This research study was initiated by the desire to identify the constraining and enabling factors experienced by environmental health officers (EH Os) and their management in the implementation of environmental health education and promotion programmes in the environmental health sector. The research contextualises the issues of health promotion, the role of education in health promotion, and community-based environmental health service provision with specific reference to the role of the EHO in relation to these issues. The foremost value ofthis study lies in the fact that it profiles the need for change in the delivery of community-based environmental health education and promotion programmes and identifies distinctive policy changes and skills development needs in the field of environmental health promotion which are central to improved and sustainable community-based environmental health education and promotion. / Educational Studies / M. Ed. (Environmental Education)

Social Work / D.Phil. (Social Work)

In contemporary multicultural societies, health is emerging as a fundamental right alongside education and welfare: a frame of reference endorsed by the Government of National Unity in South Africa. Health workers are confronting issues far beyond the more traditional modes of health education. The initial thrust of this research was to investigate the most relevant social, health and education knowledge bases and issues relative to health education in cross cultural encounters in order to formulate universal guidelines applicable to the national situation. Differences inherent in allopathic and traditional health systems are explored in historical time, in conjunction with concepts of social change, communality in diversity and the co-existence of multiple realities. An understanding of common denominators across all human and group experience emerges and, with it, insight into problems that occur when universalistic conceptions of human behaviour are linked to communicocentric hegemony. The parameters within which cross cultural health education are viewed are extended through an analytical, empirical evaluation of the andragogic consequences of a broader conceptualisation of culture and the patterned relationships existing between elements within society. The ontic fact that similar variables may have widely different meanings and be differently construed by people whose life experiences differ is affirmed. Culture shock becomes a potential personal reality for all engaged in cross cultural encounters. Radical reflection on human nature and the eidos of man constitutes the foundation upon which the aims and various theories of health education are systematically and progressively evaluated. Evidence surfaces that the original intent of the research was rooted in the Western medical tendency towards standardisation, specialisation and the creation of scientifically validated routines for professional practice and that gaps exist between the theory and practice of health education and the everyday experiences of people. On the basis of scientifically based insights, guidelines have been formulated to narrow the divide between the factual, linearly based procedural aspects of health education and the human experience of learning. The guidelines embody the notion that the health educator's role in cross cultural encounters is one of facilitating meaningful, appropriate and informed choices on the part of adult learners. / Educational Studies / D.Ed. (Philosophy of Education)

Text in Afrikaans / Summaries in Afrikaans and English / Die doel van die sensus was om 'n perspektief te verkry oar die bestuur van plaaslike owerhede in die Vrystaat se primere gesondheidsafdelings deur verpleegkundiges. Faktore rakende die omvang van die verpleegkundige in beheer se bestuursfunksies, die werksverhoudinge tussen hulle en hul hoofde, hul optimale benutting ten opsigte van bestuur en sekere aspekte van hul bestuursopleiding is ge"ldentifiseer as belangrike komponente. Ontleding van data het getoon dat verpleegkundiges en hoofde van mekaar verskil ten opsigte van hul sienings rakende die bestuursfunksies van die verpleegkundige in beheer. Werksverhoudinge tussen die verpleegkundiges en hul direkte toesighouer is nie altyd bevredigend nie. Die swak benutting van hul bestuursvaardighede blyk vir die verpleegkundiges in beheer onaanvaarbaar te wees. Sekere aspekte van die bestuursopleiding van verpleegkundiges behoort aandag te geniet. Plaaslike owerhede behoort aan verpleegkundiges geleenthede vir voortgesette bestuursopleiding te bied. Aanbevelings om die optimale benutting van verpleegkundiges in beheer van primere gesondheidsafdelings van plaaslike owerhede te bevorder, is geformuleer. / The purpose of this census was to obtain a perspective on the management of primary health services of local authorities by nurses in the Free State. Factors regarding the extent of management in primary health care services by nurses, working relationships between them and their superiors, their optimal utilisation with regard to management and certain aspects of their managerial training, were identified as important components. Analysis of data indicated that nurses and their superiors differ from one another regarding their views on managerial functions of the nurses in charge. Working relationships between nurses in charge and their superiors were not always satisfactory. Nurses found the poor utilization of their management skills unacceptable. Certain aspects of the managerial training of nurses should receive attention. Local authorities should provide opportunities for ongoing managerial training for nurses. Recommendations to utilise nurses in charge of primary health care services optimally, were formulated. / Health Studies / M.A.

