Distance Learning (DL) is recognized to be a contemporary mode of education delivery. It is used to respond to the need of human resource development in developing countries. The evolution of Information Communication Technology (ICT) is seen as an opportunity for the development of DL. DL through ICT is perceived as an opportunity for meeting most of the challenges of higher education systems in Sub-Sahara Africa in general, and in Rwanda in particular. Planning and implementing DL as an innovation in the education system of Rwanda are processes which need to be understood if DL is to expand and contribute to human resource development in different sectors. The aim of this study was to analyze the process of planning and implementing DL in tertiary health professional education in the Kigali Health Institute and in tertiary teacher education in the Kigali Institute of Education, in order to understand the dynamics of planning and implementing DL, and to suggest the way forward for the success of those two programs. Concepts taken from innovation Havelock's problem solving strategy (1982) and social system theories in particular Owens's open sociotechnical systems for schools (1998) were combined to form the framework which guided this study. A qualitative case study, using a comparative descriptive approach, was the research design. The participants were drawn from (a) policy makers in the ministry of education, ministry of health, ministry of public services and the Rwanda Information Technology Authority (RITA); (b) management in the participating institutions; (c) the teaching staff, especially those who were involved and/or are still involved in the process; (d) students; (e) and members of professional regulatory bodies. Purposive and theoretical sampling was used to select the participants. Twenty one informants were interviewed. Three focus group discussions of six, four and eight participants respectively were conducted. In addition document review and analysis, and physical artefacts served also as means of data collection. The results showed that systematic planning with a comprehensive document and strategic plan as outcome of the planning process are essential for the successful implementation of distance learning in Rwanda. Supportive and responsive institutions and suprasystems are indispensable to a conducive environment for planning and implementing DL in Rwanda. From the results, recommendations for the progress of the two programs that were part of this study were put forward. A framework of planning and implementing DL in Rwanda was developed based on these results. This framework may be used by policy makers, educators and other parties interested in the development of DL in Rwanda. / Thesis (Ph.D.)-University of KwaZulu-Natal, 2005.

HIV/AIDS care needs to be comprehensive and holistic (UNAIDS, 2002). Counselling has proved to be one of the most effective behavioral tools in the global anti-HIV/AIDS fight by equipping people mentally, emotionally, psychologically and socially for the disease (Anon, 2000). Over the past two decades researchers identified cultural factors, race, gender and class as leading inequitable treatments in general counselling situations (Coleman, 1995). This challenge happened to be the same in HIV/AIDS counselling, especially because the counselor work with sensitive information. Nurses who forms the back-bone of HIV/AIDS counselling, are all trained on a Western model of HIV/AIDS counselling. Herbst (1990) also pointed out that knowledge concerning cultures and subcultures and its implications has become a major issue for the nurse to deliver health care in South Africa. Faced with the history of South Africa and the diverse cultures it was my personal experience as a professional nurse, counselor and researcher while I was working on the *Ufe health train, that the knowledge of culture is one of the most important factors of HIV/AIDS counselling. This motivated me to embark on this research. This research aims at providing an analytical description of the experience of counselling for African (Batswana) counselees and their counselors with specific reference to HIV/AIDS counselling with view to improve this interaction. The objectives of this research was to: a) analyse the counselling done by Western and African counsellors in the health system, with a particular focus on HIV/AIDS counselling, b) establish how acceptance and decision-making is promoted, understanding of the counselee is established and psychosocial support is given, and c) develop a middle -range theory that describes appropriate HIV/AIDS counselling for African counselees. Glaser's (1965; 1967; 1992) grounded theory approach was used to guide this research. Multiple data collection methods were used, which took place concurrently with the descriptive analysis. Glaser's conceptual analysis paradigm for qualitative data analysis was utilised. Based on the results of this research the importance of an HIV/AIDS counselling approach for Africans is emphasised. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2004.

