Research that involves human subjects requires effective ethical consideration to protect their rights. Thorough explanation of the study and the procedures involved should be made clear and the researcher ensures that everything is understood by the respondents.

The aim of this research was to assess the problems that undergraduate nursing students of the University of the Free State encounter during placement in primary health care (PHC) clinics, which have a negative influence on their learning experience. The need for such research became evident from anecdotal feedback and the fact that primary health care is the core of the existing curriculum. A qualitative, explorative and descriptive research design was used, firstly to examine the problems experienced by the participating triad (PHC nurse practitioners, facilitators of the academic nursing school and the students) during the placement of students in PHC clinics. Secondly, the participating triad were requested to offer suggestions to improve or optimise the learning experience of future students in PHC practice. Data was collected mainly by means of nominal group technique (NGT) interviews and documentary analysis. Diverse problems and suggestions were offered. The same five categories were identified in the data of all groups, namely learning environment, professional socialisation, learning opportunities, culture sensitivity and management. However, the priority sequence of the categories as determined by the participating triad differed. The above sequence (from the highest to the lowest) was for the âproblemsâ, but for the âsuggestionsâ it was learning opportunities, learning environment, culture sensitivity, professional socialisation and management. The identified main problems were, among others, lack of support and ineffective communication. Lack of support is closely associated with negative attitudes and inadequate knowledge. Communication among institutions, within institutions and among colleagues must improve. Recommendations were aimed at improving communication with and supporting various role players. Not only must the students be supported, but those who guide them in the practice setting. The training of nursing students must take place within a partnership in which all the partners play an equally important role and discharge their responsibilities with insight and accountability.

Mount Cameroon is one of Africaâs largest and most active volcanoes, the last eruption occurring in 1999-2000. Communities in close proximity to this mountain were and could again be adversely affected by such volcanic eruptions. The goal of the study was to develop a community health adaptable model for the management of health care related hazards â not only for this community, but also for others within Cameroon and Africa. An exploratory qualitative approach to data collection and analysis was used in order to gain insight into what would be acceptable to the community. Purposive sampling was used to identify three groups of community members and a group of health care workers who have lived through a previous eruption (who turned out to be nurses and nursesâ aids only). Data was transcribed, notes made among researcher and assistants and cross-matched to arrive at occurring themes. The significance attached to the mountain and its eruptions, management strategies from the perspective of the community members and an identification of what matters most in this regard were elicited. An analysis of documented evidence from local resources focused on the realities of such a hazard, prevention and mitigation measures, as well as adaptable methods that could inform the model. The exploration of international relevant strategies in managing natural disasters in general, and volcanic disasters in particular, as well as a literature review, was conducted. The findings were triangulated to inform the development of an adaptable model. After an exploratory pilot study (pretest), using members of another community that was affected to some extent during the 1999-2000 eruption, two participant focus group discussions were held with each of three groups of community members. These included a group of elders, men and women. The findings indicated that community members regarded the mountain as a god to be appeased. Thus, some of the cultural practices exposed the community even further to hazards related to a volcanic eruption. They emphasised the protection of women and children, had some traditional health care actions in place, respected the local council for its important role, but thought that their role was marred by limitations such as infrastructure and resources. They were concerned about any evacuation process and confirmed previous negative experiences in this regard. Focus group discussions with a group of health workers indicated a slightly more scientific view of the eruptions and emphasised the livelihood value of the fertile soil surrounding the mountain. The group expressed concerns regarding cultural practices and the severe lack of health care infrastructure and resources, and expressed limited management strategies to deal with a health hazard of such magnitude. Documented evidence and literature was limited, but it was found that within Africa, concerns were similar. Management strategies were linked to a number of government departmentsâ involvement and scientific research and monitoring done by academic institutions or other facilities. Internationally, a number of directive frameworks exist but the need for an in-country framework, incorporating the needs of local communities, is emphasised in some models and approaches. Triangulation of focus group results, and an analysis of local and national documented evidence and international literature, indicated that a critical need exists to focus on the communityâs intricate relationship with the mountain (inclusive of cultural and religious practices), the involvement of community members as critical role-players, the enhancement of health care services, the development of the knowledge and skills of health care workers, and addressing or even simplifying the complex nature and directives on national level to deal with such emergency situations. These five major focus areas form the basic tenets of a community adaptable model that values being, belonging and becoming. In this way, community members are active participants in assessment, planning, implementation and evaluation.

