The study reports on the perceptions of the midwives and pregnant women of the PMTCT of HIV programme at the antenatal care and maternity ward at the Johan Heyns Community Health Centre. A qualitative approach was adopted to conduct the study. Purposive sampling was used to select participants and was informed by social behavioural theories. Data was collected using interviews and analysed using thematic categorisation. The findings show that at the first PMTCT encounter participants had little to no knowledge of the PMTCT programme, generally displayed a lack of interest, experienced emotional distress, and fear at the thought of having to disclosing their HIV-positive status to their partners/family and had certain trepidations about participating in the PMTCT programme. The participants’ perception on their roles was that their roles were interlinked, midwife needs the recipients (pregnant woman) and pregnant woman needs the provider (midwife) therefore one cannot do PMTCT without the other. The study recommends that the capacity building of pregnant women be optimised, that PMTCT awareness campaigns for women of childbearing age should be a priority and PMTCT skills to be prerequisite for midwives deployed to ANC clinics and maternity ward units. / Health Studies / M. A. (Social Behaviour Studies in HIV/AIDS)

Background: Literature has shown that negative attitudes and unwillingness to care for HIV-infected patients are prevailing among healthcare workers. This study aimed to assess the attitudes and willingness of student nurses towards caring for HIV-infected patients in some public hospitals in Gert Sibande district, Mpumalanga. Method: A contextual exploratory quantitative descriptive survey was conducted among student nurses enrolled for a four-year nursing qualification in a nursing college at Mpumalanga province. Self-administered questionnaires were completed after obtaining an informed consent. Results: A total of 122 (70.9%) students participated in this survey. Findings showed that most participants had positive attitudes 66 (52.7%) and were willing 121 (99.1%) to care for HIV-infected patients. Significant associations were revealed between participants’ previous HIV testing (p=0.012), age group (p=0.009), and their willingness to provide care to HIV-infected patients. Conclusion: Results showed a generally positive attitude and willingness by participants to care for HIV-infected patients. / Health Studies / M.A. (Health Studies)

The purpose of this study was to explore the views of adults with disabilities and their care providers with regard to extent to which health promotion implementation was facilitated within Protective Workshops across several service areas in South Africa. Quantitative and Qualitative Data was collected via a combination of data collection approaches that included the use of a descriptive survey, a self-administered questionnaire and a semi-structured interview. Structured questionnaires and an interview schedule were used to generate data from both the patient and care provider participants in each of the selected facilities. Participants with disabilities and care providers working in the Protective Workshops were identified and sampled through a multi-stage sampling procedure. Participants from 48 facilities participated in the study. The findings revealed that health promotion in Protective Workshops was cursory and informal. Even though health education was provided whenever the need arose, it was neither individualized nor customized in accordance with reasonable accommodation of people with disabilities. There were provincial differences in terms of the levels of participation and organizational support for people with disabilities. In certain cases bureaucratic obstacles were identified during field work. Results show inconsistency regarding access to equal opportunities for people with disabilities, albeit some agreed to a lesser extent (30.5%), others moderately (21.5%) compared to only 22.6% who agreed, were exceeded by 25% of respondents who completely disagreed to the notion that equal opportunities existed for people with disabilities. The latter was confirmed by care providers. The study recommended an urgent need for the development of inclusive health promotion, the enforcement of the requirements for reasonable accommodation and adherence to policy and legal imperatives. / Health Studies / D. Litt. et Phil. (Health Studies)

Aim: The aim of the study is to explore the perceptions of the nurses’ CPD and its contribution to quality patient care in the Gauteng province of the Republic of South Africa. Significance of the study: The significance of the study is to highlight the importance of CPD as one of the contributing factors to the quality of patient care through on-going competence. The researcher hopes the recommendations from the study may serve as a motivation to health institutions that are not actively involved in continuing professional development. Method and data analysis: Quantitative descriptive explorative design was used to achieve the objectives of the study. The study involved registered professional nurses (n =105) and enrolled nurses (n=56) employed in a state health institution. Data was collected by means of a structured questionnaire.A total of 200 questionnaire were distributed and 162 completed questionnaires were returned, giving a response rate of 162/200=81%. Statistical analysis was conducted using the SAS software version 9.3.The internal and external validity was enhanced by selecting a large homogenous sample. Ethical issues: An information leaflet indicating the key elements of the study such as the research title, the purpose of the study, voluntary participation and when to withdraw from the study was distributed to all the participants. Results: The study found that nurses participate in CPD activities to maintain their professional competence, thereby contributing to quality patient care. The findings are consistent with the findings from other studies / Health Studies / M.A. (Health Studies)

