Up to 1998, the Institutes of Nursing in the United Arab Emirates have been using the traditional lecture-based teaching/learning process in their graduate-nursing program. In 1998, however, these Institutes adopted a new approach; namely, the case-based learning (CBL) for the education of their nursing students. This approach emphasizes the use of self-directed and cooperative learning that is supposed to help students increase their critical thinking (CT) level. As the students were experiencing changes in the teaching practices, it was important to determine the effect of the teaching and learning approaches on students' CT abilities, and to describe suggestions needed for improvement. Empirically, very little is known regarding the influence of CBL on a student's CT. The question then remains, as to whether students who have undergone case-based learning, differ significantly in their CT abilities from those who studied in the traditional method. This study investigates the critical thinking skills in relation to two types of nursing educational programs: (a) the traditional teaching and (b) the case-based learning. The professed purpose of the study in hand is to measure and compare the level of critical thinking in participants from each of the two programs. The instrument of measurement guiding this study is the model developed by Facione and Facione (1998). The design has been a comparative descriptive survey. The critical thinking abilities were measured by the CCTST, which was administered to 38 participants from the traditional curriculum and 65 from the case-based learning curriculum who agreed to participate in the study. When the scores were analyzed by using the independent sample 1- test, this study found that, in general, participants from both programs performed badly on the CCTST. Nevertheless, the CBL program participants performed significantly better when compared to the traditional program participants in all aspects of the CCTST. / Thesis (M.Cur.)-University of Natal, Durban, 2001.

HIV/AIDS is no longer seen as an individual problem as it also affects the family as a whole. The purpose of this study is to purpose of analysing the mental health of family affected by HIV/AIDS in Rwanda. It should be noted that there were not studies conducted on the mental health of the affected families in Rwanda. A qualitative approach using case study design was used to describe the mental health of affected family in Rwanda. HIV/AIDS-related stressors, emotional reactions of family members and coping strategies they adopt to deal with those stressors and emotional reactions were studied. The effects of those reactions and strategies on the infected family member as well as the entire family were analysed. A purposive sampling was used to select two families from Mwana Ukundwa Association for the study. The findings of the study showed multiple losses, care, and socio-economic demands as the main stressors for both cases. Emotional reactions to those stressors included shock, anger, sadness, hopelessness, depression, fear and shame. Participants reported using both emotional and problem-focused coping strategies. Compassion, caring and showing concern had positive effects on the infected and affected as well as family members, whereas emotional reactions such as anger, unhappiness, and discouragement had negative effects on the entire family. Positive effects of family reactions and strategies to cope were associated with coping strategies such as; having opportunity to talk: to someone, distraction, family relationships, spiritual support, treatment, and socio-economic support. Ineffective strategies included family communication dysfunction due to withdrawal behaviour, alcohol abuse and going to nightclubs. These strategies had negative effects on both infected and affected family members. The results suggest that health professionals such as nurses, doctors and other healthcare providers should use a holistic approach in caring for infected family members. They should not only provided family care, but also include the family in planning to care for the infected family member. This will empower them to play a more effective role in home care-based. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2004.