The study explored the cultural dynamics of construction of sexual intercourse within gender constructions of masculinity and femininity among the Yoruba people of South western Nigeria. The Explanatory Model Interview Catalogue (EMIC/ETIC) framework, a cultural explanatory social analytic framework with guides to looking at the insiders' perspectives, was used as the theoretical base to the study. The study was conducted to broaden understanding of sexual relationships in order to generate culturally relevant programmes that can promote sexual health, control sexual coercion, sexual violence and reduce the transmission and spread of HIV. It explored information about the conceptions of sexual relationships, social dynamics of sexual negotiations in marital and non-marital relationships, the expressions and process of knowledge acquisition as such translates to sexual behaviour by men and women. The prevalence of consensus, coercive and forced sexual intercourse and sexual morbidity were determined. Perceived link of sexual coercion and sexual violence to HIV transmission was also explored. Traditional practices, including regulatory mechanisms for the control of sexual behaviour of men and women in the culture were also explored. Equally focused in the study were differences in the conceptions of sexual relationships among the study population as moderated by sex, age, educational background and marital status, along with experiences of sexual coercion, forced sex, and sexual intercourse related morbidity. Adopting the ethnographic method, qualitative data from historical review of existing information about the Yoruba people, focus group discussions, in-depth individual interviews and observations were complemented by quantitative data generated through a survey in a sample Yoruba community of lIe-Ife. Findings showed the conception of sexual relationships and sexual intercourse built around the conception and social constructions of active masculinity and passive femininity. Conceptions of sexual relationship evolved as a transitional phenomenon that individuals were expected to learn informally instinctually and as they attain sexual biological maturity through language use and observations of practices among older people. Two typologies of masculinity and femininity were discernible in the study population that also give specifications to social and sexual behaviour of men and women. There appeared a changing conception of femininity especially among young people below 30 years, which is also informing sexual behaviour of young women. Relationships were moderated by age, economic status and marriage, which invariably put women in subordinate position to men either in social or sexual relationships. Behaviour of men and women were dictated by social role assignment of leadership through economic provisions for family and control of sexual act by the man. This was within a contractual relationship of older men with younger women with the primary motive of procreation in traditional orientation. Sexual intercourse was seen as a compulsory act for both men and women especially as it results to procreation though the initiation and control were part of the social responsibility of the man. It was socially approved within marriage but pre-marital and extra marital relationships were tolerated more for men. The act was also used "as a prove of self", for economic gains, to demonstrate love, for enjoyment and as a tool of punishment of women by some men. Knowledge acquisition about sexual relationships and sexual intercourse tended to be inadequate throughout the life span. There was never a time when individuals, even after marriage, have access to correct information about sexual intercourse. There was gross assumption of what sexual partners know about sexual intercourse in the population. Within the context of 13 identifiable topical knowledge areas desirable for sexual health, more than 50% of males and females expressed lack of knowledge. There were significant differences in expressed knowledge by male and female respondents of what sexual intercourse is and the motives of sexual intercourse / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2005.

It is against the background of new developments and initiates taking place in various countries to make basic nursing education systems more responsive and relevant to the ever-changing nature of society that a cross-national study of the current systems of basic nursing education of francophone African countries of WHO Afro Region was undertaken. The aim of the study was to describe and analyze the current systems of basic nursing education in Francophone African countries of WHO Afro Region with 'a view to providing guidelines for change toward a basic nursing educatian system that is in line with the recommendations of WHO (1994, 1985, 1984, 1966) and the various countries' health care delivery systems' policies. In the first phase, data was generated by means of a self-completion mailed questionnaire, administered to the members of the national regulatory bodies of nursing and nursing education from eighteen countries. The design of the above named questionnaire was based on the WHO (1994, 1985, 1984, and 1966) recommendations pertaining to basic nursing education systems. The main results of the findings of this phase showed two major trends. Firstly, more differences than similarities existed between the WHO (1994, 1985, 1984, and 1966) recommendations and the current basic nursing education systems of the countries under study. Secondly, discrepancies existed between the various countries' health care delivery systems' policies and the existing systems of basic nursing education. Finally, all the respondents expressed the views that the current basic nursing education systems are faced with educational and organizational changes and they agreed that there is a need to change the current basic nursing education systems. In the second phase, data was generated by means of three rounds Delphi questionnaires, administered to the national members of the regulatory bodies of nursing and nursing education as well as the members of national nursing associations from eighteen countries. The design of the first round Delphi questionnaire was based on the results of the first phase of this study, while the preceding round informed the design of the questionnaire of the next round. The main results of the findings showed similarities between the future orientation of the basic nursing education systems and the recommendations of the WHO as well as the global trends in the development of the basic nursing education. The stakeholders expressed the view that the national governments, the National Associations of Nurses and the Regional Office of WHO Afro Region need to play an active role in the transformation and the development of the basic nursing education systems in the Region. They suggested that the systems of educating nurses should move toward meeting the demands of the health care services and the global trends in the development of nursing and nursing education. / Thesis (Ph.D.)-University of Natal, Durban, 2001.

