Increasing numbers of medicines are being used by pregnant South African women in the public sector during pregnancy, for the treatment of different biomedical and supernatural disease states and conditions. The motivation for the research is to support the development of more local pregnancy registries in order to strengthen evidence for the safety and efficacy of medicines used in pregnancy. A mixed methods approach was used. Women in their ninth month of pregnancy in a public sector setting, and four community pharmacists were identified. The women who met the inclusion criteria were recruited. One in-depth semi-structured interview was conducted with each woman before giving birth and data on their pregnancy outcomes were collected after labour. Coincidentally, the mother of one of the participants was found to be a traditional healer. She was also interviewed on the topic. A structured questionnaire was administered to the pharmacists. Ten pregnant women between the ages of 19 to 39 who had used or were using a traditional medicine during the pregnancy were recruited. All the participants had had at least one antenatal check up during their pregnancy with one having attended five times. No abnormal results were reported from any of the check ups or tests done during the visits. All of them had been to school and had at least Standard 8/Grade 10 education. Ten babies were seen between one and four days postpartum and no birth defects were obvious or were reported for any of them. The traditional healer did not provide additional information to what the women had said and confirmed that some of the practices the women reported were known to her as traditional medicine practices. All four pharmacists indicated that they considered complementary and alternative medicines (CAMs) to be “somewhat effective” and sold them at their pharmacies although none of them were aware of whether or not they were registered with the MCC. None of the pharmacists appeared to have an in-depth knowledge of traditional, complementary and alternative medicines (TCAMs). All four pharmacists said that it is important to have a basic understanding of TCAMs before using them, although they did not agree on the reasons for this. All of them felt that pharmacists have a professional responsibility to provide information on TCAMs (especially herbal preparations) and two felt that providing this information is part of a medical doctors’ responsibility. No harm from taking TCAMs could be shown. However herbal medicines have numerous ingredients some of which are unknown and taking these medicines is risky. The pharmacists in this sample were unsure whether they were accessing unreliable CAM information. Reliable sources of information and reference materials on CAMs to assist pharmacists and other healthcare professionals are needed. The apparent widespread use of TCAM in pregnancy indicates a need for documentation about its efficacy and safety. The establishing of TCAM pregnancy registries should seriously be considered. Due to the increase in CAM use, CAM education during pharmacists’ training as well as continuing professional development (CPD) in CAM for pharmacists in practice should be encouraged.

The major socio-economic development challenges facing most African countries include economic diversification, poverty, unemployment, diseases and the unsustainable use of natural resources. The challenge of quality healthcare provisioning is compounded by the HIV/AIDS pandemic in Sub Saharan Africa. However, there is a great potential in using electronic healthcare (e-health) as one of the supportive systems within the healthcare sector to address these pressing challenges facing healthcare systems in developing countries, including solving inequalities in healthcare delivery between rural and urban hospitals/clinics. The purpose of this study was to compile a Provincial E-health Framework (PEHF) based on the feedback from electronic healthcare readiness assessments conducted in selected rural and urban hospitals/clinics in the North West Province in South Africa. The e-healthcare readiness assessment was conducted in the light of effective use of ICT in patient healthcare record system, consultation among healthcare professionals, prescription of medication, referral of patients and training of healthcare professionals in ICT usage. The study was divided into two phases which were phases 1 and 2 and a qualitative design supported by a case study approach was used. Data were collected using different techniques to enhance triangulation of data. The techniques included group interviews, qualitative questionnaires, photographs, document analysis and expert opinions. The outcome of the assessment led to the compilation of the PEHF which was based on Service Oriented Architecture (SOA). SOA was chosen to integrate the hospitals/clinics‟ ICT infrastructure yet allowing each hospital/clinic the autonomy to control its own ICT environment. To assist hospitals/clinics integrate their ICT resources, this research study proposed an Infrastructure Network Architecture which clustered hospitals/clinics to share common ICT infrastructure instead of duplicating these resources. Furthermore, processes of the e-health services (e-patient health IV record system, e-consultation system, e-prescription system, e-referral system and e-training system) were provided to assist in the implementation of the PEHF. Finally, a set of guidelines were provided by the research study to aid the implementation of the PEHF.