The aim of this study was to develop a framework to expand public health care services to HIV exposed and HIV positive children in the Free State. The objectives set in order to meet the aim were to identify strategies to expand health care services to these children and to then develop a framework to expand health care services to them within the Free State public health sector. The study consisted of various component projects, depicted as phases. The researcher conducted two components, Phase 1b and Phase 2 which links to the fore mentioned objectives of the study. A colleague, conducting research as Master student, conducted Phase 1a of the study, describing health care services rendered to HIV exposed and HIV positive children in the Free State public health sector. The researcher was intimately involved in Phase 1a, as she was acting as co-study leader. Health policy research was used, which is a type of health systems research, in an effort to inform higher levels of health on policy choices. Health managers were therefore active stakeholders in the development of the framework. The identification of strategies to expand health care services to HIV exposed and HIV positive children were one such activity where stakeholders assisted in the development of the framework. The Nominal Group Technique was used to identify mentioned strategies. A draft framework was developed using the Theory-of-Change Logic model as theoretical underpinning of the framework, with the empirical foundation being based on triangulated data obtained from literature findings, Phase1a and Phase 1b of the study. During a workshop with stakeholders, the framework was finalized, providing stakeholders the opportunity to validate the identified problem, namely that of fragmented care being delivered to HIV exposed and HIV positive children, due to over-verticalisation of programs. The validation of the framework was completed by confirming the desired results, possible influential factors that could impact on the results, as well as strategies that could be followed to expand health care services to fore mentioned children. Since health policy research only informs policy choices, the extent to which the framework will actually inform policy is in the hands of the Free State Department of Health.

The purpose of the study was to describe patientsâ experience of nursing care as an indicator of the quality of nursing care that they received. Patients evaluate the quality of nursing care according to their own experience and perceptions. A qualitative, phenomenological and contextual research was done to explore and describe fifteen patientsâ experiences of nursing care. Data collection was done by means of in-depth interviews. In this study a positive experience of nursing care experience by the patients indicated patient satisfaction and therefore that quality nursing care was rendered. Negative experiences indicate that the patients were not satisfied with the nursing care and therefore quality nursing care was not rendered. The data was analysed according to the steps described by Tesch. The following characteristics that describe quality nursing care were identified: applicability, professional knowledge and competence, therapeutic environment, acceptability, accessibility and patient satisfaction. The respondents experienced the professional behaviour of nurses as well as their dedication in doing nursing procedures as positive. Communication and pain management that forms part of professional behaviour, were negatively experienced by most of the respondents. Accessibility was also positively experienced by the majority of the respondents. The therapeutic environment as part of quality care was experienced as both positive and negative by an equal number of respondents. Acceptability of nursing care was experienced as positive, meaning that quality nursing care was rendered. Respondents experienced applicability negatively due to the fact that they experienced that the personnel was short staffed. Respondents experienced that this lead to a high working load. The majority of respondents experienced patient satisfaction. It is indicated through this study that the experience of the patient of the most important role player in health care, the patient, could differ from the information obtained through questionnaires or surveys. This finding should not merely be ignored if rendering of quality care is an important focus of a company or department.

