Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Mental health knowledge is defined as “the knowledge and beliefs about mental disorders which aid their recognition, management or prevention”. Although mental illness is a common condition in the community, only a few people with these disorders generally undergo treatment with about only 70% of individuals seeking help. Contributing to the community’s lack of knowledge, it has also been found that the public cannot recognise different types of psychological distress and mental illness, resulting in people not seeking mental health care. From the evidence perused in the literature, the researcher observed that communities with sound mental health knowledge and a positive attitude towards mental illness are motivated to seek professional help, whilst communities with a lack of mental health knowledge and a negative attitude towards mental illness are less motivated to seek professional help. The researcher therefore aimed at determining the knowledge and attitudes of the Kinondoni community members towards mental illness. In determining the knowledge and attitudes of the Kinondoni community members towards mental illness, the research design was a descriptive, crosssectional survey, with a quantitative approach. An adjusted, existing questionnaire, with, self-compiled, closed ended questions, was used to collect data. Reliability was supported by a pilot study to test the questionnaire beforehand. Face and content validity focused on readability, clarity and development of the questionnaire. The ethical principles were used to make sure the rights of participants were protected. The ethical approval was obtained from Stellenbosch University institutional review board number IRB0005239 to conduct research. Furthermore the study permit was given by the Kinondoni Municipal Medical Officer of health with reference number TD/K/3/VOL/207. The collected data was analysed by using the Statistical Package for Social Sciences (SPSS). The results were presented in tables of means, in which each variable had its own table of analysis of variance. The results were as follows; knowledge about mental illness was very poor as most of the respondents in Kinondoni community n=182 (61%) responded that mentally ill people cannot perform regular jobs, had no friends, and were dangerous. Respondents n= 239 (79.6%) had negative attitudes towards people with mental illness as they stated that they have no right to find a job, have friends and be integrated into society. The results conclude that the Kinondoni community members have less knowledge and negative attitude towards mental illness. The researcher summarises the completed process of this research study and recommend policy makers to formulate guidelines to strengthen nursing practice and education, to create awareness to the community on mental illness and also recommend for further study. / AFRIKAANSE OPSOMMING: Geestesgesondheidskennis word gedefinieer as die kennis van geestesongesteldhede wat bydra tot die herkenning, hantering en voorkoming van geestesongesteldhede. Alhoewel geestesongesteldhede ‘n algemene toestand is in die gemeenskap, is daar slegs ‘n klein aantal geestesongestelde individue wat behandeling ondergaan, met omtrent 70% van die genoemde individue wat hulp soek. Bydraend tot die gebrek van die gemeenskap se kennis het dit ook aan die lig gekom dat die publiek ook nie die verskeie sielkundige stressors en geestesongesteldhede erken nie, wat veroorsaak dat mense nie geestesgesondheidsorg benader nie. Uit die literatuurstudie het die navorser geobserveer dat die gemeenskappe met geestesgesondheidskennis en ‘n positiewe houding gemotiveerd is om hulp te soek en gemeenskappe met ‘n gebrek aan geestesgesondheidskennis minder gemotiveerd is om professionele hulp te soek. Die navorsing het hierbenewens ten doel gehad om die kennis en houding van die Kinondoni gemeenskapslede aangaande geestesongesteldhede te bepaal. Om die kennis en houding van die Kinondoni gemeenskap te bepaal is ‘n kwantitatiewe deursnitopname gedoen. ‘n Bestaande vraelys met geslote vrae is aangepas om data in te samel. Betroubaarheid is deur die loodstudie ondersteun, terwyl sig- en inhoudsgeldigheid op die leesbaarheid, uitklaring en ontwikkeling van die vraelys gefokus het. Die etiese standaarde is gebruik om die regte van deelnemers te beskerm. Vervolgens is die gekollekteerde data met SPSS ontleed. Die bevindinge is deur middel van tabelle van gemiddeldes, waar elke verandelike sy eie variansie vertoon het, voorgestel. Ten slotte is riglyne beskryf. Die resultate is as volg; kennis betrefffende geestesongesteldhede was baie swak onder die meerderheid repondente van Kinondoni se gemeenskap n=182 (61%) het vertoon dat geestesongestelde persone nie gereelde werk kan verig nie, geen vriende kringe het nie en baie gevaarlik is. Respondente n=239 (79.6%) het n negatiewe houdng teenoor persone met n geestesgebrek en maak melding dat geestesgestremde persone geen reg op om te werk besit, vriende te het en om te integreer in die gemeenskap. Die gevolgtrekking van die resultate toon dat die Kinondoni gemeenskaps lede baie min kennis en n negatiewe houding teenoor geestesgebreke het. Die navorser maak n volledige opsomming van die navorsings’ studie en maak n aanbeveling aan beleid opstellers om riglyne te formuleer deur versterking van die verpleeg praktyk en onderwys, om bewustheid van gesondheidsgebreke aan die gemeenskap daar te stel en beveel ook verdere studies aan.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Agency-nursing work refers to nursing services provided by agency nurses employed on a casual, contracted basis. Agency-nursing has become more common in nursing practice in South Africa. This group of nurses play a significant role within the health care industry for both public and private sector. Given the pivotal role that nurses play in caring for the health of others, it is important to understand what motivates agency nurses in terms of job satisfaction. The aim of the study was to explore the perceptions of agency nurses regarding job satisfaction within critical care units in private health care institutions in the Western Cape. A qualitative research design with a phenomenological approach was applied. A sample size of n=10 was drawn from a total population of N=553, using random sampling technique. A semi-structured interview guide was designed based on the objectives of the study and validated by experts in the field before data collection. Ethical approval for the study was obtained from the Ethics Committee at the Faculty of Health Sciences, University of Stellenbosch. Permission to conduct the research was obtained from the participating nursing agency and consent was given in writing. The presentation of the results was categorised into themes and sub-themes emerged from the data analysis. The five clusters of themes that emerged were reasons for doing agency work, experiences with hospital staff, allocation of agency nurses, communication of information and staff development. The findings support Herzberg’s theory on motivation factors in terms of what motivates workers to excel in their performance. Agency nurses experienced both positive and negative aspects with regards to job satisfaction. The results of the study suggest the need to include