Substitute care is a temporary or permanent placement of children under the supervision of an adult person due to the absence of their biological parents. The escalating divorce rate, increase in extramarital births, high incidence of family violence, the growing number of children orphaned by HIV/AIDS, and the increasing career-orientatedness of parents have led to the development of diverse family structures. Grandparents and other family members are increasingly becoming the primary caretakers for children. Whilst it is generally assumed by society that children’s well-being is better served when they are raised by their biological parents, the purpose of this study is to: • explore what influence substitute care has on learners’ motivation; • formulate guidelines and recommendations for educators to improve the current levels of motivation of learners in substitute care. The literature related to substitute care and motivation were reviewed, with the aim of providing a firm theoretical basis for the study. Concepts related to motivation discussed, included types of and sources of motivation. Concepts related to the second focus of this study included forms of substitute care. Motivational theories related to this study were briefly discussed, namely: the Attribution Theory, the Drive Theory, Goal Theory, and the Self-worth and Selfefficacy Theories. Factors that have a motivational influence on learners, such as acceptance versus rejection, praise versus criticism, success versus failure and positive self-concept versus negative self-concept, were also discussed. A link was then drawn between motivation and substitute care. ii The research design chosen for this study can be described as qualitative, interpretive and constructive in nature. The research study was conducted in two phases: Phase One provided an investigation of the research problem by means of the following open-ended question: What is the influence or impact of your status as a child in substitute care on your motivation? Data were collected by means of eleven unstructured, in-depth personal interviews. Purposeful sampling was undertaken, which included high school learners all in substitute care. Data were analysed, as proposed by the eight steps of Tesch. Discussions between the observer, moderator and an independent re-coder took place to determine the final results of the research through a consensus principle. Key and related concepts were clustered together to formulate themes, categories and sub-categories. The following three themes emerged, based on the results of the data analysis. I. Problems in the close family circle have profound effects on learner motivation. II. Certain motivating forces help learners in substitute care to cope. III. Substitute care does influence learner motivation. Phase Two offered recommendations, derived from the findings of Phase One, to empower teachers in effectively supporting and motivating learners in substitute care. The conclusion was reached that substitute care does have an influence on the motivation of learners. This motivation can either be positive, which means encouraging learners towards their goal, or negative, which implies that it moves learners away from their goal.

The human immunodeficiency virus / acquired immune deficiency syndrome pandemic (HIV/AIDS) continues to increase in prevalence worldwide, particularly in South Africa. There is a concurrent and distinct increase in the prevalence of HIV/AIDS and HIV-related diseases in the paediatric population in South Africa, particularly those using public sector health services, with a corresponding increase in morbidity and mortality rates (Abdool Karim & Abdool Karim, 2010:363), which impacts greatly on paediatric healthcare services. Adding to this, the provision of paediatric antiretroviral care has numerous stumbling blocks, not least of which is lack of decentralisation of facilities to provide treatment. There is the additional shortage of staff, which includes staff that are comfortable dealing with children, lack of training programmes on the provision of antiretroviral therapy to children, and minimal on-site mentorship of staff regarding HIV/AIDS disease in children. This lack of capacity in the healthcare system means that not all of those who require treatment will be able to access it, and this is particularly pertinent to paediatric patients (Meyers et al., 2007:198). Therefore the purpose of this research was to develop a nursing model that would assist healthcare professionals, in particular professional nurses, to optimise the comprehensive treatment, care and support for HIV-positive children who require antiretroviral therapy at PHC clinics. To achieve the purpose of this study, a theory-generating design based on a qualitative, explorative, descriptive and contextual approach was implemented by the researcher to gain an understanding of how the healthcare professionals and parents/caregivers of HIV-positive children experienced the comprehensive treatment, care and support provided at primary healthcare clinics. The information obtained was used to develop a chronic care coordination model for the optimisation of comprehensive treatment, care and support for HIV-positive children requiring antiretroviral therapy. The study design comprised the following four steps: Step One of the research design focused on the identification, classification and definition of the major concepts of the study. This involved describing and selecting the research population and the sampling process prior to conducting the field work which comprised in-depth interviews with two groups of participants, namely healthcare professionals and parents/caregivers who accompany their HIV-positive children to PHC clinics in order to receive antiretroviral therapy. Step Two of the research design focused on the development of relationship statements in order to bring clarity and direction to the understanding of the phenomenon of interest. Step Three of the design concentrated on the development and description of the chronic care coordination model for optimising comprehensive treatment, care and support for HIV-positive children who require antiretroviral therapy in order to ensure a well-managed child on ART. A visual representation of the structure of the model for chronic care coordination was given and described as well as a detailed description of the process of the model. Step Four was the last step of the research design and its focus was the development of guidelines for the operationalisation of the model for chronic care coordination for the optimisation of comprehensive treatment, care and support for HIV-positive children requiring antiretroviral therapy at PHC clinics. Guidelines and operational implications for each of the five sequential steps of the model were developed. The evaluation criteria of Chinn & Kramer (2008:237‒248) were used to evaluate the model. It is therefore concluded that the researcher succeeded in achieving the purpose for this study because a chronic care coordination model that is understandable, clear, simple, applicable and significant to nursing practice has been developed for use by healthcare professionals, particularly professional nurses, in order to optimise the comprehensive treatment, care and support for HIV-positive children requiring antiretroviral therapy at primary healthcare clinics.