The aim of this study was to investigate reported needle stick injuries amongst health care workers in regional hospitals in the Free State Province during the time period January 2006-September 2007. Needle stick injuries were defined as any injury caused by different types of needle devices, irrespective of the purpose of use. A quantitative, non-experimental, descriptive and retrospective design was used. Data was collected through an interview using a questionnaire. The total population interviewed was 100 health care workers, namely doctors; professional nurses; staff nurses; auxiliary nurses and general assistants. Descriptive statistics, namely frequencies and percentages for categorical data, medians and percentiles for continuous data were calculated and compared by means of 95% confidence intervals for all categories of health care workers. The results of the study indicated that health care workers are at risk of sustaining needle stick injuries in the course of their work. The reported causes of the needle stick injuries were issues related to policy non-compliance, coupled with the use of unsafe needle devices. Ninety-nine health care workers (91.92%) were aware of the needle stick injury policy, eighty health care workers had in-service training (80%) on the prevention and eighty-three health care workers had in-service training on the management of needle stick injuries (83%). Fifty general assistants (50%) reported needle stick injuries due to wrong disposal of used needles. Injection needles (47%) accounted for the majority of needle stick injuries. A total of eighty health care workers (80%) reported two to six times occurrences of needle stick injuries. The peak time of needle stick injuries reported was between 07:00-10:00 for all health care workers, except for doctors. Less needle stick injuries were reported between 19:00-23:00 (8.42%:n=8/95) and between 23:00-06:00 (6.32%:n=6/95). Health care workers (85%:n=85) received post exposure prophylaxis (PEP) within two hours post needle stick injuries. The findings indicated that there is a need to address the needle stick injury âpolicy implementationâ and âreviewâ to include updated exposure prevention strategies. Continuous training of health care workers and evaluation of such interventions should be done to reduce the exposure to needle stick injuries. Policy compliance needs Management support and a team approach.

The credit crisis (which began in August 2008) has affected almost every segment of the international financial system. Credit has been severely curtailed as banks struggle to contain further losses caused by reckless lending practices that characterised the last two decades. Asset prices have tumbled as fearful investors flee to safer havens, abandoning traditional investments and hedge funds with resolute consistency. Governments â in an attempt to stave off stagflation and kick-start failing economies â have reduced interest rates to historic lows, initiated stimulus packages and instigated bank bailouts, but the efforts have (as yet) had minimal to no effect on markets. The dire economic environment characterised by diminishing industrial production, falling house (and other asset) prices and rising unemployment, has only discouraged spending and investing and promoted capital hoarding. In the ensuing crisis, the regulatory economic environment (dominated by the Basel Committee for Banking Supervision's (BCBS) Basel II Accord) has proved inadequate. Potential solutions have not yet presented themselves and the crisis looks likely to continue for the foreseeable future. In the light of these events and contemporary failings of finance in general, the need to continuously augment existing and invent new techniques to measure and manage financial risks are paramount. This thesis explores four significant problems facing modern risk management in a portfolio context. The first problem examines the assumption of normally distributed portfolio returns. Compelling evidence for the consistent failure of this assumption is provided. A measure for ranking portfolio performance is discussed and explained with reference to several South African hedge fund portfolios. The second of these problems explores the assumption of unlimited liquidity in market risk measurement models. This assumption has been shown to be utterly fallacious and indeed, is now believed to be the principal component of the credit crisis. A new portfolio market risk model, which incorporates the effect of severely diminished liquidity, is introduced and applied to several South African market portfolios. The results indicate a substantially improved model of market risk. The third problem probes the effect of obligor default quality discrimination to address a subtle discrepancy in the BCBS's formulation for credit portfolio capital charges. The cause of this discrepancy is located and its effects discussed with far reaching consequences for retail loan portfolios. Finally, the lack of a robust technique to extract retail asset correlations from empirical loan loss data is investigated. A methodology is devised using the underlying BCBS formulation for credit risk and the results obtained are compared with retail asset correlations stipulated by the BCBS. The empirical correlations (and the associated capital charges) were found to be considerably lower than the BCBS correlations (and capital charges), even during the elevated losses currently (2009) being experienced. The accuracy of these punitive impositions in a portfolio context is assessed and suggestions are made for further empirical study.

This study was conducted to describe the type of health service rendered by professional nurses to HIV exposed and HIV positive children in the public health care setting of the Free State province. Three objectives were set to achieve this, namely: to describe the type of service rendered to HIV exposed and HIV positive children by professional nurses in the Free State; to determine to what degree national and provincial guidelines are implemented in the management of HIV exposed and HIV positive children in the Free State; and to use the findings to make recommendations for effective service delivery to HIV exposed and HIV positive children. The researcher made use of a quantitative descriptive design to achieve the aim of the study. Data was gathered by means of structured interviews. Professional nurses, who deliver a service to children within public health care facilities, and who met the inclusion criteria, were approached to participate in the study. Data obtained showed that treatment components with regard to HIV exposed and HIV positive children were mainly rendered at primary health care facilities. In contrast herewith, it was found that treatment components in the pediatric sections of hospitals were not implemented to the same degree. Research further reflected a need for professional nurses to undergo additional training regarding the correct management of HIV affected children. Discrepancies pertaining to effective service delivery to HIV exposed and HIV positive children were also revealed. Suggestions were made with regard to approaches which could enhance service delivery. A subsequent research project regarding the quality of service which is presently being offered to HIV exposed and HIV positive children in the public health care sector of the Free State, could be of great value.