revision and implementation of human resource policies and practices to include the nurses’ “voice” in an effort to provide a more supportive work environment. Further research is recommended. Key Words: Agency nurse, nursing agency, job satisfaction. / AFRIKAANSE OPSOMMING: Agentskapverplegingswerk verwys na verplegingsdienste wat voorsien word deur agentskapverpleegsters wat op ’n tydelike, gekontrakteerde basis in diens geneem word. Agentskapverpleging het meer algemene gebruik in die verpleegpraktyk in Suid-Afrika geword. Hierdie groep verpleegsters speel ’n belangrike rol in die gesondheidsbedryf vir beide die openbare en die private sektor. Gegee die deurslaggewende rol wat verpleegsters speel in die gesondheidsversorging van ander mense, is dit belangrik om te verstaan wat agentskapverpleegsters motiveer vanuit die oogpunt van werksbevrediging. Die doel van die studie was om die persepsies en ervarings van agentskapverpleegsters ten opsigte van werksbevrediging te ondersoek binne die waakeenhede in private gesondheidsorg-inrigtings in die Wes-Kaap. ’n Kwalitatiewe navorsingsontwerp met ’n fenomenologiese benadering is toegepas. ’n Monstergrootte van n=10 is geneem uit ’n populasie van N= 553 deur die ewekansige steekproeftegniek te gebruik. ’n Semi-gestruktureerde onderhoudgids was ontwerp en gebaseer op die doelwitte van die studie en was deur deskundiges op hierdie gebied, voor die insameling van data, gelding verklaar. Etiese goedkeuring vir die studie was verkry van die Etiese Komitee van die Fakulteit van Gesondheidswetenskappe, Stellenbosch Universiteit. Goedkeuring om die navorsing te doen, was verkry van die deelnemende agentskap en toestemming was op skrif geplaas. Die voorgelegde resultate was gekategoriseer in temas en subtemas wat uit die data-analise voortgespruit het. Die vyf groepe van temas wat hieruit gespruit het, is redes vir die keuse om agentskapwerk te doen, ervarings met hospitaalpersoneel, die toewysing van agentskapverpleegsters, kommunikasie van inligting en personeelontwikkeling. Die bevindinge het onthul dat Herzberg se teorie oor motiveringsfaktore werkers aangemoedig het om te presteer in die uitvoering van hulle pligte. Werksbevrediging is volgehou deur die agentskapverpleegster. Die bevindings dui op die behoefte om die hersiening en implementering van menslike hulpbronbeleidsverklarings en -praktyke in te sluit sodat die verpleegster se stem gehoor kan word in ’n poging om ’n meer ondersteunende werkomgewing te voorsien. Verdere navorsing word aanbeveel. Sleutelwoorde: Agentskapverpleegster, verplegingsagentskap, werksbevrediging.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Academic integrity is of undisputed importance in the educational environment as honesty is regarded as a basic ethical value in all educational programmes. Yet, academic dishonesty is a wide-ranging practice which is also encountered in the nursing education environment. This phenomenon causes concern in the nursing fraternity because of the positive correlation between unethical academic practices and future unethical professional behaviour. This correlation, together with the lack of research data regarding academic dishonesty at nursing education institutions in South Africa, motivated the researcher to undertake the present study. The purpose of the study was to examine the status of academic integrity among nursing students at a nursing education institution in the Western Cape. The objectives were to determine the incidence of academic dishonesty and to investigate the individual and contextual factors that influence academic dishonesty. The students’ knowledge of institutional policies regarding academic dishonesty, their understanding of plagiarism and referencing, their attitudes towards cheating, and their recommendations to prevent cheating were also explored. A quantitative research approach with a descriptive survey design was chosen for the study. The population (N=688) included all the pre-registration nursing students in the second- (N=319), third- (N=199) and fourth-year (N=170) groups. A nonrandom convenience sampling technique was used to select a sample of 80% (n=550) from each of the second-year (n=255), third-year (n=159) and fourth-year (n=136) student groups. A self-reported questionnaire, with a set of 61 Likert-type items, was designed to obtain information about academic dishonesty. Three openended questions were included in the questionnaire to generate more in-depth data. The questionnaire, which was based on a literature review and on the objectives for the study, was pilot tested to ensure reliability and validity. The inputs of experts in research methodology and nursing education also assured reliability and validity. Data collection, where only the researcher was involved, took place during scheduled classes. Descriptive statistics and, where appropriate, inferential statistical tests were used in analysing the data. Ethical approval was obtained. Measures were taken to ensure anonymity and confidentiality to all respondents. Consent was assumed on completion of the questionnaire. It was found that academic dishonesty was a reality at the nursing education institution where this study was done. Cheating behaviours associated with plagiarism and assignments were identified as the main problem areas. An unacceptably high level of dishonesty with the completion of practical records was also an area of concern. The main recommendations were the development and implementation of a code of honour and the implementation of comprehensive academic integrity policies at the nursing education institution. Practical measures aimed at combating cheating in tests and examinations were also recommended. / AFRIKAANSE OPSOMMING: Akademiese integriteit in die opvoedkundige omgewing is ongetwyfeld van groot belang omdat eerlikheid as ʼn basiese etiese beginsel in alle opvoedkundige programme beskou word. Desnieteenstaande, is akademiese oneerlikheid ʼn algemene praktyk wat ook in die verpleegonderwys omgewing voorkom. Weens die positiewe korrelasie tussen onetiese akademiese praktyke en toekomstige onetiese professionele gedrag veroorsaak hierdie verskynsel kommer in die verpleeggemeenskap. Hierdie korrelasie, tesame met die gebrek aan navorsingsdata ten opsigte van akademiese oneerlikheid by verpleegonderwys instellings in Suid-Afrika, het die navorser gemotiveer om die huidige studie te onderneem. Die doel van die studie was om die status van akademiese integriteit onder verpleegstudente by ʼn verpleegonderwys instelling in die Wes-Kaap te ondersoek. Die doelwitte was om die insidensie van akademiese oneerlikheid te bepaal, en om ondersoek in te stel na die individuele en kontekstuele faktore wat akademiese oneerlikheid beïnvloed. Die studente se kennis van die institusionele beleide met betrekking tot akademiese oneerlikheid, hul begrip van plagiaat en die verwysing van bronne, hul houding teenoor oneerlikheid, asook hul aanbevelings om oneerlikheid te voorkom, is ook ondersoek. ʼn Kwantitatiewe navorsingsbenadering met ʼn beskrywende opname-ontwerp is vir die studie gekies. Die populasie (N=688) het al die voorregistrasie-verpleegstudente in die tweede- (N=319), derde- (N=199) en vierdejaargroepe (N=170) ingesluit. ʼn Nie-ewekansige gerieflikheidsteekproeftegniek is gebruik om ʼn steekproef van 80% (n=550) uit