Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Taking into consideration the long duration of standard treatment for Mycobacterium tuberculosis (TB), the high prevalence of HIV co-infection and the growing prevalence of drug-resistant TB, there is an urgent need for improved treatment approaches for TB and HIV. However, there is inadequate information regarding the burden being placed on the Department of Health (DOH) systems by the current treatment of patients established on Antiretroviral Therapy (ART) who are newly diagnosed with TB, and by their clinical management. The aim of the study was to determine what proportion of patients established on ART were newly diagnosed with TB, and what their clinical and treatment outcomes were in different public sector settings in the eThekwini Region, KwaZulu-Natal (KZN). Approval for the study was obtained from the Human Research Committee of Stellenbosch University and from the Biomedical Research Committee, KZN. The study used a retrospective, quantitative, cohort technique at both TB and ART clinics at three sites in the eThekwini region, KZN. These sites were DOH clinics and were selected as they all had a TB clinic and a DOH-registered ART clinic. The study focused on a period of one year prior to a patient established on ART developed TB. The study population comprised all TB patients who attended the selected DOH clinics. A data collection tool was developed and pilot-tested. A small sample of patient files (n=15, representing 2% of the study population) was randomly selected; five from each site. The files and data were excluded from the main study. A total of 1824 files (579 from the TB clinics and 1245 from the ART clinics) were reviewed. The data were captured into an electronic database (EpiData Version 3.3) and analyzed using STATA (Version 11.0) with the assistance of a statistician. The findings show that of the study sample from the TB clinics (N=579), 78% (454/579) were newly diagnosed with TB. Of the new TB cases, 90% (409/454) had pulmonary TB and 71% (413/579) were HIV-positive. Nearly 50% (68/137) of the patients had commenced ART prior to TB diagnosis and treatment, and 14% (19/137) had commenced ART after TB. Of those who commenced ART prior to TB diagnosis and treatment, 29% (20/68) had commenced ART more than three months prior to acquiring TB. The findings from the ART clinics show that of the files (N=1245) reviewed, 40% (501/1245) had TB, and of these 8% (42/501) developed TB after three months or more of ART. Missing data in the patient medical files was a major challenge. The lack of recorded data about ART in the TB clinics and about TB in the ART clinics suggests suboptimal clinical management and poor integration of HIV and TB services. It was therefore not possible to derive a combined HIV-TB outcome measure. Recommendations to promote and implement the integration of TB and HIV services included policy changes and implementation, management and practice suggestions, education and training to integrate TB/HIV services and increase research to identify gaps in clinical management and to improve integration of services. / AFRIKAANSE OPSOMMING: Met inagneming van die lang duur van die standaard behandeling vir Mycobacterium tuberkulose (TB), hoë voorkoms van MIV-infeksie en die groeiende voorkoms van dwelmweerstandige TB, is daar ’n dringende behoefte aan verbeterde behandelingbenaderings vir TB en MIV. Daar is egter ’n gebrek aan inligting oor die las geplaas op die Departement van Gesondheid (DvG) se stelsels deur die huidige behandeling van pasiënte op antiretrovirale terapie (ART) wat gediagnoseer is met TB en deur hul kliniese bestuur. Die doel van die studie was om vas te stel watter persentasie van pasiënte wat op ART gevestig is, wel met TB gediagnoseer is, en wat hul kliniese en behandeling-uitkomste was in verskillende openbare-sektorinstellings in die eThekwini-streek, KwaZulu-Natal (KZN). Goedkeuring vir die studie is verkry van die Menslike Navorsingskomitee van die Universiteit van Stellenbosch en van die Biomediese Navorsingskomitee, KZN. Die studie het gebruik gemaak van ’n retrospektiewe, kwantitatiewe ‘cohort’-tegniek by beide TB en ARB-klinieke op drie plekke in die eThekwini-streek, KZN. Hierdie terreine was DvG-klinieke en is gekies omdat hulle almal oor ’n TB-kliniek en 'n DvGgeregistreerde ART-kliniek beskik. Die studie het gefokus op ’n tydperk van een jaar voor ’n pasiënt wat op ART is, TB ontwikkel het. Die studiepopulasie bestaan uit alle TBpasiënte wat die geselekteerde DvG-klinieke bygewoon het. ’n Data-insamelinginstrument is ontwikkel en getoets. ’n Klein voorbeeld van die pasiëntlêers (n = 15, 2% van die studie bevolking verteenwoordig) is ewekansig gekies: vyf uit elke plek, en die data is vervat in ’n elektroniese databasis (EpiData Version 3,3). ’n Totaal van 1824 lêers (579 in die TB-klinieke en 