Background: Comprehensive oral care is an evidence-based, cost effective, essential routine nursing intervention that nurses ought to provide with good knowledge/understanding as it prevents and controls nosocomial infections especially Ventilator Associated Pneumonia (VAP) that is associated with increased morbidity and mortality in critically ill patients in Intensive Care Units (ICU). Aim of study: To determine ICU nurses’ knowledge, describe their practices and identify their perceptions regarding comprehensive oral health care to critically ill patients in order to refine or develop evidence based oral care protocol. Methods: A quantitative approach with a descriptive, exploratory survey was used for this study. A non probability convenience sample of thirty-four (34) ICU nurses from two public referral hospitals participated in this study. A questionnaire with a combination of open and closed ended questions was used to collect data on comprehensive oral care to critically ill patients. Results Thirty-four nurses responded to the questionnaire (response rate 89%). Only 18% (n=6) were knowledgeable about important aspects of oral care, while the majority, 82% (n=28) lacked knowledge on important aspects of oral care. Fifty-nine percent (59%) n=20 had received training on comprehensive oral care at basic nursing training and 44% (n=15) had orientation at unit level. Ninety-seven percent (97%) n=33 of the participants requested further updates on comprehensive oral care. No significant relationships were found between nurses’ demographic characteristics and knowledge of comprehensive oral care. All (100%) n=34 of nurses gave oral care a high priority and 91% ranked it very important for critically ill patients. Toothbrushes and toothpaste were used by 85% (n=29) of nurses and only 50% (n=17) used mouthwashes. The reason for non- use of mouthwashes was lack of supplies and not having been foreseen in unit protocol although neither of the units had an oral care protocol in place. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

AIM The purpose of this study was to investigate factors that may have contributed to absenteeism among bursary students undertaking a four-year Nursing Diploma course (R425), and the extent to which these factors impacted on students’ absenteeism at a selected nursing campus in KwaZulu-Natal. METHODOLOGY The study adopted a quantitative approach, utilizing a non –experimental descriptive design. Data were collected by means of self-administered questionnaires consisting of closed and open-ended questions. Data analyses were done using the Statistical Package for Social Sciences version 21(SPSS- 21). One hundred and twenty-six bursary students from the first year to the third year of training participated in the study. FINDINGS The study revealed that absenteeism at the nursing campus under study existed at all levels of student training, and that it occurred more in the clinical area than in the college area. Clinical factors identified included escorting very ill patients without indemnity, working late shifts (19h00) before a day off, allocation to one work area without rotation, and a lack of appreciation for a job well done and criticism. College factors such as stipend, transport problems, and lecturers and their teaching methods did not have any impact on student absenteeism. / M.N. University of KwaZulu-Natal, Durban 2013.

The study is exploring the inner world of old age home resident’s perceptions and how they felt on the general care they receive. The main themes were: Basic needs, psycho-social aspects, safety environment, safety medication aspect, nutrition, institutionalisation and support system. They felt aging not only meant losing independency, dignity and loneliness but also having more experiences. Not all is well at the old age home resident. BACKGROUND: Increasing life expectancy should be celebrated, but with it comes the challenges of the increased like hood of multiple health conditions. With a growing older population, aging has become an important issue for attention. Extension of services provide programmes and home resident services for senior citizens, but how much knowledge about ageing and home resident‘s perceptions regarding the general care they receive(Nina Chen2001). The motivation of the study had its origin on the ever increasing ageing population in the country and the observation made during case study on Stroke Assignment as a Gerontology Master’s student at the selected old age home resident. The observations made were less than satisfactory conditions of the general care received by the old age home residents made the researcher to seek on exploring their perception. PURPOSE: To examine old age home residents’ perceptions regarding the basic physical care they receive. To gain some more understanding on the ageing phenomenon at the Empilweni old age residence. To provide some answers that could be used by policy makers and professionals to formulate guidelines or interventions relevant to lived experiences of the older persons and the meaning attached to ageing or being old and consequently improve the basic quality of life of older person in Eastern Cape. METHODOLOGY: Phemenologic design within a qualitative approach to guide the research process: Data was collected from focus groups. Open ended group discussion was used. Data was collected using group discussions, field notes and through the medium of video and audio tape; raw data was transcribed, interpreted, and translated .data was analysed manually through generated into themes codes and into categorised and subcategories. PARTICIPANTS: An invitation in this study was announced at one of the only registered old age home at the O.R. Tambo district Eastern Cape. Purposive quota sampling was done. Twelve elderly residents participated in this study. Characteristics of the participants were described according to the age, length of stay, any chronic disease or disability, reason to stay at the residents and any relatives or family visiting. Participants were graded according to functional disabilities –active: 60-65 years semi-frail, older elderly: 65-75 years, and frail age: 75 and over years of age ranging from independency to dependency of their limitations. Senile dementia, those with cognitive impairment and very frail elderly were excluded.Data was collected. DATA ANALYSIS: The Tesch’s approach and elicitation method was used. Data collected and displayed from stage of entry to data analysis was analysed manually. Transcribed, translated and interpreted of raw data into meaningful concepts using data from the participants, observations field notes and confirming on video/tape records. Based on the data reduction, interpretations, decontexualisation and contextualisation to generate themes. Coding process was done after reducing repeated content and linking relevant concept getting sense of the whole, by colouring , marking , abbreviate the topics as codes and turn into themes .Codes were generated. The data was classified into categories and subcategories. The following categories immerged: Basic needs, Safety environment & medication, psychosocial aspect, Nutrition, Institutionalisation and Support system aspect. RESULTS: Not all residents were satisfied with the general care at the old age home residence. Loss of independency accompanied low dignity and loneliness in old age home residents. CONCLUSION: In examining the perception of old age residents regarding general care, gaps regarding the general care for elderly residents have been identified hence recommended for more health caregiver staff, in-service on ethics morals on the caregivers and extension of services to multidisciplinary approach. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2012.

