Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Background: In her clinical practice as nursing manager the researcher was concerned about incomplete and inaccurate documentation of patients diagnosed with tuberculosis (TB) which were compromising the management of these patients. The primary care nurses endorsed these concerns. Goals and Objective: The goal of this study was to audit nursing documentation according to the phases of the nursing process and the discharge planning of patients diagnosed with TB discharged from TB hospitals in the Western Cape. The objectives for the study were to determine whether the patients were adequately assessed and diagnosed, whether nursing care plans were formulated based on the assessment and whether they were implemented and evaluated according to the nursing process - including the discharged planning. Ethics approval was obtained from the Committee of Human Research Science at Stellenbosch University and permission was also obtained from the respective institutions. Methodology: A descriptive design with a quantitative approach was applied for the purpose of this study. The total population for the study was N=1768. A systematic random sample of 12% from each hospital was drawn: n=214, hospital A (n=142) and hospital B (n=72). Criteria included:  all adult patients older than 18 years  patients who were discharged between 01 January 2007 and 31st December 2007  all discharged patients from the two hospitals specializing in patients diagnosed with TB. Instrumentation: An audit instrument based on the objectives of the study was approved as the data collection tool. Guided by the proposed study a 10% (n=21) of the number of discharged patient files were drawn for the purpose of a pilot study. Reliability and validity was ensured through the use of experts in the field of nursing, research methodology and statistics. A pilot study was also conducted to support the reliability and validity of the study. Data collection: The researcher collected the data personally with the support of five trained field workers who only assisted at hospital B and was reluctant to assist at the second hospital. Data analysis: Data was analysed with the support of a statistician and expressed in frequencies and tables. Results: All phases of the nursing process showed a low compliance. Results showed that only n=90(42%) of the registered professional nurses checked and signed the initial assessment, furthermore only n=53(34%) showed that a recording was made of all referral documentation to the patient’s follow-up clinic. Recommendations: Recommendations based on the scientific evidence obtained from the study include the implementation of a quality assurance programme namely standardisation, auditing, case management of patients, education and training, rewarding of staff and further research. Conclusion: In conclusion guided by the research question “Are the audited discharged patient files at hospitals specialising in the management of patients with TB in the WCDoH compliant?” The researcher concludes that the discharged patient files are not compliant. / AFRIKAANSE OPSOMMING: Agtergrond: In haar kliniese praktyk as verpleegbestuurder is die navorser besorgd oor die onvolledige en onakkurate dokumentasie van pasiënte wat met tuberkulose (TB) gediagnoseer is en wat dus die versorging van hierdie pasiënte in gevaar stel. Hierdie besorgdhede is deur die primêre sorg verpleegsters bevestig. Doel en Doelwitte: Die doel van die studie is om die verpleegdokumente te ouditeer volgens die fases van die vepleegproses, asook die ontslagbeplanning van die pasiënte gediagnoseer met TB van die hospitale in die Wes-Kaap. Die doelwitte is om te bepaal of die pasiënte korrek geassesseer en gediagnoseer is en of verpleegsorgplanne opgestel is, wat gebaseer is op die assessering en versorgingsplanne wat geïmplementeer en geëvalueer is volgens die verpleegproses, insluitende die ontslagbeplanning. Etiese goedgekeuring is toegestaan deur die Komitee vir Menslike Navorsingswetenskap van die Universiteit van Stellenbosch en toestemming is ook ontvang van die onderskeie instansies. Metodologie: ’n Beskrywende ontwerp met ’n kwantitatiewe benadering is toegepas vir die doel van die studie. Die totale bevolking vir die studie is N=1786. ’n Sistematiese ewekansige geselekteerde steekproef van 12% van elke hospitaal is geneem: n=214, hospitaal A (n=142) en hospitaal B (n=72). Die kriteria sluit in:  alle volwasse pasiënte ouer as 18 jaar  pasiënte wat gedurende die periode 01 Januarie 2007 tot 31 Desember 2007 ontslaan is  alle ontslag pasiënte van die twee hospitale wat spesialiseer in pasiënte wat gediagnoseer is met TB. Instrumentasie: ‘n Ouditinstrument gebaseer op die doelwitte is goedgekeur as die dataversamelingsinstrument. Na aanleiding van die voorgestelde studie is 10% (n=21) van die aantal ontslag pasiëntlêers getrek vir die doel van die loodsondersoek. Betroubaarheid en geldigheid is verseker deur gebruik te maak van deskundiges in die verplegingsveld, die navorsingsmetodologie en statistiek. Die loodsondersoek is ook uitgevoer om die betroubaarhied en geldigheid van die studie te rugsteun. Dataversameling: Die navorser het die data persoonlik gekollekteer met die bystand van vyf opgeleide veldwerkers wat slegs hulp verleen het by hospital B en wat teësinnig was om hulp te verleen by die tweede hospitaal. Data-analise: Data is geanaliseer met die hulp van ’n statistikus en is uitgedruk in frekwensies en tabelle. Resultate: Alle fases van die verpleegproses het nie voldoen aan die vereistes nie. Resultate dui daarop dat slegs n=90 (42%) van die geregistreerde professionele verpleegsters die aanvanklike assessering nagegaan en onderteken het, vervolgens het slegs n=53 (34%) getoon dat ’n opname gemaak was van alle verwysde dokumentasie van die pasiënt se opvolgbesoek aan die kliniek. Aanbevelings: Aanbevelings is gebaseer op die wetenskaplike bewys wat verkry is van die studie vir die implementering van ’n gehalte versekeringsprogram, naamlik standardisering, ouditering, gevallebestuur van pasiente, opvoeding en opleiding, erkenning aan die personeel, en voortgesette navorsing. Samevatting: Ter afsluiting gelei deur die navorsering’s vraag nl. “Is die geouditeerde verpleegdokumente in hospitale wat spesialiseer in die bestuur van pasiente gediagnoseer met TB in die Weskaap se Department van Gesondheid bygehou?” Die navorser bevestig dat die verpleegdokumente nie bygehou was nie.