Thesis (MCur)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Ventilator-Associated Pneumonia (VAP) is a hospital acquired infection, not present or incubating at the time of admission and developing in patients during the process of care within the hospital setting. Between nine and twenty-seven percent of patients who are mechanically ventilated will develop ventilator-associated pneumonia. Mortality rates for ventilated patients who develop ventilator-associated pneumonia are estimated to be between 33-50%. The Institute for Healthcare Improvements (IHI) in 2006 recommended the use of ‘care bundles’ to reduce VAP but no statistically significant decline has been noted. Despite the completion of an extensive literature search for purposes of this review, no statistical data on nosocomial infections or nosocomial pneumonia relevant to South Africa was found. Mechanical ventilation, a support therapy used in approximately one third of patients, significantly increases the patient’s risk of developing this nosocomial pneumonia. Critically ill patients are by virtue of their critical illness more prone to the development of infections, especially ventilator-associated pneumonia. Consistent evidence suggests that oropharyngeal colonization can be associated with the development of VAP. Studies focusing on standard oral care, with or without the concurrent use of chlorhexidine, have not provided sufficient evidence for the use of chlorhexidine in VAP prevention. Chlorhexidine is an antiseptic agent, which when tested, proved to reduce total respiratory tract infections by up to 69% (DeRiso et al, 1996:1558). Objective: The aim of this study was to systematically appraise and review evidence on the effectiveness of chlorhexidine in reducing the incidence of ventilator-associated pneumonia in adult patients. The secondary aim was to systematically summarize evidence on the use of chlorhexidine in reducing mortality. Methodology: An extensive literature search of studies published in English was undertaken. Electronic databases searched were CENTRAL, CINAHL, EMBASE and MEDLINE. Reference lists of articles, textbooks and conference summaries were examined. Literature searches were conducted using Medical Subject Headings (MeSH). These included: Ventilator-associated pneumonia, chlorhexidine, VAP and oral care. Eight randomized controlled trials, investigating the efficacy of Chlorhexidine in ventilator-associated pneumonia prevention in adults met the inclusion criteria. The effect measure of choice was Risk ratio with 95% confidence intervals for dichotomous data using the random effects (Mantel-Haenszel) model; (p=value of 0.05). Heterogeneity was assessed using the Cochrane Q statistic and I². Results: Eight randomized controlled trials met the inclusion criteria for this review. Pooled risk ratio for the incidence of ventilator-associated pneumonia was 0.64 (95% CI; 0.44-0.91; p =0.18). Treatment with chlorhexidine decreased the risk of ventilator-associated pneumonia by 36%. There was no evidence of Chlorhexidine reducing mortality. Conclusions: Chlorhexidine is a cost effective safe treatment in the prevention of VAP. The use of 2% chlorhexidine may be more effective in reducing the incidence of VAP. No studies were found conducted in developing countries. More rigorously designed trials using 2% chlorhexidine are recommended. / AFRIKAANSE OPSOMMING: Agtergrond Ventilator-Geassosieerde Longontsteking (VAP) is 'n hospitaal verkry infeksie, nie teenwoordig met toelating nie. Ventilator-geassosieerde longontsteking word ontwikkel in pasiënte tydens die proses van sorg in die hospitaal. Tussen nege en sewe en twintig persent van pasiënte wat meganies geventileer word kry ventilator-geassosieerde pneumonie. Sterftesyfers vir geventileerde pasiënte wat ventilator-geassosieerde pneumonie ontwikkel is na raming tussen 33- 50%. Die Institute for Healthcare Improvements (IHI) het in 2006 die gebruik van 'sorg bundels' aanbeveel om VAP te verminder, maar geen statisties beduidende daling is aangeteken nie. Ten spyte van 'n uitgebreide literatuur soek, is geen statistiese data op nosokomiale infeksies of nosokomiale longontsteking toepaslik tot Suid-Afrika gevind nie. Meganiese ventilasie, 'n ondersteuningsterapie wat gebruik word in ongeveer een derde van die pasiënte, verhoog aansienlik die pasiënt se risiko vir die ontwikkeling van hierdie nosokomiale longontsteking. Kritiek siek pasiënte is op gronde van hul kritieke toestand meer geneig tot die ontwikkeling van infeksies, veral ventilator-geassosieerde pneumonie. Konsekwente bewyse dui daarop dat orofaringeale kolonisasie kan met die ontwikkeling van VAP geassosieer word. Studies wat fokus op standaard mond sorg, met of sonder die gelyktydige gebruik van chlorhexidine, het nie voldoende bewyse vir die gebruik van chlorhexidine in VAP voorkoming nie. Chlorhexidine is 'n antiseptiese agent, wat wanneer in een verewekansigde gekontroleerde studies (VGS) getoets was die totale respiratoriese kanaal infeksies verminder deur tot 69%. Doel: Die doel van hierdie sistematiese literatuuroorsig was om stelselmatig te evalueer en bewyse oor die effektiwiteit van chlorhexidine in die vermindering en voorkoms van ventilatorgeassosieerde pneumonie in volwasse pasiënte te hersien. Die sekondêre doel was om stelselmatig bewyse op te som op die gebruik van chlorhexidine in die vermindering van sterfte. Metodiek: 'n Uitgebreide literatuursoektog van studies wat in Engels gepubliseer is was onderneem. CENTRAL, CINAHL, EMBASE en MEDLINE was deursoek. Naslaanlyste van artikels, handboeke en konferensie opsommings is ondersoek. Die literatuur soektog is uitgevoer met behulp van Medical Subject Headings (MeSH). Dit sluit in: ventilator-geassosieerde pneumonie, chlorhexidine, VAP en mond sorg. Agt verewekansigde gekontroleerde studies (VGS), wat die doeltreffendheid van Chlorhexidine in ventilator-geassosieerde pneumonie voorkoming in volwassenes ondersoek, was ingesluit vir hierdie studie. Die effek mate van keuse was risiko ratio (RR) met 95% vertrouensintervalle met behulp van die ewekansige effekte (Mantel-Haenszel) model; (p = 0.05). Heterogeniteit is bepaal deur gebruik te maak van die Cochrane Q- statistiek en I². Hoof resultate: Agt verewekansigde gekontroleerde studies (VGS) het die insluiting kriteria vir hierdie oorsig gepas. Gepoelde risiko ratio vir die voorkoms van ventilator-geassosieerde pneumonie: Risiko Ratio (RR) was 0.64 (95% CI; 0.44-0.91; p=0.18). Gevolgtrekkings: Behandeling met chlorhexidine het die risiko van ventilator-geassosieerde pneumonie met 36% gedaal. Daar was geen bewyse van Chlorhexidine op die vermindering van mortaliteit nie. Chlorhexidine is 'n koste-effektiewe veilige behandeling in die voorkoming van VAP. Die gebruik van 2% chlorhexidine kan moontlik meer effektief wees in die vermindering van die voorkoms van VAP. Meer streng ontwerp studies met 2% chlorhexidine word aanbeveel.

Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Intraventricular haemorrhage is associated with neurological morbidity and mortality in low birth weight infants. In spite of improvements in treatment to reduce the incidence of the haemorrhage, the condition continues to remain a major cause of long term morbidity in low birth weight infants. The evidence from the literature has shown that low birth weight infants might benefit from delayed cord clamping particularly in reducing the risk of intraventricular haemorrhage and its neurological consequences. The primary objective of this review was to assess the effects of delayed versus early cord clamping on intraventricular haemorrhage amongst low birth weight infants. The secondary objectives were to evaluate the effects of delayed versus early cord clamping on the Apgar scores, hyperbilirubinaemia and polycythaemia in infants. The following electronic databases were searched: CINAHL, MEDLINE (searched via PubMed) and Cochrane Central Register of Controlled Trials (CENTRAL). Other information was gathered from the reference lists of retrieved articles and relevant experts. The selection criteria entailed all randomised controlled trials comparing delayed versus early cord clamping following birth in infants with low birth weight. Two reviewers independently extracted the data and assessed the quality of the trials. Disagreements on studies for inclusion were resolved by discussion with the third reviewer. The review included five randomised controlled trials with 215 participants. The risk of intraventricular haemorrhage was significantly reduced in the delayed compared with early cord clamping (RR0.52, 95% CI 0.33 to 0.82, P=0.005). No statistically significant difference was shown between delayed versus early cord clamping for the risk of hyperbilirubinaemia (RR O.48, 95% CI -0.43 to 1.39, P=0.30). There was no data available for other comparisons: Polycythaemia and Apgar scores. There is growing evidence that delayed cord clamping might benefit low birth weight infants. In the included studies, delayed cord clamping for at least 30 seconds appear to have a potential in reducing the risk of intraventricular haemorrhage. The results of this review should however be interpreted with caution due to a limited number of studies with the absence of clinically important secondary outcomes in the included trials. Further research is required on large scale randomised controlled trials. / AFRIKAANSE OPSOMMING: Intraventrikulêre bloeding word geassosieer met neurologiese morbiditeit en mortaliteit in suigelinge met ’n lae geboortegewig. Ten spyte van die verbetering in die behandeling om die gevalle van bloeding te verminder, duur die toestand voort as ’n belangrike oorsaak van langtermyn morbiditeit in lae gewig geboortes. Bewyse uit die literatuur toon dat suigelinge met ’n lae geboortegewig voordeel mag trek uit vertraagde afklemming, veral deur die vermindering van die risiko van intraventrikulêre bloeding en die neurologiese gevolge daarvan. Die primêre doelwit van hierdie navorsing was om die effek van vertraagde, versus vroeë afklemming op intraventrikulêre bloeding onder suigelinge met ’n lae geboortegewig te bepaal. Die sekondêre doelwit is om die effekte van vertraagde, versus vroeë afklemming op die Apgar uitslae, hiperbilirubinaemia en polisitaemia by suigelinge te evalueer. Die volgende elektroniese databasisse is nagegaan: CINAHL, MEDLINE (soektog via PubMed); Cochrane Central Register of Controlled Trials (CENTRAL). Ander inligting is verkry uit die bronnelyste van nagevorsde artikels en van relevante deskundiges. Die seleksie kriteria behels alle ewekansige beheerde toetsing, insluitende toekomstige studies wat vertraagde, versus vroeë afklemming vergelyk by suigelinge met ’n lae geboortegewig. Twee resensente het onafhanklik data geneem en die kwalititeit van die toetse bepaal. Verskille oor insluiting van navorsing, is met ’n derde resensent deur middel van bespreking opgelos. Die navorsing het vyf ewekansige beheerde steekproewe met 215 deelnemers ingesluit. Die risiko van intraventrikulêre bloeding is beduidend verminder in die vertraagde gevalle, in teenstelling met vroeë afklemming (RR0.52, 95% CI 0.33 tot 0.82, P=0.005). Geen statistiese beduidende verskil is bewys tussen vertraagde teenoor vroeë afklemming ten opsigte van hiperbilirubinaemia nie (RR 0.48, 95% CI – 0.43 tot 1.39, P=0.30). Daar was geen data beskikbaar vir ander vergelykings nie: Polisytaemia en Apgar uitslae. Daar is groeiende bewyse dat vertraagde afklemming lae geboortegewig suigelinge mag beïnvloed. Dit wil in die ingeslote studies voor kom dat vertraagde afklemming van ten minste 30 sekondes die potensiaal het om die risiko van intraventrikulêre bloeding te verminder. Die uitslae van hierdie beskouing sal nietemin met omsigtigheid geïnterpreteer moet word, weens die beperkte aantal studies met die afwesigheid van klinies belangrike sekondêre uitkomste in die ingeslote proewe. Verdere navorsing word benodig op grootskaalse ewekansige beheerde proewe.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Nursing is influenced by the values of each nurse (Mellish & Paton, 1999: 6). Values form an integral part of human reality; they predict thoughts, feelings, actions and perceptions. Nursing in South Africa, is defined as a "caring profession” (Act No. 33 of 2005) and forms a subculture of the South African population, with nurses coming from different cultural and ethnic groups, being of various ages and both genders. It was identified that a need exists to understand nursing values and the factors influencing these values. Consequently, together with the lack of research data regarding values in South Africa and the factors influencing them, the importance to do an investigation into the factors influencing nursing values was identified. The aim was to do an in-depth study into the factors influencing nursing values of nurses working in nursing facilities in the Paarl district employed by the Provincial Administration of the Western Cape, in the West Coast Winelands Region of the Western Cape. The objectives were to determine the main reason for entering the nursing profession for nurses working in these facilities; to identify the most important part of nursing practice; to identify the core nursing values; to determine the factors influencing nursing values and the factors influencing nursing care. A quantitative research design using a descriptive, explorative survey was conducted. The population included the three categories of nurses, with a total population of 470 nurses (N = 470). Research questionnaires were distributed to 388 participants working on the days of data collection in all nursing departments, excluded nurses not permanently employed by the Provincial Administration Western Cape, including nursing agency staff, students doing practica and personnel on leave. The return rate was 60.56% (n = 235). The questionnaire was based on a literature review and the objectives, and a pilot test ensured reliability and validity. The results of the pilot study (n =10) were included in the findings, leading to 245 respondents (n = 245) being included in the main study. The questionnaire consisted of four sections and was validated by an expert in nursing science and research methodology, a biostatistician, a quality assurance manager and ethical committees. Four open-ended questions were included to provide richer and more diverse data. Only the researcher was involved in data collection that took place during day and night duty. Descriptive statistics and appropriate inferential statistical tests were used in analysing the data. Ethical approval was obtained. Anonymity and confidentiality of respondents were observed and written consent was obtained from respondents. It was identified that nurses enter the nursing profession due to altruism and the most important part of nursing encompasses caring. Differences in values important for behaviour of a nurse, patient care and ethical decision making were identified. Findings depicted that age, years of experience, qualification obtained, job description and department influence different values. Results identified that political and social factors, as well as motivation influence nursing practice. Recommendations include setting a clear value structure for nursing in South Africa; attention to the evaluation of staff performance and management; enhancing motivation of staff and the development of a management-for-nurse strategy. / AFRIKAANSE OPSOMMING: Verpleging word beïnvloed deur die waardes van elke verpleegster (Mellish & Paton, 1999:6). Waardes vorm ’n integrerende deel van die menslike realiteit, dit voorspel gedagtes, gevoelens, handelinge en gewaarwordinge. Verpleging in Suid-Afrika word gedefinieer as ’n versorgingsberoep (Wet No. 33 van 2005) en vorm ’n subkultuur van die Suid-Afrikaanse bevolking, met verpleegsters van verskillende kulturele en etniese groepe wat verskeie ouderdomme en albei geslagte insluit. Dit is geïdentifiseer dat ’n behoefte bestaan om verplegingswaardes en die faktore wat hierdie waardes beïnvloed, te verstaan. Gevolglik, gesamentlik met die gebrek aan navorsingsdata aangaande verpleegwaardes en die faktore wat dit beïnvloed, in Suid-Afrika, is die belangrikheid geïdentifiseer om ’n ondersoek te doen