A best practice guideline for a healthy work environment for professional nurses working in the South African Military Health Service
- Authors: Mabona, Jean Fezeka Madi
- Date: 2018
- Subjects: Nurses -- Employment -- South Africa , Medicine, Military -- South Africa South Africa -- National Defence Force -- Medical care , Work environment -- National Defence Force -- Medical care
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/30811 , vital:31146
- Description: Governments, internationally and nationally, are becoming aware of the importance of healthy work environments within their health departments, environments that are caring and supportive to health professionals. This awareness is brought about by the mounting evidence that healthy work environments are critical to recruiting and retaining health professionals. On the other hand, unhealthy work environments can contribute to medical errors, ineffective delivery of care, and conflict and stress among health professionals in the clinical setting and faculty shortage that can compromise academic excellence in the academic setting. The professional nurses working in the South African Military Health Service (SAMHS), a branch of the South African National Defence Force (SANDF) could experience the military environment as unhealthy because it is rigid and controlled. The hierarchical rank structure could deprive them of their autonomy as the decision-making powers are directly proportional to the rank. Stressful conditions could be experienced when these professional nurses are taken away from the well equipped hospital environment to the deployment areas away from home. There was, however, no evidence found on the work environment of professional nurses in the SAMHS during literature review. The aim of the study is therefore to explore and describe the experiences of professional nurses working in the SAMHS and their understanding of a healthy work environment and the scope and nature of a best practice guideline, then to integrate the evidence generated to the evidence emanating from the critical appraisal of the existing best practice guidelines from other health settings in order to develop a best practice guideline for a healthy work environment for nurses in the SAMHS. The study adopted a qualitative, exploratory, descriptive and contextual research design. The research study was made up of three phases. In Phase 1, semi-structured interviews were conducted with professional nurses to collect information on their experiences of working in the SAMHS and their understanding of evidence-based best practice guidelines. The interviews were transcribed by an independent transcriptionist and data analyzed using the eight steps of data analysis as suggested by Tesch. Themes were identified and grouped together to form new categories. The process of coding was supported by an independent coder. Lincoln and Guba’s model of Page | vii trustworthiness consisting of credibility, transferability, dependability and confirmability was used to ensure the validity of the study. An integrative literature review was conducted where the existing evidence-based best practice guidelines for healthy work environment for nurses were searched for, appraised, had data extracted and were synthesized in Phase 2. In Phase 3, evidence generated in Phase 1 and Phase 2 was triangulated, forming recommendations that were utilized to develop a best practice draft guideline for a healthy work environment for professional nurses working in the SAMHS. The draft guideline was sent to five expert reviewers for their comments and recommendations. These were considered in the development of the final guideline. The final guideline consists of several recommendations in four themes: the need for effective leadership to create an empowering environment; effective communication amongst members of the health team; a culture that supports team work, and; the need for an environment that promotes professional autonomy. Further recommendations were made to address factors that impact negatively on enhancement of a healthy work environment. The guideline is intended for use by SAMHS’ leadership, at Levels 2, the strategic level, Level 3, the formation level and Level 4, the unit level (hospitals, sickbays and clinics and nursing college) and all professional nurses working in all the military health institutions of the SAMHS, including the military clinics, sickbays and hospitals irrespective of positions. However, the guideline may also be adapted by nursing institutions outside the military such as public and private hospitals and clinics where they find it applicable. Results
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- Date Issued: 2018
A best practice guideline for clinical teaching at a public college of nursing
- Authors: Gcawu, Sybil Nyameka
- Date: 2018
- Subjects: Nursing -- Study and teaching , Clinical medicine Medicine -- Study and teaching
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/30194 , vital:30860