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: During the period 2006-2008 more than 50% of midwifery students at the college under study failed the midwifery training programme. The academic performance of students can be attributed to various factors, ranging from personal uniqueness and institutional aspects to the course content itself. Accordingly, this study aims to explore the perceptions and experiences of student midwives with reference to their training programme. The objectives set for the study were set to determine the perceptions and experiences of the student midwives with regard to: • guidance in the practical field, • classroom experiences • assessment procedures and • whether the students attribute their academic successes or failures to the training programme. A qualitative approach with a descriptive design was applied to determine the perceptions and experiences of the undergraduate midwifery students concerning their training programme. The population of this study was fourth-year students who have successfully completed their midwifery-training programme. Nineteen students consented to participate in the study. The trustworthiness of this study was assured by using the Lincoln and Guba’s criteria of credibility, transferability, dependability and conformability. A pre-test was completed. All ethical principles were met. Data was collected through focus group interviews, using an interview guide. The analysis of the data revealed that students attributed their academic failures and success to guidance received in the theoretical as well as the practical field. The findings displayed the frustration that the students experienced with the lecture method as a teaching strategy. Discontentment was perceived among the participants regarding the demarcation, which differed among lecturers. Students were of the opinion that certain content of the curriculum was intended for the doctors, and they indicated a need for the extension of class time, for the instruction of the theory, as the curriculum was perceived as “content heavy”. Guidance in the clinical field, by the clinical educators, was perceived as being positive, yet the student-clinical educator ratio was proving to be a challenge. Marking of tests and examination answer sheets was perceived as too strict. Recommendations Students must be active participants in the learning process, not passive recipients of information. Teaching methods (such as role-play, brainstorming, case studies, simulations, and group work), that expand and reinforce basic communication, intellectual and interpersonal skills, should be employed. Uniformity amongst midwifery facilitators, in terms of content selection, demarcations, classroom activities and assessment techniques, should be agreed upon prior to the commencement of a block period. / AFRIKAANSE OPSOMMING: Tydens die periode 2006-2008 was meer as 50% van die verloskunde studente by die kollege waar die studie gedoen was, onsuksesvol in die verloskunde program. Akademiese prestasie van studente kan aan verskillende faktore toegeskryf word. Hierdie kwessies wissel van persoonlike uniekheid en institusionele aspekte tot die kursus inhoud self. Dus poog hierdie studie om die persepsies en ervaringe van die student vroedvroue ten opsigte van hul opleidingsprogram te verken. Die doelwitte van die studie was om die persepsies en ervaringe van die student vroedvroue met betrekking tot: • praktiese leiding, • klaskamerondervinding, • assesseringsprosedures te bepaal en • of die studente hul akademiese suksesse en mislukkings aan die opleidingsprogram toe skryf. ʼn Kwalitatiewe benadering met ʼn beskrywende strategie was gebruik om die persepsies en ervaringe van die voorgraadse studente rakende hul opleidingsprogram vas te stel. Die populasie van hierdie studie was studente, in hul vierde jaar, wat reeds die verloskunde opleidingsprogram suksesvol voltooi het. Negentien studente het ingestem om aan die studie deel te neem. Die vertrouenswaardigheid van die navorsing is verseker deur van die Lincoln en Guba kriteria – geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestiging – gebruik te maak. ʼn Voorafgaande toets is voltooi. Al die etiese beginsels is nagekom. Data is ingesamel deur onderhoude met fokusgroepe te voer. ’n Onderhoudsgids is vir die doeleinde gebruik. Die data-ontleding het getoon dat studente hul akademiese mislukkings en suksesse aan die leiding wat hulle op teoretiese en praktiese gebiede ontvang het, toeskryf. Die bevindinge het die frustrasie wat die studente met die lesmetode as ’n onderrigstrategie ervaar, getoon. Ontevredenheid rakende die werkafbakening, wat verskil van lektor tot lektor, is ook waargeneem. Studente voel dat dele van die kurrikuluminhoud vir dokters bedoel is. Hulle is van mening dat meer klastyd nodig is om teorie te onderrig, aangesien die kurrikulum oorvol is. Hoewel die leiding op kliniese gebied, deur die kliniese opvoeders, positief ervaar is, is die student-opvoeder verhouding as ʼn uitdaging beskou. Die studente het gevoel dat hul toetse en eksamenantwoordstelle te streng nagesien was. Aanbevelings: Studente moet aktief by die leerproses betrek word en moet nie bloot passiewe ontvangers van inligting wees nie. Onderrigmetodes, wat basiese kommunikasie-, intellektuele en interpersoonlike vaardighede aanvul en versterk (soos byvoorbeeld rolspel, dinkskrums, gevallestudies, simulasies en groepwerk), moet ingespan word. Die fasiliteerders moet ooreenkom en ʼn eenvormige beleid, betreffende die kurrikuluminhoud, afbakening van werk, klaskameraktiwiteite en assesseringsmetodes, voor die aanvang van die blokperiode, daarstel.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Breastfeeding is considered as the most preferable method of infant feeding to fulfill babies’ nutritional needs important to the growth and development of babies. Unfortunately, there were babies not breastfed due to numerous reasons including infant illness and hospitalization. The purpose of this research was to describe the experiences and perceptions of nurses regarding breastfeeding in a pediatric setting of an academic hospital in the Province of the Western Cape. A descriptive study design with a qualitative approach was used to explore the experiences and perceptions of auxiliary nurses regarding breastfeeding. Purposive sampling was utilized to consciously select thirteen auxiliary nurses to participate in the study. Semi-structured interviews were used to collect data. Data analysis involved the transcribing of tape recorded interviews, the generating of themes and sub-themes, coding of the data, interpretation and organization of data and the drawing of conclusions. According to the auxiliary nurses’ perceptions, most of the babies in the pediatric setting were not being breastfed. Breastfeeding was being supplemented with formula milk when mothers chose not to breastfeed, experienced breastfeeding problems, were not with the baby or the baby was too sick to breastfeed. The babies’ illness, the hospital environment and lack of resources were challenging auxiliary nurses when supporting breastfeeding mothers. Not all health professionals were supportive of breastfeeding. Interrelated factors including, shortage of staff, time constraints, heavy work-loads, auxiliary nurses’ breastfeeding knowledge and experience, their confidence to support breastfeeding and communication regarding breastfeeding, influenced auxiliary nurses’ ability to support breastfeeding babies and mothers. The research findings indicate that there was a need for breastfeeding promotion in the pediatric setting. Recommendations included a written breastfeeding policy, breastfeeding training for all health care professionals, better breastfeeding education and support for mothers, the maintenance and of breastfeeding during the babies’ illness, adequate accommodation for breastfeeding mothers and the support of breastfeeding mothers who are HIV positive. / AFRIKAANSE OPSOMMING: Borsvoeding is beskou as die mees verkieslike voeding metode vir babas om hul te voorsien aan die nodige voedingsbehoeftes belangrik vir die groei en ontwikkeling van babas. Die doel van hierdie studie was om die ervarings en persepsies van verpleeg assistente met betrekking tot borsvoeding in ‘n pediatriese instelling in ‘n akademiese hospitaal in die Provinsie