Doctoral Degrees (Nursing)

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The experiences of death and dying of Zulu patients, their families and caregivers.
(1989) Mtalane, Lissah Joyce Themba.
This thesis studies the impact of the terminal illness and awareness of undergoing the dying process and inevitable death, at the KwaZulu Government hospital Ngwelezana, at Empangeni in the Lower Umfolozi District. A case study, drawing both upon nursing and social anthropology, was conducted to establish the experiences of death and dying of Zulu patients, their families and caregivers. The basic trend reflected in the findings is the need to discuss dying with patients, the lack of skills and knowledge on the part of caregivers, lack of recognition of patients' cultural beliefs. The study does not claim to deal with a complete spectrum of the experiences of death and dying of all Zulus but is a meaningful and significant innovation into an unresearched area of patient care.
The assessment of the aggregate health status of an organisation.
(1993) Grainger, Linda Denise.; Uys, Leana Ria.; Kortenbout, Wilhelmina Petronella.
As adults spend the major portion of their lives at work, it is essential that the reciprocal relationship between their work and health be recognised. In this regard, occupational nurses have an important function, through the provision of effective occupational health programmes in the workplace, although this is a challenging task and programmes often bear little relevance to health needs. The process of identifying health needs involves the measurement of health status, requiring a clear understanding of the nature of health and how it is determined. However, conceptualisations of health in relation to work tend to be inadequate as they deal with it on an individualistic basis, often as a negative measure, do not include the various dimensions of health, and fail to take account of the influences of the wider community. This study sets out to overcome these problems. A model of aggregate (collective) health in the workplace was developed from a conceptual framework, to expain how influences inter-relate and contribute to health in this setting. Health is conceived in positive terms, with the individual represented as the core, passing through the organisation and community, thereby depicting the interrelationships between their health. At the aggregate level four sets of factors, human biology, environment, lifestyle and health care organisation, are shown to influence health. The subjective, objective, physical, psychological and social dimensions of health are incorporated, whilst the potential of work as a stressor or health strengthening influence on health is recognised. Concepts from the model have been operationalised into composites of variables, for the assessment of aggregate health status. A measurement strategy was then devised, involving the analysis of data collected by means of an examination of organisational records, interviews with key people, a survey of a random stratified sample of members, health hazard identification in the workplace and an assessment of the provision of health care in the wider community. The survey instrument, consisting of an interview and questionnaire, was developed and subjected to a field test. The model, strategy and instrument were revised according to the results.
An investigation of different approaches to the prevention of alcohol abuse among black adolescents : a community based partnership approach.
(1994) Nkonzo-Mtembu, Lulama Lorraine.; Uys, Leana Ria.
According to Amos (1989) the use of, and the attitudes towards alcohol amongst young people in Africa is an area about which little is known but which has potentially major health implications. Neither has much been done about primary prevention in this field. The case studies which included a participatory research was conducted among three groups of people in the Clermont Township near Durban in the Natal Region. The aim of the research was to describe alcohol abuse as a social problem among the black adolescents and to compare and contrast the implementation of alcohol abuse prevention strategies that were and are used by the different groups of people in their community. The case study approach documented the work of each community. All the three groups of people who participated in the research agreed that alcohol abuse was a problem in their community. They described factors in their township which were contributory to the alcohol problems in their community and described the various cycles of negative effects and consequences to the individual, family and to the community. They agreed that in the past alcohol was not a problem in the traditional African society because of cultural and economic factors. Most interesting was the serious effects all groups described alcohol abuse amongst both teachers and the pupils in the Black education system. Each group planned, implemented and evaluated a unique alcohol preventive strategy. While the youth group maintained a strong alcohol focus with an educational programme, both the adult groups moved into the more general issues of economic empowerment. All three groups also used the participation and capacity building. The willingness to get involved, and to address the problems of the groups were remarkable. The following were the research conclusions: * Material resources were relatively available in this community. * Health professionals were available in this community, but they did not follow the Comprehensive Primary Health Care approach and were not involved in community development. * Integrated drinking seemed to be in harmony with the values of these groups and could be used in the alcohol abuse prevention. An integrative, multi-faceted and comprehensive community based partnership approach was used to the multi-causal alcohol abuse prevention programmes and strategies. This strategy was successful in involving community partners and leading to the solving of the actual problems and the development of positive health behaviours. The research revealed that the development projects needed "seed money" to initiate and to maintain. Alcohol abuse prevention can be used as a vehicle to enter a community and to engage it in a health directed partnership.
The development and testing of a multi-ethnic, low literacy, family support programme for the primary prevention of child abuse and neglect in the child under five years.
(1995) Lewis, Wendy May.; Uys, Leana Ria.
