Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: see full text for abstract / AFRIKAANSE OPSOMMING: sien volteks vir die opsomming

Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The Human Immunodeficiency Virus infection (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are critical concerns worldwide; this is particularly true of South Africa. The consequences of HIV infection and complications of AIDS are a challenge that extends into the nursing profession and into the community of student nurses. Support groups can form an important part in educating nursing students about HIV and AIDS, as well as in supporting nursing students through the processes of counselling, testing and managing the physical, as well as other impacts of this syndrome. When considering the current situation at an Eastern Cape nursing college and the literature reviewed on this topic, the research question posed for this study was: ‘Why is the support offered by the HIV support group to the nursing students having such a limited effect on the students’ motivation to participate in HIV counselling and testing (HCT) and support activities to de-stigmatise HIV/AIDS?’ The aim of this study was to explore and describe the nursing students’ experiences and perceptions of the support group activities in order to improve the relevance of this initiative for students. The objectives of this study were to - Explore and describe the student’s experiences and perceptions of the support group activities - Identify and describe the student’s expectations of the support group. A qualitative approach with an exploratory and descriptive design was used to elicit data to answer the research question. Ethical approval was obtained from the Health Research Ethics Committee and access to the college campus was obtained through the appropriate authorities. The accessible population for this study were 1st, 2nd, 3rd, and 4th year students at one campus of the provincial nursing college in the Eastern Cape. In-depth individual interviews were conducted with eight participants who met the study inclusion criteria of having had experience of the support group and its activities. Interviews were recorded and transcribed by the researcher. Content analysis was used to analyse the interview data through applying Tesch’s eight steps of analysis. Data analysis revealed that participants did not experience the support group as helpful; although they had joined the support group they remained fearful of receiving test results and what their future may hold should they be diagnosed as being HIV positive. The participants experienced rejection and discrimination by the support group committee members; they also identified that the committee displayed hypocritical behaviours and a lack of respect for confidentiality of information which further undermined the functioning and influence of the group. Results revealed that joining the support group means one is automatically stigmatised as being HIV positive. The support group committee members were seen to be inaccessible having only limited communication with participants. Recommendations from the study were to hold personal and group development sessions for the committee and interested students to assist them in learning how to manage ethical issues related to counselling and testing, how to conduct effective campaigns to de-stigmatize HIV/AIDS, and to determine clearly what the purpose of this particular group is that it may better meet the needs of the student group. Limitations of this study were that the qualitative research approach that was applied limited the generalisation of the findings. The study focused only on experiences and perceptions of the undergraduate nursing students on one campus of the nursing college about the support group and its activities. Thus, the study offered an initial insight into the current negative perceptions of students towards the support group and offered a foundation for further investigation. In conclusion, experiences and perceptions of the support group were explored and elaborated on. Currently, the support group does not offer the support the students would like to be available as the fundamental functioning of the group is compromised by a lack of trust between students and the committee members. / AFRIKAANSE OPSOMMING: Die menslike immuungebreksvirus (MIV) en verworwe immuniteitsgebreksindroom (VIGS) is wêreldwyd kommerwekkende aangeleenthede, veral met betrekking tot Suid-Afrika. Die gevolge van MIV-infeksie en komplikasies van VIGS is uitdagings wat die verpleegberoep en die verpleegstudente-gemeenskap met verreikende gevolge raak. Ondersteuningsgroepe kan ’n belangrike rol speel om verpleegstudente in verband met MIV en VIGS op te lei, asook om ondersteuning te bied deur middel van die prosesse van berading, toetsing en die bestuur van die fisiese en ander gevolge van die sindroom. Toe die huidige situasie by ’n Oos-Kaapse verpleegkollege, asook die literatuuroorsig oor die onderwerp in oënskou geneem is, is die navorsingsvraag vir die studie gestel: “Waarom het die ondersteuning wat deur die ondersteuningsgroep aan die studentverpleegsters aangebied word so ’n beperkte effek op die studente se motivering om deel te neem aan MIV-berading en toetsing, asook ondersteuningsaktiwiteite om MIV/VIGS te destigmatiseer?” Die doel van hierdie studie was om die verpleegstudente se ervaringe en persepsies van die ondersteuningsgroep se aktiwiteite te ondersoek en te beskryf, ten einde die relevansie van hierdie inisiatief vir die studente te verbeter. Die doelwitte van hierdie studie was om die student se: - ervaringe en persepsies van die ondersteuningsgroep se aktiwiteite te ondersoek en te beskryf - verwagtinge van die ondersteuningsgroep te identifiseer en te beskryf. ’n Kwalitatiewe benadering met ’n ondersoekende en beskrywende ontwerp is gebruik om die data aan die lig te bring om sodoende die navorsingsvraag te beantwoord. Etiese goedkeuring is van die Universiteit van Stellenbosch se Gesondheidsnavorsingsetiekkomitee verkry en toegang tot die kollege-kampus is deur die betrokke owerhede verleen. Die toeganklike bevolking vir die studie was eerste-, tweede-, derde- en vierdejaarstudente by een kampus van die provinsiale verpleegkollege in die Oos-Kaap. Deurtastende individuele onderhoude is met agt deelnemers gevoer wat aan die studie se inklusiewe kriteria voldoen het en wat ondervinding het van die ondersteuningsgroep en hul aktiwiteite. Data is deur die navorser opgeneem en getranskribeer. Inhoudelike analise is gebruik om die data van die onderhoud te analiseer deur Tesch se ag stappe van analise toe te pas. Analise van die data het aan die lig gebring dat deelnemers nie die ondersteuningsgroep as behulpsaam ervaar nie. Ten spyte van aansluiting by die ondersteuningsgroep bly hulle angstig vir wanneer toetsresultate ontvang moet word en wat dit vir hul toekoms mag inhou indien hulle MIV-positief gediagnoseer word. Die deelnemers het verwerping en diskriminasie deur die ondersteuningsgroep se komitee-lede ervaar; hulle het ook skynheilige optredes en ’n gebrek aan respek vir vertroulikheid van inligting wat die funksionering en invloed van die groep verder ondermyn, geïdentifiseer. Resultate het aan die lig gebring dat aansluiting by die ondersteuningsgroep beteken dat hulle outomaties gestigmatiseer word as MIVpositief. Die komitee van die ondersteuningsgroep word gesien as ontoeganklik met beperkte kommunikasie met die deelnemers. Aanbevelings vanuit die studie sluit in die opvoeding en die ontwikkeling van ’n komitee en belangstellende studente om etiese kwessies te bestuur wat verband hou met berading en toetsing, veldtogte om MIV/VIGS te destigmatiseer en om duidelik te bepaal watter tipe ondersteuningsgroep hierdie betrokke groep moet nastreef om te wees. Beperkinge van hierdie studie is dat ’n kwalitatiewe navorsingsbenadering toegepas is wat die veralgemening van die bevindings beperk het. Die studie het slegs gefokus op ervaringe en persepsies van die voorgraadse verpleegstudente op een kampus van die verpleegkollege aangaande die ondersteuningsgroep en hul aktiwiteite. Sodoende, gee die studie ’n aanvanklike insig in die huidige negatiewe persepsies van studente oor die ondersteuningsgroep en bied ook ’n grondslag vir verdere ondersoeke. Ten slotte, ervaringe en persepsies van die ondersteuningsgroep is ondersoek en daarop uitgebrei. Tans bied die ondersteuningsgroep nie die ondersteuning wat die studente benodig nie, vanweë die fundamentele funksionering van die groep se gebrek aan vertroue deur studente in die komitee-lede.