elk van die tweede- (n=255), derde- (n=159) en vierdejaarstudente (n=136) te selekteer. ʼn Self-rapporteringsvraelys met ʼn stel van 61 Likert-styl-items is ontwerp om inligting ten opsigte van akademiese oneerlikheid in te samel. Drie oop vrae is ingesluit in die vraelys om meer in-diepte data te genereer. Die vraelys is op ʼn literatuurstudie en die doelwitte van die studie gebaseer en ʼn loodsstudie is gedoen om die betroubaarheid en geldigheid te verseker. Die insette van kundiges in navorsingsmetodologie en verpleegopvoedkunde het ook die betroubaarheid en geldigheid verseker. Data-insameling, waarby slegs die navorser betrokke was, het tydens geskeduleerde klastyd plaasgevind. Beskrywende statistieke, en waar toepaslik, inferensiële statistiese toetse, is gebruik vir data-analise. Etiese goedkeuring is verkry. Algehele anonimiteit en vertroulikheid is vir al die respondente gewaarborg. Voltooiing van die vraelys het ook toestemming tot deelname aangedui. Daar is gevind dat akademiese oneerlikheid ʼn werklikheid is by die verpleegonderwys instelling waar die studie gedoen is. Oneerlike gedrag geassosieer met plagiaat en werkopdragte is as die hoof-probleemareas geïdentifiseer. Die onaanvaarbare hoë vlak van oneerlikheid met die voltooiing van praktika-rekords is ook ʼn bron van kommer. Die hoofaanbevelings was die ontwikkeling en implementering van ʼn erekode en die implementering van beleide ten opsigte van omvattende akademiese integriteit by die verpleegonderwys instelling. Praktiese maatreëls gerig op die bestryding van oneerlikheid in toetse en eksamens is ook aanbeveel.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Background: For several decades childbirth educators and midwives have focused on the alleviation or reduction of pain and suffering during the childbirth experience (Brown, Douglas & Flood 2001:1). Nursing professionals who care for labouring women require current, evidence-based knowledge regarding pain management options, including mode of action, benefits, risks and efficacy (Florence & Palmer 2003:238). Objectives: This study examined the effects of non-pharmacological pain relief strategies for pain management during labour. Search methods: The researcher conducted a search between February and May 2010 on PubMed, CINAHL and CENTRAL for randomised controlled trials published from inception to 2010. The Medical Search Headings (MeSH) included non-pharmacological, alternative, pain management, labour, pregnant, complementary, randomised, randomly, midwifery, natural birth, relaxation, breathing, positioning, hypnosis, water birth, acupuncture, aromatherapy. Selection criteria: The studies included reported on pregnant women, primigravida or multigravida, term (37 weeks and more), spontaneous labour (first or second stage) without any complications in previous or current pregnancies. The researcher searched for randomised controlled trials with an intervention and a control group. Due to financial restrictions the researcher assessed studies that were published in English only. Interventions were childbirth education, continuous support, relaxation, breathing techniques, movement and positioning, music, manual healing, aromatherapy, hydrotherapy, hypnosis and acupuncture. Data collection and analysis: Meta-analysis was performed using Relative Risks and 95% Confidence Interval for dichotomous outcomes and Weighted mean differences and 95% Confidence Interval for continuous outcomes. Review Manager (RevMan), a statistical software was used. Where meta-analyses were impossible results were presented in narrative form. The outcome measures were a decreased need for pharmacological pain relief, maternal satisfaction with the overall childbirth experience, length of labour (normal or shorter progress), incidence of postnatal depression, incidence of postpartum haemorrhage, an Apgar score of more than seven at five minutes, resuscitation of the neonate and admission to the neonatal intensive care unit. Results: Thirteen (13) eligible RCT’s were included in the systematic review. Four trials involved hydrotherapy (n=585), two trials involved acupuncture (n=480), two trials involved childbirth education (n=6398), one trial involved continuous support (n=2844), one trial involved aromatherapy (n=513), one trial involved maternal positioning (n=2547), one trial involved music, massage and relaxation (n=90) and one trial involved hypnosis (n=82). In the Freeman trial (1986) women in the hypnosis group required less pharmacological pain relief 15/29 compared to women in the control group 20/36. Women in the intervention group also experienced greater satisfaction with the childbirth experience 15/29 (52%) compared to women in the control group 8/36 (23%). The trials of acupuncture showed a decreased need for pharmacological pain management in Skilnand (2002) (n=208) for epidural 11/106 (10%) for the intervention and 27/102 (26.5%) for the control group as well as Pethidine 15/106 (14%) for the intervention and 36/102 (35%) for the control group. In the Borup trial (2009) it was reported that acupuncture during labour reduced the need for pharmacological pain management for the intervention group 185/314 (58.9%) compared to control 124/149 (83.2%) without affecting the birth outcome. The secondary outcome of length of labour (minutes) in the Skilnand trial is significantly in favour of the acupuncture group with a mean value of 212 (SD, 155), compared to the control group with a mean value of 283 (SD, 225) with a p-value of 0.01. Conclusions: Acupuncture may relieve labour pain and also shorten the duration of labour, and women experience greater satisfaction with the childbirth experience. Hypnosis may decrease the need for pharmacological pain relief requirements, and may also increase an overall maternal satisfaction with the childbirth experience. There is insufficient evidence about the benefits of childbirth education, continuous support, aromatherapy, music, massage, movement and positioning, breathing and relaxation. / AFRIKAANSE OPSOMMING: Agtergrond: Vir talle dekades het die verloskundiges en vroedvroue gefokus op die verligting of vermindering van pyn en lyding gedurende die ervaring van kindergeboorte (Brown, Douglas & Flood 2001:1). Professionele verpleegkundiges wat omsien na vrouens wat kraam het die huidige, bewyslewerende kennis aangaande pynbestuuropsies nodig, insluitende die wyse van optrede, voordele, risiko en effektiwiteit (Florence & Palmer 2003:238). Doelstellings: Hierdie studie het die effekte van nie-farmakologiese pynverligtingstrategieë vir die beheer van pyn gedurende die kraamproses nagevors. Ondersoekmetodes: Die navorser het gedurende Februarie en Mei 2010 ’n ondersoek gedoen na PubMed, CINAHL en CENTRAL vir ewekansigbeheerde proewe gepubliseer vanaf die aanvang tot 2010. Die Mediese Ondersoekhoofde het farmakologiese, alternatiewe, pynbeheer, kraam, swangerskap, komplementêre, ewekansigheid, toevalligheid, verloskunde, natuurlike geboorte, ontspanning, asemhaling, posisionering, hipnose, watergeboorte, akupunktuur en aromaterapie ingesluit. Seleksie kriteria: Die studies het navorsing oor swanger vroue, primigravida of multigravida, tydperk (37 weke en meer), spontane kraam (eerste of tweede stadium) sonder enige komplikasies in vorige of huidige swangerskappe ingesluit. Die navorser het