A thesis submitted in partial fulfillment for the requirement for the degree of Doctor of Philosophy in the Department of Psychology at the University of Zululand, South Africa, 2010. / This research project was undertaken to investigate workplace bullying and its effect on health service delivery. Research participants were drawn from Prince Mshiyeni Memorial and Mosvold Hospitals; the aim was to compare the experiences of public health employees in rural and urban areas of KwaZulu- Natal. The employees have a right to be treated with respect and dignity and, most importantly, to work in a harmonious and supportive environment. Bullying behaviour breaches the employer’s duty under common law to provide a safe and a secure work environment both physically and psychologically. What makes it difficult for managers to manage bullying is that it has no tangible results but it leaves the victim with psychological and emotional problems which lead to anxiety, stress and depression if not properly attended to. The results of this research project further reveal that the majority of bullied employees are reluctant to speak out or end up not reporting the incidences because when they do report problems they believe that they will not be taken seriously. The results also prove that bullying is not a once-off event but a continuous cycle aimed at humiliating and belittling the XVII victim and that it is present in both health institutions. Though many factors were indicated as contributing to bullying, the low–self-esteem and personality factors of the bully were mentioned as the main factors, followed by inadequate training for the managers. If managers are serious about combating bullying in their workplaces they need to be in touch with what their employees go through when they execute their daily duties and they need to devise some means of ensuring that the grievance procedure is adequate and that it caters for bullying problems.

The maternal mortality ratio (MMR) and neonatal mortality rate (NMR) have been persistently high in South Africa, with black, poor, rural women and neonates mostly affected. The MMR and the NMR are indicative of the health of the population and reflect deeper issues such as inequitable distribution of the country’s resources, social exclusion, deprivation, and lack of access to quality public services. The purpose of the study was to develop a model to meet the overall health needs of the socially excluded, the deprived and the vulnerable women by listing those factors that influence maternal and child health outcomes. From the point of view that individual reproduction and health decision-making takes place in a milieu comprising multiple socio-economic and cultural factors, this study attempts to add to the body of knowledge on maternal and child health in order to influence policies and interventions. Data was collected through a multi-staged, qualitative research design. The results show how structural factors result in high risk for poor maternal and child health outcomes, suggesting that the high rates of poor health outcomes are evidence of deprivation of women’s needs due to poverty leading to an inability to cope with pregnancy and childbirth. The results are used to develop a model that proposes pathways for policy action to confront both the structural and intermediary determinants of maternal and child ill health and mortality. These pathways operate through integrative and inter-sectorial mechanisms intended at empowering women and enhancing female reproductive health care activities. / Sociology / D.Litt. et Phil. (Sociology)

Kinship care is increasingly supplementing the more traditional forms of out-of-home care. Because related foster care has potential great value, the possibility of placement with relatives needs to be explored first. At its best it provides the child love and security with known people and possibly in a familiar environment. Yet, important as it is, this area of practice is seriously underdeveloped - few publications especially in South Africa exist on how children fare in this arrangement. This situation exists in spite of the fact that many children find themselves in both legal as well as privately arranged related foster care placements. Equally of course no comprehensive study has been undertaken to study the black family's perception of formal foster care and their adjustment to formal foster care practice which for many is a new encounter in their lives. More clarity on these issues pertaining to kinship care will not only improve our understanding but can lead to a better service. Socio-political influences have weakened the mutual aid system in African families. This has resulted in needs· and problems which the African family find it difficult to deal with. This has prompted families to make use of non-family support particularly services from specialized and other welfare agencies. Formal foster care is a foreign practice to the black community as a result of their tradition and custom. It offers a new method of coping with child care problems and indicates a shift from the conventional patterns among South African blacks. As a result there is often confusion and a lack of understanding, making the community not to make proper use of this service. This study is exploratory-descriptive. The sample comprised thirty foster parents. The main objective of this study was to investigate the nature and practice of formal foster care in the black community with specific emphasis on related foster care and its perception. The study has raised a number of issues for practice and policy consideration. Notable findings were: the need to (1) promote much more active involvement of foster parents, foster child and their families (2) educate the community about foster care (3) prepare, train, support and supervise foster parents. The study revealed that these placements have become indistinguishable from natural parenthood and the foster children have become absorbed into the foster family. A need exists for permanency planning in foster care. It is hoped that the research findings will contribute to the existing body of knowledge and that more studies will be undertaken in future.