Thesis (MSc)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: The primary aim of this study was to establish normative data regarding the fears expressed by and coping mechanisms in a selected group of middle childhood children living in a children's home with respect to content, number, level and pattern of fears and the coping mechanisms as well as their perceived efficacy. Children living in a children's home were referred to as children who were removed from family care as a result of lawful intervention and were thus seen as a special population. The secondary aim was to ascertain whether any differences in the fears expressed were found with respect to the independent variables of a special population and gender. The three measuring instruments were the Free-Option Method (FOM), the Fear Survey Schedule for Children Revised (FSSC-R) and the Coping Strategy (CS). The FOM was used to determine the content and number of fears, the structured FSSC-R to establish the content, number, level and pattern of fears and the CS to obtain the coping mechanisms used and their perceived effectiveness. A predominantly quantitative method of data collection was used. This was also true for the data analysis. In all three questionnaires were completed by 141 children living in a children's home (70 boys and 71 girls) in the Western Cape between the ages of 8 and 13. The three questionnaires comprised of the FOM, FSSC-R and the CS and were administered in the above-mentioned order. The content of fears based on the results of the FOM yielded only a few similarities upon comparison to the findings of a recent study by. More similarities were apparent upon comparison of the results of the FSSC-R implying that the structuredness of the measuring instrument plays a role in how universal childhood fears really are. The number as well as level of fear was higher for the children living in a children's home in comparison to the results of normative populations. This also holds true for the level of fear on all of the fear factors of the FSSC-R Gender differences that were apparent, were consistent with previous research with girls expressing a higher number and level of fears than boys. The girls in comparison to the boys also displayed a higher level of fear on all the five factors. The coping strategy most often used as well as perceived effective was the secondary coping strategy. This was followed by the primary coping strategy and finally the relinquished control coping strategy. Specific coping strategies, which were utilised, were support seeking and avoidance and these are associated with a higher level of intemalising symptoms. Overall, the coping strategies utilised were found to be effective in reducing the fear experienced. Only a few similarities were apparent upon companson of the results of the two measunng instruments, the FOM and the FSSC-R, emphasising the need for the development of an South African Fear Schedule. Lastly, recommendations for future studies are provided. / AFRIKAANSE OPSOMMING: Die primêre doel van die onderhawige studie was die insameling van ·normatiewe data omtrent die uitgesproke vrese van 'n geselekteerde groep kinderhuiskinders in die middelkinderjare met betrekking tot die inhoud, aantal, vlak en patroon van vrese en die hanteringstrategieë, sowel as die waargenome effektiwiteit daarvan. Kinders wat in kinderhuise woon is kinders wat van hulle gesinne verwyder is as gevolg van 'n wetlike ingreep en hulle word om hierdie rede as 'n spesiale populasie beskou. Die sekondêre doel van die onderhawige studie was om vas te stelof daar verskille was in die uitgesproke vrese met betrekking tot die onafhanklike veranderlikes van 'n spesiale populasie en geslag. Die drie meetinstrumente wat toegepas is, is die "Free Option Method" (FOM), die ''Fear Survey Schedule for Children Revised" (FSSC-R) en die "Coping Strategy"(CS). Die FOM is gebruik om die inhoud en aantal vrese te bepaal, terwyl die FSSC-R gebruik is om die inhoud, aantal, vlak en patroon van vrese te bepaal. Die CS is gebruik om die hanteringstrategieë en hul effektiwiteit te bepaal. 'n Oorwegend kwantitatiewe metode van data insameling, sowel as dataverwerking is vir hierdie studie gebruik. Drie vraelyste is beantwoord deur 141 kinders (70 seuns en 71 meisies) tussen die ouderdomme van 8 en 13 jaar wat in kinderhuise in die Wes-Kaap woon. Die FOM, FSSC-R en die CS is gebruik en in hierdie volgorde toegepas. Die inhoud van vrese wat op die resultate van die FOM gebaseer is, het weining ooreengestem met die navorsingsbevindings van 'n onlangse studie. Meer ooreenstemming is gevind met betrekking tot die inhoud van vrese wat gebaseer is op die FSSC-R resultate. Dit impliseer dat die gestruktureerdheid van die meetinstrumente 'n rol speel in hoe universeel vrese is. Die aantal sowel as vlak van vrese, was hoër vir die kinders wat in 'n kinderhuis woon vergeleke met die resultate van normatiewe populasies. Die bogenoemde is ook van toepassing ten opsigte van die vlak van vrese op al vyf faktore van die FSSC-R. Geslagsverskille wat voorgekom het, is in ooreenstemming met ander navorsingsresultate waar meisies, in vergelyking met seuns, meer vrese sowel as 'n hoër vlak van vrese op al vyffaktore van die FSSC-R getoon het. Die hanteringstrategieë wat die meeste deur die kinders gebruik is is die sekondêre hanteringstrategieë. Dit is gevolg deur die primêre hanteringstrategieë en laastens die opgegeë beheer hanteringstrategieë. Spesifieke hanteringstrategieë wat gebruik is, is ondersteuning en vermyding. Hierdie strategieë word geassosieer met 'n hoër vlak van geïnternaliseerde simptome. Oor die algemeen is die hanteringstrategieë as effektief beskou in die vermindering van vrese. Daar was min ooreenstemming tussen die resultate van die twee vrees meetinstrumente, die FOM en die FSSC-R, wat die behoefte aan die ontwikkeling van 'n vrees meetinstrument vir Suid-Afrikaanse omstandighede beklemtoon. Ten slotte word enkele riglyne vir toekomstige navorsing gegee.