ewekansigbeheerde toetsing met ’n intervensie en ’n kontrole groep ondersoek. As gevolg van finansiële beperkings het die navorser studies wat alleenlik in Engels gepubliseer is, geassesseer. Intervensies soos die opvoeding oor kindergeboorte, deurlopende ondersteuning, ontspanning, asemhalingstegnieke, beweging en posisionering, musiek, handegenesing, aromaterapie, hidroterapie en akupunktuur is bestudeer. Data-insameling en analise: Meta-analise is uitgevoer deur gebruik te maak van Relatiewe Risiko’s en 95% Betroubaarheidsinterval vir tweeledige uitkomste en Gewigdraende gemiddelde afwykings en 95% Betroubaarheidsinterval vir deurlopende resultate. Review Manager (RevMan), ’n statistiese sagteware is gebruik. Waar dit ontmoontlik was om meta-analise uit te voer, was resultate gepresenteer in narratiewe vorm. Die uitkomste meting is ’n afname in die behoefte vir farmakologiese pynverligting, moederskapbevrediging met die algehele geboorteskenkervaring, die duur van die bevalling (normale of korter vordering), gevalle van postnatale depressie, voorkoms van postpartum bloeding , ’n Apgartelling van meer as sewe teen vyf minute, resussitasie van die neonaat en toelating tot die neonatale intensiewe sorgeenheid. Resultate: Dertien (13) geskikte ewekansigbeheerde proewe is ingesluit in die sistematiese oorsig. Vier proewe het hidroterapie (n=585), twee proewe akupunktuur (n=480), twee proewe die opvoeding van kindergeboorte (n=6398), een proef deurlopende ondersteuning (n=2844), een proef aromaterapie (n=513), een proef moederlike posisionering (n=2547), een proef musiek, massering en ontspanning (n=90) en een proef het hipnose (n=82). Die proef vir hipnose het ‘n afname in die behoefte vir farmakologiese pynbeheer met 15/29 vroue in die hipnose groep en 20/36 vroue in die kontrole groep getoon. Vroue in die hipnose groep het ook groter bevrediging gevind met die ervaring van die geboorteskenking met 15/29 (29%) in vergelyking met 8/36 (23%) in die kontrole groep. Die proewe vir akupunktuur het ’n afname in die behoefte vir farmakologiese pynbeheer Skilnand (2002) (n=208), met ‘n gemiddelde waarde van 11/106 (10%) vir epiduraal en 15/106 (14%) vir Pethidien in die intervensie groep en ‘n gemiddelde waarde van 27/106 (26.5%) vir epidural en 36/102 (35%) in die kontrole groep. Borup (2009) (n=384) toon ook ‘n afname in die behoefte van farmakologiese pynbeheer met ‘n waarde van 185/314 (58.9%) in vergelyking met die kontrole groep 124/149 (83.2%). Die sekondêre uitkomste van die duur van die kraamproses (minute) in Skilnand (2002), is noemenswaardig ten gunste van die akupunktuurgroep met ’n gemiddelde waarde van 212 (SA, 155) in die intervensie groep en ’n gemiddelde waarde van 283 (SA, 225) in die kontrole groep met ’n p-waarde van 0.01. Gevolgtrekkings: Akupunktuur mag kraampyn verlig en ook die duur van die kraamproses verkort, vandaar dat vrouens groter bevrediging mag ervaar met die ervaring van geboorteskenk. Hipnose mag die begeerte na farmakologiese pynverligting verminder en sodoende vroue groter ervaring met geboorteskenk mag ervaar. Daar is onvoldoende bewys aangaande die voordele van die opvoeding van kindergeboorte, deurlopende ondersteuning, aromaterapie, musiek, massering, beweging en posisionering, asemhaling en ontspanning.

Thesis (MCur)--University of Stellenbosch, 2011. / AFRIKAANSE OPSOMMING: Agtergrond Samewerking tussen belanghebbendes is ʼn baie waardevolle instrument om die holistiese ontwikkeling van gemeenskappe te bevorder. Gevolglik het die navorser deur hierdie projek gepoog om die waarde van samewerking in ’n gemeenskap te bepaal. Doelstelling en Doelwitte Die doel van die studie was om die waarde van samewerking in ʼn geïntegreerde gemeenskapsontwikkelingsprogram te ondersoek, soos dit onder die belanghebbendes in die gemeenskap van Kuilsrivier ervaar is. Die volgende doelwitte is gestel om te bepaal of: • samewerking ʼn oplossing is vir gemeenskapsontwikkeling • ʼn integrasie van al die belanghebbendes in die gemeenskap ʼn verskil maak in ontwikkelende gemeenskappe. Navorsingsontwerp Vir die doel van hierdie studie was ʼn fenomenologiese navorsingsontwerp toegepas met ‘n kwalitatiewe benadering. Populasie en steekproefneming Die populasie het bestaan uit ʼn verskeidenheid van belanghebbendes wat betrokke was in die program. Deur doelgerigte steekproefneming is 10 deelnemers gekies wat bestaan het uit ‘n fokusgroep met vyf deelnemers en onderhoude met vyf afsonderlike individue. Onderhoudsriglyne en data insameling Onderhoude is gevoer met een fokusgroep en vyf individue afsonderlik. Elke onderhoud was gelei deur semi-gestruktureerde onderhoudsriglyne wat gebaseer was op die doelwitte. Data is deur die navorser persoonlik ingesamel. ʼn Voorondersoek is nie gedoen nie. Geldigheid Om die geldigheid van hierdie studie te verseker, is die beginsels van geloofwaardigheid, gelykvormigheid, betroubaarheid en oordraagbaarheid toegepas. Etiese oorweging Toestemming vir die uitvoering van die studie was verkry van die Etiese Komitee van die Fakulteit Gesondheidswetenskappe by Stellenbosch Universiteit. Ingeligte, geskrewe toestemming was verkry. Die onderhoude is op band opgeneem met toestemming van die deelnemers. Deelname aan die studie was vrywillig en die etiese beginsels met betrekking tot privaatheid, anonimiteit en vertroulikheid is verseker deur die hele studie. Data analise Data was geanaliseer volgens Tesch (1990:154-156). Opgeneemde onderhoude is getranskribeer. Getranskribeerde data was gegroepeer in temas en sub-temas en gekodeer deur die hele proses. Bevindinge Gedurende die onderhoude, en spesifiek in die fokusgroep, het deelnemers die waarde so beskryf van aandeelhouers in gemeenskapsontwikkeling: “Samewerking is baie belangrik. Integrasie van alle partye dra definitief by tot die ontwikkeling van die gemeenskappe.” Daar is bevind dat bemagtiging die gemeenskappe in staat stel om hulle individuele take meer effektief uit te voer, n.a.v. die volgende: ”Ons skakel in en deur dit bemagtig ons ons gemeenskappe in Kuilsrivier en nou ook ander gemeenskappe”. Die projek het nuwe bewyse geïdentifiseer van ʼn wyer spektrum van die waarde van samewerking en het die waarde van persoonlike, geestelike en emosionele ondersteuning geïdentifiseer wat ervaar is deur die aandeelhouers. Verder het die studie baie belangrike persoonlike ontwikkeling en bemagtiging, soos ervaar deur die aandeelhouers gewys dat daar ʼn baie belangrike persoonlike ontwikkeling en bemagtiging ervaar is deur die aandeelhouers en dat integrasie van al die gemeenskapsaandeelhouers wel ʼn verskil maak in ontwikkelende gemeenskappe. Aanbevelings Aanbevelings wat gebaseer is op die wetenskaplike bewyse wat deur die studie bekom is, was gemaak en sluit die volgende in: ʼn Groter poging moet aangewend word om die beste moontlike mense betrokke te kry by ʼn geïntegreerde gemeenskapsonwikkelingsprogram Vertroue en respek tussen die aandeelhouers onderling en tussen die aandeelhouers en die gemeenskap is noodsaaklik ʼn Mentorprogram vir vrywilligers Persoonlike ontwikkelingsprogramme vir die vrywilligers Ter opsomming kan gesê word dat die LINK geïntegreerde program gewys het dat om verandering teweeg te bring in Suid-Afrika, sal daar ʼn toename in geïntegreerde gemeenskapsontwikkelingsprogramme te weeg gebring moet word met ʼn samewerkingsvennootskap van verskeie