Introduction: It was previously established that mental health workers in Rwanda experience secondary traumatic stress when working with trauma survivors. The effects of secondary traumatic stress can be serious and permanent in mental health workers when working with traumatized clients. It interferes with mental health worker’s ability to do their work effectively. Aim: This study aimed to explore STS and to develop an intervention model to manage secondary traumatic stress in mental health workers in Kigali, Rwanda. Methodology: This study was carried out into five cycles using action research approach. In the first cycles of the study a quantitative design was used to explore secondary traumatic stress in mental health workers in Rwanda. For this cycle, the particular aim was to determine the extent of the secondary traumatic stress in mental health workers in Rwanda. A total of 180 participants were selected using convenience sampling to be part of the quantitative study. In the second cycle of the study a qualitative design was used to explore mental health workers’ experiences of secondary traumatic stress. For this cycle 30 unstructured interviews were conducted. The third cycle aimed at developing the model to manage secondary traumatic stress. Action research approach was used in this phase. Experts from mental health services involved in the study were asked to participate in the study based on their availability as research team members. The fourth cycle of the study consisted of implementing the model in one mental health service and the fifth cycle consisted evaluation of the implementation of the model after six weeks period. The main aim of this cycle was an observation of the model implantation. Results: A diagrammatical model to manage secondary traumatic stress was developed by mental health professionals. In the model development cycle of the study, it emerged that there are very strong concurrence between the findings from experts in mental health care system and literature in terms of what needs to be included in the intervention model to manage secondary traumatic stress in mental health workers in Rwanda. The key elements to include in the model were based on preventive, evaluative and curative strategies to manage secondary traumatic stress in mental health workers in Rwanda. During the evaluation of the implementation, it emerged that participant noticed a change in coping strategies when facing the stressful incident in the practice. Recommendations: include an emphasis on more psychological support for mental health professional in their workplace and for more concrete aids such as supervision, guidelines on stress management on workplace, education on secondary traumatic stress management and implementation of counseling service for mental health workers. Conclusion: The model developed in the present study outlined different ways to manage STS at the individual, social and organizational levels. There is a need to translate the interventions to manage STS into active ongoing coping activities to be conducted at the individual, group and organizational levels. Organizational responses, such as creating a supportive organizational culture that acknowledges the potential for secondary traumatic stress, may help mental health workers to deal with workplace related secondary traumatic stress. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