Submitted in fulfillment of the requirements for the degree of Doctor in Public Management, School of Public Management and Economics, Durban University of Technology, Durban, South Africa, 2016. / The shortage of staff in hospitals resulted in the overcrowding of outpatients departments (OPDs) and long waiting times. The problems of the current health care system include the lack of access to transportation and high transport fees which cause delays in health seeking behaviours by patients or them resorting to traditional medicine in their neighbourhood. To alleviate the above issues, the new Primary Health Care (PHC) approach provides health care at a ward based and household level through community care giver (CCGs) and outreach teams. The study evaluated the management of rural ward-based primary health care in the UThukela District Municipality (UDM). The study intended to evaluate current performance systems in order to provide effective and efficient PHC; identify the role of the operational manager (OM) in the provision of PHC; and identify the factors affecting the performance of CCGs. A mixed methods approach was used amongst 368 CCGs and 17 OMs. Data was collected from CCGs using questionnaires while an interview schedule was used to collect data from OMs. The study showed that the performance management systems currently being used were not providing the desired performance management outputs. There were no performance bonuses to recognise best performing staff and therefore no increase in performance. The study also showed a significant relationship between the management of referrals and participation in the activities of PHC outreach teams. The clinic was not regularly giving feedback to the respondents and also not consistently conducting performance reviews. The findings indicated that OMs were playing various roles in the provision of PHC, namely policy and strategy implementation; leadership and governance; clinical care; allocation of resources; clinic budget management; supply chain management; and writing clinic reports. The extent of the allocation of resources to the wards varied from 43% for medicines and equipment to 31% for financial resources and only 18% for human resources. More than 95% of the CCGs viewed the availability of transport, resources, training and the provision of a stipend to be strong enabling factors for them to perform their work. Respondents indicated that monitoring and evaluation was done through reporting, performance reviews, feedback and supervision. The findings indicated that ward-based outreach teams are crucial in the delivery of PHC services in rural municipal wards within the Operation Sukuma Sakhe programme. Lack of management and supervisory support contribute to high rates of dissatisfaction amongst CCGs, as well as poor quality of work for community caregivers. There is a need for the Department of Health (DoH) to invest in the ward-based outreach teams (WBOTs) and allocate CCG budgets within the ward-based outreach teams. The study recommended that a review of monitoring and evaluation policy is required to clearly state the tools, activities and benefits of the implementation of the M & E performance management systems. The use of point-of-care technology by the WBOTs should be strengthened especially in deep rural wards. Therefore, biomedical technology will enhance point-of-care diagnosis, for instance, rapid home test kits for HIV diagnosis and pregnancy tests. The KwaZulu-Natal DoH should fast-track development of the sub-districts in order strengthen service delivery at a local level with top management ensuring development of OMs and PHC Supervisors in order to increase the level of competence and thereby improve service delivery at the PHC facilities. Another recommendation was to strengthen implementation of Operation Sukuma Sakhe (OSS) where the war room and the ward committee increase commitment to designing community-specific interventions with the engagement of community structures and government departments and local municipality through social planning, social action and locality development. Therefore, the results of the study should also influence the formulation of policies, programmes, methods and interventions which will enable UThukela District Municipality to improve health outcomes. / D