The main aim of this research was to identify a family support programme which could be used as a primary prevention strategy against child abuse as a first positive step within the family, the basic unit of society, towards reducing community violence. The central focus of this intervention was that it should be appropriate for use in a multi-ethnic South African context and implementable by community health nurses or related lay health personnel with minimal training. No such programme was identified. The researcher attempted to integrate the most appropriate and scientifically substantiated features of existing programmes and develop a unique South African programme. This programme was developed and tested in a participatory manner with multiethnic communities. Community health nurse facilitators were trained and evaluated and the developed programme was then implemented by these facilitators in several sites. The influences of the developed programme were extensively evaluated. Changes in attitudes, feelings and behaviour of the child, the mother, the maternal-child interaction and the family system were explored. A quasi-experimental design with pre and post testing of the experimental group and two control groups (control 1 received social support and control 2 receiving routine clinic nursing only) was utilized. Completed analysis has yielded some exciting and provocative results. There are clear differences in each of the groups attitudes to their children. On the Mother-Child Relationship Evaluation (MCRE) positive gains in maternal-child relationship were established for the experimental group and this was greater than that of both controls (t-test = 4.151 @ alpha = 0.0013; H=4.0734 @ alpha = 0.04 and F=7.031 @ alpha = 0.0004). On the Family Assessment Device (FAD) some limited changes were observed in the experimental group over the controls (F= 3 .33 @ alpha = 0.05). This is a positive outcome indicating that the family support programme evidenced significant changes in the participants relationships with their children and in their families and wider social life. Mothers and facilitators qualitative feedback reported positive interaction with young and older children and changed maternal and child attitude and behaviour. Despite the critical shortage of staff in community health settings facilitators continue to implement the programme voluntarily in their service settings.
The integration of diagnosis, treatment and rehabilitation of psychiatric patients into primary health care in the Eastern Cape.
(1996) Sokhela, Effie Nobesuthu.
The purpose of this study was to design and implement the two phases of a three-phased approach to the integration of the psychiatric component into the PHC system in the Eastern Cape. The study included an educational approach in which the PHC nurses were trained to diagnose, treat and rehabilitate psychiatric patients. Case studies and surveys were used to collect data. A sample of six clinics in which twenty registered nurses were trained was conveniently selected. Nurses had to volunteer so that 50% of the registered nurses would take part in the study. Each clinic was seen as a case in which a record review and questionnaires were used to collect data. The data revealed that, given the training in the diagnosis, treatment and rehabilitation, nurses could provide the first line of psychiatric care efficiently if there is a backup support from a team of consultants at the secondary health services and a support and supervision from an advanced psychiatric nurse.
An exploratory analysis of differently focused women's organizations in community development and health.
(1996) Mogotlane, Sophie Mataniele.; Uys, Leana Ria.
Two research methods, a correlational survey and a case study method were used to explore the impact of health focused and economic focused women's organizations on community development and health. Through the study the following questions were answered: (i) Is there a difference in the health and development indicators of the households of Elim Care Group Project members, Akanani members and members of the community who do not belong to any of the organizations? (ii) What contribution have these organizations made to individuals' and/or communities' way of life? (iii) What aspects of these organizations' structure and/or function strengthen or weaken the organization? For the correlational survey, quantitative data were collected from three categories of thirty households each that belonged to Care Group members, Akanani members and community members who did not belong to any organization. The analysis of the data showed that both the health focused and economic focused organizations kept their focus even though their functioning tended to overlap. The health focused group had a greater impact on health indicators e.g. number of diarrhoea episodes, respiratory tract infection episodes, nutritional state, while the economic focused group had greater impact on development indicators e.g. housing, income and education. The improvement in the development indicators did not influence the health indicators directly. The qualitative data collected for the case study provided an indepth information about the case studied. The health focused organization demonstrated stability in its management. This was composed of health personnel under the employment of the Department of Health Managing the Care Group was a paid job for them. The organization was established and supported by the community and therefore expressed the community's concerns. The economic focused organization provided opportunities for the rural people to establish money making enterprises. Some of the problems shown in this study in this regard relate to poor managerial and business skills that resulted in the production of products that were not readily marketable in the locality. This caused a lot of anxiety amongst members as earnings were irregular. The differences in the structure and functioning of the groups were analysed. These influenced the effectiveness and continued viability of the organizations.
An epistemological study of the power of women as nurses : a phenomenological approach.
(1996) Van der Merwe, Anita Serdyn.; Uys, Leana Ria.