Thesis (MCur (Nursing Science))--University of Stellenbosch, 2008. / ENGLISH ABSTRACT: Clinical teaching and training is undertaken to correlate theory and practice (Mellish et al., 1998:211). Clinical teaching is the means by which student nurses learn to apply the theory of nursing in a clinical situation so that an integration of theoretical knowledge and practical skills in the clinical situation becomes the art and science of nursing. (Mellish et al., 1998:207). The role of the lecturer/facilitator is to bridge the theory-practice gap between nursing education and practice. Since the merger of the nursing colleges in the Eastern Cape Province (South Africa) and the abolishment of the clinical department in the hospital it became essential to evaluate the clinical facilitation needs of students and tutors. For the purpose of this study the researcher evaluated the clinical facilitation, with the focus area being on the clinical needs and problems of nursing tutors and nursing students at a nursing college in the Eastern Cape Province. The objectives of this study were to determine the following: the clinical facilitation needs of student nurses of the Nursing College, clinical facilitation needs of tutors of the Nursing College, clinical facilitation related problems facing student nurses and tutors in the Nursing College and associations between the clinical facilitation of the campuses of the Nursing College. The following research question was evaluated: What are the needs and problems of nursing students and tutors in clinical facilitation at the Lilitha Nursing College? The research methodology was a descriptive exploratory design with a quantitative approach. The population for this study was the fourth-year nursing students, and all tutors of the nursing college. A convenient sample was drawn. All students available at the time of data collection were included in the study. A structured questionnaire was used to collect the data. The final sample of students was N =100 (45%) of a total population of 222 students. The final sample of tutors was N=35 (36%) of a population of 97. Reliability and validity were assured by means of a pilot study and the use of experts in nursing education, research methodology and statistics. Data were collected personally by the researcher. Ethical approval was obtained from Stellenbosch University, Department of Health ECP, and Head of the Nursing College and Principals of the campuses. Informed written consent was obtained from the participants. Statistical associations with reference to clinical facilitation between the various campuses of the nursing college were determined using the Chi-square tests. The results of this study are presented in percentages, tables and histograms. On completion of the study the following recommendations were made: standardization of policies and procedures; preplanning and publishing of clinical placement dates; manuals, rules, student needs and outcomes be available before clinical placement; improvement of communication between clinical staff, facilitators and students; improvement of infrastructure, equipment and materials.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The overall objective of this study was to ascertain whether lay counsellors offer psychosocial counselling to clients at antiretroviral therapy clinics. The study was conducted at two clinics in the Greater Tzaneen municipality, Limpopo province, South Africa. The sample of 14 consisted of seven female lay counsellors and seven HIV positive clients, three females and four males, at Xihlovo and Nyeleti antiretroviral clinics. They were interviewed using 11-item and 12-item interview guides, respectively. Interviews were conducted in the local languages. Qualitative data were collected for the study. The data were audiotaped, translated, transcribed and then categorised into a thematic framework. HIV positive participants were found to be suffering from psychosocial consequences of living with HIV, such as shock, denial, anger and blame, fear of death, fear of disclosure, and intimate-partner violence. However, lay counsellors did not offer effective counselling that could relieve the psychosocial consequences. They instead used religion to console clients, discouraged clients