van die Weskaap te beskryf. ‘n Beskrywende studie ontwerp met ‘n kwalitatiewe benadering was gebruik ver die doel van die studie. Streekproeftrekking was gebruik om doelbewus drie assistant verpleegkundiges te selekteer om deel te neem aan die studie. Semi-gestruktureerde onderhoude was gebruik om data in te samel. Die data-analise behels die transkibering van band opgeneemde onderhoude, die opwekking van temas en subtemas onderverdeel, kodering van die data, interpretasie an organisasie van die data en die opstel van gevolgtrekkings. Dit was bevind na gelang van die assistant verpleegkundiges se persepsies, dat meeste van die babas in die hospitaal was nie geborsvoed. Borsvoeding was aangevul met formule melk wanneer moeders verkies om nie te borsvoed, ervaar borsvoeding probleme, was nie met die babas, of die baba was te siek om the voed aan die bors. Baba siektes, die hospitaal omgewing en die gebrek aan hulpbronne was uitdagend vir assistant verpleegkundiges om borsvoeding moeders te ondersteun. Interafhanklike faktore insluitend, ‘n tekort aan personeel, tyd beperkinge, swaar werk-vragte, borsvoeding kennis en ondervinding, die vertroue om borsvoeding te ondersteun en kommunikasie met betrekkking tot borsvoeding, het die borsvoeding ondersteuning van assistant verpleegkundiges beinvloed. Die navorsingsbevindinge dui daarop dat daar ‘n behoefte was aan borsvoeding bevordering in die hospitaal. Aanbevelings sluit in ‘n skriftelike borsvoeding beleid, borsvoeding opleiding vir alle gesondheidspersoneel, beter borsvoeding inligting en ondersteuning vir moeders, die instandhouding van borsvoeding tydens hospitalisasie, voldoende akkomodasie vir borsvoeding moeders and die ondersteuning van borsvoeding moeders wat MIV-positief is.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Motivation. Homeostasis is a dynamic and balanced process that must be maintained in order to for health to be sustained (Scales & Pilsworth, 2008:50-57). In critically illness, homeostasis is disrupted and along with inadequate tissue perfusion potentially leads to multiple organ failure (Elliot, Aitken & Chaboyer, 2007:437). The fluid balance of a patient is essential for preserving homeostasis and to maintain optimal tissue perfusion, thus monitoring fluid balance plays an important role in the managing a critically ill patient. Current literature and best nursing practice emphasise the importance of accurate and correct fluid balance monitoring in critically ill patients including recording fluid intake and output on a purpose designed fluid balance sheet. Research has shown that the patient’s outcome after critical illness is influenced by the fluid balance management including fluid balance monitoring (Vincent, Sakr, Sprung, Ranieri, Reinhart, Gerlach, Moreno, Carlet, Le Gall & Payen, 2006:344-353), while several studies have questioned accuracy of fluid balance calculation in various acute care settings (Johnson & Monkhouse, 2009:291; Smith, Fraser, Plowright, Dennington, Seymour, Oliver & MacLellan, 2008:28-29). In an informal audit performed in a local critical care unit, seven out of ten fluid balances were incorrectly calculated. Clinical experience of nurses’ inattention to fluid balance monitoring, together with the informal audit data, reveals that fluid balance monitoring is generally not performed correctly or accurately by nurses working in critical care units. The aim of the study was to describe the perspectives and practices of registered nurses in critical care units with regard to fluid balance monitoring. Methods. A quantitative approach in the form of an audit was applied to establish the current practice of fluid balance monitoring. A survey was conducted among registered nurses to gain insight into their perspectives and knowledge of fluid balance monitoring. The sample for the audit was drawn from fluid balance records, which met the study inclusion criteria. The survey was conducted with a sample of participants from registered nurses in critical care units from a particular hospital group, in compliance with the inclusion criteria. The researcher collected the data using a purpose designed audit tool and questionnaire. Results. The audit revealed that 90 % of the sampled fluid balance records were inaccurate (tolerated deviation 0-10ml) and 79% were inaccurate if a deviation of 50ml would be tolerated. Furthermore the inaccuracy in calculation was larger in patients whoreceived diuretics. The questionnaire data revealed that registered nurses considered fluid balance monitoring as an important part of patient nursing care and were aware that inaccuracy can pose a risk to the patient. The nurses feel responsible for performing fluid balance monitoring. In addition the nurses gave recommendations for the practice. Discussion. The results of this study are similar to other studies done internationally. The nurses are aware of the importance of the fluid balance, and recognise the inaccuracies. With our limited resources, both financial and in terms of nursing staff, the solutions have to be very basic and practical. Key words: fluid balance, critical care, accuracy and auditing, best practice / AFRIKAANSE OPSOMMING: Motivering. Homeostase is ’n dinamiese en gebalanseerde proses wat onderhou moet word vir gesondheid om handhaaf te word (Scales & Pilsworth, 2008:50-57). Onder toestande van kritieke siekte, word homeostase onderbreek en kan dit saam met onvoldoende weefselperfusie moontlik tot veelvuldige orgaanmislukking lei (Elliot, Aitken & Chaboyer, 2007:437). Die vloeistofbalans van ’n pasiënt is van die uiterste belang vir die preservering van homeostase en om optimale weefselperfusie te onderhou, en dus speel die monitering van vloeistofbalans ’n belangrike rol in die bestuur van die pasiënt wat kritiek siek is. Die huidige literatuur en beste verpleegkundige praktyk beklemtoon die belangrikheid van akkurate en korrekte vloeistofbalansmonitering in pasiënte wat kritiek siek is, insluitend die aantekening van vloeistofinname en -afskeiding op ’n vorm wat vir die doel pasgemaak is. Navorsing het getoon dat die pasiënt se uitkoms ná kritiese siekte deur vloeistofbalansbestuur, insluitend vloeistofbalansmonitering, beïnvloed word (Vincent, Sakr, Sprung, Ranieri, Reinhart, Gerlach, Moreno, Carlet, Le Gall & Payen, 2006:344-353), terwyl verskeie studies die akkuraatheid van die vloeistofbalansberekening in ’n verskeidenheid kritiekesorgeenhede bevraagteken het (Johnson & Monkhouse, 2009:291; Smith, Fraser, Plowright, Dennington, Seymour, Oliver & MacLellan, 2008:28-29). In ’n informele oudit wat in ’n plaaslike kritiekesorgeenheid uitgevoer is, is daar gevind dat sewe uit tien vloeistofbalanse verkeerdelik bereken is. Kliniese ervaring van verpleërs se agtelosigheid met betrekking tot vloeistofbalansmonitering, tesame met die data vanuit die informele oudit, wys dat vloeistofbalansmonitering oor die algemeen nie korrek of akkuraat deur verpleërs in die kritiekesorgeenheid uitgevoer word nie. Die doelwit van hierdie studie was om die perspektiewe en praktyke van geregistreerde verpleërs in kritiekesorgeenhede met betrekking tot vloeistofbalansmonitering te beskryf. Metodes. ’n Kwantitatiewe benadering in die vorm van ’n oudit is gebruik om die huidige praktyk van vloeistofbalansmonitering te bepaal. ’n Opname is onder geregistreerde verpleërs gedoen om insig te bekom oor hulle perspektiewe oor en kennis van