Aim: The aim of the study was to do an epistemological analysis of the power of women as nurses working in one of the larger and more deprived regions of South Africa, namely KwaZulu-Natal. This research was based on the premises of the Standpoint theory. Concurrent to the collection of data, a literature review and a concept analysis of power, powerfulness, powerlessness and empowerment were done and incorporated where applicable in the final theoretical framework. Methodology: A phenomenological approach was used. This incorporated two to three in depth interviews with each participant, lasting an average of thirty minutes each, was used. Women, relating to the gender factor, as nurses were also marginalised in terms of class, as they belonged to the enrolled category of nurses, and race, being African. A fourth selection criterium was added to analyse the reality of locality, called rurality. The researcher applied the principle of theoretical saturation and a total number of nine women, who belonged to the enrolled category of nurses and who worked in a distinct rural health care setting, were interviewed. A second group consisting of five women enrolled nurses and working in an urban setting were interviewed, as were a third relatively contrasting group of four women registered nurses. All forty four interviews were audio taped and transcribed, and a qualitative software package called NUD*IST was used to identify and refine experiential themes. Findings: The relationship between power and rights was often layered in contradiction during the interviews and the participants portrayed a picture of being oppressed or marginalised and powerless. The women as nurses belonging to the enrolled category were alienated as women and as nurses in terms of being severed from the nursing profession and from the ruling gender of men, of being lost in an ever present routinization of activities, of being misused, maternalised and domesticated at home and at work. These phenomena were quantitatively more voiced by the rural group of women and these participants strongly emphasized the limiting influence of their prescribed scope of practice, the approach of the senior category of nurses and they conveyed a traditionalist and altruistic view of nursing and nurses. The women as registered nurses created their own freedom often away from their men as in divorce. They also sought for solutions concerning powerlessness in more global and distant terms, for example in relation to cultural practices. They communicated a sense of empowerment in terms of for example education, personal qualities and increased job satisfaction. Culture rather than race was emphasized as an essence of womens' oppression. An epistemological framework of the power of women as nurses developed by the researcher constructed the totality of empowerment in terms of fifteen transformational and hierarchial actions incorporating and adapting Dooyeweerd's theory of modalities and the surfaces of class (categorial divide), gender (the eternal carer), race (culture) and locality (rurality). These actions and reformulated concepts could be used for the development of specific strategies to facilitate the empowerment of individuals, groups and communities of women as nurses and nurses as women. Further collaborative research into the phenomenon of power, a reconceptualization of nursing education and levels of expertise and hierarchies within nursing were some of the suggestions for the way forward.
An analysis of the influence of multilevel leadership on the effectiveness of provincial hospitals in the Kwazulu/Natal Province.
(1998) Mabaso, Mokgadi Susan.; Uys, Leana Ria.
The purpose of this study was to describe and identify the leadership style that prevails in health care institutions, in order to establish the influence of multilevelleadershipon the effeciveness of hospitals in KwaZulu-Natal. Hunt's extended multilevel leadership Model was used as a conceptual framework. Six institutions were selected by random sampling, categorised into three sizes i.e. large institutions with number of beds above 400, midddle sized between 200-400 and smaller institutions with a bed state below 200. Three categories of leaders were as top, middle and operational leadership. The 8 leaders included the chief medical superintendent, the hospital secretary, the chief nurse manager, two area nurse managers and the three operational nurse managers in each of the six institutions. A total of 48 MLQ instruments designed by Bass and Avolio (1989) focused on leadership style was used to identify transformational, transactional and nonleadership styles. 121 Questionnaires were distributed to staff and community to measure hospital effectiveness. Interviews were carried out on patients and visitors to establish patients' satisfaction. The effectiveness of health care services was described by goal attainment, level of support and system's achievement. The instruments to measure goal attainment and level of support were designed by the researcher. The 6 institutions were measured for system's achievement by using the instrument designed by Beattie, Rispel and Cabral (1995). The criteria used to assess infrastructure, access to the institution, management of personnel, management of resources, patient satisfaction, community outreach programmes and the process of care, was based on the criteria developed by Beattie, Rispel, and Cabral (1995). A correlation was done to establish the relationship between leadership style and hospital effectiveness. Findings; the area manager exhibited the leadership style that is predominantly Transformational, the other four categories identified in the study, revealed a leadership style that was predominently Transactional. Of the six institutions two revealed a transfomational leadership style and three revealed a transactional leadership style. One institution reflected a Laissez-Faire leadership style. The overall leadership style was transactional. On comparing the three effectiveness criteria goal attainment was identified as the most effective area of achievement followed by system's achievement and the least being level of support. A MANOVA multivarate analysis of variance revealed that the relationship between leadership style and goal attainment was not significant. The relationship between leadership style and level of support was significant. On further analysis using the Shetre test, it was found that the level of support was significantly related to transformational leadership. The relationship between leadership style and stystem's achievement was not established, because the sample size of six institutions was too small. The overall relationships between leadership style and hospital effectiveness was significant at p-< 0.01 level. Recommendations; included that all all categoties of leadership at institutions are to increase their diagnostic level of awareness of their leadership styles. Rigorous education and training on leadership and support were essential. A further recommendation was that the methodology used in this study to measure hospital effectiveness be used more widely as a management tool. A common instrument used to evaluate acceptable standards of health care assessment should be used to ensure comparison between and within institutions in KwaZulu- Natal There was a need for further research to establish the influence of leadership style on hospital effectiveness in order to ensure quality care by health care providers and to increase professional efficiency and effectiveness in the hospitals of KwaZulu-Natal.
An investigation into the needs assessment phase of the health education process for school children.
(1998) Tanga, Tobeka Thelma.; Uys, Leana Ria.