from expressing their feelings, and minimised their clients’ concerns. It is recommended that lay counsellors be taught basic counselling theories as part of their training so that they are better able to screen their clients for psychosocial problems and provide basic counselling. / AFRIKAANSE OPSOMMING: Die algehele doelwit van dié studie is om te bepaal of leke-beraders psigo-sosiale berading aan kliënte by die die anti-retrovale terapie klinieke bied. Kwalitatiewe data is vir dié studie versamel. Die studie is by twee klinieke in die groter Tzaneenmunisipaliteit in Limpopo provinsie in Suid‐Afrika gedoen. Die eksperimentele groep van 14 het bestaan uit sewe vroulike leke-beraders en sewe MIV-positiewe kliënte: drie vrouens en vier mans, by Xihlovo en Nyeleti anti-retrovale klinieke. Daar was onderskeidelike onderhoude met hulle gevoer en die 11-item en 12-item onderhoudriglyne is toegepas. Onderhoude is in inheemse tale gevoer. Die data was opgeneem, vertaal, getranskribeer en in 'n tematiese raamwerk vasgevang. Daar is gevind dat die MIV-positiewe persone negatiewe psigo-sosiale gevolge ervaar: skok, ontkenning, woede, blaam, vrees vir die dood, vrees dat hul status openbaar sal word, asook geweld binne hul verhoudings. Leke-beraders het egter nie doeltreffende berading gegee om bogenoemde psigo-sosiale gevolge te verlig nie. Hulle het eerder godsdiens gebruik in 'n poging om hul kliënte te vertroos, nie die kliënte aangemoedig om hul gevoelens uit te druk nie en hul gevoelens en kommer afgemaak. Daar word aanbeveel dat leke-beraders basiese beradingsteorie as deel van hul opleiding ontvang sodat hulle psigo-sosiale probleme in hul kliente kan uitken en beter basiese berading kan verskaf.

Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The global epidemic of HIV continues with an estimated 2.2 million children under 15 years of age worldwide living with HIV and 640 000 newly infected in 2004 (WHO, 2009). HIV crosses the blood–brain barrier which may lead to neuronal damage and death. There is controversial evidence within available research on effects of HIV on cognitive and motor development in children because of the limitations imposed by study designs, study populations and study methodological quality. The aims of the review were: - To conduct a systematic review of published research to establish the effects and the prevalence of HIV infection on cognitive and motor development in children. - To critically appraise the methodological quality of published research regarding cognitive and motor development of HIV infected children. The objectives of the review were: - To assess evidence on the cognitive and motor development of HIV-1 infected children - To describe anthropometric outcomes including: weight for age, weight for height, height for age and head circumference in children with a HIV infection. - To assess the methodological quality of studies on the cognitive and motor development of HIV infected children. The following databases were searched for identification of articles; MEDLINE, Google Scholar, AIDSTRIALS, AIDSLINE and CINHAL. The search time frame included published works from inception to July 2011 without language restrictions. Analytical observational trials that assessed at least one outcome (cognitive or motor development or 1 of the anthropometric outcomes) between HIV positive and HIV negative children aged 5 years and below or children with a mean age of less than 5 years were employed. Two review authors independently searched for eligible studies, evaluated methodological quality and extracted the data. Meta-analysis was carried out using Rev Man 5.1 using the risk ratio for categorical data and standard mean difference for continuous data. Fifteen studies with a total of 3 086 participants met the inclusion criteria. HIV infected children were 2.45 times at higher risk of developing cognitive developmental delay than HIV negative children (RR, 95% CI, 1.95, 3.07, P < 0.00001). Infected children scored - 0.54 less than HIV negative children (SMD 95% CI, -0.70, -0.39, 97, p < 0.00001) for cognitive development and -0.68 in motor development (SMD 95% CI, -0.82, -0.55, p< 0.00001). The risk of motor developmental delays was 2.95 times in HIV positive compared with HIV negative children (RR 