vloeistofbalansmonitering. Die steekproef vir die oudit is geneem uit vloeistofbalansrekords wat aan die studiekriteria voldoen het. Die opname is gedoen onder ’n steekproef van geregistreerde verpleërs in ’n kritiekesorgeenheid van ’n spesifieke hospitaalgroep, in ooreenstemming met die insluitingskriteria. Die navorser het die data met ’n pasgemaakte ouditinstrument en vraelys versamel. Resultate. Die oudit het gewys dat 90% van die vloeistofbalansrekords in die steekproef onakkuraat was (toleransie verskil 0-50ml) en 79% was onakkuraat als een verskil van 50 ml was tolereer. Verder was die onakkuraatheid in die berekenings groter in pasiënte wat urineermiddels ontvang het. Die data vanaf die vraelys het gewys dat geregistreerde verpleërs vloeistofbalansmonitering as ’n belangrike deel van die verpleging van ’n pasiënt beskou en daarvan bewus is dat onakkuraatheid ’n risiko vir die pasiënt kan inhou. Die verpleërs voel daarvoor verantwoordelik om die vloeistofbalansmonitering uit te voer. Hulle het ook aanbevelings vir die praktyk gemaak. Bespreking. Die resultate van hierdie studie is baie soortgelyk aan dié van ander internasionale studies. Die verpleërs is bewus van die belangrikheid van die vloeistofbalans en is bewus van die onakkuraathede. Met ons beperkte hulpbronne, beide finansieel en in terme van verpleegpersoneel, is dit noodsaaklik dat die oplossings baie basies en prakties is. Sleutelwoorde: vloeistofbalans, kritieke sorg, akkuraatheid en ouditering, beste praktyk

Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The midwives are the backbone of midwifery practice with needs and opportunities to create a tradition of caring in midwifery. However, there are problems that affect the midwifery practice. These problems include the increased maternal and perinatal mortality rate, shortage of material and human resources and poor implementation of policies and guidelines. The purpose of this study was to investigate factors that affect quality of care in a midwifery practice at a hospital complex in the Eastern Cape Province, South Africa. The objectives of the study focused on the structure and process standards. - 1 Structure Standards: To determine whether • policies and procedure manuals are available and updated • support from the supervisor is available • there is adequate staff • the required qualifications were available • the required experience of registered midwives were available • in-service training was being given - 2 Process standards : To determine whether • patients were assessed according to the national guidelines for maternity care • patients were diagnosed according to the national guidelines for maternity care • patients’ care plans were formulated according to the national guidelines for maternity care The descriptive research design with a quantitative approach was applied in this study. The target population (N=172) were the registered midwives working in the maternity department at a particular hospital in the Eastern Cape Province. A specific sampling method was not applied in this study as the total population of 155 was included and17 in the pilot study with a response rate of 81.3%. A self-administered structured questionnaire was used to collect the data. The researcher distributed the questionnaires personally to all respondents who met the criteria. Reliability and validity were assessed by means of a pilot study and the use of experts in Nursing Education, Midwifery, Research Methodology and Statistics. Ethical approval was obtained from Stellenbosch University and all other relevant parties. Computerized data analysis software namely the SPSS programmes and Stastica version 9 were used to analyze the data. The results of the study were interpreted, discussed and presented in tables and frequencies. The data was predominantly presented in a quantitative form with responses to a few close-ended questions. A confirmatory analysis to test the quality of properties across a level of variables was carried out. The Chi-square test was used to test association of variables between demographic data and the responses of midwives to factors affecting quality of care. A p-value of p< 0.05 represents statistical significance in hypothesis testing and 95% confidence intervals were used to describe the estimation of unknown parameters. Results showed that the majority of respondents had an experience of 2 to 5 years (n=34/27.0%) and (n=32/25.4%) more than 14 years working in the maternity department. The minority of respondents were those that are highly skilled. Only (n=4/3.2 %) of the midwives were registered in neonatology nursing and (n=9/7.1%) in advanced midwifery. The majority of respondents (n=118/93.7%) recorded that there was not enough staff to provide quality nursing care. Some respondents recorded that comprehensive in-service education was not offered in the hospital (n=18/14.3%). Recommendations include improvement of staffing, adherence to policies and guidelines, proper implementation of staff development and quality improvement programmes. In conclusion, in order to reduce high infant and maternal mortality rates and to reach the millennium development goals, shortcomings in midwifery should urgently be addressed. / AFRIKAANSE OPSOMMING: Die vroedvroue is die ruggraat van die verloskunde-praktyk met behoeftes en geleenthede om ’n tradisie van versorging in verloskunde te skep. Nietemin is daar uitdagings wat die praktisering van verloskunde beïnvloed. Hierdie uitdagings sluit in die toenemende moeder en perinatale mortaliteit, ’n tekort aan materiële en menslike hulpbronne, en die swak toepassing van beleid en riglyne. Die doel van hierdie studie was om die faktore te ondersoek wat die kwaliteit van sorg in ’n verloskunde-praktyk by ’n hospitaalkompleks in die Oos-Kaap in Suid-Afrika, beïnvloed. Die doelwitte van die studie was op struktuur en proses standaarde gefokus. - 1 Struktuur standaarde: Om te bepaal of • beleid en prosedure handleidings beskikbaar en opgedateer is • daar ondersteuning van die toesighouer is • daar voldoende personeel is • daar voldoen is aan die vereiste kwalifikasies • die vereiste ondervinding van geregistreerde vroedvroue teenwoordig • is indiensopleding gegee - 2 Proses standaarde: Om te bepaal of • pasiënte assesseer is volgens die nasionale riglyne vir verloskunde • pasiënte gediagnoseer is volgens die nasionale riglyne • pasiëntversorgingsplanne geformuleer is volgens die nasionale riglyne vir verloskunde. Die beskrywende navorsingsontwerp met ’n kwantitatiewe benadering is in hierdie studie toegepas. Die teikenbevolking (N=172) is die geregistreerde vroedvroue wat in die kraamafdeling van die spesifieke hospitaal in die provinsie van die Oos-Kaap werk. ‘n Spesifieke steekproefmetode is nie vir die studie toegespas nie maar wel die hele populasie is betrek van 155 en 17 in die lootsstudie met ‘n respons van 81.3%. ’n Self-geadministreerde gestruktureerde vraelys is gebruik om die data te versamel. Die navorser het die vraelyste persoonlik aan al die beskikbare respondente wat aan die kriteria voldoen het, versprei. Betroubaarheid en geldigheid is geassesseer deur middel van ’n loodsondersoek en deur gebruik te maak van spesialiste in Verpleegopleiding, die Navorsingssentrum en Statistiek. Etiese goedkeuring is verkry van die Universiteit Stellenbosch en al die ander relevante partye. Gerekenariseerde data-analise sagteware, naamlik die SPSS