This study investigated the needs assessment phase of the health education process for school children. The objectives of the study were to identify health education needs of school children using three approaches, namely, the epidemiological, consumer and social science approaches. In the social science approach, a PRECEDE model has been used. Time taken in using each approach and the skills of PHC nurses necessary to use each, were investigated in order to determine the most effective and efficient approach. A comparative case study design has been used, whereby each approach was considered as a case, hence, an embedded case study. One rural administrative area in the district of Umtata, which has a health centre in its catchment area, was selected. The population for the sudy were school children aged 12 to 16 years doing standard five. Four out of ten Junior Secondary schools in the area were randomly selected. In the epidemiological approach, records from the health centre and three of the four selected schools were analysed. In the consumer approach, focus group interviews (two groups of boys and two groups of girls) were conducted. In the social science approach, focus group interviews of school children(four groups) from the other two remaining schools, focus group interviews of mothers as carers( four groups), and in-depth interviews of standard five teachers from each of the four schools were conducted. Data analysis was done using Tesch's method of qualitative data analysis.A time activity sheet was used to estimate time used in each approach. A questionnaire was distributed among PHC nurses to determine their skills in relation to the approaches used. Results showed that the social science approach was the most comrehensive approach but used the longest time. The consumer was balanced and efficient though the least time was used. The epidemiological was found to have identified physical problems to the exclusion of the social and psychological problems.
An exploration of the presence and enactment of caring in the human resource management of nurses in KwaZulu-Natal hospitals.
(2000) Minnaar, Ansie.; Uys, Leana Ria.
The aim of the study was to explore the practice of caring in human resource management of nurses. Both the qualitative and quantitative research approaches were used to ensure that the richness and the complexities of caring is reflected in the study. A qualitative analysis of the interviews vvth nurse managers and nurses indicated that they saw caring as an important part of their task. They saw caring in human resource management of nurses mainly as dealing with the interpersonal aspects- personal problem-solving-, development and growth-, welfare needs-, and HIV/AIDS issues related to nurses. A quantitative survey of nurses from different levels was done to explore the presence and enactment of caring in the formulating strategies, structuring the work, workforce planning, staffing process and in the utilising and maintaining of nurses. It was found, according to respondents that caring was not present to satisfactory levels in the human resource management process of nurses, although caring concepts, as well as Christian principles, were present and clearly described in the mission, philosophies and goals and objectives of the hospitals. The fact that nurse managers are not solely responsible for the experiences of nurses and the way nurses expressed themselves on the caring issues in human resource management in the study should be emphasised. Organisational factors such as salaries and benefits of nurses, shortage of nurses at national and international levels, organisational structures and other financial ccnstrains in hospitals, contribute to the experiences of nurses in this study. Health service administrators, nurse managers and nurses should all take the responsibility to find means to improve and instil caring in hospitals. Therefore the decision to train nurse managers and to upgrade the management knowledge and the implementation of caring concepts in nursing management with relevant care and support to HIV/AIDS nurses, is of the utmost importance to equip nurse managers to survive in these demanding circumstances in the hospitals.
An analysis of the current basic nursing education systems of francophone African countries of the World Health Organization Afro region.
(2001) Ganga-Limando, Richard Makombo.; Gwele, Nomthandazo S.
It is against the background of new developments and initiates taking place in various countries to make basic nursing education systems more responsive and relevant to the ever-changing nature of society that a cross-national study of the current systems of basic nursing education of francophone African countries of WHO Afro Region was undertaken. The aim of the study was to describe and analyze the current systems of basic nursing education in Francophone African countries of WHO Afro Region with 'a view to providing guidelines for change toward a basic nursing educatian system that is in line with the recommendations of WHO (1994, 1985, 1984, 1966) and the various countries' health care delivery systems' policies. In the first phase, data was generated by means of a self-completion mailed questionnaire, administered to the members of the national regulatory bodies of nursing and nursing education from eighteen countries. The design of the above named questionnaire was based on the WHO (1994, 1985, 1984, and 1966) recommendations pertaining to basic nursing education systems. The main results of the findings of this phase showed two major trends. Firstly, more differences than similarities existed between the WHO (1994, 1985, 1984, and 1966) recommendations and the current basic nursing education systems of the countries under study. Secondly, discrepancies existed between the various countries' health care delivery systems' policies and the existing systems of basic nursing education. Finally, all the respondents expressed the views that the current basic nursing education systems are faced with educational and organizational changes and they agreed that there is a need to change the current basic nursing education systems. In the second phase, data was generated by means of three rounds Delphi questionnaires, administered to the national members of the regulatory bodies of nursing and nursing education as well as the members of national nursing associations from eighteen countries. The design of the first round Delphi questionnaire was based on the results of the first phase of this study, while the preceding round informed the design of the questionnaire of the next round. The main results of the findings showed similarities between the future orientation of the basic nursing education systems and the recommendations of the WHO as well as the global trends in the development of the basic nursing education. The stakeholders expressed the view that the national governments, the National Associations of Nurses and the Regional Office of WHO Afro Region need to play an active role in the transformation and the development of the basic nursing education systems in the Region. They suggested that the systems of educating nurses should move toward meeting the demands of the health care services and the global trends in the development of nursing and nursing education.