1245 lêers in die ART-klinieke) is ondersoek. Die data is ontleed deur gebruik te maak van Stata (weergawe 11,0) met die hulp van ’n statistikus. Die bevindinge toon dat van die studiemonster in die TB-klinieke (N = 579), 78% (454/579) met TB gediagnoseer is. Van die nuwe TB-gevalle, het 90% (409/454) pulmonêre TB gehad en was 71% (413/579) MIV-positief. Byna 50% (68/137) van die pasiënte het ART begin vóór hulle TB-diagnose en -behandeling, en 14% (19/137) ART ná TB. Van dié wat ART voor TB-diagnose en -behandeling begin het, het 29% (20/68) meer as drie maande voor die opdoen van TB met ART begin. Die bevindinge van die ART-klinieke toon dat van die lêers (N = 1245) wat bestudeer is, 40% (501/1245) TB het, en hiervan het 8% (42/501) TB na drie of meer maande van ART ontwikkel. Ontbrekende data in die pasiënt se mediese lêers was ’n groot uitdaging. Die gebrek aan aangetekende data oor ART in die TB-klinieke en oor TB in die ART-klinieke dui op suboptimale kliniese bestuur en swak integrasie van MIV- en TB-dienste. Dit was dus nie moontlik om ’n gesamentlike MIV-TB uitkomsmaatreël af te lei nie. Aanbevelings om die integrasie van TB- en MIV-dienste te bevorder en te implementer, het beleidveranderinge en -implementering ingesluit, asook bestuur- en praktykvoorstelle, onderwys en opleiding om TB-/MIV-dienste by DvG-vlak te integreer en meer navorsing om gapings in die kliniese bestuur te identifiseer en die integrasie van dienste te verbeter.

Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The aim of this study was to compare the impact of a four-day structured Basic Infection Prevention and Control course on the knowledge of, and adherence to, Standard Precautions in clinical nursing practice amongst nurses who had completed the course and those who did not. The specific precautionary measures of investigation included hand hygiene, personal protective equipment (PPE) and sharps management. The secondary aim of the study was to identify any personal and contextual factors that influenced the application of such Standard Precautions measures in public healthcare facilities within the Cape Winelands and Overberg District. Sixty eight students (those who had been trained) with a similar number of controls (who had not been trained) were enrolled in the study. Although both the participants and controls had the knowledge, their adherence to hand hygiene, PPE and sharps management in clinical nursing practice was poor. Staff attitude was found to be the main factor for non-adherence. The knowledge of the participants was good as they had answered most of the questions correctly. It seems as if there was retention of knowledge after the four-day Basic Infection Prevention and Control course. There were, however, no significant differences between the two groups. For both groups attitude and behavioural change must be addressed in order to improve adherence to hand hygiene, PPE and sharps management. The findings of the study will form recommendations towards improved infection prevention and control practices at public healthcare facility level in the Cape Winelands District. / AFRIKAANSE OPSOMMING: Die doel van die studie was om die impak van 'n 4-dag gestruktureerde Basiese Infeksiebeheerkursus op die kennis en toepassing van Standaard Voorsorgmaatreëls in kliniese praktyk in die Kaapse Wynland en Overberg Distrikte ondersoek, vergeleke met 'n groep wat nie die kursus bygewoon het nie. Die spesifieke Voorsorgmaatreëls wat ondersoek is, het handhigiëne, die gebruik van beskermende drag en die hantering en beheer van skerpvoorwerpe ingesluit. Die studie het ook gekyk na enige kontekstuele en persoonlike faktore wat die toepassing van Standaard Voorsorgmaatreëls in openbare gesondheidsorgfasiliteite beïnvloed. Agt en sestig verpleegkundiges het die 4-dag Basiese Infeksiebeheerkursus bygewoon en 'n gelyke aantal kontrole studente het nie die kursus bygewoon nie. Alhoewel beide groepe die kennis van handhigiëne, die dra van beskermende drag en die hantering van skerpvoorwerpe gehad het, was die toepassing van die Standaard Voorsorgmaatreëls in kliniese praktyk baie swak. Personeel se houding was die grootste faktor wat gelei het tot die nie-toepassing van Standaard Voorsorgmaatreëls. Die kennis van die kursusgangers was goed, want albei groepe het die meeste van die vrae korrek beantwoord. Die waarneming wat gemaak is, is dat die kursusgangers se kennis wel verbeter het na die bywoning van die 4-dag Basiese Infeksiebeheerkursus. Data weerspieël egter geen noemenswaardige verskille tussen die groepe nie. Beide groepe se houding en gedrag moet aangespreek word om die toepassing van handhigiëne, die dra van beskermende drag en die hantering van skerpvoorwerpe te verbeter. Die bevindinge van die studie sal gebruik word om aanbevelings te maak ten einde infeksiebeheerpraktyke in die Kaapse Wynland Distrik te verbeter.

Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The imbalance between job demands and available resources could cause burnout which may impact quality patient care. A scientific investigation was conducted to evaluate burnout amongst primary health care (PHC) nurses. The objectives for the study were to identify the prevalence of burnout amongst PHC nurses and to explore the contributing factors to burnout in PHC settings. The Job Demands-Resources (JD-R) model (Bakker and Demerouti, 2007:309) was used as a conceptual framework for the study. A non-experimental, descriptive cross-sectional design with a quantitative approach was applied. The population and sample consisted of professional nurses (PN) and clinical nurse practitioners (CNP) (n=72) in the Eden District of the Western Cape. A self-report questionnaire was used to collect the data in an uncontrolled, natural environment. Analysis of the results exposed high levels of burnout amongst PHC nurses. Nurses in PHC facilities all had an equal chance to develop burnout, regardless of their level of experience. The occurrence of burnout is equal in community health centres and in community clinics, although a trend was observed that subjects in community clinics may experience more emotional exhaustion. Work pressure, workload or an increase in job demands, lack of organisational support and management problems were rated as the main factors contributing to burnout. Recommendations were made to improve the working environments of PHC nurses in order to increase motivational levels, job satisfaction and to foster work engagement, as well as to reduce levels of burnout. Opportunities for further research are recommended. / AFRIKAANSE OPSOMMING: Die wanbalans tussen beroepseise en beskikbare hulpbronne kan uitbranding veroorsaak en gevolglik kwaliteit patiëntsorg beïnvloed. ‘n Wetenskaplike studie is gedoen om uitbranding onder primêre gesondheidsorg (PGS) verpleegkundiges te evalueer. Die doelstellings van die studie was om die voorkoms van uitbranding onder PGS-verpleegkundiges te identifiseer, en om die bydraende faktore wat aanleiding gee tot uitbranding in PGS-instellings, te ondersoek. Die Beroepseise-Hulpbronne model (Bakker and Demerouti, 2007:309) is as ‘n konsepsuele raamwerk vir die studie gebruik. 'n Nie-eksperimentele, beskrywende dwarssnit studie met 'n kwantitatiewe benadering, is toegepas. Die populasie en die steekproef het bestaan uit professionele verpleegkundiges en kliniese verpleeg praktisyns (n=72) in die Eden Distrik van die Wes-Kaap. ‘n Self-rapport vraelys was gebruik om data in ‘n ongekontroleerde, natuurlike omgewing te versamel. Die analisering van resultate het hoë vlakke van uitbranding onder verpleegkundiges in PGS-dienste ontbloot. Verpleegkundiges in PGS-fasiliteite het almal 'n gelyke kans om uitbranding te ontwikkel, ongeag die vlak van ondervinding. Die voorkoms van uitbranding is dieselfde in gemeenskaps-gesondheidsentrums en gemeenskapsklinieke, alhoewel daar ‘n neiging sigbaar was dat personeel in gemeenskapsklinieke meer emosionele uitputting ervaar. Werkdruk, werklas of toename in beroepseise, die gebrek aan organisatoriese ondersteuning en bestuursprobleme is aangewys as die hoof redes wat aanleiding gee tot uitbranding. Voorstelle is gemaak om die werksomgewing van PGS-verpleegkundiges te verbeter en om motiveringsvlakke en werkstevredenheid te herstel. Dit sal werksverbintenis versterk en die voorkoms van uitbranding beperk. Geleenthede vir verdere navorsing is aanbeveel.

Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The support for portfolio-based learning as an authentic assessment method is increasing globally. However, there are no guidelines in South Africa for a clinical practice assessment portfolio (CPAP) for primary clinical practitioner training. The study set out to develop a CPAP for the Clinical Nursing Science, Health Assessment Treatment and Care programme. An exploratory, descriptive design was used that developed over three phases. In phase one, a CPAP was developed based on an extensive review of the literature. The CPAP was validated in phase two by experts and finally, student primary clinical practitioners assessed the possible contribution of the developed CPAP to their learning in phase three. The study sample for the three phases comprised of selected relevant studies published on portfolio development (n=15); experts in the field of primary health care and education in the Cape Metropole (n=11); and student primary clinical practitioners of one higher education institution in the Cape Metropole (n=45). Structured questionnaires were used for data collection from expert and student participants after they reviewed the CPAP. Ethical approval was obtained from the Health Research Ethics Committee of the Faculty of Health Sciences (N09/09/233), Stellenbosch University. Permission to conduct the research was obtained from the higher education institution. The content validity index for items (I-CVI) was used to determine the degree to which expert participants agreed with the content of the CPAP. Results identified an I-CVI of between 0.91 and 1.00, indicating that the contents and technical format of the CPAP constitute a suitable learning tool for student practitioners. Experts suggested minor revisions regarding the clarity of items, and those were included in the final CPAP. The data analysis of the student’s responses showed that adequate guidance was provided to complete the activities in the CPAP and that the CPAP would have a positive contribution to learning. Portfolio-based learning is an important teaching and learning strategy in the Clinical Nursing Science, Health Assessment Treatment and Care programme, whereby students can demonstrate their acquired clinical competencies. Recommendations include the use of a competency framework and consensus amongst stakeholders when developing the contents of a portfolio. / AFRIKAANSE OPSOMMING: Die ondersteuning vir portefeulje-gebaseerde leer as ’n outentieke assesseringsmetode is besig om globaal te verhoog. In Suid-Afrika is daar egter nie riglyne vir ’n kliniese praktyk-assesseringsportefeulje (KPAP) vir primêre kliniese praktisynsopleiding nie. Hierdie studie het ten doel om ’n kliniese praktyk-assesseringsportefeulje vir die Kliniese Verpleegkunde-, Gesondheidsassesseringbehandeling- en Sorgprogram te ontwikkel. ’n Verkennende, beskrywende ontwerp wat oor drie fases ontwikkel het, is gebruik. In fase een is ’n KPAP ontwikkel gebaseer op ’n ekstensiewe literatuurstudie. Die geldigheid van die KPAP is in fase twee deur kundiges verklaar en in fase drie is die moontlike bydrae van die KPAP tot die leerproses deur primêre kliniese praktisynstudente geassesseer. Die studiegroep vir die drie fases het bestaan uit geselekteerde relevante studies wat handel oor portefeulje ontwikkeling (n=15), kenners op die gebied van primêre gesondheidsorg en opvoeding in die Kaapse Metropool (n=11); en primêre gesondheidsorg studentpraktisyns van een van die tersiêre instansies in die Kaapse Metropool (n=45). Gestruktureerde vraelyste is gebruik vir data-insameling van kenners en studentedeelnemers nadat hulle die KPAP ondersoek het. Etiese toestemming is verkry van die Gesondheidsnavorsingsetiekkomitee van die Fakulteit Gesondheidswetenskappe (N09/09/233), Stellenbosch Universiteit. Toestemming om die navorsing uit te voer, is van die tersiêre instansie verkry. Die inhoud van die item-geldigheidsindeks is gebruik om die mate waarmee kenner-deelnemers met die inhoud van die KPAP saamstem, te bepaal. Resultate van die inhoud van die item-geldigheidsindeks van tussen 0.91 en 1.00 is geïdentifiseer, wat ’n aanduiding is dat die inhoud en tegniese formaat van die KPAP ’n toepaslike leerinstrument vir studentpraktisyns is. Kenners het klein veranderings vir die duidelikheid van items voorgestel en dit is ingesluit in die finale KPAP. Die data-analise van die studente se antwoorde het aangedui dat genoegsame leiding voorsien was om die aktiwiteite in die KPAP te voltooi en dat die bydrae van die KPAP positief is tot die bevordering van die leerproses. Portefeulje-gebaseerde leer is ’n belangrike onderrig- en leerinstrument vir die Kliniese Verpleegkunde-, Gesondheidsassesseringbehandeling- en Sorgprogram, waardeur studente kan demonstreer dat hulle die kliniese bevoegdhede bekom het. Aanbevelings sluit in die gebruik van ’n bevoegdheidsraamwerk en konsensus onder belanghebbendes wanneer die inhoud van ’n portefeulje ontwikkel word.

Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The profession of nursing is a twofold vocation that has a scientific theory as the foundation of all nursing intervention or skill. Despite clinical preceptorship being a useful strategy of teaching, many training hospitals and clinical facilities are without this avenue of learning and where available, it is often not optimally utilised. The aim of this study was to explore the role of the clinical preceptor in enhancing nursing education at Edendale Hospital and Edendale campus of a nursing college. A mixed method approach was applied utilizing both qualitative and quantitative methods to collect information about the experiences and challenges as well as clarify existing problems. Samples were drawn from all stakeholders of nursing education i.e. nursing students, nurse educators and ward managers of Edendale Hospital and Campus using random and purposive sampling respectively. Data were collected using selfadministered questionnaires for students and nursing managers and an interview guide for focus group interviews for nurse educators. Ethical approval was sought from the Health Research Ethics Committee at the Faculty of Medicine and Health Sciences at Stellenbosch University, the Department of Health, the Kwazulu-Natal College of Nursing and Edendale Hospital and Campus. The findings of this study support Weidenbach’s Prescriptive Theory in which the author maintains that nursing is a practice discipline designed to produce explicit desired results which here refers to the enhancing of nursing education with the contribution of clinical preceptorship. Patricia Benner’s Dreyfus and novice to expert models were used to express the need for meaningful practical experience in nursing students and to shows nurse educators how to identify the practical learning needs of the students and assist them acquire competence. The results of the study suggest that the clinical preceptor is a mentor and a guide who facilitates the correlation of theory and practice in nursing education. The results also suggest that students are experiencing problems in clinical practice and that clinical preceptorship is needed. A number of recommendations are made based on limitations identified in the present teaching-learning process. One of the recommendations is that partnership building strategies be fostered between the hospital, the campus and the Faculty of Nursing Education. This team approach could clearly define the role of the clinical preceptor to ensure optimum nursing education. Further research is recommended. / AFRIKAANSE OPSOMMING: Verpleging is ’n tweeledige beroep met ’n wetenskaplike teorie as grondslag vir elke verpleegintervensie of -vaardigheid. Ten spyte daarvan dat kliniese instruksie (“preceptorship”) ’n nuttige onderrigstrategie is, ontbreek dit by baie opleidingshospitale en kliniese fasiliteite, en waar dit beskikbaar is, word dit dikwels suboptimaal aangewend. Die doel van hierdie studie was om ondersoek in te stel na hoe belanghebbendes by verpleegopleiding by Edendale-hospitaal en -verpleegkampus kliniese instruksie ervaar, en om sodoende vas te stel of kliniese instruksie verpleegopleiding by daardie fasiliteite versterk. ’n Gemengde benadering van sowel kwalitatiewe as kwantitatiewe metodes is gevolg om inligting oor die ervarings en uitdagings in te win en bestaande probleme te verklaar. Steekproewe is met behulp van onderskeidelik lukrake en doelbewuste seleksie uit alle belanghebbendes by verpleegopleiding by Edendale-hospitaal en - verpleegkampus geneem, met inbegrip van verpleegstudente, verpleegopvoeders en saalbestuurders. Data is deur middel van selfvoltooiingsvraelyste vir studente en eenheidsbestuurders, en ’n onderhoudsgids vir fokusgroepgesprekke met verpleegopvoeders ingesamel. Etiekgoedkeuring is verkry van die Gesondheidsnavorsingsetiekkomitee van die Fakulteit Geneeskunde en Gesondheidswetenskappe aan die Universiteit Stellenbosch, die Departement van Gesondheid, die KwaZulu-Natalse Verpleegkollege sowel as Edendale-hospitaal en - verpleegkampus. Die bevindinge van die studie ondersteun Wiedenbach se voorskriftelike teorie, waarin sy volhou dat verpleging ’n praktiese dissipline is wat ontwerp is om bepaalde gewenste resultate te behaal. Patricia Benner se Dreyfus- en beginner-tot-kennermodel is ook gebruik om die behoefte aan sinvolle praktiese ervaring by verpleegstudente te staaf, en om verpleegopvoeders te wys hoe om studente se praktiese leerbehoeftes te bepaal en hulle vaardighede te help ontwikkel. Die resultate van die studie dui daarop dat die kliniese instrukteer as mentor en begeleier die korrelasie tussen teorie en die praktyk van verpleegonderwys fasiliteer. Die resultate dui verder daarop dat student probleme in kliniese praktyk ervar en kliniese instruksie benodig. ’n Aantal aanbevelings word gedoen op grond van beperkinge wat in die huidige onderrig-en-leer-proses uitgewys is. Een van die aanbevelings is die ontwikkeling van strategieë om vennootskappe tussen die hospitaal, die verpleegkampus en die fakulteit verpleegkunde te bou. Hierdie spanbenadering kan die rol van die kliniese instrukteur duidelik omlyn ten einde optimale verpleegopleiding te verseker. Verdere navorsing word aanbeveel.