programme en Statistica uitgawe 9 is gebruik om die data te analiseer. Die resultate van die studie is geïnterpreteer, bespreek en aangebied in tabelle en frekwensies. Die data is oorwegend in ’n kwantitatiewe formaat aangebied met response op ’n paar geslote vrae. ’n Bekragtigingsanalise om die eienskappe oor ’n vlak van veranderlikes te toets, is gedoen. Die Chi-kwadraat toets is gebruik om assosiasie van veranderlikes te toets tussen demografiese data en die response van vroedvroue vir faktore wat die kwaliteit van versorging beïnvloed. ’n P-waarde van p<0.05 verteenwoordig statistiese beduidendheid in hipotese-toetsing en 95% sekerheidsintervalle is gebruik om die beraming van onbekende parameters te beskryf. Resultate dui aan dat die meerderheid van respondente 2 tot 5 jaar werkervaring (n=34/27.0%) het en (n=32/25.4%) meer as 14 jaar in die kraamafdeling het. Die minderheid respondente is diegene wat hoogsbekwaam is. Alleenlik (n=4/1.0%) vroedvroue is in neonatale verpleging gereistreer en (n=9/7.1%) in gevorderde verloskunde geregistreer is. Die meeste respondente (n=118/93.7%) het aangedui dat daar nie voldoende personeel is om kwaliteit verpleegsorg te gee nie. Sommige respondente het aangedui dat omvattende indiensopleiding nie in die hospitaal aangebied is nie (n=18/14.3%). Aanbevelings sluit in die verbetering van personeelvoorsiening, die nakoming van beleid en riglyne, behoorlike implementering van personeelontwikkeling en gehalte verbeteringsprogramme. Ten slotte, om die hoê insidensie in moeder en kind mortaliteit te verminder en die millennium ontwikkelingsdoelwitte te bereik, moet die tekortkomings in verloskunde dringend aangespreek word.

Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The increasingly complex role of the critical care nurse in an intensive care environment demands a much higher level of critical thinking and clinical judgment skill than ever before. Critical thinking in nursing practice may be defined as the cognitive ability to analyse, predict and transform knowledge, ensuring quality nursing care. To reason from a nurse’s perspective requires that we learn the content of nursing; this includes the concepts, ideas and theories of nursing. The aim and objectives of the study were to explore critical care nurses’ perspectives and experiences with regards to the concept of critical thinking, facets influencing the application of critical thinking skills in clinical practice and how these impact on the delivery of quality nursing care. A qualitative approach, using a case study design was utilised. A sample of six participants, who met the study inclusion criteria and consented to participate, were interviewed individually. Subsequently, five of these six participants took part in a focus group discussion to capture additional data to clarify and enrich the individual interview data. A field worker was present during the interviewing processes to note non-verbal data and later verify transcribed data. Feasibility of the proposed study was established by conducting a pretest which elicited relevant information. Ethical approval for the study was obtained from the Health Research Ethics Committee at the Faculty of Medicine and Health Sciences, Stellenbosch University. Permission and consent was obtained from the relevant hospital group to interview nurses working in the intensive care units. Qualitative content analysis, which focuses on the content or contextual meaning, was used to analyse interview data. Coding of the data through emergent themes and sub-themes was done by the researcher and supported through independent coding to verify and strengthen the analysis and interpretation of the researcher. . The results depicted how the participants personally understood the concept of critical thinking and the components influencing the application of critical thinking skill in clinical practice. The study of the participants’ perspective of the concept of critical thinking and portrayed how they experience analytical and independent thinking, competence and confidence, as well as knowledge, skill and expertise, to influence the quality of patient care. The data revealed several themes that facilitated critical thinking in critical care nurses. These themes were ‘team support’, ‘experience and exposure’ and ‘empowering the mind’. Emergent themes elaborating the limitations of critical thinking included ‘being stressed’, ‘professional boundaries’ and ‘being busy’. Several recommendations and suggestions for future research were offered. / AFRIKAANSE OPSOMMING: Die toenemende komplekse rol van die kritieke-sorgverpleegster in ’n intensiewe-sorg omgewing verg ’n veel hoër vlak van kritiese denke en ’n kliniese oordeelvaardigheid as ooit tevore. Kritiese denke in ’n verplegingspraktyk kan gedefinieer word as die kognitiewe vermoë om te kan analiseer, om vooruit situasies te kan bepaal en die vermoë om kennis te omskep sodat kwaliteit verpleegsorg verseker kan word. Om soos ’n verpleegster te kan dink, stipuleer dat die inhoud van verpleging geleer moet word wat konsepte, idees en teorieë daarvan insluit. Die doel en oogmerke van die studie is om die ervarings en perspektiewe van kritieke-sorgverpleegsters te ondersoek, met betrekking tot die konsep van kritiese denke, fasette wat die toepassing van kritiese denkvaardighede in ’n kliniese praktyk beïnvloed en die impak daarvan op die lewering van kwaliteit verpleegsorg. Die metodologie wat toegepas is, is ’n kwalitatiewe benadering deur middel van ’n gevalle-studie ontwerp. ’n Steekproefgrootte van ses deelnemers wat aan die inklusiewe kriteria voldoen het, is mee onderhoude individueel gevoer en daarna is met vyf van hierdie ses deelnemers in ’n fokusgroep onderhoude gevoer ten einde data op te neem wat andersins verlore kon geraak het. ’n Veldwerker was teenwoordig gedurende die proses van onderhoudvoering om die opgeneemde en getranskribeerde data te verifieer. Die data-insamelingsinstrument is in die vorm van ’n onderhoudsgids ontwikkel om die navorser gedurende die onderhoudvoering te help. ’n Loodsondersoek is uitgevoer om die haalbaarheid van die voorgestelde studie te ondersoek en is sodoende geskep om relevante inligting te onthul. Etiese goedkeuring vir die studie is verkry van die Gesondheidsnavorsing Etiese Komitee aan die Fakulteit van Geneeskunde en Gesondheidswetenskappe, Universiteit Stellenbosch. Goedkeuring en toestemming is van die hospitaalgroep aan wie die hospitaal behoort verkry, waar die studie onderneem is om sodoende onderhoude te kan voer met verpleegsters wat in die intensiewe-sorgeenhede werk. ’n Primêre, kwalitatiewe inhouds analise is gebruik om omderhoud data te analiseer wat fokus op die inhoud of kontekstuele betekenis daarvan. Kodering van die data deur die toepassing van die temas en sub-temas wat voorgekom het, is deur die navorser gedoen. Die data is onafhanklik gekodeer om die analise en interpretasie van die navorser te verifieer en te bekragtig ten einde die akkuraatheid en getrouheid in die formulering van die betekenis en interpretasie van gebeure met juiste weergawe daarvan, te verseker. Die resultate wat as hooftemas vanuit die individuele onderhoude voortgespruit het, asook die van die fokusgroep het die deelnemers se eie begrip van die konsep van kritiese denke en komponente wat die toepassing van kritiese denkvaardigheid in ’n kliniese praktyk beïnvloed, getoon. Die konsep van kritiese denke het die wyse waarop analitiese en onafhankilke denke, bevoegdheid en selfvertroue, asook kennis, vaardigheid en kundigheid die kwaliteit van pasiëntsorg beïnvloed, uitgebeeld. Die voortkomende data het daartoe aanleiding gegee dat die faktore wat die fasilitering en beperking van kritiese denke beïnvloed, bespreek kon word. Data rakende fasilitering het getoon hoedat die ondersteuning van die span, ervaring, blootstelling en die verruiming van die gees, kritieke-sorgverpleegsters positief kan beïnvloed om kritiese denke in hulle daaglikse verplegingsaktiwiteite effektief te kan toepas. Data wat verband hou met beperkings het getoon hoedat stres, professionele kwessies en besigwees kritieke-sorgverpleegsters negatief kan beïnvloed in die toepassing van kritiese denke gedurende daaglikse verplegingsaktiwiteite. Verskeie aanbevelings vir toekomstige navorsing is voorgestel.