An evidence-based approach to clinical practice aims to deliver appropriate care in an efficient manner to individual patients. This approach entails the integration of research evidence, clinical expertise and the interpretation of patients' needs and perspectives in making decisions about the best care modalities. The increased emphasis internationally on improved patient care and cost effectiveness in health care delivery highlighted the need for quality health services that have to be built upon the use of best evidence to inform practice and patient-care decision-making (McKenna, Ashton and Keeney, 2004:178). Critical care nursing science, a specialised branch of nursing, focusing on the care of the critically ill patient in a designated unit, is no exception to the drive to provide improved quality and cost-effective patient care. Critical care practitioners are seen to have a specialised knowledge base, specific skills in delivering advanced health care and a commitment to serve the critically ill patient. It is expected of them to be aware of new and emerging evidence about health disease processes, treatment modalities and technology used in the critical-care units. Due to the dynamic nature of a critical care unit, it is essential that every practitioner working in the unit, whether a novice professional nurse or senior unit manager, needs to be aware of the current evidence guiding their practices (Elliot, Aitken, Chaboyer, 2007:18). With reference to the critically ill patient who is connected to a mechanical ventilator, practices related to the nursing care of this group of patients, who mostly occupy the critical care units, should be based on the best evidence in order to provide cost-effective and quality care. The research study aimed to explore and describe four identified nursing care practices related to safety of a mechanically ventilated patient as performed by professional nurses in the critical care units in the Nelson Mandela Metropole. The identified nursing-care practices include: endotrachael tube placement verification, endotracheal tube cuff pressure monitoring, endotrachael tube suctioning and mechanical ventilator settings. This objective was operationalized in Stage One of the study, by using a quantitative, explorative, descriptive and contextual approach. A structured questionnaire was utilised to collect data from professional nurses working in critical care units. From the analysed data, it was decided to select the two nursing care practices that were done least according to the best recommended practice, namely endotracheal tube suctioning and endotracheal tube cuff pressure monitoring. Based on the results, systematic reviews were done respectively on the two nursing care practices. On completion of Stage One of the study, evidence-informed clinical guidelines for the two identified nursing care practices were developed. The clinical guidelines were based on the evidence found in conducting the systematic reviews. The draft clinical guidelines were reviewed by an expert panel. Feedback from the reviewers was considered to prepare the final evidence-informed clinical guidelines. Based on the clinical guidelines, two clinical algorithms were developed, which might be used at the patient's bedside and can assist in quick dissemination of the recommendations for practice. Ethical considerations were maintained throughout the study. The quality of the study was ensured in applying the principles of validity and reliability as well as performing a critical appraisal of all data collected during the systematic review. It is envisaged that the study findings be disseminated in the critical care units in the Nelson Mandela Metropole and published in peer reviewed journals.

In South Africa, the quality of health care is directly related to the concept of patient-centred care and the enactment of the Batho Pele Principles and the Patients’ Rights Charter. The quality of health care delivery has dropped drastically, and reports in the media indicate that public hospitals in the Eastern Cape Province are on the brink of collapse, with thousands of patients being treated in condemned hospitals. Receiving and rendering health care in the face of such challenges, the question arose: “Are patients receiving patient-centred care in public hospitals?” The answer to this rhetorical inquiry appeared to be obvious, but this research study explored and described professional nurses’ perceptions of patient-centred care in public hospitals and their understanding of evidence-based practice and best practice guidelines. The proposed study followed a qualitative, exploratory, descriptive and contextual design. The research population included professional nurses who are employed in public hospitals in Nelson Mandela Bay, and consisted of nurse managers and nurses who work in the wards. The research study consisted of three phases. In Phase 1, semi-structured interviews and focus groups were conducted with nurse managers and professional nurses working in the wards in order to collect data about their perceptions of patient-centred care and their understanding of evidence-based practice and best practice guidelines. The interviews were transcribed and Tesch’s eight steps of data analysis were followed to create meaning from the data collected. Themes were identified and grouped together to form new categories. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness, which consists of the following four constructs: credibility, transferability, dependability and confirmability. An independent coder assisted with the coding process. In Phase 2, an integrative literature review was conducted in order to identify previous guidelines regarding best practice for patient-centred care. Relevant guidelines were selected, critically appraised, data was extracted and synthesised for the development of a best practice guideline for patient-centred care. An independent appraiser critically appraised the guidelines, thereby ensuring trustworthiness. In Phase 3, the data in Phase 1 and Phase 2 were integrated to formulate a draft best practice guideline for patient-centred care. The guideline was submitted to an expert panel for review and was modified according to the recommendations of the panel, whereby the best practice guideline for patient-centred care in public hospitals in Nelson Mandela Bay was finalized.