95% CI, 2.19, 3.99, p < 0.00001). HIV infected children are slower in aspects of cognitive and motor development compared to their HIV negative counterparts. They also showed delays in anthropometric outcomes; weight for age and height for age. Study design influenced results of the studies with children scoring more on cross sectional than cohort studies. There is still need to develop culturally appropriate or standardise neurodevelopment tools as most African studies still rely on international tools. More evidence is needed on the effectiveness of HAART in reducing cognitive and motor delay. / AFRIKAANSE OPSOMMING: Die wêreldwye MIV epidemie duur voort met ongeveer 2.2 miljoen kinders onder 15 jarige ouderdom wat wêreldwyd met MIV leef en 640 000 onlangs in 2004 geïnfekteerd (WHO, 2009). MIV strek oor die bloed-brein grens wat kan lei tot neuronale skade en die dood. Daar is kontroversiële bewys binne beskikbare navorsing oor die effek wat MIV het op kognitiewe en motoriese ontwikkeling in kinders, vanweë die beperkinge wat geplaas word deur studie ontwerpe, studie bevolkings en studie metodologiese kwaliteit. Die doelwitte van die oorsig is om - ‘n sistematiese oorsig van gepubliseerde navorsing te doen om sodoende die effek en voorkoms van MIV infeksie op kognitiewe en motoriese ontwikkeling by kinders vas te stel - ’n kritiese waardering van die metodologiese kwaliteit van gepubliseerde navorsing te doen ten opsigte van die kognitiewe en motoriese ontwikkeling van MIV geïnfekteerde kinders. Die doelwitte van die oorsig is om - assessering te doen van die bewyse van kognitiewe en motoriese ontwikkeling by MIV-1 geïnfekteerde kinders - antropometriese uitkomste te beskryf, insluitend: gewig vir ouderdom, gewig vir hoogte, hoogte vir ouderdom en omtrek van die hoof by kinders met ’n MIV infeksie - die metodologiese kwaliteit te assesseer van studies op die kognitiewe en motoriese ontwikkeling van MIV geïnfekteerde kinders. Die volgende databasisse is nagevors vir die identifisering van artikels: MEDLINE, Google Scholar, AIDSTRIALS, AIDSLINE en CINHAL. Die tydraamwerk vir navorsing het gepubliseerde werk ingesluit vanaf aanvang tot Julie 2011 sonder taalbeperkings. Analitiese waarneembare toetse wat ten minste een uitkoms geassesseer het (kognitiewe of motoriese ontwikkeling of 1 van die antropometriese uitkomste) tussen MIV positiewe en MIV negatiewe kinders van 5 jarige ouderdom en jonger, of kinders met ’n gemiddelde ouderdom van minder as 5 jaar is betrek. Twee oorsig outeurs het onafhanklik vir geskikte studies gesoek, metodologies geëvalueer en data getrek. Meta-analise was uitgevoer deur gebruik te maak van Rev Man 5.1 met behulp van die risiko-ratio vir kategoriese data en die standaard gemiddelde verskil vir aaneenlopende data. Vyftien studies met ’n totaal van 3 086 deelnemers met die insluitingskriteria. MIV geïnfekteerde kinders het 2.45 keer ’n hoër risiko gehad om kognitiewe ontwikkelingsvertraging te ontwikkel as MIV negatiewe kinders (RR, 95% CI, 1.95, 3.07, P< 0.0000). Geïnfekteerde kinders het ’n -0.54 telling behaal, minder as MIV negatiewe kinders (SMD 95% CI, -0.70, -0.39,97 p < 0.00001) vir kognitiewe ontwikkeling en -0.68 vir motoriese ontwikkeling (SMD 95% CI, -0.82, -0.55, p< 0.00001). Die risiko van motoriese ontwikkelingsvertragings was 2.95 keer by MIV positiewe in vergelyking met MIV negatiewe kinders (RR 95% CI, 2.19, 3.99. p < 0.00001). MIV geïnfekteerde kinders is stadiger in aspekte van kognitiewe en motoriese ontwikkeling in vergeyking met hulle MIV negatiewe eweknieë. Hulle het ook vertragings getoon in antropometriese uitkomste; gewig vir ouderdom en hoogte vir ouderdom. Studie ontwerpe het uitslae beïnvloed van die kinders wat ’n hoër telling behaal het met deursnee as in kohort studies. Daar is nog ’n behoefte om kultureel geskikte of gestandaardiseerde neuro-ontwikkelingsinstrumente te ontwikkel, omdat die meeste Afrika-studies nog steeds staat maak op internasionale instrumente. Meer bewyse is nodig aangaande die effektiwiteit van HAART om kognitiewe en motoriese vertraging te verminder.