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Research supervision forms an essential part of higher education. The emergence of global trends in the production and dissemination of knowledge is compelling universities and university of technologies in South Africa to become more market-orientated, competitive and entrepreneurial. The supervision process is vital to successful completion of the research component of master’s degrees and consequently increase throughput in higher education. Successful and meaningful supervision contribute largely to mutual satisfaction and professional development between supervisors and students. Good supervision should be an integral component of quality research governance. Objective: The aim of this study was to explore research supervision needs and experiences of the master’s students in nursing. Methodology: A descriptive phenomenological research design was used with a qualitative research approach. A non-probability, purposive sampling method was used to select respondents in this study. The target population includes all nursing science master’s students enrolled at University of Stellenbosch in the past three years (N=109). A sample size of twelve students was included in the study, whereby all twelve face to face interviews were conducted using the semi-structured interview guide. The inclusion criterium for students was that they were all currently registered students who initially enrolled for the Masters in Nursing degree program between 2008 and 2010 in the division of Nursing at Stellenbosch University. Results: Eight themes arose from the interviews. These included: isolation; lack of skills/ time management; family dynamics/personal circumstances; supervisor support; student and supervisor roles and responsibilities; workplace dynamics and support; financial and institutional support and implications; and motivation to complete studies. Conclusions: Successful completion of research undertaken on postgraduate level and supervision at a master’s level depend on a healthy and productive relationship between the supervisor and the student. Exploring and implementing the guidance and suggestions in this paper will assist students in considering supervision preferences. This in turn will result in achieving a good supervisory relationship which is the key to successful master studies. / AFRIKAANSE OPSOMMING: Agtergrond: Navorsing toesighouding vorm ‘n belangrike deel van hoer onderwys. Die opkomende wêreldtendense in die toename en verspreiding van kennis verplig Resultate: Ag temas het vanuit die onderhoude voortgespruit. Dit het ingesluit: isolasie; gebrek aan vaardighede/tydsbestuur; familie-dinamika/persoonlike omstandighede; ondersteuning van toesighouer; rolle van student en toesighouer, asook verantwoordelikhede; werkplek dinamika/ondersteuning; finansiële en institusionele ondersteuning/implikasies en motivering om die studie te voltooi. Gevolgtrekking: Die suksesvolle voltooiing van die navorsing wat onderneem word op nagraadse vlak en toesig is afhanklik van ’n gesonde en produktiewe verhouding tussen die toesighouer en die student. Die nagaan en implementering van die leiding en voorstelle in hierdie studie sal die studente help in die oorweging van toesighouer voorkeure. Dit sal gevolglik aanleiding gee tot die bereiking van ’n goeie toesighoudende verhouding wat die sleutel is tot die suksesvolle voltooiing van magistergraad studies. universiteite en universiteite van tegnologie in Suid-Afrika om meer markgeoriënteerd, kompeterend en ondernemend te word. Suksesvolle en betekenisvolle toesig maak hoofsaaklik n bydra tot die onderlinge bevrediging en professionele ontwikkeling tussen toesighouers en studente. Goeie toesig behoort ’n integrale komponent van kwaliteit begeleiding in navorsing te wees. Doelwit: Die doel van hierdie studie was om die behoeftes van navorsingtoesig en ervaring van die magisterstudent in verpleging te ondersoek Metodologie: ’n Beskrywende, fenomenologiese navorsingsontwerp met ’n kwalitatiewe navorsingsbenadering is gebruik. ’n Nie-waarskynlike, doelbewuste steekproefmetode is gebruik om respondente vir hierdie studie te selekteer. Die teikenbevolking sluit in alle magisterstudente wat ingeskryf is vir verpleegwetenskap aan die Universiteit van Stellenbosch oor die afgelope drie jaar (N=109). ’n Steekproefgrootte van twaalf studente is ingesluit in hierdie studie, waaronder daar met al twaalf van aangesig tot aangesig onderhoude gevoer is deur gebruik te maak van die semi-gestruktureerde onderhoudsgids. Insluitingskriteria vir die studente was dat hulle almal bestaande geregistreerde studente moes wees wat aanvanklik ingeskryf het vir die program vir die Meestersgraad in Verpleging tussen 2008 en 2010 in die afdeling van Verpleging aan die Universiteit van Stellenbosch.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Scientific evidence based practices are essential to efficient health service delivery. Continuous education to Master’s Degree level is the springboard to future research projects, but the throughput of Master’s Degree students is however a concern. The poor attainment rate of Master’s Degree in nursing delays improvement in evidence based nursing practices and impedes the availability of academia. This study aimed to identify factors that influence the throughput of Master’s Degree nursing students in a distance education programme at a university in South Africa. The objective was to identify influencing factors related to • the individual • the Higher Education Institution • the employer A non-experimental, descriptive research design was applied with a quantitative approach. The target population was all the enrolled Master’s Degree Nursing students between 2004 and 2010 at the university under study. A structured electronic questionnaire was implemented for data collection. The questionnaire was presented to (n = 201) with a response rate of (n = 46/23%). Ethical approval was obtained from Stellenbosch University to conduct this study. Permission was obtained from the university under study to utilize the contact details on the data base of the target population. Reliability and validity was assured by two pilot studies to test the instrument and the use of experts in nursing research, methodology and statistics. The electronic instrument allowed automatic data capturing. The collected data was archived in the accessed controlled electronic data surveys pool of Stellenbosch University. Data analysis was done with the support of