Although open to debate, it is something of an undisputed fact and has been since the days of Florence Nightingale, that hospital management is frustrated with recurring problems - many of them due to broken processes. Hospitals are places of phenomenal healing and heroic care. However, as with any human-led endeavour, there are problems. (Grunden (2009)). A first time use of the word ‘lean’ generally begs some explaination as it is not a commonly used word. The simplest way to explain the word is by way of the introduction of the concept known as ‘lean management’. Lean management is a methodology which allows hospitals to advance the quality of patient care by reducing errors and waiting times. Lean is a system of reinforcement of hospital business for the long term thereby reducing costs and risk. Kanban (2009) states that lean is a toolset; a management system and a viewpoint that can change the way hospitals are structured and managed. Lean helps managers to comprehend and identify broken systems and to improve these in small parts, while employees aid in finding solutions for broken systems. This proposal analyses the effect lean tools have had within Arwyp Medical Centre in Kempton Park, South Africa.

Text in Afrikaans / Verpleegktmdiges het 'n etiese en professionele verantwoordelikheid om elke bej aarde se reg op selfbeskikking te erken, bulle in die uitvoering daarvan te ondersteun en op volgehoue basis te ontwikkel met die oog op die bereiking van die hoogste moontlike vlak van onafhanklikheid in die daaglikse lewe. Die doel van hierdie studie was om die mate te bepaal waarin professionele verpleegkundiges werksaam in geregistreerde, gesubsidieerde tehuise vrr bejaardes in die Pretoria-omgewing hierdie verantwoordelikl1eid uitleef Ontleding van die data, wat deur 'n vraelys ingewin is, dui daarop dat verpleegktmdiges sonder twyfel die bejaarde se reg op selfaktualisering erken. V erpleegkundiges ervaar egter onsekerheid oor die praktiese wyse van selfsorgondersteuning sowel as die wenslik11eid van gesondheidsbevordering by die gelnstitusionaliseerde bejaarde. Ten einde die sinvoll1eid van die gelnstitusionaliseerde bejaarde se bestaan te verseker, sentreer die belangrikste aanbevelings in hierdie studie rondom die voorsiening van opleidingsprogramme aan gerontologiese verpleegktmdiges asook gesondheidsvoorligting aan die bejaarde self / Nurses have an ethical and a professional responsibility to acknowledge the elderly's right to self-determination, to support them in this regard and to ensure ongoing development so that they may attain the highest possible level of independence in their daily life. The purpose of tllis study was to determine to what extent nurses working in registered, subsidized homes for the aged in the Pretoria area live up to tllis responsibility. Analysis of tl1e data, obtained by questimmaire, has clearly shown that nurses acknowledge the right of the elderly to self-actualization, but they feel uncertain about the practical ilnplementation of self-care support and tl1e desirability of promotil1g health amongst the il1stitutionalized aged. In order to ensure that tl1e institutionalized aged person leads a meanil1gfullife, the mail1 recommendations of tllis study centre on providil1g educational progrmes for gerontological nurses as well as health education for the elderly. / Health Studies / M.A. (Nursing)