This thesis studies the impact of the terminal illness and awareness of undergoing the dying process and inevitable death, at the KwaZulu Government hospital Ngwelezana, at Empangeni in the Lower Umfolozi District. A case study, drawing both upon nursing and social anthropology, was conducted to establish the experiences of death and dying of Zulu patients, their families and caregivers. The basic trend reflected in the findings is the need to discuss dying with patients, the lack of skills and knowledge on the part of caregivers, lack of recognition of patients' cultural beliefs. The study does not claim to deal with a complete spectrum of the experiences of death and dying of all Zulus but is a meaningful and significant innovation into an unresearched area of patient care. / Thesis (Ph.D.)-University of Natal, Durban, 1989.

In 1998 the Institutes of Nursing in the United Arab Emirates adopted a new approach of Case-Based learning in their three year nursing program. This categorical change created a need to examine the development of nursing students' self-efficacy and motivation under this new curriculum. The aims of this study were to investigate whether the students in the final year of the program will evidence higher levels of motivation and self-efficacy compared to those in the second and first year of the program, and to demonstrate that the higher the level of self-efficacy, the more internal, unstable and controllable the attributions for success and/or failure. This study was based on Bandura's theory of self-efficacy. A randomly selected cross-sectional survey involving nursing students in the three-year diploma nursing program of Abu-Dhabi and AI Ain Institutes was studied (N=178). The participants of this study involved a total of 86 (48.3%) enrolled in year one diploma, 51 (28.7%) enrolled in year two and 41 (23.0%) in year three diploma. On the whole the participants' levels of motivation and self-efficacy were high, but both ANOVA and Kruskall Wallis tests did not support any level increase by year of education as was expected. However, the Spearman's rho (r) test yielded low but positive and significant correlations between the levels of self-efficacy and students attribution for success and/or failure. / Thesis (M.Cur.)-University of Natal, Durban, 2002.

Purpose: The purpose of this study was to identify the stressors that affecting the critical care nurses in Abu Dhabi hospitals in order for the managers to take action to decrease or control these stressors where possible, or to take other appropriate action. Design: A cross sectional survey design was adopted in this study, as the phenomena of stress in CCNs was surveyed at one point of time . Sample: A convenient sample of 50 CCNs was included in the study. The participants were working as a CCNs in Abu Dhabi hospitals for a minimum one-year. Instruments: Two questionnaires were utilized to collect the data for this study; The Critical Care Stressors Scale and The Hamilton Anxiety Scale. Results: Results showed that The CCNs did not show a high level of anxiety according to the adopted scale. The most frequent stressors perceived by the CCNs were the stressors related to the critical care unit environment and the nursing responsibilities. On the other hand, the most severe stressors perceived by the CCNs were also under the categories of the critical care unit environment and Nurse-Health care workers conflicts. Conclusion: The hospital/nursing administrations were asked to revise the policies of visiting , dealing with infectious hazards, and portable X-rays . Also, the results showed that hiring more rton-nurses staff to deal with non-nursing jobs, and more male staff to carry out the heavy jobs such as changing position will aid in decreasing the stress perceived by the CCNs. / Thesis (M.Cur.)-University of Natal, Durban, 2003.

Background: Despite years of implementation, the program for PMTCT is not reaching the HIV positive pregnant women. Poor documentation as well as poor monitoring and evaluation for the program has contributed to the poor performance. This has led to South Africa being one of the 12 countries in the world with an increasing child mortality rate which is related to HIV/AIDS. Multi-steps and the complexity of the program and poor documentation have resulted in gaps in the provision of care. Objective: The aim of the study was to assess the documentation of the core activities of Prevention of Mother-to-Child Transmission of HIV program provided to pregnant women from antenatal, maternity and post-natal care at a selected Regional hospital in Ethekwini District. Methods: A non-experimental retrospective descriptive exploratory design informs the study. Provides a description of whether the activities of PMTCT are perfomed through the use of documented activities on patient’s charts. A data extraction tool was used to extract information, with the demographic information as well as the key activities of PMTCT. One hundred and thirty charts of women who had delivered in the hospital of study were sampled. Results: The study revealed gaps in the documentation of some activities, with dual therapy initiated at antenatal clinic documented to be n=98(75%), whilst NVP to the baby was 105/130 (80%). The results are in contrast with Horwood’s (2010) study which reported 91% receiving the Nevirapine prophylaxis. Although there are children missed by the program, it is interesting to note that more babies are receiving prophylaxis compared to women receiving NVP. The cd4 count, n=78(60%) uptake, seems not to be doing well, with only n=45(35%) , which is supported by Horwood’s (2010) study that showed much improvement in the cd4 uptake (70%) compared to the study results of 60%, but less cd4 results documented were reported by Horwood (2010), showing 33% respectively. Conclusion: The National strategic Plan’s (SADOH, 2007- 2011/2013) for South Africa, as well as the global Millennium Development Goals can only be achieved if all the activities for the PMTCT are improved. Documentation of activities remains the key to improved care. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

