, wetenskaplik te ondersoek. Die teikengroep het al die geregistreerde kraampersoneel wat permanent in die primêre gesondheidssorgklinieke in die Buffalo City Plaaslike Diensarea werk, ingesluit. ’n Gestratifieerde ewekansige steekproef van n=43 (44%) gekies uit ’n gesamentlike plattelandse en stedelike bevolking van N=98 klinieke met ’n steekproef van n=101 (44%) van N=228 geregistreerde vroedvroue wat in die klinieke werk. ’n Vraelys wat hoofsaaklik uit geslote vrae bestaan, is gebruik vir die insameling van data wat persoonlik deur die navorser ingesamel is. Etiese toestemming is verkry van die Universiteit Stellenbosch, die Departement van Gesondheid asook individuele ingeligte toestemming. ’n Loodsondersoek is uitgevoer om die vraelys te toets by die klinieke wat nie deel van die studie was nie. ’n 10% (n=10), steekproef van die geregistreerde vroedvroue van 4 klinieke het deelgeneem aan die loodsondersoek. Die geldigheid en betroubaarheid is verseker deur die loodsondersoek, die gebruik van ’n statistikus asook kundiges in kraamverpleging en ’n navorsingsmetodoloog. Die data is geanaliseer en weergegee in tabelle en histogramme, statistiese korrelasietoetse is gedoen om korrelasies te bepaal tussen die veranderlikes. Die bevindings, bewys dat ongenoegsame kennis bestaan by deelnemers met spesifieke verwysing na kennis, assessering, diagnose en hantering ten opsigte van aangaande toestande van hipertensiewe toestande. ’n Statistiese korrelasie is getoon tussen die teenwoordigheid van geneeshere en die kennis van vroedvroue deur gebruik te maak van die Mann-Whitney statistiese toets (p=0.04). In klinieke waar daar geen doktersbesoeke is nie, is die personeelkennis beter (0.691) as die totale gemiddelde kennistelling (0.666). Waar geneeshere gereeld die klinieke besoek, is die gemiddelde kennistelling laer (0.656). Hierdie resultate bewys dat waar die vroedvroue geen bykomende ondersteuning deur die teenwoordigheid van geneeshere het nie, het individuele moeite gedoen om op die hoogte te bly, aangesien hulle as onafhanklike praktisyns optree. Aanbevelings is gebaseer op wetenskaplike bewyse wat verdere onderrig beklemtoon in gevorderde kraamverpleging, werkswinkels, konferensies, die bywerk van kennis en weeklikse indiensopleiding, die instel van ’n kwaliteitsversekering en opvoedingsprogramme vir pasiënte. Ten slotte die bemagtiging van vroedvroue wat oor die vereiste kennis beskik van toestande van hipertensiewe toestande, sal bydra tot die afname van sterfte- en siektesyfers.

Thesis (MCur)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Differences were observed in clinical demonstration and assessment techniques of clinical supervisors involved with the supervision of undergraduate nursing students at an institution of higher education. These differing techniques displayed by the clinical supervisors may have implications for the standard of nursing care provided by the students and the throughput of these students. A qualitative approach with a descriptive design was applied to explore the perceptions and experiences of the undergraduate nursing students’ on clinical supervision. Nine (n=9) students were deliberately selected by means of purposive sampling from each year to participate in focus group interviews. Nine 1st year students, nine 2nd year students, nine 3rd year students and nine 4th year students respectively constituted the groups that were interviewed. Thus the total sample consisted of n=36 nursing students. Consent to conduct the study was obtained from the Health Research Ethical Committee at Stellenbosch University, as well the institution under study. Informed consent was obtained from all the participants. Data collection was completed by two trained fieldworkers who were not affiliated with the institution under study. The interviews were analysed through content analysis. Six themes emerged from the data. These included support, professionalism, realities of supervision, student preferences regarding supervisors, experiences that relate to abusive behaviour and the clinical supervision process. The findings indicated negative and positive experiences on clinical supervision. Recommendations were proposed to enhance clinical supervision and the learning experiences of student nurses. Key words: Clinical supervision, undergraduate nursing, clinical supervisor, clinical practice, differing techniques. / AFRIKAANSE OPSOMMING: Verskille was waargeneem in kliniese demonstrasie- en assesseringstegnieke van kliniese toesighouers wat betrokke is met die supervisie van voorgraadse verpleegstudente by 'n institusie van hoër onderwys. Die verskille in tegnieke gedemonstreer deur die kliniese toesighouers mag implikasies hê vir die standaard van verpleegsorg gelewer deur die studente en die slaagsyfer van hierdie studente. 