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Absenteeism is a problem all over the world and a solution cannot be easily found. This is also a challenge faced by employers in South Africa. Absenteeism exacerbates the difficulty of health service delivery in many countries where the number of nurses available is insufficient to meet all of the healthcare demands in the health care sector, in this regard South Africa is no exception to this problem. The annual loss to the South African economy caused by absenteeism is between R12 billion and R19.144 billion per year. A combination of factors, namely characteristics of the nurse, the workplace, management, as well as characteristics of the organisation can influence absenteeism. Absenteeism of nurses is on the increase at primary care centres in the Ethekwini municipal district and it has a negative impact on provision of health care services where the study is proposed. It is imperative that sufficient nursing staff be available for duty to provide services to clients. No research on absenteeism has been conducted at these institutions. Therefore, identifying the contributing factors in order to be able to manage it effectively is essential. The aim of this research was to identify factors that contribute to absenteeism of nurses at eight primary care centres in the Ethekwini municipal district of KwaZulu- Natal. A quantitative descriptive exploratory research design was applied for this purpose. The population was all categories of permanently employed nursing staff working at the eight primary care centres. The total population consisted of 689 nurses. Following a pilot study consisting of 10% of the total sample, a research sample was compiled by means of a simple random sampling method and included 30% of all categories of nurses – registered nurses, enrolled nurses and nursing assistants. Hundred and ninety one nurses out of 209 responded to the research study, which sets the response rate at 91%. Data was collected by means of an existing questionnaire. The questionnaire focused on the characteristics of the nurse, manager, work environment and organisation in order to identify factors that contribute to absenteeism of nurses. The data was analysed with the support of a statistician and was expressed as frequencies in tables and histograms. Descriptive statistical analyses, including tests for statistical associations, were performed. Results of this study indicate significant relationships between characteristics of the nurse, the manager, workplace and the organisation. Factors that were identified included stress, staff shortage, work overload, lack of promotion opportunities, lack of child care facilities, lack of appreciation and feedback, bureaucratic leadership styles, inflexible working schedules and lack of a satisfactory reward system. The results further indicate no significant relationship between demographical variables and absenteeism. Recommendations based on the results were offered and recommendations for future research were made. / AFRIKAANSE OPSOMMING: Afwesigheid is ’n probleem dwarsoor die wêreld waarvoor daar nie ’n maklike oplossing gevind kan word nie. Dit is ook ’n uitdaging wat werkgewers in Suid-Afrika in die gesig staar. Afwesigheid vergroot die struikelblok om gesondheidsdienste in menige lande te verskaf waar die aantal beskikbare verpleegsters onvoldoende is vir die gesondheidssorgaanvraag. In hierdie opsig is Suid-Afrika geen uitsondering nie. Die jaarlikse verlies aan inkomste vir die Suid-Afrikaanse ekonomie veroorsaak deur afwesigheid is tussen R12 en R19.144 biljoen per jaar. ’n Kombinasie van faktore, naamlik kenmerke van die vepleegster, die bestuurder, die werkplek, asook kenmerke van die organisasie kan afwesigheid beïnvloed. Afwesigheid van verpleegsters is aan die toeneem by gesondheidssorg gemeenskapsentrums in die Ethekwini-distrik in Kwazulu-Natal en dit het ’n negatiewe impak op die voorsiening van gesondheidssorgdienste waar die studie onderneem is. Dit is noodsaaklik dat voldoende verpleegpersoneel beskikbaar moet wees vir diensverskaffing aan kliënte. Geen navorsing oor afwesigheid is al onderneem by hierdie inrigtings nie. Die identifisering van die faktore wat bydra tot afwesigheid van die werk is essensieel sodat die probleem effektief bestuur kan word. Die doel van hierdie navorsing is om die faktore te identifiseer wat bydra tot die afwesigheid van verpleegsters by agt primêre gesondheidssorg gemeenskapsentrums