aangaande die faktore wat verpleegwaardes beïnvloed. Die doel was om ’n dieptestudie te doen van die faktore wat die verpleegwaardes van verpleegsters beïnvloed wat in verpleeg instansies in die Paarl-distrik werk in diens van die Provinsiale Administrasie van die Wes-Kaap, in die Weskus Wynlandstreek van die Wes-Kaap. Die doelwitte was om die hoofrede te bepaal waarom verpleegsters wat in hierdie fasiliteite werk die verpleegberoep betree het; om die belangrikste aspek van die verpleegpraktyk te identifiseer; die kern verplegingswaardes te identifiseer; en die faktore te bepaal wat verplegingswaardes en verpleegsorg beïnvloed. ’n Kwantitatiewe navorsingsontwerp is toegepas deur van ’n beskrywende, ondersoekende opname gebruik te maak. Die bevolking het die drie kategorieë van verpleegsters ingesluit, met ’n totale bevolking van 470 verpleegsters (N=470). Navorsingsvraelyste is versprei aan 388 deelnemers wat op die dae van data-insameling gewerk het in die verpleegdepartemente en het verpleegsters uitgesluit wat nie permanent indiens was van die Provinsiale Administrasie van die Wes-Kaap, asook verpleegagentskap personeel, studente wat praktika verrig en personeel op verlof. Die terugkeerkoers was 60.56% (n=235). Die vraelys was gebaseer op ’n literatuurstudie en die doelwitte van die studie, ’n loodsstudie het betroubaarheid en geldigheid verseker. Die resultate van die loodsstudie (n=10) is ingesluit in die bevindinge, wat gelei tot 245 respondente (n=245) in die hoof studie. Die vraelys het bestaan uit vier afdelings en is geldig verklaar deur ’n spesialis op die gebied van verpleegkunde en navorsingsmetodologie, ’n biostatistikus, ’n kwaliteitversekeringsbestuurder en etiese komitees. Vier oop-vrae is ingesluit om omvattende en meer uiteenlopende data te voorsien. Slegs die navorser was betrokke by data-insameling wat gedurende dag en nag skofte plaasgevind het. Beskrywende statistiek en geskikte afleibare statistiese toetse is gebruik in die analisering van die data. Etiese goedkeuring is verkry. Anonimiteit en vertroulikheid van respondente is behou en geskrewe toestemming is verkry van respondente. Bevindinge het getoon dat verpleegsters die verpleegberoep betree weens hul onbaatsugtigheid en dat die belangrikste aspek van verpleging versorging is. Verskille in waardes wat belangrik is vir die gedrag van ’n verpleegster/verpleër, pasiënt versorging en etiese besluitneming is geïdentifiseer. Daar is bevind dat ouderdom, ondervinding in jare, kwalifikasies behaal, posbeskrywing en die departement verskillende waardes beïnvloed. Resultate het bewys dat politieke en sosiale faktore, asook motivering verpleegpraktyk beïnvloed. Aanbevelings sluit die daarstelling van ’n duidelike struktuur van verpleegwaardes in Suid-Afrika; die nodigheid vir aandag aan die evaluering van personeelprestasie en -bestuur; die verheffing van personeelmotivering en die ontwikkeling van ’n bestuur-vir-verpleegster strategie.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: There is no formal succession plan for paediatric professional nurses (PNs) in academic, tertiary hospitals in the Western Cape. A lack of a succession plan could have major implications for the sustainability of effective and efficient health care services (Department of Health, DoH, 2010:1). Therefore, a systematic scientific investigation is required to determine the opinions of PNs regarding the characteristics or criteria for a succession plan in a paediatric organization. The aim of this study was to determine the opinions of paediatric PNs regarding succession or career planning in academic, tertiary hospitals in the Western Cape. A quantitative approach with an exploratory, descriptive, non-experimental design was applied by means of a questionnaire survey which consisted of closed and openended questions. Reliability and validity were assured by means of a pilot study and consultation with nursing experts and a statistician. Cronbach’s alpha test was used to test for internal consistency between the responses to the 3-point Likert scale and dichotomous questions on the characteristics of an ideal succession plan. The data was collected by means of a self-administered, structured questionnaire to elicit opinions regarding the characteristics of an ideal succession plan that includes a career plan. Ethical approval was obtained from the Health Research Ethics Committee of the University of Stellenbosch. Permission for access to the hospitals was obtained from the hospital and nursing managers. Informed written consent was obtained from the participants. The questionnaires were distributed personally by the researcher at two hospitals and via the assistant manager in nursing at one hospital. Data was analysed by the statistician and descriptive statistics were presented by means of frequency distribution tables and histograms. Furthermore, the existence of relationships between variables was compared by means of a t-test or when assumptions of the t-test were not fulfilled an appropriate non-parametric test was considered. The results were evidence of the need for the development of a succession plan based on Benner’s Novice to Expert Model for paediatric PNs in academic, tertiary hospitals in the Western Cape. In addition, participants’ opinions on the value of a succession plan, including a career plan showed multiple benefits that will outweigh its challenges once developed and implemented. Recommendations are based on the scientific evidence that show the urgent need for the development and implementation of a formal five level skill-based clinical training programme that includes a 360-degree feedback system for paediatric PNs by means of an integrated, collaborative approach. The development and implementation of a formal succession plan will strengthen and enhance the retention of the various levels of competent, proficient and expert paediatric PNs. In addition, a formal succession plan will attract and motivate the novice and advance beginners to progress to competent, proficient and expert levels. / AFRIKAANSE OPSOMMING: Daar is geen formele opvolgplan vir pediatriese professionele verpleegpersoneel in akademiese tersiêre hospitale in die Wes-Kaap nie. ’n Gebrek aan ’n opvolgplan kan ernstige gevolge vir die volhoubaarheid van effektiewe en doeltreffende gesondheidssorgdienste inhou (DoH, 2010:1). Dus, is ’n sistematiese wetenskaplike ondersoek nodig om die opinies van professionele verpleegpersoneel te bepaal, ten opsigte van die eienskappe of kriteria vir ’n opvolgplan in ’n pediatriese organisasie. Die doel van hierdie studie was om die opinies van pediatriese professionele verpleegpersoneel te bepaal ten opsigte van ’n opvolg- of beroepsplan in akademiese, tersiêre hospitale in die Wes-Kaap. ’n Kwantitatiewe benadering met ’n ondersoekende, beskrywende, nie-eksperimentele ontwerp is toegepas deur gebruik te maak van ’n vraelysopname wat bestaan het uit geslote en ope-vrae. Betroubaarheid en geldigheid is verseker deur gebruik te maak van ’n loodsondersoek en raadpleging van verpleegkundiges en ’n statistikus. Cronbach se alpha-toets is gebruik om te toets vir interne konsekwentheid tussen die response tot die 3-punt Likertskaal en tweeledige vrae oor die kenmerke van ’n ideale opvolgplan. Die data is gekollekteer deur gebruik te maak van ’n selfgeadministreerde, gestruktureerde vraelys om opinies te onthul ten opsigte van die kenmerke van ’n ideale opvolgplan, wat ’n beroepsplan insluit. Etiese goedkeuring is verkry van die Gesondheidsnavorsing se Etiese Komitee van die Universiteit van Stellenbosch. Toestemming vir toegang tot die hospitale is verkry van die hospitaal en verpleegbestuurders. Ingeligte skriftelike toestemming is van die deelnemers verkry. Die vraelyste is persoonlik versprei deur die navorser by twee hospitale en via die assistentbestuurder wat by een van die hospitale verpleeg. Data is geanaliseer deur die statistikus en beskrywende statistiek is aangebied by wyse van frekwensie verspreidingstabelle en histogramme. Voorts, is die bestaan van verwantskappe tussen veranderlikes vergelyk, deur gebruik te maak van ’n ttoets of waar veronderstellings van die t-toets nie bereik is nie, is ’n gepaste nieparametriese toets oorweeg. Die resultate is bewys van die behoefte vir die ontwikkeling van ’n opvolgplan wat gebaseer is op Benner se Novice to Expert Model vir pediatriese professionele verpleegpersoneel in akademiese, tersiêre hospitale in die Wes-Kaap. Daarbenewens, het deelnemers se opinies die waarde van ’n opvolgplan wat ’n beroepsplan insluit, die veelvoudige voordele wat dit inhou getoon wat die uitdagings sal oortref, sodra dit ontwikkel en geïmplementeer word. Aanbevelings is gebaseer op die wetenskaplike bewys wat dui op die dringende behoefte vir die ontwikkeling en implementering van ’n formele vyfvlak vaardigheidsgebaseerde kliniese opleidingsprogram wat ’n 360-grade terugvoersisteem insluit vir pediatriese professionele verpleegpersoneel deur middel van ’n geïntegreerde, medewerkende benadering. Die ontwikkeling en implementering van ’n formele opvolgplan sal die retensie van die verskeie vlakke van bekwame, vaardige en kundige pediatriese professionele verpleegpersoneel versterk en bevorder. Boonop sal ’n formele opvolgplan nuwelinge en gevorderdes trek en motiveer om te ontwikkel tot bekwame, vaardige en kundige vlakke.