'n Kwalitatiewe benadering met 'n beskrywende ontwerp was toegepas om die persepsies en ervaringe van die voorgraadse verpleegstudente oor kliniese supervisie te verken. Nege (n = 9) studente vanuit elke jaargroep was bewustelik gekies by wyse van doelgerigte steekproefneming om deel te neem in fokusgroep onderhoude. Nege 1ste jaar studente, nege 2de jaar studente, nege 3de jaar studente en nege 4de jaar studente het onderskeidelik die groepe gevorm waarmee onderhoude gevoer was. Die totale steekproef het uit n=36 verpleegstudente bestaan. Toestemming om die studie te doen was vanaf die Etiese Komitee vir Gesondheidsnavorsing by Stellenbosch Universiteit, asook die instelling ter ondersoek verkry. Ingeligte toestemming is van al die deelnemers verkry. Data insameling was deur twee opgeleide veldwerkers gedoen wat nie geaffilieer is met die instelling ter ondersoek nie. Die onderhoude was deur inhoudsontleding geanaliseer. Ses temas het uit die data ontstaan. Dit sluit in ondersteuning, professionaliteit, realiteite van supervisie, student voorkeure ten opsigte van toesighouers, ervaringe wat verband hou met mishandelende gedrag en die kliniese supervisie-proses. Die bevindinge het negatiewe en positiewe ervaringe oor kliniese supervisie getoon. Aanbevelings is voorgestel om kliniese supervisie en die leerervaring van die studentverpleegsters te verbeter. Sleutelwoorde: Kliniese supervisie, voorgraadse verpleging, kliniese toesighouer, kliniese praktyk, teenstrydige tegnieke.

Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: In South Africa, currently enrolled nurses make up the largest proportion of members of the nursing healthcare team. As in direct contact with patients it is essential that the practice environment supports patient and nursing outcomes. Studies confirm the complexity of the practice environment and the impact on both personnel and on the quality of nursing care provided. Job satisfaction is integrally linked to the quality and safety of care provided. The scarcity of registered professional nurses, particularly in the South African context, has resulted in enrolled nurses being widely used to continue to deliver acute care in quite complex situations. It is well documented that the use of suboptimal nursing personnel levels or substituting enrolled nurses for registered professional nurses is associated with an increase of adverse events such as infections, pressure ulcers and unanticipated death. The purpose of this study was to explore the experiences of enrolled nurses regarding quality nursing care in general nursing units in the private healthcare setting. The objectives being: - The exploration of the enrolled nurses understanding of the concept of quality care - The exploration of the enrolled nurses understanding of her value and contribution to quality care and - The exploration of the enrolled nurses experiences (positive and negative) of quality nursing care in private health care setting A descriptive qualitative methodology was applied. A purposive sample size of n=13 was drawn from the total population of N=387. An exploratory interview was completed. Lincoln and Guba’s criteria of credibility, transferability, dependability and confirmability were applied and ethical principles were met. Findings demonstrated that enrolled nurses experienced both positive and negative work experiences, some more negative than others. They had a very good understanding of quality care but had difficulty in reconciling the patient’s needs with what they were able to deliver, due to workload pressures and resource constraints: P6: “I miss the quality because that patient that needs just that back rub or just to hold his hand ...the thing is with quality nursing we don’t do quality nursing on the patient anymore.” Most participants experienced registered professional nurses absolving their clinical supervisory responsibility. This endangers the quality and duty of care of patients and is a legal liability. A recommendation is that registered professional nurses require professional development through utilising good role models. This exposure to positive learning experiences will enable their professional development and ethical behaviour. Registered professional nurses need to be taught the skills of how to be team players. / AFRIKAANSE OPSOMMING: Ingeskrewe verpleegsters maak huidiglik die grootste deel van die verplegingsspan se gesondheidsorg uit. As gevolg van die direkte kontak met pasiënte, is dit belangrik dat die omgewingspraktyk pasiënt- en verpleeguitkomste moet kan ondersteun. Navorsingsstudies bevestig die kompleksiteit van die omgewingspraktyk en die impak wat dit op beide personeel en op die kwaliteit van verpleging wat verskaf word, het. Werksbevrediging vorm ’n geïntegreerde skakel met die kwaliteit en