The maternal mortality ratio (MMR) and neonatal mortality rate (NMR) have been persistently high in South Africa, with black, poor, rural women and neonates mostly affected. The MMR and the NMR are indicative of the health of the population and reflect deeper issues such as inequitable distribution of the country’s resources, social exclusion, deprivation, and lack of access to quality public services. The purpose of the study was to develop a model to meet the overall health needs of the socially excluded, the deprived and the vulnerable women by listing those factors that influence maternal and child health outcomes. From the point of view that individual reproduction and health decision-making takes place in a milieu comprising multiple socio-economic and cultural factors, this study attempts to add to the body of knowledge on maternal and child health in order to influence policies and interventions. Data was collected through a multi-staged, qualitative research design. The results show how structural factors result in high risk for poor maternal and child health outcomes, suggesting that the high rates of poor health outcomes are evidence of deprivation of women’s needs due to poverty leading to an inability to cope with pregnancy and childbirth. The results are used to develop a model that proposes pathways for policy action to confront both the structural and intermediary determinants of maternal and child ill health and mortality. These pathways operate through integrative and inter-sectorial mechanisms intended at empowering women and enhancing female reproductive health care activities. / Sociology / D.Litt. et Phil. (Sociology)

M.A. (Social Work) / Relevant literature clearly indicates a steady increase in not only the number of aged persons but also the demented population. Consequently it has become imperative that the nursing staff responsible for the day - and night care of demented patients in a residential setting, acquire appropriate knowledge of dementation as such, and clarity on their roles in an endeavour to decelerate the dementation process. They, furthermore, need to be aware of the special needs of demented aged persons --needs which call for particular professional skills. In this study the emphasis is on the development and evaluation of a group work programme for nurses in two homes for demented aged persons. The programme is based upon knowledge on dementation, and its contents are directed at a repertoire of skills which, when effectively practised, will serve as a support system to nurses. Researcher made use of an indirect measuring method: an experimental - and control group were established at two homes where direct observation was done in respect of the behaviour of the residents and the nature of nursing. A questionnaire was completed by the experimental - and control group, prior to and following on the provision of a group work programme. The target universe consisted of fifteen nurses at two homes for demented aged persons. Nine and six members of the nursing staff were respectively connected to the experimental - and control groups. The experimental group attended nine sessions which incorporated the mediating - goal model designed by Papell and Rothman (in du Preez 1979:73)...

Background: Despite the prevalence of HIV/AIDS stabilizing and slightly decreasing in certain provinces, there are a number of People Living With HIV/AIDS (PLWHA) in South Africa. Many people seek help at primary health clinics and hospitals and receive chronic care at these facilities. Caring for these chronic patients and new patients entering the health system can be stressful to the health professionals who are involved. Many studies that have been conducted have focused on the clinical aspects of individual patients, while few studies have focused on the experiences and stressors of health professionals looking after PLWHA. To ensure quality of care for patients with HIV/AIDS, it is important to understand the experiences of health professionals looking after HIV/AIDS patients and how stressful experiences may influence their attitude towards these patients. Aim: The aim of this study is to report the factors health professionals perceive as occupational stressors caring for people living with HIV/AIDS in the public health sector of the Nelson Mandela Metropolitan Municipality. Research design and Methodology: A quantitative, descriptive and non-experimental research design was followed. A pilot study was conducted to determine the clarity of questions, effectiveness of the instructions, completeness of the response sets, the time required to complete the questionnaires and the success of the data collection. The primary method of data collection was self-administered questionnaires. The questionnaires were dispatched to 30 health professionals at the public health facilities in the Nelson Mandela Metropolitan Municipality. A descriptive statistical analysis was done using a Statistical Package. This revealed the following findings. Findings: The following are the findings that were perceived to be occupational stressors: organizational factors, job design factors, career and promotional factors, role-related factors and cultural factors. iv Conclusion and recommendations: There are occupational stressors that affect health care professionals working in an HIV/AIDS setting. The following are the recommendations to rectify or to improve the situation: • Improve the communication of goals and objectives; • Redesign the job; • Human-resources development ; • Improvement of salaries; • Career planning and mentoring; and • Sensitisation of employees to cultural differences.

Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2015. / Introduction Access to effective health care is at the heart of the discourse on how to achieve the health related Millennium Development Goals. Lesbian and gay persons are affected by a range of social and structural factors in their environment, and as a result have unique health needs that might not be met by existing health care services. Sexual stigma remains a barrier to seeking appropriate health care. Lesbians and gays might delay seeking health care when needed or avoid it all together, because of past discrimination or perceived homophobia within the health care system. Aim of the study The aim of the study was explore and describe the accessibility of primary health care services to lesbians and gays in Umlazi in the province of KwaZulu-Natal. Methodology A qualitative, exploratory, descriptive study was conducted which was contextual in nature. Aday and Andersons’ theoretical framework of access was chosen to guide this study. Semi-structured interviews were conducted with 12 lesbian and gay participants. The findings of this study were analysed using content analysis. Results Four major themes that emerged from the data analysis were discrimination of homosexual men and women by health care providers and community members in PHC facilities; attitudes of homosexual men and women towards health care providers; homophobic behaviour and equality of PHC services. Few participants were satisfied with the primary health care services they received. Intervention by the Department of Health, Department of Education, curriculum planners and Health Professionals Councils is recommended wherein homosexuality education should be addressed during pre-service and in-service education sessions so as to familiarise health care providers with such clients’ health care needs and to decreased homophobic attitudes.