Description and analysis of the process of implemetation of the national qualifications framework (NQF) in nursing education (NE) in South Africa.
(2001) Maqutu, Lucy Kathleen Nonkosi.; Uys, Leana Ria.
The intention of this study was to describe the implementation process of the NQF in nursing education at central and provincial levels in order to explore the change process. It deals with this process as follows: Implementation of NQF in nursing education.; Organizational health at central and provincial levels.; The change strategies used at these levels.; The implementation level reached. It is a qualitative study of an enthographic type to describe and document the implementation of the NQF as it occurred. The researcher who was part of the group that generated the culture of learning in nursing, directly participated in the activities and events as they occurred at this initial stage of implementation of the NQF. A discussion between the researcher and nurse educators took place on strategies used and whether they find the existing environment promoting changes. The research techniques used for gathering information were interviews and documents. With this information the researcher was able to reflect, make inferences and interpretations. The state of nursing education was described within the organizational self-renewal strategies described by Owens (1998). The description of the process of implementing the NQF was viewed against the change strategies as described by Bennis, Benne and Chin (1969), which are the empirical rational, normative re-educative and power coercive. The stage of implementation of the NQF in NE that has been achieved has been assessed using the NQF principles as a yardstick. The data collected is largely qualitative and its analysis has been qualitative. The categories of the theoretical framework which are inputs (organizational health); process (change theories); and outcomes (awareness, planning, use and refinement) of the NQF principles, have been used to analyze the data. The findings on organizational health reveal that nursing education is a healthy organization at both central and provincial levels. It has taken the opportunity presented by the NQF to address some of its organizational problems such as the Scope of Practice for nurses and midwives. There are, however, problems in making final decisions about the planned implementation of the NQF because of differences in vision about the future of nursing education. The movement of nursing education (NE) to higher education (HE) is hampering progress because the National Government is not implementing the Education Act No. 101 of 1997 which has moved NE to HE. Both the South African Nursing Council (SANC) and Natal College of Nursing (NCN) have no coherent human resources development policy. At both the central and provincial levels of NE normative re-educative strategies are ones that have been used extensively rather than power coercive strategies. Empirical rational strategies were also made use of to identify the advantages of the NQF policy and to incorporate them into the planned changes. There is full awareness and planning for the implementation of all the principles of the NQF. The principles of the NQF that are already in use and are being refined are integration of education and training, relevance, credibility and legitimacy.This is because they had already been in use in nursing education and practice before the inception of the NQF policy.
Development and testing of a model for implementation of recognition of prior learning.
(2001) Khanyile, Thembisile.; Uys, Leana Ria.
The Minister of Education's public statement In August 1999, that South African citizens should mobilize and build an education and training system for the 21'st century . among other things emphasized the application of procedures for recognition of prior learning as part of the restructuring process. On the other hand the resolution taken by the South African nursing Council at the beginning of 2000. that enrolled nurses should be upgraded through the process of recognition of prior learning further increased the urgency for nursing education institutions to develop and implement RPL policies In South Africa, Recognition of Prior learning (RPL)is seen as an appropriate approach to offer equity and redress of past imbalances in the education and training system. The purpose of the study was to develop and test an appropriate model that could be used for Recognition of Prior Learning for nurses. To test the model, it was implemented in a form of pilot projects by three institutions. It was important for the model development to identify and involve all the stakeholders of the nursing education system. An appropriate design for the study was a multiphase decision oriented evaluation research . Stuffelbeam's Context. Input, Process and Product evaluation model was used to guide the research process. The first phase was the development of the model which involved the Context evaluation. During the context evaluation phase, the Education Committee of the South African Nursing Council and the evaluative researcher developed the guidelines for the RPL process. These were refined by the stakeholders during the regional workshops. The results of this phase was the RPL guidelines. The second phase was the Input and the Process evaluations. Each institution had to make planning decisions for Implementation. The result was RPL policies for each institution Thereafter. the three institutions Implemented the RPL guidelines to specific target groups of nurses that were identified for the purpose of the pilot project. Data collection instruments varied according to the phase of the model development. Checklists were used to measure the extent to which each Institution had followed the RPL guidelines Dunng the Product (evaluation) phase. candidates' scores were compared with those of other candidates who accessed the specific programs through the traditional entry routes. According to the results all RPL candidates were successful In the programs they aimed at accessing DUring the testing phase after access, the RPL candidates compared favourably with other the other candidates who accessed the programs through traditional routes . The result indicate that the self- directed approach used during RPL helped the candidates in the actual programs. A process onented and competency- focused model was developed through an inclusive process. Nursing education Institutions and policy makers can use the model to structure and evaluate RPL implementation in nursing education institutions in South Africa.
Spiritual care in nursing : a grounded theory analysis.
(2001) Mahlungulu, Sarah Nomalizo.; Uys, Leana Ria.