Thesis (M.Phil.)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: The aim of this research is to identify the various levels of health care units, their relationships and the problems hindering an effective referral system. To achieve this goal, use is made of a case study of the West Rand area in Gauteng. The standpoint is that, to achieve Primary Health for all South Africans referral systems within health care units and levels must be reciprocal. It is argued that for Primary Health Care to be successful, it must satisfy the goal of affordability appropriateness and accessibility. Results from the research revealed that four health care levels, namely traditional healers, health NGOs, Clinics, and Hospitals. Though there is some degree of referral in the study area, it was observed that referrals in the study area were not reciprocal. Amongst the major problems identified as hindering an effective referral system in the study area, include lack of cooperation between health institutions, poor health infrastructure and communication network as well as lack of other health paraphernalia. The research also found that government policy towards some of the health institutions (Traditional healers) contributes to the inefficiency of proper referrals in the study area. / AFRIKAANSE OPSOMMING: Die oogmerk van hierdie ondersoek is om die verskillende vlakke van gesondheidsorgeenhede, hulonderlinge verbande en die probleme wat doeltreffende verwysings in die wiele ry, te identifiseer. Dit word gedoen aan die hand van 'n gevallestudie van die Wes-Randarea in Gauteng. Die uitgangspunt is dat doeltreffende Primêre Gesondheid vir alle Suid- Afrikaners afhang van resiprokale verwysingsisteme tussen gesondheidsorgeenhede en -vlakke. Suksesvolle Primêre Gesondheidsorg vereis bekostigbaarheid, toepaslikheid en toeganklikheid. Die ondersoek het vier gesondheidsorgvlakke aan die lig gebring: tradisionele genesers, gesondheids-nie-regerings-organisasies, klinieke en hospitale. Hoewel daar 'n mate van onderfinge verwysing in die studie-area bestaan, was dit nie wederkerig nie. Onder die vernaamste struikelblokke vir 'n doeltreffende verwysingsisteem tel swak samewerking tussen gesondheidsinstellings, gebrekkige gesondheidsinfrastruktuur en kommunikasienetwerk, en 'n skaarste aan ander gesondheidsmiddelle. Die ondersoek het ook bevind dat regeringsbeleid aangaande sommige van die gesondheidsinstellings (tradisionele genesers) bydra tot die ondoeltreffendheid van verwysings in die studie-area.

Thesis (MTh)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: AIDS is stigma, disgrace, hatred, hardship, abandonment, isolation, exclusion, prohibition, persecution, poverty, privation. AIDS is a metaphor. It is a threat, a tragedy, a blight, a blot, a scar, a stain, a plague, a scourge, a pestilence, a demon, killer, rampant, rampaging, murderer. It is made moral. It is condemnation, deterrence, retribution, punishment, a sin, a lesson, a curse, rebuke, judgement (Pillay, 2008:21). The above quotation represents societal perceptions, discourses and responses to the AIDS pandemic. Sadly, in the early days of this pandemic, some theologians and churches held the above-mentioned perception, creating the fear in sufferers of the disease that they might be judged. Communities, families and people living with HIV/AIDS (PLWHA) also still hold this view. The aim of this study is to investigate the judgemental attitudes in pastoral care and spiritual counselling for women living with HIV/AIDS. One of the aspects that contribute to the spread of the HIV pandemic is the stigma attached to it as it is the stigma that causes the silence. This study aims to explore the definition of stigma and investigate its causes and results as well as looking into the judgemental attitudes of the community, church, society, family and counselling of the HIV/AIDS sufferer, their identity crisis and their question of meaning. Furthermore, the study aims to investigate the theological reflection on the notion of God, through the doctrine of judge ment (how God is presented as a judge in both the Old and the New Testaments), as well as Old and New Testaments’ views on illness. Using these sources, this study investigates whether or not HIV is a punishment from God. Using case studies, the resurrection of hope and the role of hope in a person was explored. This study also investigates how pastoral care and spiritual counselling can empower and bring hope and healing to PLWHA. This was done through the use of Louw’s five-phase model of counselling PLWHA, an externalising method from a narrative approach. This study seeks to determine the judgemental attitudes in pastoral care and counselling towards women living with the HI virus in the local township of Lwandle. It is said that the people most vulnerable to the HI virus and most infected are women and especially those living in the poor townships of South Africa. Their lack of education and poverty put these women in a more dangerous situation than their counterparts. In the township churches, women are in the majority. This study