Thesis (DCur)--Stellenbosch, 2000. / ENGLISH ABSTRACT: Guided by the researcher's clinical experience and through recent outreach research projects (Stellenberg, 1996 and 1997) the factors influencing the health status of two communities were identified through health screening. It was further identified that these problems affecting the health status of these communities were magnified through the poor accessibility, availability, and affordability of health services. According to the researcher, despite the efforts of the Government and attempts to remedy the disparities of the past, the introduction of any such policy should be based on scientific evidence. The researcher decided to investigate the factors influencing the health status of the Coloured people of the Western Cape. This population group is the largest in the Western Cape, being 60,8%. Its domination in this province determines the health status of the province. By acquiring knowledge about the factors influencing the health status of the Coloured population, it will be possible for the policy makers in health care to direct their emphasis on health care policies more appropriately. Currently differences in socio-economic and knowledge levels, along with existing inequalities in health service pose major challenges for the policy makers in health care. Therefore, knowledge about the health status, health practices and health beliefs of minority groups will improve the average health status of the general population. It is against this background, that this research study was undertaken. Specific objectives were set for the study. • To determine the health status of economically active Coloured people in an urban area as defined with specific reference to the indicators as identified by the researcher • To determine the prevalence of factors influencing the health status of economically active Coloured people in an urban area as defined. • To determine the relationship between the health status and the factors influencing the health status of economically active Coloured people in an urban area as defined. • To determine an association between factors influencing the health status of economically active Coloured people in an urban area as defined. • To make recommendations to the health policy-makers concerning factors influencing the health status of the economically active Coloured people in an urban area as defined and possibly related ethnic groups. These objectives were met through an in-depth research study of this population group in six identified suburbs. Factors influencing the health status of an individual as described in the literature were explored and described. The recommendations based on the findings confirmed that the health status of the Coloured population is influenced by the following factors: • Socio-economic Level (education, financial income and occupation) • Lifestyle of individuals (High Risk Behavioural Practice such as smoking, use of alcohol and illegal drugs, dietary intake, minimal exercise, stress management and leisure time) • Ethno-cultural Beliefs: health and illness • Religion, health and illness • Environmental factors • Health Services: accessibility and affordability of services Recommendations based on the findings • Emphasis on re-development and health education of all age groups. • The introduction of social grants for those who are unable to support themselves and their families have become essential in order to improve their health status. • The creation of jobs to improve the socio-economic circumstances of the populations. • Current health services at primary health care level and environmental factors influencing the health status of the population require urgent attention. / AFRIKAANSE OPSOMMING: Gelei deur die navorser se persoonlike kliniese onde'rvinding asook onlangse navorsingsprojekte oor uitreikingsaksies ten opsigte van gemeenskapsgesondheid (Stellenberg, 1996 en 1997), is faktore wat In rol in die gesondheidstatus van gemeenskappe speel, geïdentifiseer. Daar is ook bevind dat faktore wat probleme rondom die gesondheidstatus van hierdie gemeenskappe vererger, elemente is soos toeganklikheid, beskikbaarheid en bekostigbaarheid van gesondheidsdienste. Ten spyte van pogings van die regering om die ongelykhede van die verlede uit die weg te ruim behoort die regstelling daarvan volgens die navorser op wetenskaplike bewyse gegrond te word. Die navorser het daarom besluit om die faktore wat gesondheidsorg van die Kleurlinggemeenskap in die Wes-Kaap beïnvloed, te ondersoek. Hierdie bevolkingsgroep is die grootste in die Wes-Kaap, naamlik 60,8%. Die oorheersing van die Kleurling in die provinsie bepaal grootliks die gesondheidstatus van die provinsie. Deur kennis in te win van faktore wat die gesondheidstatus van die Kleurlinggemeenskap beïnvloed, is dit moontlik vir besluitnemers in gesondheidsorg om dit beter te bestuur. Daarom sal kennis oor gesondheidsorg, gesondheidspraktyke en -gelowe van minderheidsgroepe die gesondheidstatus van die totale bevolking verbeter. Dit is teen hierdie