Thesis (MBA)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: This report provides a broad overview of the health industry, and the dental industry in particular, identifying trends and searching for possible solutions to problems posed by these trends. It attempts to offer perspectives of importance to all the stakeholders in health care - the patients, the providers of care and third party payers. The current focus of healthcare industry is not actually the health of the patient. Practitioners (the providers) focus too much on treatment, while insurance companies and governments (the payers) emphasise cost containment. As national health care costs spiral, it is ironic that the main reasons for the dramatic health improvements over the last few decades are improvements in socio-economic factors and changes in lifestyle, rather than better treatment. The willingness of insurers to cover new or improved services has acted as a continuing stimulus to cost-increasing advances in medical technology and in tum to spending growth. Managed care has evolved to attempt to improve resource allocation in health care. Thirdparty private-sector regulators have wrested power from government regulators. Their gain in power relative to private practitioners has shifted the power balance from the supply side to the demand side of health care. By leveraging their power in the use of information technology, the practitioner has been forced into a defensive, reactive stance. Managed care is being implemented by profit-driven third parties that benefit from the cost savings. As health providers are the ones who have to implement the cost-savings; it is proposed that they are the ones who should manage healthcare. The ideal would be a coordinated approach with funders and service providers working toward a common goal. Financial accountability is forcing dental practitioners to evaluate their mode of practice in a critical manner. Promoting health, by educating and evoking behaviour change will create a better world for current and future generations. There is a shift in focus from the health of the individual at all costs, to the health of the population. There should be a special emphasis on the dental health of children for whom prevention offers the most gain in outcome. Evidence-based care evolved from the search for the best care, in terms of quality and price, outcome and process, and attempts to reduce variability and subjectivity in clinical decisions, by using systematic reviews of quality evidence to increase objectivity. Emphasis on improved outcomes provides earlier, more valuable, long-term improvements for a patient, than the later, short-term benefit of a cure. Because most canes and gum disease is preventable, dental health professionals should accentuate health promotion and education of patients. The benefits would be to the advantage of all stakeholders in health. A focus on prevention for children could be the ideal form of dental private practice to instil oral wellness in children. / AFRIKAANSE OPSOMMING: Hierdie verslag is 'n breë oorsig van die gesondsheidsindustrie, en van die tandheelkunde industrie in besonder om tendense te identifiseer en na moontlike oplossing te soek vir probleme wat hieruit mag spruit. Dit poog om perspektiewe aan te bied wat van belang is vir die betrokke rolspelers - die pasiënte, die diensverskaffers en die befondsers. Die huidige fokus van gesondheidsorg is nie eintlik die gesondheid van die pasiënt nie. Die die voorsieners van sorg fokus meestal op behandeling, terwyl versekeringsmaatskappye en die regering (die betalers) fokus op die besnoeing van koste. Terwyl nasionale gesondheidskostes styg, is dit ironies dat die belangrikste redes vir die dramaties verbetering in gesondheid oor die laaste paar dekades eerder verbeteringe in sosioekonomiese faktore en veranderinge in leefwyse is as beter behandeling. Die bereidwilligheid van versekeraars om nuwe en verbeterde dienste te dek, is die oorsaak van die aanhoudende stimulus vir mediese tegnologiese vooruitgang en koste stygings. Bestuurde sorg het ontwikkel om te probeer om bron toewysing in gesondheidsorg te verbeter. Derde party privaatsektor-reguleerders het die mag van regering-reguleerders ontruk. Hul invloed, relatief tot die van privaat praktisyns, het die mags-ewewig verskuif van die voorsienings- na die aanvraagkant van gesondheidsorg. Deur die gebruik van hulle voordeel op die gebied van inligtingstegnologie, het hulle die praktisyn in 'n defensiewe houding gedwing. Bestuurde Gesondheidsorg word beheer deur winsgedrewe derde partye wie baat vind by kostebesparings. Aangesien gesondheidsverskaffers die kostebesparings moet implementeer, word daar aanbeveel dat hulle gesondheidsorg moet bestuur. 'n Gesonde samewerkings ooreenkoms tussen befondsers en diensverskaffers is wenslik. Finansiële verantwoordelikheid dwing tandartse om hulle praktyke krities te evalueer. Daar is 'n fokus verskuiwing vanaf die gesondheid van die individu, ten alle koste, na die gesondheid van die bevolking. Besondere klem behoort geplaas te word op die mondgesondheid van kinders, vir wie voorkoming die meeste baat inhou. Bewys-gebaseerde Gesondheidsorg het ontwikkel uit die soektog na die beste sorg in terme van kwaliteit en koste, uitkoms en proses, en pogings om wisselvalligheid en subjektiwiteit in kliniese besluite te verminder. Klem op beter resultate gee vroeër, meer waardevolle langtermyn verbeteringe vir die pasiënt, as die later kort-termyn voordele van genesing. Omdat tandbederf en tandvleissiektes voorkombaar is, behoort tandheelkundiges die bevordering van mondgesondheid te beklemtoon. Voorkoming by kinders word gesuggereer as die ideale vorm van privaat praktyk om mondgesondheid te bevorder.