There is scientific evidence that the spiritual well-being of a person can influence the quality of life lived and the general responses to life's crises of illness, pain, suffering and even death (Ross, 1994). The problem that was identified in this study was the absence of an explicit description or the phenomena of spirituality and spiritual care in nursing within a South African context. Concept clarification was imperative ifnurses, patients/clients in South Africa were to realize spirituality and spiritual care within a broader context of holistic nursing. The purpose of the study was to conceptualize the phenomena of spirituality and spiritual care from the perspectives of nurses and patients/clients with an aim of generating a middle range theory of spiritual care in nursing that explained the phenomena by utilizing data that were grounded in the participants' experiences. A qualitative mode of inquiry using a grounded theory method was applied. A sample of 56 participants composed of 40 nurses, 14 patients and 2 relatives of patients was recruited by theoretical sampling procedure from two hospitals, and one hospice settings. Data were collected by utilizing focus groups interviews followed by one to one in depth interviews and observations. An audio tape recorder was used to record the conversation, field notes and memos were also kept to strengthen the data, and to ensure trustworthiness. Data were collected and analyzed simultaneously. A software called Nvivo was used to code data into different levels of coding. The results were rich descriptions of the phenomena in question and a development of a theoretical model for spiritual care. The concept of spirituality was described as a unique individual quest for a transcendent relationship by establishing and maintaining a dynamic relationship with self, others and with God as understood by the person. The ability to establish and maintain a meaningful transcendent relationship seemed to be related to the person's beliefs, faith or trust. 99% of the participants expressed their quest for a transcendent relationship through organized religion while I % claimed to have their spiritual fulfilment outside an organized religion. The phenomena of spirituality and spiritual care were conceptualized as occurring in phases which begin with a comfortable zone, trigge r-response and spiritual caring. The nurses role in spiritual care was perceived as based upon the principles of ubuntu. compassion for human suffering and pain and acceptance of a patient/client as a unique being. Nurses carried their spiritual care roles by accompanying, helping, presencing, valuing and intercessory roles. The outcomes of spiritual care were cited as hope, inner peace, finding meaning and purpose in life, illness, and in death. / Thesis (Ph.D.)-University of Natal, Durban, 2001.

The subject of international migration has become an important social issue and feature of globalized labour market in health care. International migration of nurses has increasingly become a concern and the volumes are reported to be increasing particularly from the developing world where, in some countries, is a leading cause of attrition and subsequent shortage of nurses as a human resource. This has implications on the capacity of health systems to respond to the challenge of health care delivery to populations considering that nurses form the largest health workforce in most countries. In Zambia, nurse migration has equally been a concern including the absence of relevant studies with evidence to inform policy direction, planning and management of nursing human resource. The purpose of this study was to determine the extent of nurse migration, the reasons why nurses resign their employment positions and leave the country, why other nurses do not migrate and to further determine the perceived nurse migration impact on the public health care system. The study was a non-experimental descriptive survey design that used both quantitative and qualitative approaches to data collection and data analysis. A triangulation approach was used in data collection involving various methods; multistage, stratified and systematic sampling; purposive and snowball with a range of data collection instruments; semi-structured for focused interviews of nurse migrants, nurses seeking verifications and policy makers; self-administered questionnaire that enlisted data from clinical nurses and nurse educators on the perceived impact of nurse migration on the public health care system and topic guides for focus group discussions. Computer software were used to code and analyze data; SPSS version 11.0 for quantitative data and NVivo7 for qualitative data. A total of 309 clinical nurses and 23 nurse educators responded to the self administered questionnaire. Thirty three key informants participated in focus group discussions conducted in four health facilities situated in four districts. There were five directors at provincial, district and national levels and 13 nurse migrants interviewed. Data on nurses with verification of qualifications sent to countries were collected from a total of 1,142 records; 931 for RNs and 211 for ENs. The study was guided by a conceptual framework developed from two migration theories namely the World Systems Theory and the Push and Pull Theory. The World Systems Theory structured the world into three zones of Periphery (poor countries), Semi-Periphery (Transitional economies) and the Core (industrialized wealthy countries). Push factors caused people to leave the Periphery to the Semi-periphery and to the Core where the Pull factors attracted those from the Periphery and Semi-periphery. Major findings of the study showed dissatisfaction with work conditions, poor living conditions, lack of professional recognition and autonomy and lack of access to professional development as being among the push factors while the pull factors included attractive work conditions, conducive work environment and access to professional development, among others. The perceived impact included nurse shortage, excessive workload, long working hours and poor quality of patient care. Findings on issues for policy on managing nurses leaving for greener pastures were in the form of interventions that would address the push factors and formed the basis for recommendations from the study. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.