speculates about the role of pastoral care and counselling in empowering these women, in particular those living with HIV and AIDS and seeks to explore how the faith community, society and their families judge these women. It also investigates how pastoral care can dispute irrational and unrealistic constructs applied to the interpreta tion of the pandemic and how the Christian community can contribute to constructive pro cesses of de-stigmatisation. In the early days of the pandemic, the church regarded intercourse as intended solely for procreation (Van Dyk 2008:318). Therefore, since it is well established that HIV and AIDS is a desease that is mostly contracted through sexual activity, those who contracted the disease were regarded as being not morally sound or upright members of society. This resulted in pastoral counsellors finding it difficult to counsel without discussing the causes of this disease as when they did so, they often appeared to be condemning the infected persons by judging them. This study focuses on the judgemental attitudes and stigmatisation, a theological reflection on the notion of God, as well as on women living with the HI virus in a specific context. In order to determine the attitudes of pastoral care and counselling, an empirical study was done to assess the attitudes in the above-mentioned location to PLWHA in that community. The aim of the empirical research was not to create statistical evidence, but rather to reflect the stories of the women living with the virus in this community. For the study, a certain group of women was selected from the support group of women who are living with HIV/AIDS. The co-ordinator of the support group helped the researcher to access the people from the Ikhwezi clinic. A questionnaire was used for the findings. The study showed the pain, vulnerability as well as the bravery of these women. Through the case study, the researcher was able to demonstrate how hope can change the lives of PLWHA. / AFRIKAANSE OPSOMMING: Vigs is stigma, haat, swaarkry, verlating, isolasie, uitsluiting, verbod, vervolging, armoede, ontbering. VIGS is 'n metafoor. Dit is 'n bedreiging, 'n tragedie, 'n vloek, 'n klad, 'n letsel, 'n vlek, 'n plaag, 'n kastyding, 'n pestilensie, 'n demoon, 'n doodmaker, wild, vervloek, 'n moordenaar. Dit is sedelikheid gemaak. Dit is veroordeling, afskrikking, vergelding, straf, 'n sonde, 'n les, 'n vloek, teregwysing veroordeling (Pillay, 2008:21). Bostaande aanhaling verteenwoordig sosiale persepsies, gesprekke en reaksies betreffende die VIGS pandemie. Tragies om te sê, in die begin van die pandemie was bostaande persepsie die standpunt van sommige teoloë en kerke, wat die vrees by lyers van die siekte geskep het dat hulle veroordeel sou word. Gemeenskappe, gesinne en mense wat lewe met MIV/VIGS (MWLMV) huldig nog steeds hierdie seining. Die doel van hierdie studie is om die veroordelende houdings by pastorale sorg en berading van vroue wat lewe met MIV/VIGS, te ondersoek. Een van die kwessies wat bydrae tot die toename van die MIV- pandemie is die stigma wat daaraan kleef, omdat dat die stigma is wat die verswyging daarvan veroorsaak. Hierdie studie beoog om die definisie van sigma te verken, en om die oorsaak en die gevolg daarvan te ondersoek, asook as om ’n kykie te kry in die veroordelende houdings van die gemeenskap, die kerk, die samelewing, die familie en die berading van die MIV/VIGS-lyer, hulle identiteitskrisis en hulle soeke na betekenis. Verder beoog die studie om die teologiese besinning oor die idee van God n.a.v., die leerstelling van oordeel (hoe God voorgestel word as Regter in sowel die Ou en Nuwe Testament), sowel as die Ou Testamentiese en Nuwe Testamentiese sienings oor siekte, te ondersoek. Deur die gebruik van hierdie bronne will hierdie studie ondersoek of MIV ’n straf deur God is. Hierdie studie ondersoek ook hoe pastorale sorg en berading kan bemagtig en hoop kan bring vir MWLMV. Dit is gedoen deur die gebruik van Louw se vyf fase beradingsmodel vir MWLMW-’n eksternaliseringsmetode vanuit ’n narratiewe benadering. Deur gebruik te maak van gevallestudies is die opwekking van hoop en die rol van hoop in ’n persoon verken. Hierdie studie poog om die veroordelende houdings by pastorale sorg en beranding van vroue wat leef met die MI-virus in die plaaslike dorpie Lwandle, vas te stel. Daar word gesê dat die kwesbaarste vir die MI-virus en die mees geïnfekteerde persone die vroue is, en by uitstek die wat in die arm dorpies van Suid-Afrika woon. Hulle gebrek aan geletterdheid en hulle armoede bedreig hierdie vroue meer as hulle mans. In die dorpskerke is vrouens in die meerderheid. Hierdie studie besin oor die rol van pastorale sorg en berading in die bemagtiging