Thesis (Mcur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: A literature study showed that the topics of medication safety and medication error prevention have been studied in depth. Findings from the literature revealed that medication errors are reported to be common in neonatal and paediatric ICUs, that more than half of these errors are preventable and that risk reduction measures protect patients against untoward outcomes or adverse events (Clifton-Koeppel, 2008:72). If and when there is a failure in the process of safe medication administration, it results in a medication error, which is defined as a breach of one or more of the five rights of medication administration (Institute for Safe Medication Practices Alert, 2007:1). Medication administration, which is predominantly a nursing task, is of high risk and high volume in the intensive care unit (ICU). The accuracy of intravenous medication administration is critical for a neonatal and paediatric ICU patient since it can potentially heighten the patient’s vulnerability if further harm is caused. In view of the complexity of medication administration for neonatal and paediatric ICU patients, researchers confirm the diverse role of the registered nurse in safe medication administration practices. The purpose of the study was to describe the perceptions of registered nurses (RNs) regarding the factors that influence IV medication safety practice in the neonatal intensive care unit (NICU); paediatric intensive care unit (PICU); and paediatric cardiac intensive care unit (CSICU) in Saudi Arabia. The study objectives were set to describe the actual factors that have an influence on IV medication safety practices of RNs working in these ICUs; to determine the knowledge of registered nurses in the selected ICUs with regard to safe intravenous medication administration practices and to describe nursing medication administration strategies that are focused on medication error prevention. A quantitative research approach was selected for this study which had a descriptive, survey design. An 85% non-probability purposive sampling method was used to draw a sample (n=103) of the target population of NICU-, PICU- and CSICU-registered nurses (N=121) who were responsible for administering intravenous medication at King Faisal Specialist Hospital and Research Centre in Jeddah (KFSHRC-J). A self-administered questionnaire with closed-ended Likert and open-ended question was designed to describe the objectives under study. A pilot study was conducted to pre-test the questionnaire. A quantitative method was used to analyse the study data. MS Excel was used to capture the quantitative data after which it was analysed using descriptive statistics by means of STATISTICA 9 software. The open–ended questions (indicating “other” and Question 70) were also interpreted quantitatively after exploring the main aspects in the responses. The main findings were that multiple perceived factors influence the intravenous medication safety practices of RN’s working with neonatal and paediatric ICU patients in a particular Saudi Arabian tertiary hospital. It was found that these nurses’ had knowledge regarding safe medication administration practice that constitutes that all five medication rights have to be checked through nursing ‘double-checks’ in the steps of medication administration, as the method of checking as per hospital policy. However, from the findings, it is reflected that RNs perceptions of completely and correctly checking medication rights through complete and independent nursing ‘double-checks’, do not match the steps required by policy and that their knowledge is inadequate. It is evident from the perceptions of RNs that they are aware of the multiple factors influencing IV medication safety practice in this vulnerable patient setting. As perceived by RNs, it is possible to implement more safety strategies. Key recommendations on conclusion of the study include that there are more nursing medication administration strategies that could still be implemented for medication error prevention. These strategies relate to medication safety awareness, the role of the nurse and nursing managers, mandatory staff education, and review of knowledge and skills. / AFRIKAANSE OPSOMMING: Gebaseer op ʼn literatuurstudie blyk dit dat medikasieveiligheid en voorkoming van medikasiefoute reeds in diepte bestudeer are. Bevindings dui daarop dat medikasiefoute algemeen voorkom in neonatale en pediatriese intensiewesorgeenhede, dat meer as die helfte daarvan voorkombaar is, en dat maatreëls om risiko te vermindering pasiënte teen voorkombare uitkomste beskerm (Clifton-Koeppel, 2008:72). Indien en wanneer die proses vir veilige medikasietoediening faal, kom ʼn medikasiefout voor, wat gedefinieer word as die verbreking van een of meer van die vyf medikasieregte (Institute for Safe Medication Practices Alert, 2007:1). Medikasietoediening is hoofsaaklik ʼn verpleegtaak, wat ʼn hoërisiko- en hoëvolume-taak behels. Die akkuraatheid van intraveneuse medikasietoediening is kritiek vir neonatale en pediatriese intensiewesorgpasiënte, aangesien hul weerloosheid verhoog word indien verdere skade veroorsaak word. Omrede medikasietoediening vir neonatale en pediatriese intensiewesorgpasiënte kompleks is, bevestig navorsers dat geregistreerde verpleegkundiges se rol ten opsigte van veilige medikasietoediening veelsoortig is. Die doel van die studie was om die persepsies van geregistreerde verpleegkundiges aangaande die faktore wat medikasieveiligheid in die neonatale en paediatriese intensiewe eenhede in Saoedi-Arabië beinvloed, te beskryf. Studiedoelwitte is gestel om die spesifieke faktore te beskryf wat aanleiding gee tot medikasietoedieningsfoute in die genoemde intensiewesorgeenhede; om geregistreerde verpleegkundiges in die geselekteerde intensiewesorgeenhede se kennis van veilige medikasietoediening te bepaal; en die medikasietoedieningstrategieë wat op die voorkoming van medikasietoedieningsfoute fokus, te beskryf. ʼn Kwantitatiewe navorsingsbenadering is geselekteer vir die studie wat ʼn beskrywende navorsingsontwerp gehad het. ʼn 85% nie-waarskynlike gerieflikheidsteekproef is gebruik om ʼn steekproef (n=103) te selekteer vanuit die teikenpopulasie geregistreerde verpleegkundiges (N=121) wat verantwoordelik was vir medikasietoediening in die geselekteerde intensiewesorgeenhede by King Faisal Specialist Hospital and Research Centre, Jeddah (KFSHRC-J). ʼn Self-geadministreerde vraelys met geslote Likert- en oop-eindevrae is opgestel om die gestelde studiedoelwitte te ondersoek. ʼn Vooraf-toetsing van die vraelys is tydens die loodsstudie uitgevoer. ʼn Kombinasie van kwantitatiewe en kwalitatiewe metodes is gebruik vir die ontleding van die studie-data. Die kwantitatiewe data is op MS Excel ingevoer, waarna beskrywende statistiek deur middel van Statistica 9-sagteware gebruik is om dit te ontleed. Die studie het hoofsaaklik bevind dat veelvuldige faktore die veiligheidspraktyk ten opsigte van intraveneuse medikasie van geregistreerde verpleegkundiges wat met neonatal en pediatriese intensiewesorgpasiënte in ʼn spesifieke tersiêre hospitaal in Saoedi-Arabië werk, beïnvloed. Dit blyk dat hierdie verpleegkundiges se kennis voldoende is aangaande ‘n veilige medikasie toedieningspraktyk wat bestaan uit die kontrolering van al vyf medikasieregte deur verpleegkundige dubbel-kontrolering, soos beskryf is in die hospitaalbeleid. Volgens die bevindinge blyk dit egter dat die verpleegkundiges se persepsie van volledige and korrekte verpleegkundige dubbel-kontrolering, nie met die stappe volgens die hospitaalbeleid ooreenstem nie en dat hulle kennis onvoldoende is. Dit is duidelik dat die verpleegkundiges bewus is van die veelvuldige faktore wat intraveneuse medikasieveiligheidpraktyk vir weerlose pasiënte beïnvloed. Die verpleegkundiges se persepsie is dat daar meer verpleegkundige medikasietoedieningstrategieë is wat geïmplementeer kan word om medikasiefoute te voorkom, insluitende veiligheidsbewustheid ten opsigte van medikasie, die rol van verpleegkundiges en verpleegbestuurders, verpligte personeelopleiding, en hersiening van kennis en vaardighede.

Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The objective of this study was to explore the perceived need among nurses from different cultures in a private hospital in Saudi Arabia for a program to teach cultural sensitivity. The hypotheses for this study were:  Diverse bio- and demographical/cultural/educational backgrounds of nursing staff have an input on their cultural knowledge and sensitivity of care given in the hospital  The amount of occurrence reports generated due to cultural differences and clashes indicate the need for a program to teach cultural sensitivity. A descriptive quantitative study was done, using a self administrative questionnaire on a randomly selected sample 15.8% (n=200) of the population (N=1272) of registered nurses. The data was collected by structured questionnaires with sections requiring the following:  Biographical information (age, gender, nationality)  Amount of experience in nursing of patients with diverse cultures  Nursing education received about caring for patients of diverse cultures  Cultures of colleagues and patients in the hospital  Whether incidents occur because of cultural differences  Amounts of incident reports generated by each respondent per month The study is descriptive and made use of non-parametric Kruskal-Wallis, Mann- Whitney U and Chi-square computations to determine relationships between the answers of the different respondents to be able to come to a conclusion about the research question. The study reflects a youthful component of nurses from very diverse cultures working in the hospital, with a large variety of patients of equally diverse cultures. Only 1:5 of the nurses felt that they have enough knowledge about each others’ and their patients’ cultures. Recommendations for the implementation of a program for cultural sensitivity are the end result of this study. The ultimate goal for such a program is culturally sensitive nursing where the patients would experience that their culture has been considered in the planning and implementation of their nursing care. / AFRIKAANSE OPSOMMING: Die doelwit van hierdie navorsing was om te bepaal of geregistreerde verpleegkundiges van verskillende kulture by ’n privaat hospitaal in Saudi Arabië die behoefte ervaar en herken vir die aanleer van kulturele sensitiwiteit. Die hipoteses van die navorsing was soos volg:  Diverse bio- en demografiese/kulturele/opvoedkundige agtergrond van verpleeglui sal hul kulturele kennis en dus kultuur sensitiewe verpleging in die hospitaal beinvloed.  Die aantal insidente wat voorkom oor kultuurverskille en botsings is ‘n aanduiding vir die nodigheid van ‘n program om kulturele sensitiwiteit aan te leer. ’n Beskrywende navorsingsontwerp met ‘n kwantitatiewe benadering is in die studie gevolg. ’n Vraelys wat deur die respondente self voltooi moes word, is ingevul deur die ewekansige verkose steekproef van 15.8% (n=200) van die bevolking van geregistreerde verpleegkundiges (N=1272).Die gestruktureerde vraelys het afdelings bevat wat die volgende inligting verlang het:  biografiese inligting (ouderdom, geslag, nasionaliteit),  hoeveelheid ondervinding van verpleging van ander kulture,  verpleegonderrig ontvang in die hantering van pasiёnte met diverse kulture,  kulture van kollegas en pasiёnte in die hospitaal,  of daar insidente voorkom weens kultuur verskille,  hoeveelheid insidentverslae wat elke deelnemer moet invul per maand. Die studie is beskrywend van aard en daar is gebruik gemaak van nie-parametriese Kruskal-Wallis, Mann-Whitney U en Chi-kwadraat berekeninge om verhoudinge tussen die antwoorde van die verskillende respondente te bepaal en om tot ‘n gevolgtrekking te kom oor die navorsingsvraag. Die resultate van die navorsing toon dat daar ’n jonger komponent van geregistreerde verpleegkundiges van baie diverse kulture in die hospitaal werk met ‘n groot verskeidenheid van pasiente van ewe diverse kulture. Slegs 1:5 van die verpleegkundiges in die steekproef het gevoel dat hulle oor die nodige kennis beskik m.b.t. mekaar en hul pasiёnte se kulture. Aanbevelings vir die implementering van ’n program vir kulturele sensitiwiteit is die eindresultaat van hierdie navorsing. Die uiteindelike doel van so ‘n program is kultureel sensitiewe. verpleegsorg waar pasiёnte ervaar dat hul kultuur aangespreek word in die beplanning en implementering van sulke sorg

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Many HIV positive patients are on antiretroviral therapy (ART) to assist in decreasing the replication of the HIV virus within the body. Adherence to this medication is important, as non- adherence can have serious repercussions. Therefore, the patients’ knowledge of ART and their disease is crucial in ensuring good adherence. A range of barriers to patient education were suspected by the researcher in this community of Delft. The high influx of patients into the clinic everyday minimized consultation time and thereby diminished the opportunity for effective patient education. Consequently, adherence to medication which is closely related to the knowledge and understanding of patients about the disease may be affected. The following research question was therefore explored: What is the knowledge of infected HIV/AIDS patients who are receiving antiretroviral treatment about HIV/AIDS and ART? The objectives set were to evaluate the patient’s knowledge of HIV/AIDS, evaluate the knowledge of ART and to determine whether there are statistical differences between the dependant and independent variables within the study. A quantitative descriptive correlational research design was applied and a convenience sample of n= 200 (8.5%) patients was selected from a population of N= 2349 at the Delft Community Health Centre. A multiple choice questionnaire comprising of mainly closed ended questions with multiple responses was used in individual interviews conducted by either the researcher or fieldworker. Reliability and validity was ensured through the consultation of experts in the fields of research methodology, statistics, HIV/AIDS and the Health Research Ethics Committee of Stellenbosch University. Permission to conduct this study was granted by the Health Research Ethics Committee of Stellenbosch University, the Provincial Regional Head for Primary Health Care Services, as well as the head of the Delft Community Health Centre. Data revealed that the participants were mainly female (n=145/72.5%), and the mean age was 37.5 years. Participants were mostly Xhosa speaking and literate, and the majority (n=112/56%), of the participants had a highest education level between grade 9 and grade 12. Many (n=73/36.5%) of the participants had been living with HIV for more than 5 years, but had been on ART for between 1 to 3 years. Knowledge was assessed by asking questions about