The aim of this study was to investigate whether patients were satisfied with midwifery services rendered at the two Community Health Centres in the Eastern Cape Province.The study sites were Empilweni Gompo and Nontyatyambo Community Health Centres. Descriptive quantitative study design was employed, using a questionnaire with closed and open ended questions as the data collecting tool. Likert Scale was used to measure the following variables: quality care variables to measure level of satisfaction with midwifery services rendered and to determine positive and negative perceptions regarding quality of care received during antenatal, labour and postnatal period. Non-random convenience sampling of sixty pregnant women, thirty from each Community Health Centre, with two or more antenatal subsequent visits and forty postpartum women, twenty from each health facility, six hours after delivery if there were no complications. Out of 60 participants interviewed n=60 (100 percent) agreed that individual counseling and importance of HIV testing was explained.The majority of participants n=53(88 percent) disagreed that they were educated about focused antenatal visits. Out of 60 participants interviewed n=41(68 percent) agreed that delivery plan formed part of their ANC visits and n=18 (30 percent) disagreed. Of the 60 participants interviewed n=11(18 percent) agreed that they were told that they had the right to choose labour companions and n=48 (80 percent) disagreed.Out of 60 participants interviewed n=23 (38 percent) stated that they waited a long period of time without being attended to by midwives. In general, the study revealed high satisfaction level with intrapartum and postnatal care due to functional accessibility of both Community Health Centres. Both health centres delivered normal healthy babies and mothers. However, the participants were dissatisfied with antenatal care rendered at the two facilities. The researcher’s recommendations were based on the closing of gaps that were identified with regard to the implementation of Basic Antenatal Care; birth companions: health education deficiency; community involvement and participation.

The Republic of South Africa emerged as 'a product of a historical moment' and also as a reaction against imperialism, colonialism, racial discrimination and domination over the majority of black South Africans by the white minority. The democratic dispensation came into being also for the first time in its life in memorial for a long turbulent history followed by the general democratic elections held on 27th April 1994. The 1994 first general election liberated South Africa from the apartheid system and its subsequent primary objective was “… to transform South Africa into a non-racial and democratic society”. The new democratic government now looks politically different from the racist regime because the current government since 1994 has been, and to date still is, a truly and broadly representative of the South African citizens and also a transparent one, whereas the defunct apartheid government was characterized primarily by, among other things, the violation of human rights, denying black South Africans of any rights of basic services, no rights of owning property or land, no freedom of association and speeches and firmly practised discrimination which was detrimental to the majority of the black population groups in this country. According to the then President Nelson Mandela whilst addressing the ANC masses that were commemorating the eighty-third (83rd) anniversary of the African National Congress on the 8th January 1995, democracy entails “… a thorough-going process of transformation, of overcoming the political, social and economic legacy of apartheid colonialism, of racism, sexism and class oppression.” The government is still grappling with the challenge of ensuringa better life for all the citizens of this country (http://www.anc.org.za/show.php?doc=ancdocs/history/jan8-95html:1).