in die Ethekwini munisipale distrik van KwaZulu-Natal. ’n Kwantitatiewe beskrywende, ondersoekende navorsingsontwerp is toegepas vir hierdie doel. Die populasie het bestaan uit alle kategorieë van permanent aangestelde verpleegpersoneel wat werk by agt primêre gesondheidssorg gemeenskapsentrums. Die totale populasie het bestaan uit 689 verpleegsters. Na ’n loodsprojek van 10% van die totale steekproef, is ’n navorsingssteekproef saamgestel deur middel van ’n eenvoudige ewekansige steekproefmetode wat 30% van alle kategorieë verpleegsters ingesluit het, naamlik geregistreerde verpleegsters, ingeskrewe verpleegsters en verpleegassistente. Honderd een-en-negentig verpleegsters uit 209 het reageer op die navorsingsondersoek wat ‘n responsvlak van 91% daargestel het. Data is ingesamel deur middel van ’n bestaande vraelys. Die vraelys het gefokus op die eienskappe van die verpleegster, die bestuurder, werksomgewing en organisasie ten einde die faktore te identifiseer wat bydrae tot die afwesigheid van verpleegsters. Die data is geanaliseer met die ondersteuning van ’n statistikus en is uitgedruk as frekwensies in tabelle en histogramme en diagramme. Beskrywende statistiese analises, insluitende toetse vir statistiese assosiasies is uitgevoer. Resultate van hierdie studie dui aan dat ‘n beduidende verhouding bestaan tussen die kenmerke van die verpleegster, die bestuurder, werkplek, organisasie en afwesigheid van die werk. Faktore wat geidentifiseer is sluit in stress, personeel tekort, werkoorlading, gebrekkige bevorderingsgeleenthede, afwesigheid van fasiliteite vir die versorging van klein kinders, gebrek aan waardering en terugvoer, burokratiese leierskapstyle, onbuigbare werkskedules en ‘n gebrek aan ‘n bevredigende vergoedingstelsel. Die resultate van hierdie studie dui verder aan dat daar geen verband bestaan tussen demografiese veranderlikes en afwesigheid nie. Aanbevelings ten opsigte van die resultate is gemaak, asook aanbevelings vir toekomstige navorsing.

Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: HIV infection poses a major obstacle in breastfeeding as it represents the most common way by which children acquire HIV. Exclusive breastfeeding has been discovered as the most effective intervention in preventing mother-to-child transmission of HIV, mortality and promotion of HIV free survival. The main objective was to evaluate the evidence on the effectiveness of exclusive breastfeeding versus formula feeding and/ or mixed feeding in the prevention of HIV-1 transmission from mother to child. To identify the studies, an electronic search was conducted using PUBMED/MEDLINE, CINAHL, CENTRAL and EMBASE databases. Electronic journals, which include the Southern African Journal of HIV medicine (SAJHIV), HIV Medicine Journal and American Journal of Public Health, were also accessed. Manual searches were carried out. In addition, relevant experts were contacted in order to locate more data. There were no limitations with regards to date and language. The review considered studies on infants who were vertically HIV-1 exposed (mother HIV positive during pregnancy, birth and breastfeeding). These infants were exclusively breastfed for six months with administration of antiretroviral prophylaxis and were compared to infants exclusively formula fed. The outcomes measured were vertically acquired HIV infection; mortality and HIV free survival up to 24 months of age. Two reviewers independently selected articles which met the inclusion criteria. They independently extracted the data using a data extraction tool. Disagreements were solved by discussion. Data was then meta-analysed using Rev Man 5.1.0. Methodological quality of each trial was assessed by the reviewers using the Cochrane assessment tool for risk of bias. Two randomised clinical trials and one intervention cohort study (n=2112 infants) comparing exclusive breastfeeding with exclusive formula feeding were included. HIV infection was associated with exclusive breastfeeding as compared with exclusive formula feeding (Risk ratio 1.67, 95% CI 1.26 to 2.23, p=0.0005). Exclusive formula feeding was associated with high mortality from infections (Risk ratio of 0.67 95% CI 0.43 to 0.83, p=0.002 Chi²= 1.30, p=0.52, I²=0%). There were no statistically significant differences