veiligheid van sorg wat verskaf word. Die tekort aan geregistreerde professionele verpleegsters, veral binne die Suid-Afrikaanse konteks, het tot die gevolg dat ingeskrewe verpleegsters oral gebruik word om akute sorg in taamlik komplekse situasies te lewer.. Dit is goed gedokumenteer dat die gebruik van suboptimale verpleegpersoneelvlakke of die vervanging van geregistreerde professionele verpleegsters met ingeskrewe verpleegsters, geassosieer word met ’n toename in nadelige gevalle soos infeksies, druk-ulkusse en onverwagte dood. Die doel van hierdie studie is om die ervaringe van ingeskrewe verpleegsters ten opsigte van die kwaliteit van verpleegsorg binne algemene verpleegeenhede in die private gesondheidsorgomgewings te ondersoek. Die doelwitte is ’n ondersoek na die ingeskrewe verpleegsters se: - begrip van die konsep van kwaliteitsorg - begrip van hul waarde en bydrae tot kwaliteitsorg en - ervaringe (positief en negatief) van kwaliteit verpleegsorg binne private gesondheidsorgomgewings. ’n Beskrywende, kwalitatiewe metodologie is toegepas. ’n Doelgerigte steekproefgrootte van n = 13 is geneem uit die totale populasie van N = 387. ’n Voortoets is voltooi. Lincoln en Guba se kriteria van geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestigbaarheid is toegepas en etiese beginsels is nagekom. Bevindings het bewys dat ingeskrewe verpleegsters beide positiewe en negatiewe werkservaringe gehad het; sommige meer negatief as ander. Hulle het ’n baie goeie begrip van kwaliteitsorg, maar vind dit moeilik om aan die pasiënt se behoeftes, vanweë drukkende werkladings en beperkte bronne te voldoen. P6: “Ek mis die kwaliteit want al wat die pasiënt benodig is die vryf van die rug of net die vashou van sy hand…die probleem met kwaliteitsorg is dat ons nie meer kwaliteitsorg op die pasiënt doen nie.” Die meerderheid van die deelnemers verklaar dat die geregistreerde professionele verpleegkundiges hulle kliniese toesighoudende verantwoordelikheid afskeep. Die gedrag is bydraend tot swak kwaliteit pasient sorg en het direkte wetlik implikasies. Die aanbeveling is dat professionele ontwikkeling van geregistreedrde verpleegkundigies verbeter kan word deur gebruik te maak van goeie rol modelle. Die blootstelling aan positiewe leer ervarings en omgewing sal bydrae tot hulle professionele ontwikkeling en etiese gedragspatrone. Geregistreerde verpleegkundiges moet die vaardighede aanleer om as deel van ’n span te kan funksioneer.

The issue of adolescent health has steadily grown momentum with people realizing the vulnerability ofthis sector ofthe world's population. Within the South African context, the tide had also turned. However, most initiatives aimed at the prevention of problems, one of which was adolescent pregnancy. Extant literature revealed that despite efforts to reduce adolescent pregnancy, adolescent fertility rate in SubSaharan Africa remained on the rise. As such, the need for appropriate maternity services for this group became a concern, as extant literature also revealed the costly long term effects to pregnant and parenting adolescents, as well as society as a whole. Within KwaZulu-Natal pregnant and parenting adolescents use the same maternity services as their adult counterparts. It was not clear if these services were appropriate to the needs of these clients. As such, a Glaser Grounded Theory approach was used to explore the maternity services from the points of view of the various stakeholder groups. Data was collected, using theoretical sampling, by means of semi-structured interviews and focus group interviews. Constructs of adolescent-friendly maternity care were identified from the findings. The components of the constructs included aspects of (1) Structures and Resources, (2) Attitudes to AMCs, and (3) Services. The resources or structures that either need to exist and/or be improved included policies, the quality and quantity of HCps, formalized support for AMCs, a sensitized administration, community involvement and the educational preparation of HCps. The attitudes that service providers were expected to demonstrate in their interaction with AMCs included those of equality, empathy and respect. They were also expected to show understanding towards AMCs and provide them with reassurance and support. The third component identified specific services to be provided to AMCs during the antenatal, labour and delivery, and postnatal period. These constructs can be used by health care planners and providers to strengthen and improve service provision to and utilization by pregnant and parenting adolescents and form the foundation on which a theory of adolescent-friendly maternity care can be based. Recommendations were made with regards to future service and research endeavours. / Thesis (Ph.D.)-University of KwaZulu-Natal, 2005.