various aspects of HIV and ART throughout the study. Scores for the 14 critical questions revealed that (n=0/0%) of the participants had good knowledge, (n=40/20%) of the participants had average knowledge and (n=160/80%) of the participants had poor knowledge. The average score for all participants for all 20 knowledge testing questions was (12.6/63%). The findings showed that the overall knowledge (n=160/80%) is poor. Basic terms and principles of HIV/AIDS and ART were not understood and serious misconceptions regarding the disease were revealed. / AFRIKAANSE OPSOMMING: Baie MIV positiewe pasiënte is op antiretrovirale terapie (ART) om te help met die vermindering van die replisering van die HIV virus in die liggaam. Gebruik van hierdie medikasie is belangrik omdat versuiming van inname ernstige gevolge kan hê. Dus, is die pasiënte se kennis van ART en hul siekte van deurslaggewende belang om volgehoue inname te verseker. ’n Reeks van hindernisse om pasiënte te onderrig, is deur die navorser in die Delftgemeenskap vermoed. Die hoë toestroming van pasiënte na die kliniek elke dag het die konsultasietyd tot die minimum beperk en daardeur die geleentheid vir effektiewe pasiëntonderrig laat verminder. Gevolglik, kan die nakoming om die medikasie te neem wat ’n noue verband toon met die kennis en begrip wat pasiënte het oor die siekte, geaffekteer word. Die volgende navorsingsvraag is gevolglik ondersoek: Wat is die kennis van geïnfekteerde HIV/VIGS pasiënte wat antiretrovirale behandeling ontvang oor HIV/VIGS en ART? Die doelwitte wat gestel is, is om die pasiënt se kennis van HIV/VIGS te evalueer, die kennis van ART te evalueer en te bepaal of daar ’n statistiese verwantskap tussen onafhanklike en afhanklike veranderlikes binne die studie is. ’n Kwantitatiewe beskrywende korrelerende navorsingsontwerp is toegepas en ’n gerieflikheidsmonster van n= 200 (8.5%) pasiënte is geselekteer uit ’n bevolking van N = 2349 by die Delftgemeenskap Gesondheidssentrum. ’n Veelkeusige vraelys wat hoofsaaklik uit geslote vrae met veelkeusige response bestaan het, is gebruik in individuele onderhoude wat deur of die navorser of veldwerker gevoer is. Betroubaarheid en geldigheid is verseker deur oorlegpleging met spesialiste op die gebied van navorsingsmetodologie, statistiek, HIV/VIGS en die Gesondheidsnavorsing se Etiese Komitee van die Universiteit van Stellenbosch. Toestemming om die navorsing te doen, is gegee deur die Gesondheidsnavorsing se Etiese Komitee van Stellenbosch Universiteit, die Provinsiale Streekshoof vir Primêre Gesondheidsdienste, asook die hoof van die Delftgemeenskap Gesondheidssentrum. Data het bewys dat die deelnemers hoofsaaklik vroulik is (n=145/72.5%) en die gemiddelde ouderdom 37.5 jaar. Deelnemers is meestal Xhosasprekend en geletterd en die meerderheid (n=112/56%) van die deelnemers se hoogste opleidingsvlak is tussen graad 9 en graad 12. Baie (n=73/36.5%) van die deelnemers het met HIV geleef vir 5 jaar, maar was op ART vir tussen 1 tot 3 jaar. Kennis is geassesseer deur vrae te stel oor verskeie aspekte van HIV en ART dwarsdeur die ondersoek. Puntetelling vir die 14 kritiese vrae het aan die lig gebring dat (n=0/0%) van die deelnemers goeie kennis het, (n=40/20%) van die deelnemers beskik oor gemiddelde kennis en (n=160/80%) van die deelnemers se kennis is gering. Die gemiddelde puntetelling vir al die deelnemers van al 20 kennisvrae wat getoets is, is (12.6/63%). Die bevindinge bewys dat die algehele kennis (n= 160/80%) gering is. Basiese terminologie en beginsels van HIV/VIGS en ART word nie begryp nie en ernstige wanopvattinge aangaande die siekte is geopenbaar.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Pain management is a vital component of post-operative nursing care. Orthopaedic patients in particular experience severe pain following surgical intervention. Since effective pain management is crucial in the post-operative recovery of orthopaedic patients, it was essential to explore the knowledge and clinical practice of nurses in orthopaedic wards. The aim of the study was to establish nurses’ knowledge and clinical practice for adult postoperative pain management of orthopaedic patients. A non-experimental, descriptive self-administered survey using a quantitative approach was applied. The total population of N=97 registered professional and enrolled nurses working in dedicated orthopaedic wards in two central hospitals in the Cape Town Metropole district, South Africa were invited to participate in the study. A structured questionnaire was used to collect the data. Reliability and validity was assured by means of a pilot study and consultation with nursing experts and a statistician. Ethical approval was obtained from the Health Research Ethics Committee of the University of Stellenbosch. Permission for access to the hospitals was obtained from the hospital and nursing managers. Informed written consent was obtained from the participants. The data was analysed by the statistician and presented in frequencies, tables and histograms. The variables were compared using either the Pearson chi-square test for differences in nursing category or the Mann-Whitney U-test for differences in years of experience. The analysis of the results illustrated knowledge deficits, inconsistent clinical practices and limited training in post-operative pain management. The recommendations include training courses, revision of the patient’s observation chart and formulation of policies and guidelines for pain management. Appropriate knowledge and clinical skills of nurses are critical to ensure optimal pain management for post-operative orthopaedic patients. / AFRIKAANSE OPSOMMING: Die bestuur van pyn is ’n essensiële component van post-operatiewe verpleegsorg. Ortopediese pasiënte ervaar spesifiek fel pyn na afloop van ’n chirugiese intervensie. Aangesien effektiewe pynbestuur belangrik in die post-operatiewe herstel van ortopediese pasiënte speel, was dit nodig om die kennis en kliniese praktyke van verpleegpersoneel in ortopediese sale te verken. Die doel van die studie was om verpleegpersoneel se kennis en kliniese ervaring van volwasse post-operatiewe pynbestuur van ortopediese pasiënte vas te stel. ’n Nie-eksperimentele, deskriptiewe, self-toegediende opname is toegepas wat gebruik maak van ’n kwantitatiewe benadering. Die totale populasie van 97 geregistreerde professionele en ingeskrewe verpleegkundiges wat in toegewyde ortopediese sale van twee sentrale hospitale in die Kaapstad Metropol distrik, Suid Afrika werk, is genooi om aan die studie deel te neem. ’n Gestruktureerde vraelys is gebruik om data in te samel. Betroubaarheid en geldigheid is verseker deur middel van ’n voortoets en konsultasie met verpleegkundige kenners en ’n statistikus. Etiese goedkeuring is verkry van die Gesondheidsnavorsing Etiese Komitee van die Universiteit Stellenbosch. Toestemming om toegang tot die hospitale te kry is verkry van die hospitaal en verpleegbestuurders. Ingeligte, geskrewe toestemming is van die deelnemers verkry. Die data is geanaliseer deur die statistikus en is aangebied in frekwensietabelle en histogramme. Die veranderlikes is vergelyk deur of die Pearson chi-vierkant toets te doen vir verskille in verpleegkategorieë, of die Mann-Whitney U-toets vir verskille in jare ervaring. Die analise van die resultate het kennistekorte, teenstrydige kliniese praktyke en beperkte opleiding in post-operatiewe pynbestuur uitgewys. Die aanbevelings sluit opleidingskursusse, hersiening van pasiënte se waarnemingsgrafiek en die formulering van beleid en riglyne vir pynbestuur in. Toepaslike kennis en kliniese vaardighede van verpleegpersoneel is krities om optimale pynbestuur vir post-operatiewe ortopediese pasiënte te verseker.