aandeelhouers. / ENGLISH ABSTRACT: Background Collaboration between stakeholders is a valuable tool to enhance holistic development in communities. Consequently through this project the researcher endeavored to determine the value of collaboration in development of a community. Goal and objectives The purpose of the study was to explore the value of collaboration of an integrated community development programme as experienced by stakeholders which was introduced in Kuils River. The following objectives were set to determine whether: • collaboration is a solution to community development • an integration of all community stakeholders makes a difference in developing societies. Research design For the purpose of this study a phenomenological research design with a qualitative approach was applied. Population and sampling The population comprised of the various stakeholders involved in the programme. Through purposive sampling 10 participants were selected, which consisted of one focus group of five participants and five face to face individuals interviews. Interview Guide and data collection Interviews were conducted with one focus group and five individual participants. Each interview was guided by a semi-structured interview guide based on the objectives. Data was collected personally by the researcher. A pretest was not done. Validity To ensure the validity of the study the principles of credibility, conformability, dependability and transferability were applied. Ethical considerations Consent to conduct the study was obtained from the Ethical Committee of the Faculty of Health Sciences at Stellenbosch University. Informed written consent was obtained. The interviews were recorded with the consent of the participants. Participation in the study was voluntary and the ethical principles pertaining to privacy, anonymity and confidentiality were maintained throughout the study. Data analysis Data was analysed according to Tesch (1990:154-156). Recorded interviews were transcribed. Transcribed data was grouped into themes, subthemes and coded throughout the process. Findings During the interviews, specifically with the focus group, participants described the value of collaboration of various stakeholders in community development: “Collaboration is very important. Integration of all the parties definitely contributes to the development of the communities”. It was shown that empowerment enables communities to fulfil their individual tasks more effectively as the following comment illustrates: “We are linking in and through that we are empowering our communities, our community in Kuils River and now also other communities”. The project identified new evidence of a broader range of the value of collaboration and has identified the value of personal, spiritual and emotional support experienced by stakeholders. Furthermore, the study has shown the high importance of personal development and empowerment experienced by stakeholders and that the integration of all community stakeholders does make a difference in developing societies. Recommendations Recommendations were made based on the scientific evidence obtained and include the following: Effort should be made to involve the best possible people in the integrated community development programme (ICDP). Trust and respect between the stakeholders and between the stakeholders and the community are imperative A mentorship programme for volunteers Personal development programme for the volunteers In conclusion the Local Integrated Network in Kuils River (LINK) integrated programme has shown that to bring about change in South Africa, an increase in ICDP’s should be introduced with a collaborative partnership of various stakeholders.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The National Cancer Association of South Africa estimates that over 80,000 of South Africans currently die from cancer each year, whilst statistics show an increase in newly diagnosed cancer cases. Despite an improvement in cure rates, cancer, because of its association with pain, suffering and death, still affects human beings in their totality. It has been demonstrated that effective psychosocial care, as provided by oncology nurses, improve the outcomes for cancer patients. Therefore, nurses’ attitudes towards caring for patients that are dying are of vital importance to the quality of care provided to these patients. Attitudes towards caring for patients that are dying may be influenced by the demographic factors of oncology nurses, such as age, workplace and years of experience in oncology. It may also depend on the degree of work satisfaction and by the nature of the work environment, particularly regarding the level of support being offered to the nurse. The purpose of this study hence was to explore the influences of demographic and work environment factors on nurses’ attitudes towards caring for patients that are dying in oncology settings in the Western Cape Metropole. The objectives of this study were to determine oncology nurses’ attitudes towards caring for patients that are dying, to determine the degree of work satisfaction experienced by these nurses, to determine the perceived supportive nature of their work environments, and to establish and examine any relationships between oncology nurses’ attitudes towards caring for patients that are dying and demographic factors, work satisfaction and a supportive work environment. This study was theoretically underpinned by Paterson and Zderad’s (quoted in Praeger, 2002) humanistic nursing theory and Peplau’s (quoted in Belcher & Brittian Fish, 2002) interpersonal relations in nursing theory, because of their relevance to palliative care. A quantitative research approach, with a descriptive design, was selected to conduct the study. The target population was all the oncology nurses, caring for patients that are dying in palliative and oncology settings in the Western Cape Metropole. A convenience sample of 127 oncology nurses was selected in three different, but typical oncology settings, namely a state hospital, a private hospital and three hospices. Data was collected by means of a selfreporting questionnaire. A pilot study was done, in order to assure the validity and reliability of the data collection instrument. Ethical approval was obtained in advance from the Ethical Research Committee of the Faculty of Health Sciences of the University of Stellenbosch. Written consent was obtained beforehand from the managers of the three oncology settings where the research was conducted, as well as from the participants. The main findings of this study were that the majority of the respondents displayed positive attitudes towards caring for patients that are dying. In addition, most of the respondents experienced a high degree of work satisfaction and also regarded their work environments as supportive. Significant relationships were found between positive attitudes towards caring for patients that are dying and: • hospice settings; • higher age and; • rank of the professional nurse. The overall recommendation that was made was that continuing education in all aspects of palliative care be regarded as an essential strategy in maintaining and further enhancing positive attitudes amongst oncology nurses towards caring for patients that are dying. In addition, coping strategies needed