van hierdie vroue, in besonder hulle wat met MIV/VIGS lewe in die studie poog om te verken hoe die geloofsgemeenskap, die samelewing en hulle gene hierdie vroue beoordeel. Dit ondersoek ook hoe pastorale sorg irrasionele en onrealistiese opvattings rakende die interpretasie van die pandemie kan betwis, en hoe die Christengemeenskap kan bydrae tot ’n opbouende proses van destigmatisering. In die vroeë dae van die pandemie het die kerk gemeenskap gesien as uitsluitlik bedoel vir voorplanting (Van Dyk 2008:318). Aangesien dit algemeen aanvaar word dat MIV en VIGS ’n siekte is wat meestal opgedoen word deur seksuele aktiwiteite, is hulle wat hierdie siekte opgedoen het, nie gesien as moreel, of as onkreukbare lede van die gemeenskap nie. Dit het daartoe gelei dat pastorale beraders dit moeilik gevind het om te beraad sonder om die oorsaak van die siektetoestand te bespreek indien hulle dit wel gedoen het, en het dit dikwels gelyk asof die geïnfekteerde persoon veroordeel is deurdat hulle geoordeel is. Hierdie studie fokus op die veroordelende houdings en stigmatisasie-op ’n teologiese besinning oor die idee van God, sowel as op die vroue wat met die MI-virus binne ’n bepaalde raamwerke leef. Ten einde die houdings van pastorale sorg en berading teenoor MWLMV te bepaal, is ’n empiriese studie in daardie gemeenskap gedoen. Die doel met die empiriese navorsing was nie om statistiese bewyse te skep nie, maar eerder om te besin oor die verhale van die vroue wat met die virus leef in hierdie gemeenskap. Vir die studie is ’n bepaalde groep vroue geselekteer uit die ondersteuningsgroep vroue wat met MIV/VIGS leef. Die koördineerder van die ondersteuningsgroep het die navorser gehelp om die mense van die Ikhwezi kliniek te bereik. ’n Vraelys is gebruik vir die bevindinge. Die studie het die pyn, verwondbaarheid, sowel as die moed van hierdie vroue getoon. Deur die gevallestudie het die navorser aangetoon hoe hoop die lewens van MWLMV kan verander.

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: BACKGROUND Post anesthesia discharge criteria scoring systems have been used successfully to aid discharge from the post anesthetic care unit (PACU) for over 40 years. They do not replace, but rather act in conjunction with good clinical judgment, and provide concise, standardized documentation of a patient’s readiness for discharge. 1,2,3,4,5 In order to improve patient safety, provide clear documentation and to aid future audit, a discharge criteria scoring system was developed for use in our PACU (Addendum A). It is a modification of the Aldrete Scoring System and the modified Post Anesthetic Discharge Scoring System (PADSS) proposed by Chung.1 There is a steadily increasing patient burden on the existing medical infrastructure in South Africa. Tygerberg Academic Hospital is no exception, and because of the high demand on our theatre services, optimal efficiency is essential. We speculated that our discharge criteria scoring system might increase the efficiency of our PACU when compared to the traditional time based system. The more healthy patients, undergoing minor procedures, could potentially spend less time in PACU, allowing the nurses to focus on problem cases. Increasing the speed of transit might also help prevent delays in theatre due to lack of bed space in PACU. Our primary endpoint was to compare the duration of time spent by patients in the PACU at Tygerberg Academic Hospital, from the moment they are admitted, to the time they are discharged to the ward, before and after the introduction of a discharge criteria scoring system. While planning the audit, one of the factors that staff identified as contributing to delayed discharge from PACU, was the time it took for the wards to collect their patients. A secondary objective, therefore, was to assess the amount of time that elapsed between calling the ward to collect the patient, and the patient leaving PACU. METHODS AND MATERIALS Prior to commencing the audit, approval was obtained from the Human Research Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch and Tygerberg Academic Hospital. The Audit, its purpose and possible benefits, was discussed with representatives of the nurses working in PACU, and written consent was obtained from those who would be involved in the data collection (Addendum B). Audit forms (Addendum C), collection boxes, and posters reminding staff to participate in the audit were prepared. Our first audit was performed over approximately a week in August 2012. During this period, the traditional time-based discharge system was still in operation. Data was captured from 327 patients. Audit forms were placed in a collection box, which was cleared daily by the primary investigator. The