a statistician and was expressed as frequencies and in tables. Descriptive statistics and tests for statistical associations were also performed. The individual related outcomes showed that respondents had a mean age of 42 years and (n = 22/48%) had 21 to 40 years experience as a professional nurse. The majority of respondents were female (n = 45/98%) and married (n = 30/54%). Results indicated that the management of family and studies was not easy (n = 30/65%), but respondents experienced their family as an effective support (n = 37/80%) during their studies. Respondents who left their studies indicated the main reason to be a lack of a supporting network (n = 7/19%). Impeding factor results from the Higher Education Institution showed that WebCT was not an effective communication instrument (n = 19/42%) and (n = 22/48%) respondents had difficulty to access their supervisors. Enhancing factors related to study outcomes that were easy to comprehend (n = 39/85%) and efficiency of face-to-face workshops (n = 21/88%) provided support. All the respondents were employed at the time of study (n = 46/100%). Results showed that service demands were the reason why (n = 4/11%) non-completing respondents left their studies. Employers required from (n = 22/48%) respondents to do overtime during their studies. Employer demands influenced the studies of (n = 16/65%) respondents. In conclusion, this study showed specific factors that influence the throughput of Master’s Degree in Nursing students at the university under study. Recommendations were made to influence policy makers and stakeholders to reconsider their present practices regarding continuous education and support to their clients. / AFRIKAANSE OPSOMMING: Wetenskaplikgefundeerde uitkomsgebaseerde praktyke is noodsaakik vir doeltreffende gesondheidsdienslewering. Voortgesette onderrig tot die vlak van ’n Magistergraad is die vertrekpunt vir toekomstige navorsingsprojekte, maar die voltooiing van Magistergrade is egter ‘n bekommernis. Die gebrekkige verwerwing van Meestersgrade in Verpleegkunde het nie net ’n sleureffek op die verbetering van uitkomsgebaseerde verpleegpraktyke nie, dit strem ook die beskikbaarheid van akademici. Die studie het ten doel gehad om faktore te identifiseer wat die voltooiing van die Magistergraad in Verpleegkunde vir studente van die afstandsonderrigprogram, aan ‘n universiteit in Suid-Afrika, beïnvloed. Die doelwit behels die identifisering van faktore wat te make het met • die individu • die Hoëronderwys Instansie • die werkgewer ’n Nie–eksperimentele, beskrywende navorsingsontwerp met ’n kwantitatiewe benadering is gevolg. Die teikengroep is al die ingeskrewe Magisterstudente in Verpleegkunde tussen 2004 en 2010 aan die teiken-universiteit. ’n Gestruktureerde elektroniese-vraelys is gebruik vir dataversameling. Die vraelys is aangebied aan (n = 201) kandidate en ‘n (n = 46/23%) voltooiingrespons is verkry. Etiese goedkeuring om die studie te doen is van die Universiteit Stellenbosch verkry. Toestemming is ook van die teiken-universiteit verkry om die kontakbesonderhede van die teikenbevolking vanuit die databasis te benut. Betroubaarheid en geldigheid is deur twee loodsstudies verseker en vakkundiges in verpleegnavorsing, metodologie en statistiek is betrek by die studie. Die elektroniese instrument het voorsiening gemaak vir outomatiese datavaslegging met voltooiing. Die versamelde data is in die toegangsbeheerde elektroniese-navorsingsdatabank van die Universiteit Stellenbosch geberg. Die data is ontleed met die hulp van ‘n statistikus en is as frekwensies en tabelle weergegee. Beskrywende statistiek en toetse vir statistiese verhoudings is ook uitgevoer. Die bevindings rakende die individu dui daarop die gemiddelde ouderdom van deelnemers 42 jaar was en dat (n = 22/45%) tussen 21 en 40 jaar ervaring as professionele verpleegkundiges het. Die meeste van die deelnemers was vroulik (n = 45/98%) en getroud (n = 30/54%). Bevindings toon dat die hantering van familie en studies nie maklik was nie (n = 30/65%), maar deelnemers het egter hul familie as goeie ondersteuning (n = 37/80%) gedurende hul studies beleef. Deelnemers wat hul studies gestaak het, het as die hoofrede ’n gebrek aan ‘n ondersteuningsnetwerk aangevoer (n = 7/19%). Bevindings wat verwys na stremmende faktore van die Hoëronderwysinstelling hou verband met WebCT wat ondoeltreffend was as kommunikasie-instrument (n = 19/42%) en studieleiers wat moeilik deur deelnemers bereik kon word (n = 22/48%). Versterkende faktore was verwant aan studiedoelwitte wat maklik verstaanbaar was (n = 39/85%) en die ondersteuningsukses van aangesig tot aangesig werkswinkels (n = 21/88%). Al die deelnemers was in diens tydens hul studie (n = 46/100%). Bevindings toon dat diensverwagtinge die rede was waarom (n = 4/11%) deelnemers hul studies gestaak het. Werkgewers het van (n = 22/48%) deelnemers verwag om oortyd te werk tydens hul studies terwyl (n = 16/65%) deelnemers aangedui het dat hul studies beïnvloed was deur hul werkgewer se eise. Ten slotte, hierdie studie het getoon dat spesifieke faktore die voltooiing van Magisterstudies in Verpleegkunde aan die teiken-universiteit beïnvloed. Aanbevelings is gemaak om beleidmakers en belangegroepe te beïnvloed om hul bestaande praktyke rakende voortgesette onderrig en ondersteuning aan hul kliënte te heroorweeg.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Non-compliance with (tuberculosis) TB treatment is a problem at the Nyanga Clinic in the Western Cape Province. Non-compliance is defined as when a patient interrupted TB treatment for more than two months consecutively, at any time during the treatment period. The aim of the study was to explore the patient experiences and perceptions of non-compliance regarding their TB treatment. The following research question was posed by the researcher as a guide for this study: “What are the patient experiences and perceptions of non-compliance with TB treatment?” The objectives of this study were to determine the: - patients’ experiences and perceptions of non-compliance with TB treatment - non-compliant patients’ knowledge regarding TB - reasons why patients are not compliant with TB treatment. A qualitative, explorative, descriptive and contextual design was applied. The target population included the 354 non-compliant with TB treatment patients from March 2010 until May 2011. A purposive, non-random sampling technique was used to select participants for the study. Every tenth participant who, according to the TB register, was colour-coded as non-compliant with TB treatment, was selected for interviewing until data saturation should occurred. A sample of fourteen (14) participants was realised. A semi-structured interview schedule was developed based on the objectives of the study, which was validated by experts in nursing and approved by the Human Resources Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch. Data was collected personally by the researcher. Informed written consent was obtained from the participants. One patient who was not included in the main study was selected at random to pre-test the semi-structured interview. The pilot study revealed no pitfalls. Trustworthiness of the research was enhanced by adhering to the principles of credibility, confirmability, transferability and dependability. Credibility was ensured by member checking, data saturation, triangulation and involvement