agtergrond wat die navorsing onderneem is. Spesifieke doelwitte vir die studie was om die volgende te bepaal: • Die gesondheidstatus van die ekonomies aktiewe Kleurling-gemeenskap in In stedelike gebied soos gedefinieer met spesifieke verwysing na die indikatore soos geïdentifiseer deur die navorser • Die prevalensie van faktore wat 'n invloed op die gesondheidstatus van die ekonomies aktiewe Kleurling-gemeenskap in In stedelike gebied soos gedefinieer • Die verwantskap tussen die gesondheidstatus en die faktore wat In invloed uitoefen op die gesondheidstatus van die ekonomies aktiewe Kleurling-gemeenskap in In stedelike gebied soos gedefinieer • Die moontlike assosiasie te bepaal tussen faktore wat die gesondheidstatus beïnvloed van die ekonomies aktiewe Kleurlinggemeenskap in In stedelike gebied soos gedefinieer. • Aanbevelings aan die gesondheidsowerheidsbeleidmakers oor bevindings wat In invloed uitoefen op die gesondheidstatus van die ekonomies aktiewe Kleurling-gemeenskap in In stedelike gebied soos gedefinieer, en moontlike verwant etniese groepe. Die doel is bereik deur in-diepte navorsingsonderhoud met die Kleurling bevolkingsgroep in ses geïdentifiseerde gebiede. Faktore wat die gesondheidstatus van individue soos in die literatuur beskryf beïnvloed, is ondersoek en beskryf. Die aanbevelings is gebasseer op bevindings gedoen in die ondersoek van die gesondheidstatus van die Kleurling bevolking, en is deur die volgende faktore in die ondersoekgroep beïnvloed: • Die sosio-ekonomiese vlak (opleiding, inkomste en beroep) • Lewenstyl van respondente (hoë risiko faktore soos rook, die gebruik van alkohol, verdowingsmiddeis, daaglikse dieët, oefening, hantering van spanning en vryetydsaktiwiteite). • Etnies-kulturele gelowe: gesondheid en siekte • Geloofsgesondheid en siekte • Omgewingsfaktore • Gesondheidsdienste: toeganklikheid en bekostigbaarheid van dienste Aanbevelings wat op die navorsingsbevindings gebaseer is, is die volgende: • Beklemtoning van die herontwikkeling van gesondheidsvoorligting vir alle ouderdomsgroepe. • Die instel van In toelae vir individue wat nie in staat is om hulself en hulle gesinne te help nie, is noodsaaklik vir die verbetering van hulle gesond heidstatus . • Die skep van meer werk om sosio-ekonomiese omstandighede in die bevolking te verbeter • Huidige gesondheidsdienste op pnmere gesondheidsorgvlak en omgewingsfaktore wat die gesondheidstatus van die gemeenskap beïnvloed, vereis dringend aandag.

Background to the study: The Internet is rapidly becoming an important learning tool in academic institutions and workplaces. In academic institutions it plays a pivotal role in meeting information and communication needs of students, academics and researchers. Despite internet becoming an important information gathering and dissemination tool, literature reflects under-utilization both in academic and in practice settings for a number of reasons. This study therefore described the utilization of internet as an academic tool among undergraduate nursing students in a selected University in KwaZulu Natal in order to establish ways of enhancing its utilization. Methodology: A quantitative, non-experimental, descriptive design was used in this study. The population of the study was 222, and the the sample size was 141 of undergraduate nursing students which was calculated using Raosoft sample size calculator. The sample was stratified according to the percentages of the population in the Nursing program and the year of the study of the respondents. However, only 115 agreed to participate in this study and the response rate was rate therefore 81.1%. Data was collected using a survey after obtaining ethical clearance from the university and were analyzed descriptively. Findings: The findings revealed that participants perceived themselves to be at different levels of utilizing the Internet; intermediate level (32.2%) advanced level (19.1%) competent level (29.6%), beginner level (17.4%) and expert level (1.7%). The results reflected traditional university students as better equipped to use the Internet than non-traditional university students. The Internet was used for different purposes including; academic (96.5%); communication (82.6%), pleasure (71.3%), work related activity (53.9%) and shopping (13.9%). Facebook (77.4%) was the most commonly used social network followed by the twitter (24.3%). Challenges cited covered restricted access to certain sites (62.6%), very slow internet connection (55.7%), limited training in the use of the Internet (38.3%), limited number of computers (37.4%). The majority of the participants (89%) singled out training on internet use as priority with specific focus on basic IT skills (72.2%), accessing academic related material (70.4%), using Moodle (51.3%), Turnitin (35.7%) and endnote (33.9%). Conclusion: Contrary to other studies, this study reflected that students do use the Internet for a number of reasons. They however recommend structured support on how to use internet for academic purposes. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2013.