MCur / Department of Advanced Nursing Science / The path of children heading families following the death of both parents takes many twists and turns, and a lot of support to face the challenging environment is needed. The path is not easy as compared to children with parents in terms of support and guidance. The purpose of the study was to determine the experiences of children heading families at Makhado municipality of Limpopo Province, South Africa. The objective of this study is to explore and describe the experiences of children heading families. Qualitative research approach with explorative, descriptive, contextual, interpretative phenomenological designs were used. Population of the study comprised of children heading families following the death of both parents, residing at Makhado municipality in Vhembe district of Limpopo Province, South Africa. Non-probability purposive sampling was used to select the participants. The sample size of 20 participants was determined by data saturation. Data was transcribed verbatim and translated from Tshivenda to English language. Tesch’s eight steps criteria was used to analyse data. The results of the study revealed that children heading families following the death of both parent’s experience various challenges and ineffective support from different community structures. The researcher ensured trustworthiness and ethical consideration were considered throughout the study. Recommendations were developed based on the findings of the study. Keywords: Child, Child headed families, Experience, Family, Parent / NRF

The purpose of the study is to investigate lived experiences of refugees when accessing healthcare services in Pretoria, South Africa. A qualitative phenomenological research approach was followed which assisted in exploring and describing the day-to-day lives of refugees living in Pretoria regarding their health outcomes. Face-to-face interviews were conducted on purposively selected participants, representing refugees from different African countries ranging from age 27 to 58 years. Collected data were transcribed, coded, and relevant themes were extracted and analysed by employing Colaizzi's seven-step analysis framework. Main findings demonstrated that the public healthcare services accessed by refugees, compared to private healthcare services, can be described as mostly dysfunctional. Also, healthcare providers from public healthcare services are often hostile towards refugees of African descent. Failure to speak a local language, unofficial documentation as viewed by a healthcare provider on duty, being a foreigner, and failure to pay undue consultation fees led to refugees being denied access to healthcare or receiving negative treatment in the public healthcare sector. Recommendations for programmes to promote human rights and refugee awareness in healthcare facilities could subsequently contribute to alleviating complications around access to healthcare services, which would denote improved health outcomes for the refugees. / Health Studies / M. P. H. (Health Studies)

MCur / Department of Advanced Nursing Science

MPH / Department of Public Health / South African youth, like many young people the world over, experience obstacles related to accessing age-specific health care services. School-based health centres, therefore, represent a mode of delivery of youth-friendly services tailored to meeting the healthcare needs of young people, such as university students. The aim of the study was to investigate the barriers faced by University of Venda (UNIVEN) students in accessing the institution’s health services.The objectives of the study were to assess the level of awareness of the respondents regarding the UNIVEN campus health services and to determine the availability and acceptability barriers experienced by students in accessing the campus health services.The study is quantitative using a self-administered questionnaire, informed by literature review, to collect data from the respondents. The study population consisted of all the students who were resident on campus. The sample size were five hundred and thirty four (534) respondents drawn from all the residences on the university campus and comprising of students from all the schools and levels. Questionnaires were administered face-to-face to respondents in the respondents’ rooms. The validity and reliability of the study were ensured. Ethical considerations, such as informed consent, right to privacy, and no-harm to participants, were observed and addressed in this study. Data was entered and analysed using Statistical Package for Social Sciences 23. For continuous variables such as age, descriptive variable was calculated. For categorical variables, frequencies and percentages are presented.The results indicated that the average age of the study population was 21.85 years with almost all of the respondents (95%) being aware of the existence of a health clinic on the Univen campus. However, only 63% had gone for consultation at the clinic. Awareness of the clinic’s services appears to be poor, with HIV Counselling & Testing being the most known service, while minor illnesses’ management was the most utilised service (48%). Barriers experienced by the respondents were related to waiting times and opening hours of the clinic, with only 33% and 39% respectively, describing them as ideal.The study provides evidence that although university health services may be provided at no cost students still experience barriers in accessing them. Effective measures are needed to increase students’ awareness of the clinic’s services and to shorten waiting times and improve clinic opening hours.