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Abstract Minor and major forms of depression are the most common mental disorders seen in primary health care. The number of disability pensions granted for major depression multiplied in Finland during the years 1987 and 1995. Over half of the client visits in health care centres are conducted by nurses. In most cases, practice nurses, health visitors, midwifes and school nurses are the first contact the patient or client has in a primary health care. However, there is no published literature in Finland concerning the role of primary care nurses in the recognition and treatment of depression. The purpose of this study was to describe and analyse the notions of primary care nurses concerning the recognition and treatment of depression in primary health care. The first phase of the study was part of a primary health care depression project organized by the National Research and Development Center for Welfare and Health (STAKES). The data was collected with three questionnaires from the nurses in four health care centers (n = 281). The data were partly compared with the data from 58 doctors working in same health care centres. The intervention was a three-day training program on depression held in four health care centres. The first questionnair was filled by 68 % of the nurses, the second by 48% of the nurses and the third by 30% of the nurses. In the second phase of the study 13 nurses from five health care centres were interviewed. The interview material was analysed using a phenomenographic method. The most essential themes in the study were: Prevalence and recognition of depression in primary health care patients, symptoms of depression, abilities and resources of nurses and their co-workers in treating depressive patients, management of depression, multiprofessional co-operation and nurses personal experiences of depression. The nurses felt that depression is most common in the working aged population and the frequent attenders, but most difficult to recognize in children and elderly people. The most essential symptoms they mentioned were sleeping disturbances, thoughts of death, sadness,lack of pleasure and physical symptoms. In the nurses opinion, the most common reasons for depression were concrete or emotional losses and the female predisposition to depressiveness. They found it very difficult to arrange psychotherapy for their depressive patients and to get the patients families involved in the treatment. All of the interviewed nurses considered the doctors are too busy and drug-centred in their management of depression but yet doctors were the most important co-workers for nurses. After the training program the nurses opinions of the possibilities to treat depressive patients in health centres were more positive than before the training-program. On the basis of the notions of the interviewed nurses five different treatment orientations emerged. The treatment orientations reflect different attitudes in the willingness to treat depressive patients and to ask direct questions with psychological content, in assessing one's own ability to treat depressive patients and in assessing one's own tendency to get depressed. All of the interviewed nurses felt it their duty to help depressive patients, but most of them mentioned a lack of time, a lack of confidence in one's own abilities and a fear of responsibility as restraints to do more in helping depressive people. Nursing education should give more practical and theoretical knowledge and encouragement in the recognition and treatment of mental disorders, especially mild mood disorders. The multiprofessional co-operation and intervention models in in the treatment of depressive disorders at the primary health care level should be improved and the possibilities to preventive work increased. Preventive interventions should also include the recognition of nurses exhaustion before it develops into depression.

Doctor Scientiae / Following the introduction of the Health Act of 1995, the Primary Healthcare Package for South Africa, a set of norms and standards was developed in 2000, to ensure good quality of care and to act as a guide to provide good service at this level of care. Related to this, and bringing health services to the people, was the aspect of rehabilitation. It was highlighted that rehabilitation services should be restructured and strengthened in order to improve access to these services for those who did not have them before. This led to the development of the National Rehabilitation Policy in 2000, which focused on improving accessibility to all rehabilitation services, in order to facilitate the realisation of every citizen’s constitutional right to have access to healthcare services, but this policy was not implemented. During 2002, the Department of Health produced a strategic plan for the reshaping of public health services in the Western Cape. This initiative, Healthcare 2010, the Future for Health in the Western Cape 2020, mapped the way forward to improve substantially the quality of care provided by the health service. This plan was based on the primary healthcare approach and aimed to shift patients to more appropriate levels of care. It became evident that in order to move forward with the 2020 vision, there needed to be a greater understanding of the current situation. This study focused primarily on the aspect of rehabilitation, with a specific focus on systematic review and three dimensions of the process of care, namely patient information; service provider information; and realised access. These dimensions assisted in evaluating the rehabilitation service in order to understand what was happening in the delivery of rehabilitation services, focusing on the experiences of patients with physical disabilities, as well as service providers and caregivers, and realised access that included satisfaction of all participants in the rehabilitation centres. Hence the aim of this study was to evaluate the process of care at three selected rehabilitation centres in the Western Cape Province within the contextual framework of the National Rehabilitation Policy (NRP) and the United Nations Convention Rehabilitation Policy for People with Disabilities (UNCRPD). To assist in achieving this aim, objectives were developed as follows: to determine the reported barriers and facilitators to rehabilitation services through a systematic review; to determine the profile of patients with disabilities accessing rehabilitation services at three rehabilitation centres in the Western Cape Province; to determine the profile of service providers providing rehabilitation service to patients with disabilities attending rehabilitation centres in the Western Cape Province; to explore clients’ perceptions of and satisfaction with the rehabilitation services; to explore caregivers’ perceptions of and satisfaction with the rehabilitation services; to explore the experiences of service providers with the rehabilitation services; and to map the links between the experiences and perceptions of the key stakeholders. This was an evaluation study, which was primarily descriptive, with the focus on process evaluation. Process evaluation provides an indication of what happened, and why. The study was conducted at three rehabilitation centres in the Western Cape Province. Voluntary participation of patients, service providers and caregivers was gained by signing a consent form. Both qualitative and quantitative methods of data collection were used in this study. Questionnaires were used for quantitative data collection and SPSS version 17 and 21 was used to analyse the data. Focus group discussions and in-depth interviews, which were based on interview guides and tape recorded, were used to gather information on experiences and perceptions of all the participants. Quantitative data capturing was checked for errors by using excel spread sheets, where data was entered twice in two different spread sheets and checked for differences, as responses were coded by using numbers. Qualitative data was checked for errors by following the trustworthiness process where data was transcribed verbatim, and where necessary translated by two different translators to ensure accuracy. The researcher consulted with the supervisors during data analysis to enhance quality in the coding process and identification of themes and relevant quotations. Results showed that barriers to rehabilitation outnumbered facilitators of the rehabilitation process. There was a gap identified in the profile of the patients with regards to their rehabilitation needs. Records of the patients had missing information posing a challenge to data collection and possible presenting a distorted picture of service provision. However, records showed that not all rehabilitation professionals were not consulted during the rehabilitation process of care. Ninety-five percent (95%) of the clients consulted with physiotherapists, whereas only 4% consulted social workers. Rehabilitation service providers did not reflect a rehabilitation team. There was a shortage of rehabilitation service providers, in that some centres had full time staff while other centres only had sessional rehabilitation professionals. Service providers were negligent with some of the processes to be followed when consulting clients, such as getting consent to treat the patient and educating patients regarding their ailments, which then affected satisfaction of the patients. However, there were also positive aspects like treating patients with respect and allowing patients to ask questions during consultation. Caregivers on the other hand were satisfied with the rehabilitation process, as they found the centre easily accessible for their family members and were involved in the rehabilitation of the patients. In conclusion, the rehabilitation process was satisfying to the participants of this study. The main challenge that patients and caregivers experienced was financial constraints. Staffing remains a problem in rehabilitation centres in the Western Cape Province, as there were not enough staff for rehabilitation service delivery at these selected rehabilitation centres. Other staff members were not utilised during the rehabilitation process. These findings raise issues for the Western Cape Department of Health to consider regarding rehabilitation, as people with disabilities are not receiving optimal care. The study makes recommendations to the Department of Health in the Western Cape Province regarding the improvement of the rehabilitation process of care.