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Objective: The aim of the study was to determine the outcome of critically ill neonates and children admitted to a general intensive care unit in a large regional hospital (Worcester) in the Western Cape. A secondary aim of the study was to determine the risk factors for death in these neonates and children. Methodology: This was a retrospective descriptive survey of all paediatric admissions (under 13 years of age; July 2008 till June 2009) to an intensive care unit at a large regional hospital in Worcester, South Africa. Data collected included: demography, admission time, length of stay, diagnoses, interventions and outcome. Outcome was defined as successful discharge, death or transfer to a central hospital. Results: There were 194 admissions including children and neonates. The files of 185 children and neonates were analysed, while 8 children were excluded due to incomplete data set and one patient was a surgical admission. The male: female ratio was 1.3: 1 and the majority of patients (83%) admitted, were younger than 12 months of age at admission with a mean age of 8.5 months (median age 3.7 months; range 0 to 151 months). The majority (70%) of admissions were successfully discharged, nearly a quarter (24%) transferred to central hospitals in Cape Town and only 6% died (all younger than 5 years of age). Causes of death included acute lower respiratory tract infections (33%), acute gastroenteritis (25%), birth asphyxia complicated by pulmonary hypertension (16%) and prematurity (16%). Patients requiring airway assistance, were more likely to experience an adverse event (p=0.0001) and invasive ventilation was associated with an increased risk for a poor outcome (p=0.00). Conclusion: The majority of children requiring access to a paediatric ICU are younger than one year of age. The common causes of death are acute lower respiratory tract infections, acute gastroenteritis, prematurity and neonatal asphyxia. A regional hospital in South Africa should offer intensive care to children as the majority of their admissions can be successfully cared for without transfer to tertiary hospitals. To our knowledge, this is the first study reporting admissions and outcome of neonates and children cared for in a mixed intensive care unit in a large regional hospital in South Africa. This study suggests that large regional hospitals in South Africa should have mixed intensive care units to improve child survival.

HIV/AIDS is a pandemic infecting and affecting millions of people worldwide. South Africa is also severely affected by this disease. Because hospitals cannot cope with patients admitted daily especially with the influx caused by HIV/AIDS patients, the government has introduced home-based care of people living with HIV/AIDS. Amongst those who practice home-based care are the volunteers. This study is aimed at exploring and describing the experiences of volunteers involved in home-based care of people living with HIV/AIDS in the Lusikisiki Magisterial district in the former Transkei area of the Province of the Eastern Cape. The researcher used a qualitative methodology with the aim of finding out what it is like to be a volunteer involved in home-based care in a rural area. The data was collected by means of semi-structured one-to-one interviews or guided interviews. A total sample of thirteen research participants was acquired through purposive as well as snowball sampling. The interviews were guided by a number of broad question themes. Data was analyzed using Tesch’s framework of data analysis as described in Creswell (1994). The researcher used Guba’s model as outlined in Krefting (1991) to ensure trustworthiness of the research findings. A literature control was undertaken to find out what other researchers and authors say about the issues raised by the study. There were five themes that came out of the data analysis process and these themes are: o The experiences of volunteers with home-based care. o Factors facilitating the work of volunteers. o Problems encountered by volunteers. o Possible solutions to problems encountered. o Views of volunteers regarding home-based care. These broad themes were further reduced into sub-themes and categories. Based on the discussion of themes, sub-themes, and categories, some research findings were presented. The discussion of the themes, sub-themes and categories was supported by verbatim quotations from the participants. On the basis of research findings, conclusions and recommendations were made.

Data quality is one of many challenges experienced in electronic healthcare (e-health) services in South Africa. The collection of data with substandard data quality leads to inappropriate information for health and management purposes. Evidence of challenges with regard to data quality in e-health systems led to the purpose of this study, namely to prioritise data quality challenges experienced by data users of e-health systems in South Africa. The study followed a sequential QUAL-quan mixed method research design to realise the research purpose. After carrying out a literature review on the background of e-health and the current status of research on data quality challenges, a qualitative study was conducted to verify and extend the identified possible e-health data quality challenges. A quantitative study to prioritise data quality challenges experienced by data users of e-health systems followed. Data users of e-health systems in South Africa served as the unit of analysis in the study. The data collection process included interviews with four data quality experts to verify and extend the possible e-health data quality challenges identified from literature. This was followed by a survey targeting 100 data users of e-health systems in South Africa for which 82 responses were received. A prioritised list of e-health data quality challenges has been compiled from the research results. This list can assist data users of e-health systems in South Africa to improve the quality of data in those systems. The most important e-health data quality challenge is a lack of training for e-health systems data users. The prioritised list of e-health data quality challenges allowed for evidence-based recommendations which can assist health institutions in South Africa to ensure future data quality in e-health systems. / School of Computing / M. Sc. (Computing)