The purpose of this study was to determine the levels and causes of stress amongst nurses in private hospitals within the Gauteng Province. Specific focus was drawn to three nursing categories: professional- and staff nurses as well as nursing auxiliaries. The specific objectives were to determine the perceived levels of stress in concurrence with diverse socio-demographic characteristics, influence of non-work-related causes of stress, work-related factors contributing to stress within the work environment as well as the methods of coping utilised. The levels and factors of stress amongst the different nursing categories, including suggestive recommendations, to the organisation involved, also formed part of the objectives for this study. The study design was an analytical, cross-sectional research design involving the three specified nursing categories. From these three categories 588 respondents were selected according to a convenience or availability sample from similar wards within four predetermined hospitals of the selected private hospital group: 370 professional nurses, 157 staff nurses and 61 nursing auxiliaries. The Experience of Work and Life Circumstances Questionnaire (WLQ) were used as measuring instrument and were preceded by a section regarding socio-demographic questions. The number of complete and unspoiled questionnaires received was calculated at 116 (59.18%) professional nurses, 45 (22.96%) staff nurses and 35 (17.86%) nursing auxiliaries. Skewed or asymmetrical data were obtained and thus lead to the use of only non-parametric methods. The only possible significant correlations with the level of stress, as revealed by the analysis, involved race, in particular Black/African nurses, non-work related causes of stress, causes of stress within the work environment with specific reference to organizational functioning, task characteristics, the physical working environment itself and social matters. These results were however not statistically significant for a specific nursing category. It is suggested that further research is conducted to facilitate the design of a comprehensive model and questionnaire specifically for nurses. Further research should also include nursing students into the nursing population and investigate the level of stress of Black nurses within South Africa. It is also suggested that the organisation, that were selected for the purpose of this study, should focus on all statistical significant areas as previous mentioned for the prevention, combating and management of all causes of work-related stress.

Several research studies suggest that final year nursing students do not consider psychiatric nursing as a popular career option. There is an international and widespread concern about the nursing shortages in psychiatry. The demand for psychiatric services continues to grow and there is a need for strategies to recruit nurses for this specialization. The purpose of this study was to identify the factors that prevent undergraduate nursing students from choosing psychiatric nursing as a career. A qualitative, explorative and descriptive research design was used. Data was collected through the Nominal Group Technique. A sample of convenience consisted of nursing students from the School of Nursing from the University of the Free State as well as the Free State School of Nursing. This unit of analysis comprised of four nominal groups. Two of the groups were from the School of Nursing at the University of the Free State, of which each had eight members. The other two groups were from the Free State School of Nursing and comprised alternatively of five and six members. The four nominal groups were managed by an experienced facilitator. The following main causal categories emerged from the content analysis of the data, presented in the order that they were prioritized: Personal factors, working environment, unprofessional behaviour, learning environment and an unclassified category. Each category was divided into relevant themes. The themes in the category of personal factors included the loss of skills, emotional draining, poor prognosis of the patients, emotionally over-involvement, limited career opportunities and career choice. Significant of the working environment was the participantsâ opinion that psychiatry was unsafe and boring. Noteworthy in the category of unprofessional behaviour was the lack of professional discipline and the abuse of patients reported by the participants. The learning environment was depicted as stagnant and rife with the incorrect nursing care of the staff. Lastly there is the unclassified category with unclassified themes. In regard to the abovementioned categories, the researcher has made a variety of recommendations. Firstly the focus falls on teaching strategies in the undergraduate nursing curriculum that need to transform. Secondly, the clinical practice would require certain changes. In the third place, the focus would be on the branding of psychiatric nursing as an acceptable future career for young people. Finally, there is a need for further research concerning the nursing students in other provinces, and whether they share the same opinions regarding a career in psychiatry. Lastly, research would also be required to identify those factors that positively influence the attitudes of those students that decide on a career in psychiatric nursing.