to be widely implemented to help oncology nurses cope with their emotions and anxieties. / AFRIKAANSE OPSOMMING: Die Nasionale Kankervereniging van Suid-Afrika beraam dat meer as 80,000 Suid-Afrikaners huidig jaarliks aan kanker sterf, terwyl statistieke ‘n toename in die aantal nuwe gevalle van kanker toon. Ten spyte van ‘n toename in die sukses van behandeling, beïnvloed kanker, weens sy assosiasie met pyn, lyding en die dood, steeds die mens in sy totaliteit. Dit is bewys dat effektiewe psigososiale versorging deur onkologiese verpleegkundiges die uitkomstes van pasiënte met kanker verbeter. Daarom is die ingesteldhede van verpleegkundiges, jeens die versorging van pasiënte wat sterwend is, van kardinale belang in die kwaliteit van versorging wat aan hierdie pasiënte gebied word. Sodanige ingesteldhede mag deur demografiese faktore, soos ouderdom, werkplek, en jare ondervinding in onkologie, beїnvloed word. Dit mag ook van die mate van werksbevrediging en van die aard van die werksomgewing, spesifiek met betrekking tot die mate van ondersteuning wat aan die verpleegkundige gebied word, afhang. Die doel van hierdie studie was dus om die invloed van demografiese en werksomgewingsfaktore op die ingesteldhede van onkologiese verpleegkundiges, jeens die versorging van pasiënte wat sterwend is in onkologiese afdelings in die Wes-Kaapse Metropool, te ondersoek. Die doelwitte van hierdie studie was om die ingesteldhede van verpleegkundiges jeens die versorging van pasiënte wat sterwend is te bepaal, om hulle mate van werksbevrediging te bepaal, om hul persepsie van die ondersteunende aard van hul werksomgewing te bepaal, en om enige verband tussen onkologiese verpleegkundiges se ingesteldhede jeens die versorging van pasiënte wat sterwend is en demografiese faktore, werksbevrediging en die aard van ‘n ondersteunende werksomgewing te bepaal en te ondersoek. Hierdie studie is teoreties, vanweë hul relevansie tot palliatiewe sorg, deur Paterson en Zderad (aangehaal in Praeger, 2002) se humanistiese teorie en Peplau (aangehaal in Belcher & Brittian Fish, 2002) se interpersoonlike verhouding in verplegingsteorie, onderskraag. ‘n Kwantitatiewe navorsingsbenadering, met ‘n beskrywende ontwerp, is gekies om die studie mee uit te voer. Die populasie het al die onkologiese verpleegkundiges, wat sterwende en palliatiewe pasiënte in kankerafdelings in die Wes-Kaapse Metropool versorg, ingesluit. ‘n Gerieflikheidsteekproef van 127 onkologiese verpleegkundiges, in drie verskillende, maar tipiese kankerinstellings, is gekies, naamlik ‘n staatshospitaal, ‘n privaathospitaal en drie hospitiums. Datainsameling is deur middel van ‘n self-gerapporteerde vraelys gedoen. ‘n Loodsstudie is uitgevoer om die geldigheid en betroubaarheid van die vraelys te verseker. Etiese goedkeuring is vooraf vanaf die Etiese Navorsingskomitee van die Fakulteit Gesondheidswetenskappe van die Universiteit van Stellenbosch verkry. Skriftelike toestemming is ook vooraf vanaf die bestuur van die instellings, waar die navorsing gedoen is, sowel as van die deelnemers verkry. Die hoofbevindings van hierdie studie was dat die meerderheid van die respondente positiewe ingesteldhede jeens die versorging van pasiënte wat sterwend is openbaar het. Boonop het die meeste respondente ’n hoë mate van werksbevrediging ervaar en hul werksomgewing as ondersteunend beskou. Beduidende verbande is getrek tussen positiewe ingesteldhede jeens die versorging van pasiënte wat sterwend is, en: • versorging in hospitiums; • hoër ouderdom en; • rang van professionele verpleegkundige. Die algemene aanbeveling wat gemaak kon word was dat deurlopende opleiding in alle aspekte van palliatiewe sorg, as ‘n grondliggende strategie beskou moet, ten einde positiewe ingesteldhede ten opsigte van die versorging van pasiënte wat sterwend is onder onkologiese verpleegundiges te behou en verder aan te moedig. Voorts behoort strategieë geïmplementeer te word om onkologiese verpleegkundiges te help met die hantering van hul emosionale behoeftes en vrese.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The aim of this descriptive survey was to investigate the attitudes of mental health care providers with regards to the management of aggression and violence. The absence of scientific data describing the attitudes of nurses towards the management of aggression and violence motivated the researcher to conduct this study. The researcher undertook a descriptive survey to describe the attitudes of nurses towards the management of aggression and violence. The management of aggression and violence attitude scale (MAVAS) was administered to N92 nurses with different qualifications these nurses are employed in the acute admission units of four psychiatric hospitals in a province in South Africa. The results showed no significant differences in attitudes between the different categories of nurses in most of the questions. Enough evidence was gathered that indicated, compared to trained staff, staff without a qualification in psychiatric nursing science had found it difficult to calm patients down, had not understood the effect of the environment on a patient, had felt that patients should control their feelings and had lacked the perception of trained nurses, with regards to the effect of negotiation and poor communication on violent and aggressive mental healthcare users. These findings can make significant contributions towards the implementation of training programmes and policies to assist staff to deal with patient related aggression and violence. Furthermore the data generated can contribute towards future research in this field with subsequent expansion of skills programmes. / AFRIKAANSE OPSOMMING: Die doelstelling van hierdie navorsings studie was om die houding van psigiatriese gesondheidsdiens voorsieners ten opsigte van die hantering van aggresie en geweld te bepaal. Die afwesigheid van wetenskaplik gefundeerde data het die navorser genoop om hierdie studie te onderneem. Die navorser het derhalwe ʼn beskrywende studie gedoen om die houding van verpleegsters ten opsigte van die hantering van aggressie en geweld te bepaal. Die “management of aggression and violence attitude scale” (MAVAS) is deur N92 verpleegsters met verskillende kwalifikasies voltooi. Hierdie verpleegsters is indiens van vier verskillende psigiatriese hospitale in ʼn provinsie in Suid- Afrika. Die verpleegsters werk in die akute opname eenhede van die onderskeie hospitale. Die resultate het geen noemenswaardige verskille tussen die onderskeie kategorieë verpleegsters se houding teenoor die hantering van aggressie en eweld aangedui nie. Genoegsame bewys is ingesamel wat aandui; dat in vergelyking met opgeleide personeel, personeel sonder ʼn kwalifikasie in psigiatriese verpleeg wetenskappe, dit moeiliker vind om pasiënte te kalmeer, nie verstaan watter effek die omgewing op ʼn pasiënt het nie. Dié kategorieë voel pasiënte moet hul gevoellens beheer en het ook nie dieselfde persepsie ten opsigte van die effek van onderhandeling en swak kommunikasie op aggressiewe en geweldadige psigiatriese gesondheids diens verbruikers as hul kollegas nie. Hierdie bevindings is ʼn belangrike bydrae ten opsigte van die implementering van opleidings programme en beleid ten einde personeel te ondersteun om pasiënt verwante aggressie en geweld te hanteer. Die nuwe data gegenereer deur dié navorsings studie kan bydra tot toekomstige navorsing in hierdie veld asook gevolglike uitbreiding van vaardigheids programme.