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Primary Health Care (PHC) provide a quality, comprehensive health service to the community, based on the principles of equity, affordability, accessibility and community participation. It is a nurse driven service with the Clinical Nurse Practitioner (CNP), a registered nurse specialising in the clinical elements of primary, secondary and tertiary prevention at the forefront. It is against this background that this study was endeavored to investigate the community’s perceptions and lived experiences of the quality of care being rendered by CNPs in the West Coast rural district of the Western Cape. The objectives of this study included the following: - To explore and describe the perceptions of patients in the West Coast rural community regarding the attitudes, knowledge and skills of CNPs. - To provide policy makers with feedback and possible recommendations with regards to the implementation of this nurse driven PHC service. - To provide recommendations for improvement of the existing curricula at nursing education institutions based on whether the current training meets patients’ needs and thereby possibly influence curricular change. A qualitative, descriptive, research design was used. The guideline by Colaizzi (as cited in Streubert & Carpenter, 1999:14) was used for data collection and analysis. Twenty-six participants took part in five different group interviews. Semi-structured, open ended questions were used to encourage the participants to actively partake. Each interview was audio taped and field notes were taken. Thematic analyses was performed to highlight three main themes, i.e. the attitudes of the CNPs, the knowledge and skills of CNPs, and the impact of the current training programmes on the quality of care being rendered by these CNPs. Written approval from the Ethics Research Committee, University of Stellenbosch, as well as from the Research unit of the Western Cape Department of Health was obtained. Prior informed consent was further obtained from each participant, after being assured of voluntary participation, confidentiality and anonymity. Credibility, dependability and transferability were ensured by returning to two participants who validated that the transcripts were a true reflection of their experiencesand opinions. This study concluded that patients perceived CNPs as being unfriendly, uncompassionate and unprofessional. Dissatisfaction with the prevalence of unjust practices due to family members and certain race groups being attended to first by CNPs, were expressed. Participants found the competency levels of CNPs more than adequate when assessing, examining and providing health information and medicine. However, they expressed the need that CNPs should be able to prescribe a greater variety of medicines and perform more diagnostic tests than currently permitted by the scope of practice as set out by the South African Nursing Council. Therefore, these views of the participants indicated that the current postgraduate training programme do fulfill their health needs, although the need for expansion of the role and function of the CNP were expressed. Recommendations made included: - An in-depth investigation into the alleged rude attitudes of CNPs should be undertaken, soas to improve the professional behavior of CNPs towards patients. - Applicable policy makers should consider expanding the roles and functions of the CNP. - Enforcing continuous, professional competency through adequate and productive in-service training programmes. In conclusion, this study showed that CNPs need to be constantly aware that they work with human beings, with feelings and with health needs. The need for a therapeutic environment is thus crucial to the rendering of a quality, comprehensive service to the community they serve. / AFRIKAANSE OPSOMMING: Primêre Gesondheidsorg (PGS) voorsien ’n kwaliteit, omvattende gesondheidsdiens aan die gemeenskap, gebaseer op die beginsels van gelykheid, bekostigbaarheid, toeganklikheid en gemeenskaps-betrokkenheid.Dit is `n verpleegaangedrewe diens met die Kliniese Verpleegspraktisyn (KVP) wat gespesialiseerd is in die kliniese elemente van primêre, sekondêre en tersiêre voorkoming, aan die voortou. Dit is teen hierdie agtergrond wat hierdie studie aangepak is, ten einde ondersoek in te stel aangaande die gemeenskap se persepsies en geleefde ervarings van die kwaliteit van sorg wat deur KVPs in die plattelandse Weskusdistrik van die Wes-Kaap gelewer word. Die doelwitte van hierdie studie het die volgende ingesluit: - Om die persepsies van pasiënte, rakende die ingesteldhede (gedrag), kennis en vaardighede van KVPs te ondersoek. - Om toepaslike beleidsmakers metterugvoer en moontlike aanbevelings te voorsien aangaande die implimentering van verpleegaangedrewe, PGS. - Om aanbevelings te maak vir die verbetering van bestaande kurrikula aan verpleegopleidingsinstellings op grond van óf die huidige opleiding in pasiëntbehoeftes voorsien, en sodoende kurrikulumverandering moontlik te beïnvloed. ’n Kwalitatiewe, beskrywende navorsingsontwerp is gebruik. Die raamwerk van Colaizzi (soos beskryf in Streubert & Carpenter, 1999:14) is tydens datainsameling en analiese gebruik. Ses-en-twintig deelnemers het aan die vyf verskillende groepsonderhoude deelgeneem. Semi-gestruktureerde, oop-einde vrae was gebruik om die deelnemers aan te moedig om aktief aan die besprekings deel te neem. Elke onderhoud is op oudio band opgeneem en veldnotas is gemaak. Tydens analiese is drie hooftemas geïdentifiseer, nl die houdings van KVPs, die kennis en vaardighede van die KVPs sowel as die impak van die opleidingsprogram op die kwaliteit van sorg wat deur KVPs gelewer word. Skriftelike toestemming vir die studie is by die Etiese Navorsingkommittee, Universiteit van Stellenbosch, asook die Navorsingseenheid van die Wes- Kaapse Departement van Gesondheid verkry. Voorafgaande toestemming is voorts vanaf elke deelnemer verkry, nadat hulle verseker is van vrywillige deelname, konfidensialiteit en anonimiteit. Geloofwaardigheid, afhanklikheid en oordraagbaarheid is verseker, deur na twee van die deelnemers terug te gaan wat die transkripsies geverifieër het as juis en korrek. In hierdie studie is tot die slotsom gekom dat pasiënte KVPs as onvriendelik enongevoeligervaar het. Onbillike praktyke kom steeds voor, deurdat familielede en sekere rassegroepe voorkeur behandeling kry. Deelnemers se ervarings aangaande die bevoegdheid van KVPs was as toereikend beskryf aangaande die assessering, ondersoek en voorsiening van gesondheidsinligting en medisyne. Hulle het egter ook die behoefte uitgespreek dat die KVP’s `n groter verskeidenheid medisyne behoort voor te skryf en meer diagnostiese toetse behoort te kan uitvoer as wat tans binne die bestek van praktyk, soos neergelê deur die Suid-Afrikaanse Raad op Verpleging, moontlik is. Hierdie persepsie van die deelnemers impliseer dat die huidige nagraadse opleidingsprogram voldoende is en hul gesondheidsbehoeftes aanspreek. Die behoefte vir die uitbreiding van die rol en funksie van die KVP is egter uitgespreek. Die aanbevelings wat gemaak is sluit in: - ’n In-diepte ondersoek oor die onbeskofte ingesteldhede van KVPs behoort uitgevoer te word, ten einde die professionele gedrag van KVPs teenoor pasiënte te verbeter. - Beleidmakers behoort die uitbreiding van die rolle en funksies van die KVP te oorweeg. - Benadruk voortgesette, professionele bevoegdheid deur toepaslike en produktiewe indiensopleidingsprogramme. Ter aflsuiting: hierdie studie het aangetoon dat KVPs voortdurend bewus moetbly dat hulle met mense werk wat gevoelens het en wat gesondheidshulp benodig. Dit is uiters belangrik om aan die behoeftesvan ’n terapeutiese omgewing te voorsien, ten einde ’n kwaliteit, omvattende diens aan die gemeenskap te lewer.