discharge criteria scoring system was introduced to the PACU staff in January 2013. The nurses were trained in its use, and a one month period was allowed for all involved to become accustomed to the new system. A second audit was performed in February 2013, again over a week, during which we gathered data from 313 patients. RESULTS The median value of the time spent by patients in the PACU decreased from 1 hour 25 minutes, to 1 hour 15 minutes, after introduction of the discharge criteria scoring system. This was statistically significant (p-value = 0.003). The median time between calling the ward to collect a patient, and the patient leaving recovery, was 15 minutes. CONCLUSION The main finding of the study was that the introduction of a discharge criteria scoring system decreased the median duration of time spent by patients in the post anesthetic care unit at Tygerberg Academic Hospital. / AFRIKAANSE OPSOMMING: AGTERGROND Puntestelsels as ontslag kriteria na narkose, word vir die afgelope 40 jaar suksesvol gebruik as maatstaf om pasiënte uit die herstelkamer te ontslaan. Hierdie kriteria vervang nie goeie kliniese oordeel nie, maar is ’n addisionele hulpmiddel om te bepaal of die pasiënt gereed is vir ontslag en om noukeurige, gestandardiseerde dokumentasie te verseker. 1,2,3,4,5 'n Nuwe puntestelsel vir ontslag is vir die herstelkamer van Tygerberg Akademiese Hospitaal ontwikkel om pasiëntesorg en dokumentasie te verbeter, asook om ouditering in die toekoms te vergemaklik (Addendum A). Hiervoor is die Aldrete Scoring System en die gemodifiseerde PADSS, voorgestel deur Chung, aangepas. 1 Die bestaande mediese infrastruktuur in Suid-Afrika beleef tans ‘n geleidelike toename in die getal pasiënte. Tygerberg Akademiese Hospitaal is geen uitsondering nie en as gevolg van die hoë aanvraag na ons teaterdienste, is uiterste doeltreffendheid noodsaaklik. Ons vermoede was dat hierdie aangepaste puntestelsel doeltreffendheid in die herstelkamer sou verbeter in vergelyking met die meer tradisionele tyd-gebaseerde sisteem. Gesonde pasiënte wat kleiner prosedures ondergaan, sal waarskynlik na ’n korter periode ontslaan kan word wat die verpleegpersoneel in staat sal stel om meer aandag aan probleem gevalle te gee. Bespoediging van die pasiëntvloei behoort onnodige vertragings van teatergevalle weens 'n tekort aan beddens in die herstelkamer, te beperk. Die primêre doel van die studie was om te bepaal of die gebruik van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal, die tydperk wat die pasiënt in die herstelkamer deurbring, verkort. Die herstelkamer verpleegsters het beweer dat die saal personeel ‘n lang tyd gevat het om hulle pasiente in herstelkamer te kom haal. Vervolgens is 'n sekondêre doelwit ingesluit om die tydperk te bepaal vandat die saalpersoneel in kennis gestel word, totdat die pasiënt die herstelkamer verlaat. METODE Goedkeuring is verkry van die Menslike Navorsing en Etiese Komitee van die Gesondheidswetenskap Fakulteit van die Universiteit van Stellenbosch en Tygerberg Akademiese Hospitaal voor die aanvang van die studie. Die studie, asook die doel en moontlike voordele daarvan is vooraf bepsreek met verteenwoordigers van die herstelkamer verpleegpersoneel en skriftelike toestemming is verkry van al die deelnemers wat betrokke sou wees by die data versameling (Addendum B). Oudit vorms (Addendum C), versamelhouers en inligtingsplakkate vir die betrokke personeel is voorberei. Die aanvanklike oudit is in Augustus 2012 oor 'n periode van ongeveer een week uitgevoer. Tydens hierdie oudit is die tradisionele tydgebaseerde sisteem gebruik. Inligting van 327 pasiёnte is versamel. Die oudit vorms is in die versamelbokse geplaas en is daagliks deur die primêre navorser verwyder. Die aangepaste puntestelsel as ontslag kriteria, is in Januarie 2013 in die herstelkamer geïmplementeer. Die verpleegpersoneel het opleiding ontvang waarna die aangepaste puntestelsel vir een maand gebruik is om te verseker dat die personeel vertroud is daarmee. In Februarie 2013, is ‘n tweede oudit oor ‘n tydperk van een week uitgevoer, waartydens inligting van 313 pasiёnte versamel is. RESULTATE Na die implementering van die aangepaste puntestelsel as ontslag kriteria, het die mediane tyd wat pasiënte in die herstelkamer deurbring afgeneem van 1 uur en 25 minute tot 1 uur en 15 minute. Hierdie afname is statities betekenisvol (p-waarde = 0.003) Die mediane tyd vandat die saal in kennis gestel is totdat die pasiënt die herstelkamer verlaat, was 15 minute. GEVOLGTREKKING Die hoof bevinding van die studie is dat die mediane tydperk wat die pasiënte in die herstelkamer deurbring verminder is deur die implementering van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal.