This study addresses the effectiveness of communication between the team (doctors, sisters and social workers) and patients at the Breast Cancer Clinic of the Johannesburg Hospital. Tue needs of patients were highlighted, as well as the role of care-giver, both as a group and in their separate disciplines, in attempting to meet these needs. Tue empirical survey was carried out through the use of questionnaires as well as interview schedules. Patients, doctors, nurses and social workers were used as respondents. Results indicated that the majority of patients' needs for information and support were met by the team in general; however, a need for further social work intervention seemed to be apparent. In addition, several barriers were found to inhibit both team-patient and inter-team communication. Tue researcher used the information gathered in this study to make recommendations that will facilitate improved communication in the clinic, with specific reference to the role of the social worker. / Social Work / M.A.(Social Science: Mental Health)

In this study an ecosystemic and social constructionist approach is used to understand the meanings and perceptions held by working mothers in relation to their experiences with the childcare and organisation settings. These meanings are described in terms of the influence of wider social discourses, personal epistemological assumptions, tacit knowledge, past experiences and current contexts. The working mothers, together with the researcher, form a linguistic system in which meanings about motherhood, employer-support and childcare arrangements are co-constructed and shared. The relationships between the working mothers and the researcher are not only observed within a linguistic context, but also within the ecosystemic view of mutual reciprocity, self-referentiality and double description. A qualitative and naturalistic research methodology is followed to describe the emergent design and the grounded theory. Based on the qualitative paradigm, the conclusions drawn at the end of the study are idiographic and reflective. / Psychology / M.A.(Clinical Psychology)

Decentralisation of the multidrug resistant tuberculosis (MDR TB) programme to primary health care (PHC) facilities in the Nelson Mandela Metropolitan was implemented in order to improve the effectiveness of MDR TB services. This study explored the knowledge gaps of nurses at PHC facilities as regards MDR TB. A quantitative, cross-sectional descriptive study was conducted; data was collected using a structured questionnaire. Non-probability sampling was applied in this study. A convenient sampling technique was used and 25 of the 42 facilities were selected. Thirty-two respondents completed the questionnaire with a response rate of 64%. Descriptive statistics were used to describe the data. Only 38% of the nurses had been trained on MDR TB. Overall scores were high with a mean knowledge score of 61%. However there were knowledge gaps regarding side effects of MDR TB medication. This study revealed gaps in knowledge of certain areas of MDR TB management / Health Studies / M.A. (Public Health)

The purpose of this study was to explore first year student nurses’ experiences of encounters with death and dying of a patient during clinical practice so as to make recommendations on increase support for first year student nurses. Qualitative research which was explorative, descriptive and contextual was conducted. Data collection was done using in-depth unstructured interview. Nine participants were interviewed and data was analysed. The findings revealed that lack of knowledge, emotional trauma, low self-esteem and nutritional disorder are the results of dealing with death and dying of patients for first year student nurses. Negative attitudes of clinical professionals, shortage of staff and congested block programme were identified as some aspects worsening the situation. Incidental learning that occurs with negative experience encountered was also identified. The findings show the need for review of curriculum for first year student nurses and the need for change of attitudes of clinical professionals / Health Studies / M.A. (Health Studies)

Patient and public criticism of care in many South African public hospitals has resulted in negative media reports. The purpose of the study was to determine the effect of appointing Quality Assurance Nurse Managers (QANMs) on the provision of quality patient care in selected public hospitals of the Limpopo Province and to make recommendations where appropriate. The study was quantitative, exploratory and descriptive in nature. Data was collected by means of a self-developed questionnaire from 112 respondents, consisting of 10 QANMs and 102 Quality Assurance Team members (QAT). The response rate was 100% for the QANMs and 57% for the QAT members. The study found that most of the ten selected hospitals have a good QA foundation with a vision, mission and goals, QA programme and manual. Moreover, the appointment of the QANMs had a positive impact on the nursing care. Regarding the improvement and change in the provision of nursing care, the majority of the respondents indicated that patients’ complaints about nursing care had declined considerably; the in-service training assisted in improving nursing care, and patients were nursed in totality because of the quality guidelines in the QA manuals. However, the study found that the shortage of equipment, which interferes with the delivery of quality patient care, is a serious problem that hinders the QA programme and needs to be tackled. Recommendations were made for practice and further research. / Health Studies

With the advent of the new National Health Act, health care in South Africa is at a critical point as this will be the first time in history that a National Health Insurance is being implemented in this country. Globally National Health Insurance has been around for more than a hundred years, however some countries with long established national health schemes are currently grappling with funding issues surrounding their health systems. South Africa should take note of these issues as it embarks on this journey. The objective of this study was to perform a literature review on how South Africa’s National Health Insurance can be funded taking cognisance of the history of the country and experiences of other countries. It is imperative for each country to achieve optimal health care funding to ensure the success and long-term sustainability of National Health Insurance. The analysis of the problems experienced by other countries revealed that balancing the three main funding options namely, allocated from the national revenue fund, user charges and or donations or grants from international organisations, is critical as the funds needed in a system to achieve coverage at an affordable cost is dependent on the current state of health care in a country. Considering South Africa’s history and current inequality in society and health care it is clear that the majority of funding for the National Health Insurance should be supplied by the national revenue fund. The required funds can either be raised by increasing existing taxes or introducing a new tax specifically aimed at financing the National Health Insurance. The use of user charges is important however, although not purely for a revenue collection point, but from a cost control point of view as well. Some studies have revealed that the lack of user charges results in a misuse of the system. / Financial Accounting / M. Phil. (Accounting Science)