Text in Afrikaans / Verpleegktmdiges het 'n etiese en professionele verantwoordelikheid om elke bej aarde se reg op selfbeskikking te erken, bulle in die uitvoering daarvan te ondersteun en op volgehoue basis te ontwikkel met die oog op die bereiking van die hoogste moontlike vlak van onafhanklikheid in die daaglikse lewe. Die doel van hierdie studie was om die mate te bepaal waarin professionele verpleegkundiges werksaam in geregistreerde, gesubsidieerde tehuise vrr bejaardes in die Pretoria-omgewing hierdie verantwoordelikl1eid uitleef Ontleding van die data, wat deur 'n vraelys ingewin is, dui daarop dat verpleegktmdiges sonder twyfel die bejaarde se reg op selfaktualisering erken. V erpleegkundiges ervaar egter onsekerheid oor die praktiese wyse van selfsorgondersteuning sowel as die wenslik11eid van gesondheidsbevordering by die gelnstitusionaliseerde bejaarde. Ten einde die sinvoll1eid van die gelnstitusionaliseerde bejaarde se bestaan te verseker, sentreer die belangrikste aanbevelings in hierdie studie rondom die voorsiening van opleidingsprogramme aan gerontologiese verpleegktmdiges asook gesondheidsvoorligting aan die bejaarde self / Nurses have an ethical and a professional responsibility to acknowledge the elderly's right to self-determination, to support them in this regard and to ensure ongoing development so that they may attain the highest possible level of independence in their daily life. The purpose of tllis study was to determine to what extent nurses working in registered, subsidized homes for the aged in the Pretoria area live up to tllis responsibility. Analysis of tl1e data, obtained by questimmaire, has clearly shown that nurses acknowledge the right of the elderly to self-actualization, but they feel uncertain about the practical ilnplementation of self-care support and tl1e desirability of promotil1g health amongst the il1stitutionalized aged. In order to ensure that tl1e institutionalized aged person leads a meanil1gfullife, the mail1 recommendations of tllis study centre on providil1g educational progrmes for gerontological nurses as well as health education for the elderly. / Health Studies / M.A. (Nursing)

Dissertation in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, in the Department of Chiropractic, Durban University of Technology, 2010. / Background: Chiropractic in South Africa seems to be gaining acceptance by medicine with increased recognition from the private healthcare sector. This trend is reflected by the recognition of private healthcare providers of chiropractic services. Integration would accelerate the growth of the chiropractic profession in this country. It is therefore important to understand how chiropractic is currently perceived with respect to integration into the KwaZulu-Natal (KZN) healthcare system. As well as to determine factors perceived to facilitate or hinder this integration. Objectives: To explore and describe the perceptions of selected stakeholders about the integration of the chiropractic profession into the KZN healthcare system. Method: The sample included ten selected stakeholders within the KZN healthcare sector. Each participant participated in a semi-structured interview. Questions included participants‟ experience of chiropractic, the role and scope of chiropractic practice, and key developmental issues affecting integration. Interviews were captured on a digital voice recorder and transcribed into text. Data was analysed by the use of NVivo software (NVivo 8, developed and designed in Australia, copyright 2008 QSR International Pty Ltd. ABN 47 006 357 213). Results: The majority of participants (n = 7) had a positive experience of chiropractic, but few (n= 2) recognised the diagnostic role of chiropractic. All participants, except two doctors, believed that integrating chiropractic into the public healthcare system would benefit the healthcare fraternity, the chiropractic profession and patients. However, hindering factors perceived by the participants included: chiropractors practicing non-evidence based techniques; chiropractic being registered with a different council and being taught at a different institution to conventional medical professionals; and most importantly a lack of knowledge of the profession. Facilitating factors were III perceived to be: increased education of stakeholders about chiropractic; improved communication between chiropractors and medical doctors; improved marketing strategy; and lastly improved patient management. Conclusions: A positive experience of chiropractic is directly affected by a positive exposure to the profession. The profession itself is responsible for dispelling some of the confusion it has created, by collectively practicing evidence based medicine, and marketing a united message to stakeholders.