Thesis (MPA)--University of Stellenbosch, 2001. / ENGLISH ABSTRACT: The South African Government of National Unity, through its adoption of the Reconstruction and Development Programme (RDP) in 1994, committed itself to the development of a District Health System (DHS) based on the Primary Health Care (PHC) approach as enunciated at Alma Ata in 1978. This approach is the philosophy, on the basis of which many health systems around the world have been reformed, and out of which has developed the concept of the DHS. District-based health systems are now applied successfully in many countries, and have been adapted to a wide variety of situations, from developing countries on our own continent, to more sophisticated systems elsewhere. A National Health System based on this approach is as concerned with keeping people healthy as it is with caring for them when they become unwell. The concepts of "caring" and "wellness" are promoted most effectively and efficiently by creating decentralised comprehensive management units of the health system, adapted to cater for local needs. These units will provide the framework for our district-based health system, in which a district health authority can take responsibility for the health of the total population in its area. This population-based model allows for constant assessment and monitoring of health problems in the district, the facilities and system provided, and leads to efficient and rational planning. The researcher conducted interviews with key stakeholders, used structured questionnaires and observation and reviewed the relevant National and Provincial documentation and performed a literature review, to assess the feasibility of implementing DHS in the City of Cape Town. The main findings of this research are that the City of Cape Town does have the capacity to implement and sustain the DHS, that it is necessary to implement the DHS in the CCT in order to improve the quality of life of the population, and that there is enough personnel to take the process forward. The main recommendations include the need for training of staff, the promotion of communication and transparency in relation to finances and an ongoing support system from the provincial and national health departments. The research assignment has revealed that the move towards DHS has the blessings of the top management and politicians of the eeT. In addition, it has been established that the Cï.T possesses good infrastructure, technical skills, and human resource capacity. There is also willingness on the part of the unions to take this process forward. There are also challenges that need to be addressed, such as difficulties around staff attitudes, and the training of officials so as to accommodate the requirements of a comprehensive primary health care system, effective and efficient utilisation of available resources and change management. / AFRIKAANSE OPSOMMING: Die Suid-afrikaanse regering van nasionale-eenheid het met die aanvaarding van die Herekonstruksie en Ontwikkelings program (Hop) in 1994, Suid Afrika tot die ontwikkeling van gesondheidsdistrik stelstel verbind. Hierdie stelsel is gebaseer op die primere gesondheidsorg (POS) benadering wat te Alma Alta in 1978 geformuleer is. Die POS is die dryfkrag agter die verandering van verskeie gesondheidstelsels die wereld oor. Vanuit hierdie POS het die distriksgesondheidstelsel ontwikkel. Hierdie distriksgesondheidstelsel word tans suksesvol in baie lande toegepas en is aanpasbaar by verskillende omstandighede, van die Afrika kontinent tot meer gesofistikeerd stelsels op ander kontinente. 'n Nasionale gesondheidstelsel gebaseer op hierdie benadering is ewe besorg om mense gesond te hou asook om na hulle om te sien wanneer hulle ongesond is. Die begrippe van besorgheid en welsyn word effektief en doeltreffend bevorder deur die skepping van n gedesentraliseerde omvattende bestuurseenheid van die gesondheidstelsel wat aangepas is vir plaaslike behoeftebevrediging. Hierdie eenhede voorsien die raamwerk vir n eie distriksgebaseerde gesondheidstelsel, waarbinne die distriksgesondheidsregeerders verantwoordelikheid vir die gesondheid van die totale bevolking en hul gebied aanvaar. Hierdie bevolkingsgebaseerde model laat toe vir voortdurende beoordeling en monitering van gesondheidsprobleme binne die distrik. Dit bepaal watter beskikbare fasiliteite en dienste voorsien moet word sodat doeltreffende en rasionele beplanning kan geskied. Navorsing is onderneem om die lewensvatbaarheid van die implementering van n distrikgesondheidstelsal binne die stad Kaapstad, met 'n speciale fokus op finansiele en menslike hulpbronne, te bepaal. Die navorser het gebruik gemaak van 'n gestruktureerde vraelys en literatuurstudie om die lewensvatbaarheid tydens die implementering van die distrikgesondheidstelsel vir die stad Kaapstad te bepaal. Die belangrikste gevolgtrekking met betrekking tot hierdie navorsing is dat die stad Kaapstad oor die vermoe beskik om 'n distrikgesondheidstelsel te implementeer en te onderhou ten einde die lewenskwaliteit van mense te verseker. Daar is verder bevind dat daar genoeg personeel is om hierdie proses te voltooi. Die belangrikste aanbeveling sluit in die opleiding van personeel, die bevordering van kommunikasie en deursigtigheid in verhouding tot finansies en voortdurende ondersteuning vanaf provinsiale en nasionale gesondheids departmente.