Two research methods, a correlational survey and a case study method were used to explore the impact of health focused and economic focused women's organizations on community development and health. Through the study the following questions were answered: (i) Is there a difference in the health and development indicators of the households of Elim Care Group Project members, Akanani members and members of the community who do not belong to any of the organizations? (ii) What contribution have these organizations made to individuals' and/or communities' way of life? (iii) What aspects of these organizations' structure and/or function strengthen or weaken the organization? For the correlational survey, quantitative data were collected from three categories of thirty households each that belonged to Care Group members, Akanani members and community members who did not belong to any organization. The analysis of the data showed that both the health focused and economic focused organizations kept their focus even though their functioning tended to overlap. The health focused group had a greater impact on health indicators e.g. number of diarrhoea episodes, respiratory tract infection episodes, nutritional state, while the economic focused group had greater impact on development indicators e.g. housing, income and education. The improvement in the development indicators did not influence the health indicators directly. The qualitative data collected for the case study provided an indepth information about the case studied. The health focused organization demonstrated stability in its management. This was composed of health personnel under the employment of the Department of Health Managing the Care Group was a paid job for them. The organization was established and supported by the community and therefore expressed the community's concerns. The economic focused organization provided opportunities for the rural people to establish money making enterprises. Some of the problems shown in this study in this regard relate to poor managerial and business skills that resulted in the production of products that were not readily marketable in the locality. This caused a lot of anxiety amongst members as earnings were irregular. The differences in the structure and functioning of the groups were analysed. These influenced the effectiveness and continued viability of the organizations. / Thesis (Ph.D.)-University of Natal, Durban, 1996.

According to Amos (1989) the use of, and the attitudes towards alcohol amongst young people in Africa is an area about which little is known but which has potentially major health implications. Neither has much been done about primary prevention in this field. The case studies which included a participatory research was conducted among three groups of people in the Clermont Township near Durban in the Natal Region. The aim of the research was to describe alcohol abuse as a social problem among the black adolescents and to compare and contrast the implementation of alcohol abuse prevention strategies that were and are used by the different groups of people in their community. The case study approach documented the work of each community. All the three groups of people who participated in the research agreed that alcohol abuse was a problem in their community. They described factors in their township which were contributory to the alcohol problems in their community and described the various cycles of negative effects and consequences to the individual, family and to the community. They agreed that in the past alcohol was not a problem in the traditional African society because of cultural and economic factors. Most interesting was the serious effects all groups described alcohol abuse amongst both teachers and the pupils in the Black education system. Each group planned, implemented and evaluated a unique alcohol preventive strategy. While the youth group maintained a strong alcohol focus with an educational programme, both the adult groups moved into the more general issues of economic empowerment. All three groups also used the participation and capacity building. The willingness to get involved, and to address the problems of the groups were remarkable. The following were the research conclusions: * Material resources were relatively available in this community. * Health professionals were available in this community, but they did not follow the Comprehensive Primary Health Care approach and were not involved in community development. * Integrated drinking seemed to be in harmony with the values of these groups and could be used in the alcohol abuse prevention. An integrative, multi-faceted and comprehensive community based partnership approach was used to the multi-causal alcohol abuse prevention programmes and strategies. This strategy was successful in involving community partners and leading to the solving of the actual problems and the development of positive health behaviours. The research revealed that the development projects needed "seed money" to initiate and to maintain. Alcohol abuse prevention can be used as a vehicle to enter a community and to engage it in a health directed partnership. / Thesis (Ph.D.)-University of Natal, 1995.

The purpose of this study was to design and implement the two phases of a three-phased approach to the integration of the psychiatric component into the PHC system in the Eastern Cape. The study included an educational approach in which the PHC nurses were trained to diagnose, treat and rehabilitate psychiatric patients. Case studies and surveys were used to collect data. A sample of six clinics in which twenty registered nurses were trained was conveniently selected. Nurses had to volunteer so that 50% of the registered nurses would take part in the study. Each clinic was seen as a case in which a record review and questionnaires were used to collect data. The data revealed that, given the training in the diagnosis, treatment and rehabilitation, nurses could provide the first line of psychiatric care efficiently if there is a backup support from a team of consultants at the secondary health services and a support and supervision from an advanced psychiatric nurse. / Thesis (Ph.D.)-University of Natal, Durban, 1996.