of an experienced research supervisor. Confirmability was enhanced through member checking and the leaving of an audit trail. Transferability through keeping an intensive description of all the processes and dependability by using an interview schedule and by submitting the transcribed tape-recorded data and field notes to the research supervisor for verification. The quantitative data was summarised in a table format to enhance clarity and facilitate a rapid overview of the results. The qualitative data was analysed manually with the findings coded and divided into subthemes and themes. Four themes emerged, namely: health system, client-related, social-economic and therapy factors. These themes identified the impeding factors regarding the non-compliance with TB treatment. The main conclusion is that there is a need to educate the community regarding the lengthy duration of the TB treatment, its side-effects, its curability and the spread of the infection as well as the consequences of inadequate treatment to empower the community at large about the disease. The National Department of Health framework of contributing to non-compliance with TB treatment was used as the conceptual framework for this study. The researcher applied the problem-solving approach of Faye Glen Abdellah’s theory. According to this theory it is anticipated that by solving the problems or needs of patients, through appropriate and organised health strategies the client will be moved towards ultimate health. / AFRIKAANSE OPSOMMING: Onderbreking van tuberkulose (TB) behandeling is ’n probleem by die Nyanga-kliniek in die Wes-Kaap Provinsie. Onderbreking kan gedefinieer word wanneer’n pasiënt vir twee of drie opeenvolgende maande TB behandeling onderbreek het (Jaggarajamma, Sudha, Chandrasekaran, Nirupa, Thomas, Santha, Muniyandi & Narayanan, 2007:131). Die doel van die studie is om die pasiënte se ervaringe en persepsies betreffende die onderbreking in TB behandeling te ondersoek. Die navorser het die volgende navorsingsvraag as riglyn vir hierdie studie gestel: “Wat is die pasiënte se ervaringe en persepsies wat TB-behandeling onderbreek het?” Die doelwitte van die studie was om te bepaal wat die: - pasiëntervaringe en persepsies is wat TB-behandeling onderbreek - kennis van pasiënte is wat TB-behandeling onderbreek - redes is waarom pasiënte TB-behandeling onderbreek. ’n Kwalitatiewe navorsingsontwerp met’n ondersoekende, beskrywende en kontekstuele benadering is aangewend. ’n Doelbewuste, lukrake steekproef is gebruik om deelnemers te selekteer. ‘n Steekproef van veertien (14) deelnemers uit ’n totale populasie van 354 hetrealiseer en sluit pasiënte in wat behandeling onderbreek het vanaf Maart 2010 tot en met Mei 2011. ’n Semi-gestruktureerde onderhoudsgids is ontwerp, gebaseer op die doelwitte van die studie en gevalideer deur kundiges in verpleegkunde en die Etiese Komitee van die Fakulteit van Gesondheidswetenskappe aan die Universiteit van Stellenbosch. Die data is persoonlik deur die navorser ingesamel. Ingeligte skriftelike toestemming is van die deelnemers verkry. Een deelnemer wat nie ingesluit is by die hoofstudie nie, is lukraak gekies om die semi-gestruktureerde onderhoud te toets. Die loodsondersoek het geen tekortkominge aangedui nie. Betroubaarheid van die studie is verseker deur die beginsels van objektiwiteit, bevestiging, veralgemening en neutraliteit te verseker. Getranskribeerde data is gekontroleer met die deelnemers, volledige beskrywings van alle prosesse is bygehou, ’n onderhoudsgids is gebruik om te verseker dat vir al die deelnemers dieselfde vrae gevra word, en ’n ervare navorsing toesighouers was deurgaans teenwoordig wat alle data gevalideer het. Kwantitatiewe data is in ’n tabel opgesom ten einde goeie oorsig te bied. Kwalitatiewe data-analise is met die hand gedoen. Die data wat uit die analise na vore gekom het, is geënkodeer en in subtemas en temasgekategoriseer. Die vier temas wat hieruit voortspruit, is faktore betreffende die gesondheidsorgsisteem, kliënte, sosio-ekonomiese en terapie-verwante faktore. Die navorser het n geskrewe verslag saamgestel betreffende die weergawe van die data-analise ten einde te verseker dat belangrike data nie verlore gaan. Die belangrikste bevindinge van die studie dui daarop dat die gemeenskap ’n behoefte aan opleiding het betreffende die onderbreking in TB behandeling, die langdurige tydperk van behandeling, newe-effekte van die medikasie, geneesbaarheid daarvan, hoe die siekte versprei en die gevolge betreffende onvoldoende medikasie ten einde die gemeenskap te bemagtig betreffende die siekte. Die raamwerk van die Nasionale Departement van Gesondheid (2009:45) betreffende die faktore wat bydra tot onderbreking in TB-behandeling is gebruik as konseptuele raamwerk vir die studie. Faye Abdellah se teorie (George, 2002:173-1830)verduidelik verpleging as ’n omvattende diens wat insluit: identifisering van die pasiënt se verplegingsprobleme, die besluit van ’n toepaslike plan van aksie, sowel as die voortgesette sorg betreffende die individu se totale behoeftes.

The study seeks to explore and to offer a critical account for the 'discursive doings' of student psychiatric nmsing practice as they are jointly constructed in the episodes of conversation between the nmse and client-speakers within the context of the communitybased psychiatric clinic. The study is built around a social constructionist framework and is concerned with the analysis of the discursive activities present within seven (7) transttibed, audio-recordings of student nurse-psychiatric client interactions. A thick and sometimes critical description of three of the contextual forces back grounding/foregrounding the discursive processes of psychiatric nursing is given. These include the public health psychiatric care context, the problem-solving approach of the undergraduate psychiatric nursing curriculum and the assumption and effects of modem psychiatric nursing theory. The first level of analysis is an aspect of the methodology and offers a descriptive and interpretive analysis of the talk in the texts. Various conversational discourse analytic tools were used here to transform talk into text and to develop the starting point for the subsequent positioning theory analysis. The second level of analysis is a positioning theory analysis of happenings within these texts. Some of the textual descriptions generated in the first level of analysis are used to illuminate and to add substance to the accounts of these positioning theory happenings. The analysis has shown that from a social constructionist positioning perspective, the unfolding nurse-client dialogue in these texts operates in four potentially distinct ways - highlighting, herding, hectoring and heeding - with specific effects for their going on together in conditions of relationship. These ways of talking are shown to be contrary to the person-eentered rhetoric of modem psychiatric nursing and more aligned with the bio-medical format of talk in helping contexts. Can these activities be dismissed as non-nursing activities? The implications for a modem psychiatric nursing theory that holds the person-centred approach to be its quintessential essence are considered and a number of ideas for how client-authorised expressions may be jointly manifest in conversations situated in this practice context are offered. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.