in HIV free survival between exclusive breastfeeding and exclusive formula feeding as measured by trialists at 9, 18 and 24 months (Risk ratio 1.19, 95% CI, 0.92 to 1.54, p=0.19, Chi²= 3.15, p=0.21, I²=36 % 3 studies, 1012 infants). None of the studies included reported on mixed feeding. Complete avoidance of breastfeeding is effective in preventing mother-to-child transmission of HIV. HIV infection during breastfeeding might be an indicator of mixed feeding and poor adherence. Formula feeding is only applicable in settings where formula milk is accessible, feasible, acceptable, safe and sustainable (AFASS) because formula feeding carries a high risk of mortality from causes other than HIV. If the AFASS criteria cannot be met, mothers should be encouraged to exclusively breastfeed and ensure that their infants completely adhere to the antiretroviral prophylaxis because they decrease the rate of vertical HIV-1 transmission. / AFRIKAANSE OPSOMMING: MIV besmetting veroorsaak ‘n groot struikelblok vir borsvoeding, omdat dit die mees algemene manier is waarop babas met MIV besmet word. Eklusiewe borsvoeding is as die mees effektiewe intervensie ontdek in die voorkoming van moeder na kind oordrag van MIV, morbiditeit en die bevordering van MIV vrye oorlewing. Die hoofdoelwit is om die effektiwiteit van eksklusiewe borsvoeding teenoor formule-voeding en of gemengde voeding in die voorkoming van MIV oordrag van moeder na kind te evalueer. Elektroniese navorsing is gedoen deur gebruik te maak van PUBMED/MEDLINE, CINAHL, CENTRAL en EMBASE databasisse. Elektroniese joernale wat die Southern African Journal of HIV medicine (SAJHIV), HIV Medicine Journal and American Journal of Public Health insluit, is ook gebruik. Handnavorsing is ook gedoen, asook relevante data van kenners op die gebied, is verkry. Geen beperking is geplaas op taal of tyd nie. Studies op babas wat blootgestel is aan die MIV-1 (moeder MIV positief gedurende swangerskap en borsvoeding) is in die oorsig oorweeg. Hierdie babas is eksklusief vir 6 maande gerborsvoed, met of sonder anti-retrovirale behandeling, en is vergelyk met eksklusiewe formule-voeding. Die resultaat was dat almal tot op 24 maande gemeet is aan MIV besmetting, mortaliteit en MIV vrye oorlewing. Twee resensente het onafhanklik artikels geselekteer wat aan die ingeslote kriteria voldoen het. Hulle het onafhanklik data geselekteer deur van ’n selekteringsinstrument gebruik te maak. Misverstande is deur besprekings opgelos. Data was daarna gemeet en gemetaanaliseer deur Rev Man 5.1.0. Die metadologiese kwaliteit van elk proeflopie is geassesseer deur die resensente wat gebruik gemaak het van die Cochrane evalueringsinstrument om die risiko van onewewigtigheid uit te skakel. Twee ewekansige kliniese proewe en een intervensie kohort studie (n = 2112 babas) wat eksklusiewe borsvoeding vergelyk met 'n eksklusiewe formule-voeding is ingesluit. MIVinfeksie wat verband hou met 'n eksklusiewe borsvoeding is vergelyk met eksklusiewe formule-voeding (risiko verhouding van 1.67, 95% CI 1.26 tot 2,23, p=0.0005). Eksklusiewe formule-voeding hou verband met 'n hoë mortaliteit van infeksies met ’n risiko verhouding van 0.67, 95% CI 0.43 tot 0.83, p = 0.52, Chi ² = 1.30, p = 0.52, I ² = 0%. Daar is geen statisties beduidende verskille in MIV-vrye oorlewing tussen eksklusiewe borsvoeding en eksklusiewe formule-voeding nie wat deur die proefnemers gemeet is op 9, 18 en 24 maande (risiko verhouding 1.19, 95% CI, 0.92 tot 1.54, p = 0,19, Chi ² = 3,15, p = 0.21, I ² = 36% 3 studies, 1012 babas). Nie een van die ingeslote studies het verslag gedoen oor gemengde voeding nie. Algehele vermyding van borsvoeding is effektief in die voorkoming van Moeder na Kind oordrag van MIV. MIV-infeksie gedurende borsvoeding mag ’n aanduiding van gemengde voeding en swak nakoming wees. Formule voeding is alleenlik van toepassing in situasies waar formule-melk toeganklik, uitvoerbaar, veilig en volhoubaar is, want formule-voeding dra ’n hoë risiko van mortaliteit weens ander oorsake buiten MIV. Indien daar nie aan hierdie kriteria voldoen kan word nie, behoort moeders aangemoedig te word om eksklusief te borsvoed en seker te maak dat hulle babas die antiretrovirale profilaksie getrou neem, want dit verlaag die koers van vertikale MIV-1 oordrag.