There is scientific evidence that the spiritual well-being of a person can influence the quality of life lived and the general responses to life's crises of illness, pain, suffering and even death (Ross, 1994). The problem that was identified in this study was the absence of an explicit description or the phenomena of spirituality and spiritual care in nursing within a South African context. Concept clarification was imperative ifnurses, patients/clients in South Africa were to realize spirituality and spiritual care within a broader context of holistic nursing. The purpose of the study was to conceptualize the phenomena of spirituality and spiritual care from the perspectives of nurses and patients/clients with an aim of generating a middle range theory of spiritual care in nursing that explained the phenomena by utilizing data that were grounded in the participants' experiences. A qualitative mode of inquiry using a grounded theory method was applied. A sample of 56 participants composed of 40 nurses, 14 patients and 2 relatives of patients was recruited by theoretical sampling procedure from two hospitals, and one hospice settings. Data were collected by utilizing focus groups interviews followed by one to one in depth interviews and observations. An audio tape recorder was used to record the conversation, field notes and memos were also kept to strengthen the data, and to ensure trustworthiness. Data were collected and analyzed simultaneously. A software called Nvivo was used to code data into different levels of coding. The results were rich descriptions of the phenomena in question and a development of a theoretical model for spiritual care. The concept of spirituality was described as a unique individual quest for a transcendent relationship by establishing and maintaining a dynamic relationship with self, others and with God as understood by the person. The ability to establish and maintain a meaningful transcendent relationship seemed to be related to the person's beliefs, faith or trust. 99% of the participants expressed their quest for a transcendent relationship through organized religion while I % claimed to have their spiritual fulfilment outside an organized religion. The phenomena of spirituality and spiritual care were conceptualized as occurring in phases which begin with a comfortable zone, trigge r-response and spiritual caring. The nurses role in spiritual care was perceived as based upon the principles of ubuntu. compassion for human suffering and pain and acceptance of a patient/client as a unique being. Nurses carried their spiritual care roles by accompanying, helping, presencing, valuing and intercessory roles. The outcomes of spiritual care were cited as hope, inner peace, finding meaning and purpose in life, illness, and in death.
Facilitating collaboration between traditional healers and western health practitioners in the management of chronic illnesses in Swaziland.
(2001) Dlamini, Priscilla Sibongile.; Uys, Leana Ria.
The purpose of the study was to analyze the process of facilitating collaboration between traditional healers and western trained health care workers in the management of chronic illnesses, hypertension and diabetes. This process was facilitated through qualitative participatory action research which utilized the principles of Action Science Enquiry. This was a qualitative research. Two phases were as followed: phase one was the analysis of the problem of collaboration while phase two was the implementation of strategy one and two. Strategy one was the development of the constitution of traditional healers towards the establishment of the Swaziland traditional Healers' Council and a traditional healers' department within the Ministry of Health and Social Welfare. Strategy two was a small comparative survey into the safety and efficacy of traditional medicine. The survey compared clients who utilized only traditional medicines and those who utilized only western medicines to control their hypertension. Data was collected through interviews, meetings, observations and clinical measurements. Audio-taped and field notes were transcribed, carefully studied and analyzed. The editing analysis described by Crabtree and Williams (1992) was utilized in the analysis of data. The results of phase one was a descriptive profile of traditional healers and the way hypertension and diabetes were managed by the traditional healers and the western trained health care workers, with the aim of finding out how they could collaborate. A number of barriers for collaboration were identified such as the lack of a legal body of traditional healers, negative attitudes of western trained health care workers towards clients and traditional healers, ethical issues, perceptions of illnesses and payments as well as the lack of transparency. Enhancers for collaboration were also identified. Consequences of a successful collaborative process were established by the participants. Strategies to solving the problems of collaboration were identified and two of the strategies were implemented. A traditional collaborative model was identified and compared to an existing modem collaborative model. Phase two, strategy one, the legalizing of traditional healers in Swaziland, was decided upon during one of the meetings held between traditional healers, clients and western trained health care workers. Barriers to successfully organize this strategy were also identified, such as organization and exclusion, leadership style, traditional and cultural structures, lack of resources, poor communication and different traditional healers' categories. Action plans to solve those problems were developed and progress was made. The end result was that a draft of the traditional healers' constitution content was developed. Stakeholders who would be part of the development of the constitution were contacted. The stakeholders included the Ministry of Health and Social Welfare, the Ministry of Natural Resources and Agriculture, the Swaziland World Health Organization, the Ministry of Justice and the University of Swaziland. The traditional healers managed to form an interim committee called the Traditional Healers' Constitution Development Committee. This committee was still in a process of involving all traditional healers in Swaziland to furnish their views and opinions to the committee concerning the constitution. The target date for the constitution to be completed was set to be around April, 2001. The researcher will still be working with the committee until the legalizing process is completed. This would take another one year to complete. Phase two : strategy two, establishing the efficacy of traditional healers' medicines to control hypertension was established to enhance trust between the traditional healers and the western trained health care personnel. From the small sample, it would seem that fluctuations of blood pressure levels were similar between the two groups. This showed that traditional healers medicines to control hypertension in Swaziland is effective. Though it was difficult to establish the safety of those clients who utilized only the traditional medicines, there were no abnormalities discovered to be associated with the use of the traditional medicines.