Dissertation in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, in the Department of Chiropractic, Durban University of Technology, 2010. / Background: Chiropractic in South Africa seems to be gaining acceptance by medicine with increased recognition from the private healthcare sector. This trend is reflected by the recognition of private healthcare providers of chiropractic services. Integration would accelerate the growth of the chiropractic profession in this country. It is therefore important to understand how chiropractic is currently perceived with respect to integration into the KwaZulu-Natal (KZN) healthcare system. As well as to determine factors perceived to facilitate or hinder this integration. Objectives: To explore and describe the perceptions of selected stakeholders about the integration of the chiropractic profession into the KZN healthcare system. Method: The sample included ten selected stakeholders within the KZN healthcare sector. Each participant participated in a semi-structured interview. Questions included participants‟ experience of chiropractic, the role and scope of chiropractic practice, and key developmental issues affecting integration. Interviews were captured on a digital voice recorder and transcribed into text. Data was analysed by the use of NVivo software (NVivo 8, developed and designed in Australia, copyright 2008 QSR International Pty Ltd. ABN 47 006 357 213). Results: The majority of participants (n = 7) had a positive experience of chiropractic, but few (n= 2) recognised the diagnostic role of chiropractic. All participants, except two doctors, believed that integrating chiropractic into the public healthcare system would benefit the healthcare fraternity, the chiropractic profession and patients. However, hindering factors perceived by the participants included: chiropractors practicing non-evidence based techniques; chiropractic being registered with a different council and being taught at a different institution to conventional medical professionals; and most importantly a lack of knowledge of the profession. Facilitating factors were III perceived to be: increased education of stakeholders about chiropractic; improved communication between chiropractors and medical doctors; improved marketing strategy; and lastly improved patient management. Conclusions: A positive experience of chiropractic is directly affected by a positive exposure to the profession. The profession itself is responsible for dispelling some of the confusion it has created, by collectively practicing evidence based medicine, and marketing a united message to stakeholders. / M

Thesis presented in partial fulfilment for the degree of Master of Management (in the field of Public Sector Monitoring and Evaluation) to the Faculty of Commerce, Law, and Management, University of the Witwatersrand March 2016 / The South African public health care system is and continues to experience shortage of professional health care workers like other developing countries. These professional health care workers leave the country for better salaries and working environment for private sector and developed countries. The aim of the study is to gather and analyse information on how to integrate traditional health practitioners into the South African primary health care system to address the shortage of the health care workers. This qualitative study used a cross-sectional design to explore the perception, knowledge and recommendation of the national and district Department of Health officials, the western practitioners, the traditional practitioners and the SA citizens in Pretoria, South Africa on how to address this problem. Thirteen individual in-depth interviews and one focus group with the four categories of the research participants were conducted using a semi-structured interview guide. The results indicated that the SA government in partnership with the Interim Traditional Health Practitioners Council have opted for a parallel system to integrate the traditional practitioners into the primary health care level. For the parallel system to be fully implemented there are still issues that need to be achieved by the key stakeholders, one is for the government to build the traditional health care facilities for traditional practitioners, whilst the ITHPC finalise the registration of the traditional practitioners and approval of the Traditional Health Practitioners Regulations of 2015. Lastly, the District Health System has to prepare themselves for a new entrant, which is the traditional health care, into the primary health care to complement the existing system. / MT2017

Attachment theory has implications for relational functioning across the lifespan. The attachment experience of institutionalised children in South Africa is understudied. Using a psychoanalytic perspective as an addition to thematic analysis of the ASCT, this research aims to add to the functional perspective of attachment, an internal psychic frame of reference with which to view attachment of at risk children in South Africa. Using 58 ASCT protocols, divided between children’s homes and hospitals, stories were analysed using thematic content analysis and discussed with an object relations perspective. Results suggest the inclusion of additional categories of attachment to the current classification system as well as a deeper relational understanding of the experience of insecure attachment. This has implications for the current understanding and classification of attachment.