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Member states of the United Nations accepted eight Millennium Development Goals in 2000. Millennium Development Goal number four addresses the improvement of child health. The purpose of goal number four is to decrease the child mortality rate by 60% for the period 1990 to 2015. South Africa is one of twelve countries where the incidence of child mortality increased during this period. Guided by the research question “What are the experiences and perceptions of mothers utilizing child health services”, a study was done. A qualitative, descriptive phenomenological methodology was applied to explore the experiences and perceptions of mothers utilizing child health services for children younger than two years. The goal of this study was to determine the experiences and perceptions of mothers utilizing child health services. The objectives were to explore their experiences and perceptions, with specific reference to the service they receive regarding: - immunization - nutrition assessment - the growth of the child - the growth chart - other underlying illnesses Ethical approval was obtained from Stellenbosch University and various health authorities. Validity was assured by adhering to the principles of trustworthiness, namely credibility, transferability, dependability, and conformability. The population for this study was mothers who utilized ten clinics in a demarcated area of Cape Town for child health services. Purposive sampling was utilized to consciously select three clinics (N =10), and at each of the clinics four mothers were purposively selected to participate. A total of seventeen mothers participated in the study. An interview guide was used to conduct interviews with participants. The researcher conducted and recorded the interviews after obtaining written informed consent from each participant. A field diary was kept for notation of observations. Data analysis involved the transcribing of digitally recorded interviews, the coding of the data, the generating of themes and sub-themes, interpretation and organization of data and the drawing of conclusions. The Modeling Role-Modeling Nursing theory of Erickson, Tomlin and Swain were utilized as conceptual theoretical framework to facilitate application to the broad population. Findings of the study indicated varied experiences. All mothers did not receive information about the RtHB or RTHC. Not all mothers developed a relationship of trust with caregivers or were afforded the respect of becoming part of the child’s health care team. According to the mothers integrated child health care services were not practised. The consequences were missed opportunities in immunization, provision of Vitamin A, absence of growth monitoring, feeding assessment and provision of nutritional advice. Hospitals and private practitioners equally did not provide immunization services or offered holistic care. Simple interventions such as oral rehydration, early recognition and treatment of diseases, immunization, growth monitoring and appropriate nutrition are not diligently offered; that could reduce the incidence of child morbidity and mortality. The following recommendations are made: determine why hospitals do not immunize children. The root causes must be addressed to change practice. Rendering of child services must happen in an integrated approach. Staff must be empowered with skills regarding procurement, in particular regarding vaccines. / AFRIKAANSE OPSOMMING: In 2000 het die lidlande van die Verenigde Volke Organisasie die Millenium Ontwikkelingsdoelwitte aanvaar. Die Millenium Ontwikkelingsdoelwit nommer vier roer die kwessie van kindergesondheid aan. Die strategie om die voorkoms van kindersterftes met 60% te verminder vanaf 1990 tot 2015 is die vierde millenium doelwit. Suid Afrika is een van twaalf lande in die wêreld waar die kindersterftes vir hierdie tydperk toegeneem het. ‘n Studie is gedoen om te bepaal “Wat die ervaring en persepsies van moeders is wat van kindergesondheidsdienste gebruik maak. ‘n Kwalitatiewe, beskrywende, fenomenologiese studie is gedoen,om die ervaring en persepsies van moeders wat kinders jonger as twee jaar na klinieke geneem het, te bepaal. Die doel van die studie was om die ervaring en persepsies van moeders ten opsigte van kindergesondheidsdienste vas te stel. Spesifieke doelwitte was die bepaling van die ervaring en persepsies rondom: - immunisasiedienste - groeimonitering - voedingsvoorligting - die groeikaart - behandeling van siektes Etiese goedkeuring was verkry vanaf die Universiteit van Stellenbosch en die verskeie gesondheidsowerhede. Geldigheid van die studie is verseker deur die beginsels van geloofwaardigheid na te kom naamlik, aaneemlikheid, betroubaarheid, oordraagbaarheid en inskiklikheid. Die bevolking betreffende die studie was moeders wat kliniekdienste gebruik het vir hulle kinders in ‘n spesieke area van Kaapstad, bestaande uit tien klinieke. Drie klinieke (N=10) is doelgerig geselekter vir deelname. Vier moeders is doelgerig by elk van die drie klinieke geselekteer vir deelname. Onderhoude is met sewentien deelnemers gevoer. ‘n Onderhoudsgids is gebruik en die navorser het rekord gehou van waarnemings. Die navorser het onderhoude gevoer en opgeneem na skriftelike toestemming daarvoor van elke deelnemer verkry is. ’n Veldwerkdagboek is gehou van alle waarnemings. Data-analise het behels: digitale opnames wat woordeliks beskryf , tematies ontleed en geïnterpreteer is en volgens temas georganiseer is. Toepassing na die breër populasie is bevorder deur die gebruik van die verpleegteorie van Erickson, Tomlin en Swain. Bevindinge van die studie het getoon dat moeders verskillende ervaringe gehad het. Nie alle moeders het inligting ontvang omtrent die RtHB of RTHC nie. Nie alle moeders het vertroue in die kliniek nie en moeders word nie erken as bepalende faktore in die sorgspan nie. . Volgens die moeders is geïntegreerde gesondheidssorg nie beoefen nie. Die gevolge is dat geleenthede nie benut word om te immuniseer nie, vitamien A te verskaf, groei te kontroleer, voeding te bepaal en voedingsadvies te verskaf. Die voorraadvlakke van entstof word nie oral doeltreffend beheer nie. Hospitale en dokters beoefen nie altyd immunisering en holistiese kindergesondheidsdienste nie. Eenvoudige intervensies, wat die voorkoms van kindermorbiditeit en kindermortaliteit kan bestry, word nie verskaf nie. Voorbeelde van sulke intervensies is mondelinge rehidrasie, vroeë diagnose en behandeling van siektes, immunisering, groeimonitering en geskikte voedingsinligting. Daar word aanbeveel dat daar indringend bepaal word hoekom hospitale nie kinders immuniseer nie en dat die oorsake aangespreek word. Integrasie van dienste by klinieke moet as prioriteit gesien en geïmplimenteer word. Personeel se vaardighede betreffende beheer van voorraad moet verbeter word, veral t.o.v. entstof voorraad.