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Complications of chronic conditions pose serious consequenses for the patient and financial implications for the health authorities, in the form of serious procedures, adaptions of medication, hospitalisation or rehabilitation. The goal of the study was to investigate the management of patients with diabetes mellitus type 2 on primary health care level. The objective of the study: • a retrospective investigation into the holistic management of patients with diabetes mellitus type 2 by CNPs. The research design was descriptive, non-experimental with a quantitative approach. The population included 896 files of patients diagnosed with diabetes mellitus type 2 over a period of 6 months at 4 clinics in the George Subdistrict. The sample consisted of 180 files, namely 20% of the population. The researcher gathered the data personally by means of a structured check list. Ethical approval was obtained by Stellenbosch University and above mentioned health authorities. Reliability and validity was ensured by means of a pilot study, as well as inputs from a statistician, experts in the fields of primary health care and a research panel. Descriptive statistics were used for data-analysis. Variables were presented in the form of tables, graphs and frequencies. Statistica Version 9 software were used and relations between the various variables were analysed by means of ANOVA (“Analysis of Variance”). By means of systematic probability sampling every second file that adhered to the inclusion criteria was drawn, until 20% saturation was reached at each clinic. Thereafter every second file was drawn from the rest of the appropriate files, until the sample was sufficient or until there were no more suitable files left over. The results of this study provide evidence that the holistic approach was not constantly applied by CNPs in patients with diabetes mellitus type 2. Drug treatment was renewed by a doctor every six months, but no attention was given to the diabetes mellitus in between the doctor's visits. Health information was given. It varied between 100% to 81%. Complications were not addressed appropriately though. In clinic A for example 6% (n=5) recorded on the condition of the patients' feet, while in clinic B 4% (n=2) addressed this issue. At clinic C nothing was recorded on this aspect, while at clinic D 13% (n=2) recorded on this. Respiratory and cardio-vascular systems often fail in patients with diabetes mellitus type 2. At clinic A CNPs enquired only in 18% (n=16) of cases about these systems, at clinic B 22% (n=11), at clinic C 27% (n=7) and at clinic D 6% (n=1). This study has the potential to stimulate further research, especially regarding the reasons why CNPs do not manage chronic patients holistically. / AFRIKAANSE OPSOMMING: Komplikasies van kroniese toestande het gevolge vir die pasiënt en koste-implikasies vir die gesondheidsdienste, byvoorbeeld ernstige ingrepe, medikasieaanpassings, hospitalisasie of rehabilitasie. Die doel van die studie was om te bepaal hoe KVPs pasiënte met diabetes mellitus tipe 2 op primêre gesondheidsorgvlak hanteer. Die doelwit van die studie: • retrospektiewe waarneming na die holistiese hantering van pasiënte met diabetes mellitus tipe 2 deur KVPs. Die navorsingsontwerp was beskrywend, nie-eksperimenteel, met ‘n kwantitatiewe benadering. Die populasie was 896 lêers van pasiënte wat oor ses maande met diabetes mellitus tipe 2 gediagnoseer was by vier klinieke in die George Subdistrik. Die steekproef was 180 lêers, naamlik 20% van die populasie. Die navorser het persoonlik data ingesamel met ‘n gestruktureerde kontrolelys. Etiese goedkeuring is verleen deur die Universiteit van Stellenbosch en bogenoemde gesondheidsowerhede. Betroubaarheid en geldigheid is verkry deur ‘n loodstudie en deur insette van 'n statistikus, primêre gesondheidsorg eksperts, asook 'n navorserspaneel. Beskrywende statistieke is aangewend vir data-analise. Veranderlikes is voorgestel in die vorm van tabelle, grafieke en frekwensies. Statistica Version 9 sagteware is gebruik en verhoudings tussen veranderlikes is geanaliseer deur van ANOVA (“analysis of variance”). Deur middel van sistematiese waarskynlikheidsteekproefbepaling is elke 2de lêer wat aan die insluitingskriteria voldoen het getrek, tot 20% saturasie by elke kliniek bereik is. Verder is elke 2de lêer uit die oorblywende lêers getrek, totdat die hoeveelheid genoeg was, of totdat daar nie meer geskikte lêers was nie. Resultate van hierdie studie bewys dat pasiënte met diabetes mellitus tipe 2, nie holisties hanteer was deur KVPs nie. Medikasie was meestal elke 6 maande deur 'n dokter hernu, sonder enige aandag aan die diabetes mellitus tipe 2 gedurende die tussen-in periodes. Gesondheidsvoorligting was goed. Dit het gewissel van 100% tot 81%. Komplikasies was egter onvoldoende aangespreek. In kliniek A het byvoorbeeld 6% (n=5) oor die toestand van die pasiënte se voete gerekordeer, terwyl in kliniek B 4% (n=2) hiervan melding gemaak het. By kliniek C was daar niks hieroor aangeteken nie, terwyl by kliniek D 13% (n=2) hieroor gerekordeer het. Respiratoriese en kardiovaskulêre sisteme versaak dikwels by pasiënte met diabetes mellitus tipe 2. By kliniek A het KVPs slegs by 18% (n=16) navraag gedoen oor hierdie sisteme, by kliniek B 22% (n=11), by kliniek C 27% (n=7) en by kliniek D 6% (n=1). Hierdie studie behoort verdere navorsing te stimuleer, veral oor die redes hoekom die KVPs nie kroniese pasiënte holisties hanteer nie.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: This research was an attempt to investigate the role of the doula during labour and the promotion of natural childbirth as well as the assessment of the effect of the presence of the doula during natural childbirth. There has been a shift from home-based deliveries to hospital-based deliveries, which does not sufficiently provide for optimal care and emotional support to the women during labour. The registered midwives in the maternity units in Port Elizabeth in the Eastern Cape region in both private and public hospitals displayed some reluctance in using the doulas during labour. The design for this study utilised a quantitative approach which is non-experimental, explorative, descriptive and contextual in nature. The data -collection method used was only the statistical data from the registered midwives’ questionnaire designed as per the format from the University of Stellenbosch. Research ethics implemented were confidentiality, informed consent, privacy, protection, information and debriefing. Validity and reliability had to be observed on this study as it was observed that the content of the study had to be closely related to what was measured, as well as consistency of the data –gathering instrument in obtaining the same results in similar situations The study took place at the Port Elizabeth Maternity Units in the Eastern Cape with registered midwives (40 in the Public Sector and 45 in the Private Sector),and 45 in the private sector of the maternity units of the selected hospitals. The results of this study and the interpretation thereof assisted the researcher to confirm that there was indeed a great need for the doulas