Schools reach further into communities of young people than any other institutions, and therefore, they are critical for reducing the HIV and AIDS vulnerability and risk among this age group (UNESCO, 2002). Therefore, if the schools are to be used as an entry point for prevention activities, it is important to have a clear idea of the current level of knowledge, attitudes and behaviour with regard to HIV/AIDS. A quasi-experimental design was adopted for this study. Qualitative and quantitative data were collected during the period between June and October 2004 to establish baseline knowledge and behaviour. A total number of 613 respondents participated in this study. Two groups, an experimental and a control group with equal number (306) of pupils in each were established by drawing a random sample of 51 respondents per school from 12 secondary schools in Kigali. However, an extra respondent from one school was noted. A selfadministered questionnaire was used to collect quantitative data whereas qualitative data was generated by asking each respondent to write any concerns or experiences with HIV/AIDS on a piece of paper. All respondents (n= 613) expressed their thoughts anonymously and freely on these papers. Furthermore, focus groups and interviews were conducted with some key informants amongst the respondents who were especially the leaders of Anti-AIDS clubs and student managers from schools or counselling session organizers at Kacyiru Health Centre. These were particularly Anti-AIDS club leaders and/or active club members. After a baseline assessment, a phased intervention (sensitization, pre-test counselling, testing, post-test counselling and follow-up) were implemented with the experimental group. This process was described, identifying all barriers to implementation. Finally a second measurement concerning both groups took place. During the baseline measurement, respondents were more concerned about their reproductive health issues rather than HIV/AIDS as a specific topic. With regard to HIV/AIDS transmission, however, the following was found: high awareness, many misconceptions about HIV/AIDS transmission and almost half of respondents have had sexual intercourse. Unprotected sexual intercourse was also reported. A summary of reasons given for having sexual intercourse is: experience, curiosity, peer pressure, partner empathy, monetary gain, and coercion. A sensitization phase prior to the testing sessions resulted in a large number of respondents (434) attending Voluntary Counselling and Testing (VCT) services, the main intervention for this study which took place in a Health Centre. Only twelve respondents (3%) tested HIV positive while five respondents (1%) tested syphilis positive. Although the immediate coping with test results for all respondents was successfully dealt with, the findings from this study indicate some difficulties with regard to the management of individual respondents who tested positive. The strong emphasis on anonymity during the study did not allow the researcher to follow-up all respondents who tested positive. All steps were successfully implemented according to this study model. In spite of certain problems encountered in terms of access to schools, there was nothing insurmountable during the VCT implementation process. After the intervention, a large number of respondents showed a high HIV/AIDS awareness, expressed willingness to change their behaviours, and a willingness to advocate for VCT amongst their peers. The follow-up sessions and the quantitative data at the second measurement and especially statistical analysis carried out did not indicate a significant difference in the sexual behaviour of respondents. However, a significant difference was found when comparing the knowledge of the two groups on HIV/AIDS's physiological effects and transmission. Finally, recommendations and Best Practice Guidelines were established with regard to further research and the implementation of VCT in secondary schools. / Thesis (Ph.D.)-University of KwaZulu-Natal, 2006