A grounded theory analysis of the meaning of community-based education in basic nursing education in South Africa.
(2003) Mtshali, Ntombifikile Gloria.; Gwele, Nomthandazo S.
An extensive review of literature revealed that although CBE was a familiar concept and a national policy for health professionals' education in South Africa, there was, however, limited understanding of this phenomenon. Most of the existing CBE programmes were a reaction to the inadequacy of traditional nursing education and had emerged without any intellectual discourse on the phenomenon CBE. The aim of this study was to analyse the phenomenon CBE in basic nursing education and the meaning attached to it. Furthermore, the researcher aimed at developing a middle-range theory of CBE. Strauss and Corbin's (1990) grounded theory approach was used to guide the research process. The South African Nursing Council's (SANC) education committee and seven nursing education institutions with CBE programmes were included for participation in the study. Data were collected by means of observation, interviews and document analysis. Purposive and theoretical sampling was used for selecting interviewees, resulting in a total of 41 interviewees. Data collection and initial analysis took place concurrently. Descriptive analysis followed by conceptual analysis was performed using Strauss and Corbin's paradigm for qualitative data analysis. The primacy of the community as a learning environment, timing of first exposure, duration, frequency and sequencing of community-based learning experiences, as well as service provision, emerged as discriminatory core characteristics of CBE in basic nursing education. Irrelevance of traditional nursing education and political change emerged as antecedents of CBE. The need to respond to national health policies and community health needs was seen as conditions under which CBE had to operate in South Africa. The nature of the CBE educative process, which placed emphasis on active learning and curriculum relevance, emerged as essential for the realization of expected outcomes of CBE in basic nursing education. Based on these results, it was concluded that CBE in basic nursing education in South Africa is (a) relevant education, (b) responsive education, (c) education for social justice, (d) a conscious and deliberate PHC socialisation process and (e) a process and outcomes education. As this was a ground breaking study on the meaning of CBE in basic nursing education in South Africa, a number of further research studies are recommended.
The development of an intervention model for managing abrupt death trajectories in KwaZulu-Natal level 1 emergency departments.
(2004) Brysiewicz, Petra.; Uys, Leana Ria.
AIM: The aim of this research was to describe how the health professionals manage sudden/abrupt deaths in the ED and to foster change in current practice by involving the clients (dead or dying clients and their families) and the health professionals. METHOD: Action research was the approach used in this four year research project, and co-researchers (nurses) from three Level I ED's in KwaZulu-Natal were actively involved in shaping and guiding the project. The participants involved in the research were health professionals, bereaved families and mortuary staff members. FINDINGS: An intervention model, the Dealing with Sudden Death Model, was developed in order to guide the therapeutic management of sudden/abrupt deaths in ED's. Along with this was the development of the family pamphlet, the Preparation Checklist and the Incident Evaluation Checklist. Following the implementation of this model the health professionals emphasized the fact that this model provided guidance and meaning to the care rendered to the dead or dying client, the bereaved families and fellow colleagues. The Dealing with Sudden Death Model had resulted in a production of knowledge and planned changes in the management of sudden/abrupt deaths in the ED's.
The development of an HIV/AIDS counselling approach for Africans.
(2004) Pienaar, Abel Jacobus.; Uys, Leana Ria.
HIV/AIDS care needs to be comprehensive and holistic (UNAIDS, 2002). Counselling has proved to be one of the most effective behavioral tools in the global anti-HIV/AIDS fight by equipping people mentally, emotionally, psychologically and socially for the disease (Anon, 2000). Over the past two decades researchers identified cultural factors, race, gender and class as leading inequitable treatments in general counselling situations (Coleman, 1995). This challenge happened to be the same in HIV/AIDS counselling, especially because the counselor work with sensitive information. Nurses who forms the back-bone of HIV/AIDS counselling, are all trained on a Western model of HIV/AIDS counselling. Herbst (1990) also pointed out that knowledge concerning cultures and subcultures and its implications has become a major issue for the nurse to deliver health care in South Africa. Faced with the history of South Africa and the diverse cultures it was my personal experience as a professional nurse, counselor and researcher while I was working on the *Ufe health train, that the knowledge of culture is one of the most important factors of HIV/AIDS counselling. This motivated me to embark on this research. This research aims at providing an analytical description of the experience of counselling for African (Batswana) counselees and their counselors with specific reference to HIV/AIDS counselling with view to improve this interaction. The objectives of this research was to: a) analyse the counselling done by Western and African counsellors in the health system, with a particular focus on HIV/AIDS counselling, b) establish how acceptance and decision-making is promoted, understanding of the counselee is established and psychosocial support is given, and c) develop a middle -range theory that describes appropriate HIV/AIDS counselling for African counselees. Glaser's (1965; 1967; 1992) grounded theory approach was used to guide this research. Multiple data collection methods were used, which took place concurrently with the descriptive analysis. Glaser's conceptual analysis paradigm for qualitative data analysis was utilised. Based on the results of this research the importance of an HIV/AIDS counselling approach for Africans is emphasised.