Traditional male circumcision is a rite of passage among the AmaXhosa in South Africa. According to the custom of male traditional circumcision, initiates should remain in the bush for the entire seclusion period. The AmaXhosa male initiates encounter complications due to a ritual that has gone wrong. Common complications are penile sepsis, dehydration, penile amputations and septicaemia. As a last resort, when the AmaXhosa male initiates do not improve from complications associated with the custom they are referred to hospital for admission (Meintjes, 1998; Warren-Brown, 1998). The main purposes of this study were, first to explore and describe the delivery of care to the hospitalized AmaXhosa male initiates whilst in the hands of healthcare professionals and professional care system. Second, to describe what constitutes culturally appropriate care for hospitalized AmaXhosa male initiates. This study took place in three research sites, that included one rural hospital and two urban hospitals which admitted the AmaXhosa male initiates of traditional circumcision. A total of 13 hospitalized AmaXhosa male initiates and nine health professionals took part in this study. Leininger's ethnonursing qualitative research approach was used to guide this study. Data were collected, using purposive sampling, by means of unstructured interviews using guides, tape-recorder, and field notes. The study was first piloted at Umlamli Hospital using the same data collecting strategies as for the major study. Data from key and general informants were analysed separately using Leininger's (1991) four-phase method. This was carried out in order to answer the research questions and research purposes. Major themes and patterns emerged from this process. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.

No abstract available. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

Sex and sexuality issues are still sensitive and controversial subjects despite the growing numbers of sexual and reproductive health (SRH) programmes for adolescents in subSaharan African countries (WHO, 2002; Department ofInternational Development (DFID), 2004). The purpose of this study was to examine and analyze the structure and procedural mechanisms adopted by adolescent sexual and reproductive health (SRH) programmes in two African countries. This study also explored the adolescents' perceived usefulness and relevance of these programmes in addressing their SRH needs. The study was conducted in Ghana (West Africa) and South Africa (Southern Africa) as a cross-national study in these two sub-Saharan African countries. A comparative case study design was adopted involving the use of both quantitative and qualitative approaches to data collection and analysis. Snowballing, critical case, and purposive sampling methods were used. A wide range of personnel from both countries including programme directors, managers, nurse/midwives, peer educators and youth counselors (n=48) were interviewed within the context of adolescent sexual and reproductive health (ASRH) programmes and adolescents (n=247) participated through client exit surveys and focus group discussions. Records review, document analysis and observation of the facilities were employed through a checklist. A Tri-dimensional conceptual framework adapted from Donabedian (1980) and WHO (2001) for: (1) Structure, (2) Process, and (3) Output of ASRH programmes, guided the study and served as the frame for analysis and comparison. Qualitative data were transcribed and analyzed using framework analysis and quantitative data through use of SPSS Version 13.0. Findings of the study revealed that both Ghana and South Africa have established ASRH structures through development of programmes and policies for young people. They also shared common features related to programme focus and philosophy on ASRH matters. Both countries face several challenges associated with sexuality issues, inadequate human and material resources. Religious, socio-cultural, logistical and structural factors were identified as barriers, which hindered access and use of the facilities. These barriers were found to have a profound influence on programme implementation, achievement of objectives and future development. Adolescents in the two countries are confronted with a range of issues affecting their sexual health and general well-being for which they seek services from ASRH programmes. These programmes in both countries were generally perceived as relevant and important by youth utilizing the facilities. The need for changes in the attitude of service providers, structural layout, logistical improvement and staffing composition was expressed. Despite efforts made, there are still programmatic issues needing attention, for which specific recommendations towards improvement were made on the basis of findings from both countries. Findings from this study have implications for nursing practice, management, education, research and relevant stakeholders involved with adolescent health, including policy makers. Recommendations are made that may contribute to the development of an effective model of "Adolescent-Friendly" programmes in the two countries. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.