The intention of this study was to describe the implementation process of the NQF in nursing education at central and provincial levels in order to explore the change process. It deals with this process as follows: Implementation of NQF in nursing education.; Organizational health at central and provincial levels.; The change strategies used at these levels.; The implementation level reached. It is a qualitative study of an enthographic type to describe and document the implementation of the NQF as it occurred. The researcher who was part of the group that generated the culture of learning in nursing, directly participated in the activities and events as they occurred at this initial stage of implementation of the NQF. A discussion between the researcher and nurse educators took place on strategies used and whether they find the existing environment promoting changes. The research techniques used for gathering information were interviews and documents. With this information the researcher was able to reflect, make inferences and interpretations. The state of nursing education was described within the organizational self-renewal strategies described by Owens (1998). The description of the process of implementing the NQF was viewed against the change strategies as described by Bennis, Benne and Chin (1969), which are the empirical rational, normative re-educative and power coercive. The stage of implementation of the NQF in NE that has been achieved has been assessed using the NQF principles as a yardstick. The data collected is largely qualitative and its analysis has been qualitative. The categories of the theoretical framework which are inputs (organizational health); process (change theories); and outcomes (awareness, planning, use and refinement) of the NQF principles, have been used to analyze the data. The findings on organizational health reveal that nursing education is a healthy organization at both central and provincial levels. It has taken the opportunity presented by the NQF to address some of its organizational problems such as the Scope of Practice for nurses and midwives. There are, however, problems in making final decisions about the planned implementation of the NQF because of differences in vision about the future of nursing education. The movement of nursing education (NE) to higher education (HE) is hampering progress because the National Government is not implementing the Education Act No. 101 of 1997 which has moved NE to HE. Both the South African Nursing Council (SANC) and Natal College of Nursing (NCN) have no coherent human resources development policy. At both the central and provincial levels of NE normative re-educative strategies are ones that have been used extensively rather than power coercive strategies. Empirical rational strategies were also made use of to identify the advantages of the NQF policy and to incorporate them into the planned changes. There is full awareness and planning for the implementation of all the principles of the NQF. The principles of the NQF that are already in use and are being refined are integration of education and training, relevance, credibility and legitimacy.This is because they had already been in use in nursing education and practice before the inception of the NQF policy. / Thesis (Ph.D.)-University of Natal, Durban, 2001.

Aim: This study explored and described residential care for the elderly in eThekwini Municipality in terms of the organizational structure, staff and residents, and determined how those factors influenced elder care. This was aimed to make recommendations for residential care in eThekwini Metropolitan Municipality. Methodology: A descriptive explorative case study design, using both quantitative and qualitative approaches was adopted for this study. The study participants included eight administrators, twenty elderly residents and thirty nursing staff from four residential care facilities (RCFs) in eThekwini Municipality, Durban. Data were collected through interviews, questionnaires, record review and observation based on the structure, process and outcome of the study's conceptual framework. Qualitative data were gathered from administrators and elderly residents. The data were transcribed and analyzed manually using Framework Analysis (Ritchi & Spencer, 1994). Quantitative data was obtained from nursing staff using questionnaires, and analyzed using SPSS. Findings: Administrative fmdings followed the structure, process and outcome of the study. The structural findings were focused on facility philosophy and human-material resources, as well as on emerging themes from the data. The emerging themes from facility philosophy were assisting vulnerable people across age groups, document review, quality indicators, admission criteria and reasons for admission to each facility. Emerging themes from human-material resources were fmancial sustainability, staff-resident ratio and material resources. The process findings were focused on care and service delivery to the elderly and the emerging themes were one big family, incidence of abuse, methods of elder care and service delivery, knowledge about elder care, relationship of control, being there, gentle restraint, setting boundaries with the residents, medication safety, common religious belief and resident satisfaction. Findings from the outcome were focused on success and challenges of elder care, experiences of the elderly and nursing staff care experiences. Thus, emerging themes from success and challenges were strong bond, retaining staff, maintenance of physical structure, location of care centre; success and its dependence and challenges of procuring basic medical equipment. Findings from experiences of the elderly were reasons for admission, relationship, experiences of the elderly, response shift, psychosocial support and satisfaction with care, cultural belief and well respected. Emerging themes from nursing staffs experiences of caring for the elderly was mainly focused on their professional knowledge about elder care. Details of these findings are written down in Chapters Four and discussed in relation to literature in Chapter Five. Conclusion: The study concluded by making recommendations for the care of the elderly in -RCFs in eThekwini Municipality in line with the findings of the study. The recommendations have implications for the government, policy makers, nursing education and nursing research. Moreover, those concerned are encouraged to adopt and use the recommendations where applicable to promote residential care quality for the elderly in eThekwini Metropolitan Municipality. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.