during natural childbirth in the maternity units in the public sector, where there is a shortage of registered midwives and care workers to attend to the basic needs of the patients. The value of the contributions of the doula to support and provide comfort measures to women during labour should not be underestimated; and registered midwives should be informed about the important role of the doula and how the doula can complement the obstetrical care rendered by the midwife. / AFRIKAANSE OPSOMMING: Hierdie navorsingstudie is uitgevoer om die rol van die doula of kindergeboorte-begeleidster gedurende baring in die bevordering van natuurlike kindergeboorte asook die effek van die teenwoordigheid van laasgenoemde te ondersoek. Die klem het verskuif van tuisbevallings na hospitaal- bevallings. Hierdie tendens het veroorsaak dat daar nie genoeg voorsiening gemaak word vir versorging en emosionele ondesteuning nie. Die geregistreede vroedvroue in die verlossings-eenhede in Port Elizabeth in die Oos-Kaapse streek, in beide openbare en private hospitale toon ‘n mate van onwilligheid om doulas tydens baring te benut, Die studie ontwerp is non-eksperimenteel, eksploratief, beskrywend en kontekstueel van aard, met ‘n kwantitatiewe benadering. In kwantitatiewe studies help die ontwerp, die navorser deur middel van prosedures om akkurate en interpreteerbare data te ontwikkel. Die studie is onderneem by die Port Elizabeth se Verloskunde-eenhede in die Oos-Kaap. In hierdie hospitale is daar 40 geregistreerde vroedvroue in die Openbare- en 45 in die Privaatsektor. Die resultate van hierdie studie en die interpretasie daarvan het die navorser gehelp om te bevestig dat daar inderdaad ‘n groot behoefte bestaan vir die bydraes van kindergeboortbegeleidsterss en veral in die openbare sektor waar daar groot tekorte aan geregistreerde vroedvroue voorkom en nie genoeg personeel is om in die basiese behoeftes van die pasiënte te voorsien nie. Die waarde van die bydraes van doulas om ondersteuning en bemoedigingsmaatreëls vir die vrou tydens baring te voorsien moet nie onderskat word nie; en geregistreerde vroedvroue behoort bewus gemaak te word van die belangrike rol van die doula en hoe die doula die obstetriese sorglewering van die pasient kan komplementeer.

Thesis (MCur (Nursing Science))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: This research study aims at enhancing the utilisation of primary mental health care services in Dodoma, Tanzania. Primary health care (PHC) according to the Alma Ata conference 1948 is an essential part of the health care system for bringing health care closer to where people live and work, is people-centred, affordable and achieves better health outcomes, and is considered to contribute to communities’ social and economical development. PHC facilities in Tanzania are health centres and dispensaries, which are within five kilometres from where people live. In the 1980s’ countries integrated mental health into PHC to improve the mental health status of their people. To facilitate delivery of Primary Mental Health Care (PMHC), Tanzania has formulated a mental health policy and trained PHC workers on mental health. Despite of these efforts, people still go to referral hospitals for mental health care services. However, authors commented that “when comprehensive primary health is implemented fully” it will bring about security, safety and hope to people and therefore, they will continue to fend for health for all. The main aim was to explore and describe why people go to referral hospitals instead of utilising PMHC services closer to them. A qualitative descriptive clinical ethnographic research design was employed to examine the mental health care-giving within the context of this research. Purposive non-probability sampling was utilised. Sample size was determined by the saturation. Data collection methods were in two phases. Phase one was participative observation on mental health care-giving in the Primary Health Care (PHC) facilities for a period of at least four weeks, and phase two was by use of an in-depth interview with family members at referral hospitals who had passed Primary Health Care facilities. Data analysis was an open thematic coding. Trustworthiness of the research was established through credibility, dependability, conformability, triangulation and a thick description. The findings of this research suggested that there is inadequate service delivery at PHC facilities, disrespect of patients and lack of knowledge on available services and on referral systems, which led to not utilising the available Primary Mental Health Care services. In conclusion the researcher expresses the recommendations of this research in the form of strategies. / AFRIKAANSE OPSOMMING: Hierdie navorsing is daarop gemik om die gebruik van primêre geestesgesondheidsorg dienste in Dodoma, Tanzanië te bevorder. Volgens die Alma Ata verklaring van 1948 is primêre gesondheid sorg (PGS) ʼn noodsaaklike deel van die gesondheidsorg stelsel ten einde gesondheidsorg nader na mense werkplek en tuistes te neem. PGS is persoons-gesentreerd, bekostigbaar en het beter gesondheids resultate, dit word aanvaar dat PGS bydra tot die sosiale en ekonomoiese ontwikkeling van gemeenskappe. PGS fasiliteite in Tanzanië is hoofsaaklik gesondheidsentra en apteke, wat binne ʼn radius van vyf kilometere vanaf mense se woninigs is. Gedurende die 1980’s het lande geestesgesondheid integreer in die PGS stelsel in ’n poging om die geestesgesondheidstatus van mense te verbeter. Ten einde die lewering van primêre geestesgesondheid sorg (PGGS) te verbeter het Tanzanië ʼn geestesgesondheidsbeleid geformuleer en primêre gesondheidsorg werkers opgelei in geestesgesondheidsorg. As omvattende primêre gesondheidsorg ten volle implementeer is sal dit bydra tot sekuriteit, veiligheid en hoop en mense sal aanhou veg vir ”gesondheid vir almal”. Die hoofdoel van hierdie navorsingstudie was ʼn ondersoek en beskrywing ten opsigte van die redes waarom mense eerder verwysings hospitale as PGS fasiliteite nader aan hulle besoek. Die navorser het gebruik gemaak van ʼn kwalitatiewe, beskrywende kliniese etnografiese studie ten einde geestesgesondheidsorglewering te ondersoek binne die konteks van hierdie studie. Die navorser het doelgerigte nie-waarskynlikheids steekproefneming gebruik en die versadigingsvlak is bereik deur middel van data-saturasie. Data is tydens twee fases ingesamel. Fase een was gekenmerk deur deelnemende observasie ten opsigte van geestesgesondheidsorg lewering in ʼn PGS fassiliteite. Tydens fase twee het die navorser in-diepte onderhoude gevoer met famililede van die persoon wat eerder die verwysings hospitaal as PGS fasiliteit besoek het. Data analise is gedoen deur tematiese, kwalitatiewe kodering te gebruik. Betroubaarheid van die navorsing is verkry deur middel van vertrouenswaardigheid, eerbaarheid, triangulasie en in-diepte beskrywing. Die bevindings van hierdie navorsings studie suggereer die teenwoordigheid van ondoeltreffende diens lewering by PGS fasiliteite, onrespekvolle hantering van pasiënte en gebrekkige kennis rondom die beskikbare dienste en verwyssings stelsel in plek, derhalwe maak pasiënte eerder gebruik van die verwysings hospitale. Gevolglik beveel die navorser aan dat strategieë gebasseer op die resultate van hierdie navorsings geïmplementeer word.