Background. People living with HIV/AIDS (PLWHA) are not always cared for by nurses who are competent to deal with mental health problems (MHP) in Blantyre district, Malawi. Little is known regarding nurses’ perceptions about their ability to provide mental health care in the district’s general settings. Purpose. The purpose of the study was to explore nurses’ perceptions about their provision of mental health care to PLWHA in Blantyre district. Methodology. A quantitative study was conducted to explore nurses’ perceptions about their provision of mental health care to PLWHA in Blantyre. Permission was granted by relevant authorities to conduct the study. Between March and April 2010, 165 nurses were randomly sampled from all wards and other departments at a central hospital and five selected health centres. They gave a written consent before joining the study. 151 questionnaires which were completed at participant’s convenient time were personally collected. Descriptive statistics were used to analyse data and nonparametric tests were also used to explore associations amongst variables. Findings. This study found that nurses’ perceptions about their provision of mental health care to PLWHA vary. Most nurses reported positive perceptions about caring for PLWHA who have MHP in general settings although some had negative perceptions. It was apparent that a relationship exists between nurses’ willingness to deal with MHP and perceptions about their knowledge, skills and access to support from mental health specialist. The perceived lack of knowledge, skills and support from mental health specialists were identified as reducing nurses’ ability to provide relevant mental health care to PLWHA. Conclusion. Conclusively, it is logical to say that the more support nurses receive from mental health specialists, the more knowledgeable and skilled they will become in dealing with MHP and, consequently, these nurses may demonstrate more willingness to deal with MHP of PLWHA. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2010.

Aim: The aim of this study was to explore the lived experiences of reintegration into the community of mental health care users in the Libode district. Methodology: A phenomenological approach was used in this study to explore the lived experiences of reintegration into the community of mental health care users. It describes the feelings experienced by mental health care users concerning their reintegration into the community, and explores barriers to their reintegration into the community. The study was conducted in the Libode mental health clinic in the Libode district. A total of six participants volunteered to participate in the study. The interviews were audio-taped then transcribed. The data were manually analysed using Tesch’s approach of phenomenological analysis. Findings: The results of the study revealed that the participants were not living independent lives following their discharge from the mental health institution. The evidence suggests that the environment is not conducive to meeting the needs of mental health care users. They lack support from families and communities which impacted on them negatively, contributing to the high relapse and readmission rate. This study explores the barriers to their reintegration into the community such as the following: poor medication compliance, lack of vocational skills, unemployment, substance abuse, stigma and discrimination which were the main barriers to their reintegration into the community. The study consequently makes recommendations for practice and policy which can contribute to an improved quality of service delivery. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2010.

A knowledgeable person can deal with problems in a confident and flexible manner. This statement is certainly applicable in the area of health where an adequate knowledge helps clients to avoid complications. This study was conducted to explore the perceptions of ischemic heart disease patients and their families regarding the content and format of health education they need, before discharge from the hospital. A non-experimental survey study was conducted in the coronary care unit (ccu) of three governmental hospitals in Abu Dhabi, United Arab Emirates (UAE). A convenient sample of one hundred and twelve (112) participants consisting of eighty (80) patients and thirty two (32) relatives, were selected over a three month period. A self-report approach was used to collect data and a questionnaire in the form of five point Likert scale, was developed with appropriate content matching the study purpose. Reliability was tested by test- retest for nine (9) patients not participating in the sample. A panel of experts tested its validity. The confidentiality of the participants was carefully considered. The study has revealed that patients and their families indicate a strong need for health education. Most of the sample prefers health education during the hospital stay by the doctor, although nurses and different health service members were also seen as being important. The respondents perceived the health education function as increasing their confidence in dealing with the disease, while reducing their readmission and anxiety. They preferred a member of the family to attend the session. They wanted comprehensive health education addressing a wide range of topics. Since the study result agreed with other previous research results, it confirmed that people's perceptions about the need for information is similar in the UAE and everywhere else in the world. / Thesis (M.Cur.)-University of Natal, Durban, 2002.