Planning and implementing distance learning in Rwanda.
(2005) Mukamusoni, Dariya Mahuku.; Gwele, Nomthandazo S.
Distance Learning (DL) is recognized to be a contemporary mode of education delivery. It is used to respond to the need of human resource development in developing countries. The evolution of Information Communication Technology (ICT) is seen as an opportunity for the development of DL. DL through ICT is perceived as an opportunity for meeting most of the challenges of higher education systems in Sub-Sahara Africa in general, and in Rwanda in particular. Planning and implementing DL as an innovation in the education system of Rwanda are processes which need to be understood if DL is to expand and contribute to human resource development in different sectors. The aim of this study was to analyze the process of planning and implementing DL in tertiary health professional education in the Kigali Health Institute and in tertiary teacher education in the Kigali Institute of Education, in order to understand the dynamics of planning and implementing DL, and to suggest the way forward for the success of those two programs. Concepts taken from innovation Havelock's problem solving strategy (1982) and social system theories in particular Owens's open sociotechnical systems for schools (1998) were combined to form the framework which guided this study. A qualitative case study, using a comparative descriptive approach, was the research design. The participants were drawn from (a) policy makers in the ministry of education, ministry of health, ministry of public services and the Rwanda Information Technology Authority (RITA); (b) management in the participating institutions; (c) the teaching staff, especially those who were involved and/or are still involved in the process; (d) students; (e) and members of professional regulatory bodies. Purposive and theoretical sampling was used to select the participants. Twenty one informants were interviewed. Three focus group discussions of six, four and eight participants respectively were conducted. In addition document review and analysis, and physical artefacts served also as means of data collection. The results showed that systematic planning with a comprehensive document and strategic plan as outcome of the planning process are essential for the successful implementation of distance learning in Rwanda. Supportive and responsive institutions and suprasystems are indispensable to a conducive environment for planning and implementing DL in Rwanda. From the results, recommendations for the progress of the two programs that were part of this study were put forward. A framework of planning and implementing DL in Rwanda was developed based on these results. This framework may be used by policy makers, educators and other parties interested in the development of DL in Rwanda.
The development of a district-based model of intervention for improving the quality of maternal health care at primary level.
(2005) Voce, Anna Silvia.; Uys, Leana Ria.
The Limpopo MCWH Directorate, concerned about the high perinatal and maternal mortality rates arising from the poor quality of maternal health care provided at primary level, commissioned this study to explore what would be the appropriate interventions that could be applied province-wide to improve the quality of maternal health care at municipal and district level. Thus the study aimed to develop a useable and replicable model of intervention with Reproductive Health Management Teams (RHMTs) at municipal and district level that would lead to improvements in the quality of maternal health care. The study objectives were to: 1. Identify indicators and the method for a baseline assessment of the quality of maternal health care at municipal and district level. 2. Identify indicators that would permit an analysis of the factors that influence the key issues emerging from the baseline assessment. 3. Develop a programme of intervention, with its monitoring and evaluation procedures, that would address the factors that influence the key issues. 4. Recommend a strategy for replicating the intervention programme. An action-research approach was adopted in this study, and was implemented in a series of cyclical action-research steps in cooperation with the RHMTs. The study was implemented in 25 municipalities in Limpopo Province and was implemented over a period of 28 months, from December 2001 to March 2004. Both qualitative and quantitative methodologies were used. Indicators were identified to conduct a baseline assessment of the quality of maternal health care; the tools were developed to collect the data necessary to calculate these indicators; the indicators were applied to achieve a baseline assessment of the quality of care, and the information analysed to identify priority key issues affecting the quality of maternal health care. These key issues were identified as: the poor quality of the 1st ANC visit and poor management of labour. These key issues were analysed in order to identify what were the most important influencing factors affecting the quality of maternal health care. Staffing, supervision, referral systems, support services and the planning and organisation of the health facilities were found to be the most influential factors. Indicators were developed to measure these factors, with the data collection tools required to collect the data necessary to calculate the indicators. The indicators were measured to describe the current situation with regards to each. Once the influencing factors had been identified, interventions were identified, prioritised and planned for implementation in each municipal area. The priority interventions that could be implemented at municipal level were: in-service training in antenatal care and the management of labour; supervision of antenatal care and labour; audit of the service and improving referral systems. Tools were developed to monitor the implementation of these interventions and the outcomes of monitoring reported. The model to improve the quality of maternal health care developed in Limpopo Province is possible to implement within the context of health services in South Africa. A limiting factor to full implementation may well be staffing shortages, although this study did not set out to establish the degree of influence that staffing shortages do actually exert. The real challenge to full implementation, however, lies in the ability of managers at different levels to work together to support quality service delivery, and for providers to deliver an integrated, comprehensive service to pregnant women. Municipal and district level Reproductive Health Management Teams, with a full mandate and good leadership, managerial, clinical and public health skills, have the potential to address the most critical factors at the local level that are influencing the quality of care.

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