Background: Reviewed literature revealed a number of responses to the calls to reform nursing education to respond to the priority health needs of the country. The 1997 National Health Care Policy served as the basis for the reforms in nursing education. Some of the nursing schools in South Africa embarked on a process of recurriculating to community based, problem based education long before the tabling of the 1997 National Health Care Policy with the aim to respond to priority health needs. Literature however showed that no research has been conducted to explore the concept responsive education within the South African context, especially in nursing education and whether nursing programmes are responding to the needs of the South Africa population. Therefore the purpose of the study was to explore the concept responsive education and responsiveness of the Nursing Education Programmes at Lilitha College of Nursing to the health needs of the Eastern Cape population. Research Methodology: A qualitative research approach with an ethnography design was used to guide the research process in this study. Purposive and convenient sampling was used to select the participants. The participants included policy makers from the Department of Health (Eastern Cape), lecturers and campus heads of Lilitha's three campuses (Umthatha, Port Elizabeth and East London), the professional nurses and the graduates at the primary health clinics, as well as the college principal. Initially, data collection and data analysis took place concurrently, Findings: Responsive education in this study was characterized by relevance to the health needs of the community, responding to national policies, community involvement and participation, use of health priorities to update the curriculum and graduates who can provide quality care. Cultural themes that emerged under responsive nursing programmes included; the special nature of the curriculum used, the innovative teaching strategies used, clinical learning sites which are congruent with the programme outcomes, the role played by all stakeholders in the programme, and assessment strategies used which are in line with the programme outcomes. A number of factors emerged as barriers to the production of responsive graduates. The findings in this study also revealed competencies of graduates from a responsive nursing programme, which included practical and transferable life skills. Recommendations: These included reviewing of existing nursing programmes with the aim of ensuring that they respond to the health needs of the community, revisiting teaching strategies used, building capacity of lectures in the area of innovative teaching and revisiting graduate competencies in nursing programmes to that they are in line with what the community demands. / Thesis (M.Nursing)-University of KwaZulu-Natal, 2008.

There is a great deal of literature and a number of research studies that have been carried out on reflective practice, models and frameworks of reflection and teaching strategies that successfully promote reflective thinking. This study addresses the need to adopt teaching - learning approaches in nursing education that develop a link between theory and practice in a meaningful way. Reflective thinking is one such approach which is gaining popularity. Reflection is claimed as a goal in many teacher education programmes but the application of reflective teaching strategies has been problematic. This study was aimed at exploring how nurse educators of the Nursing Colleges in KwaZulu-Natal promoted reflective thinking in their teaching. Three of the four Nursing Colleges chosen for data collection were from the greater Durban Metropolitan area because of the accessibility of the participants. There were seventy-two participants in the study. A quantitative design was used, followed by statistical analysis of the data. Data was collected by means of a questionnaire which included structured and semi-structured questions. What emerged in this study is the need for Nurse Educators to take cogniscance of determining appropriate teaching strategies that would develop reflective thinking skills amongst learners. However, the findings indicate that most Nurse Educators do utilize teaching strategies that promote reflective thinking, but a large percentage still use the lecture method as the primary teaching strategy. / Thesis (M.A.)-University of KwaZulu-Natal, 2007.

The aim of the study was to explore the perceptions of the HIV negative pregnant women, after their hiv negative results, towards preventive sexual behaviour. Methodology: A qualitative approach was used in exploring the perceptions of hiv negative pregnant women and describing their behaviour according to the findings. Fifteen participants were interviewed. Two semi - structured interviews were conducted with each participant, an initial interview and a verifying interview, for the purpose of saturation and verification. Each interview lasted for 20 - 30 minutes. The interviews were recorded and transcribed. Manual data analysis was used to identify categories and themes. Findings: The study revealed that the participants knew what the negative status entailed. They were also aware that there is a chance of hiv negative person being infected by hiv virus if they do not engage in preventive sexual behaviour. Furthermore, they had also disclosed their hiv negative status to their partners and most of the partners refused to go for testing. Though the participants believed that it was necessary to use condoms even if they were hiv negative, most of them had not use condoms during their last sexual intercourse. Reasons for not engaging in preventive sexual behaviour were revealed by the study. Recommendations were suggested for clinical practice, nursing education, management and research. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2005.