- Description: Clinical teaching is a critical component of the education and training of undergraduate nursing students. It determines the level of clinical competence that nursing students achieve during their studies. It should be informed by current best practice evidence available in the nursing care literature (Emanuel, Day, Diegnan & Prys-Muller, 2011:21-22). Clinical teaching is centred around provision of patient care in clinical practice. It takes place through an interaction between the nurse educator and the nursing students. During this process nursing students are moulded so they can demonstrate minimum competency in order to be registered by the regulatory body. Nursing students learn to become competent nurses in the clinical learning environment (Baxter 2006; Nash, 2007 in Franklin, 2013:35). In South Africa nurse educators are required to be fully responsible for clinical teaching through the use of appropriate teaching approaches and learning facilitation techniques (RSA DoH, 2013:91). The overall purpose of the current research study was to explore and describe the current clinical teaching practices of nurse educators; to search, appraise, extract and synthesise literature related to clinical teaching in nursing; and to develop A Best Practice Guideline for Clinical Teaching at a Public College of Nursing in the Eastern Cape Province. This had to be realized in three phases. In Phase One a quantitative, exploratory, descriptive and contextual study was conducted. A structured questionnaire was used to collect data from the nurse educators involved in clinical teaching within the Diploma in Nursing (General, Community, Psychiatric) and Midwifery programme. The data analysed was used as the basis of Phase Two—namely, an integrative literature review of evidence pertaining to the clinical teaching practices of nurse educators doing clinical teaching within the undergraduate programmes. The evidence from Phases One and Two was used to develop a draft Best Practice Guideline. The draft guideline was reviewed by a group of expert reviewers and their suggestions were incorporated in the final guideline. Ethical considerations were maintained throughout the research study. The rigour of the research process was ensured by cognitive testing of the questionnaire, and by critical appraisal of the literature accessed from an integrative literature review. The v authenticity of critical appraisal was ensured by having the critical appraisal done by the researcher and an independent reviewer.
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- Date Issued: 2018
A model of support for divorced professional nurses in the Eastern Cape, South Africa
- Authors: Murray, Daphne
- Date: 2018
- Subjects: Divorce counseling -- South Africa -- Eastern Cape Divorce -- Social aspects -- South Africa -- Eastern Cape Employees -- Counseling of -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , Nursing
- Identifier: http://hdl.handle.net/10353/10028 , vital:35293
- Description: The purpose of this research study was to develop a support model for divorced professional nurses in the health-care facilities of the Department of Health, Eastern Cape, with guidelines to operationalise the model. Divorce is a process with psychological as well as social implications, and with a series of economic causes it also has implications in terms of the society and culture in which individuals operate. The main causes for divorce are adultery and domestic violence, especially against women and children (Lurea, 2011:99). A need for support from managers in the health-care facilities of the Department of Health, Eastern Cape during the process of divorce was identified by divorced professional nurses, since a lack of support and all the negativity that encompasses divorce could lead to severe depression, which will later have a negative effect on work performance (Abdul Kadir & Bifulco, 2010:858). The literature in this field of study, along with experience, indicates that it is imperative for divorced professional nurses to be supported in the workplace to help them to cope emotionally with their work demands, as prescribed by the South African Nursing Council. An explorative, descriptive and contextual qualitative design with theory generation was used to achieve the purpose of the study. Snowball sampling was employed to select participants, namely divorced professional nurses who were unknown to the researcher. A sample of 21 divorced professional nurses who work in health-care facilities in the Buffalo City Metropolitan Municipality in the Eastern Cape participated in the study. Data was collected by means of individual face-face interviews with divorced professional nurses. The interviews continued until data saturation was reached. Field notes supplemented data that could not be portrayed by audio-taped interviews, such as non- verbal communication in observed interactions. Data analysis was done using Tesch’s approach to open coding in qualitative research. Themes, categories and sub-categories emerged from the data analysis and were fully discussed, becoming fundamental units in the development of the conceptual framework as well as in the model. The researcher did a thorough literature review to conceptualise the identified concepts on which the model was based. The description and evaluation of the model, along with guidelines to operationalise the model, were done in accordance with the method described by Chinn and Kramer (2011:197). The justification of the research, the limitations, and the recommendations for operationalisation of the model of support for divorced professional nurses working in the Buffalo City Metropolitan Municipality of the Department of Health, Eastern Cape Province, and South Africa were indicated accordingly.
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- Date Issued: 2018
A programme of academic support for students at the public nursing college of the Eastern Cape Province in South Africa
- Authors: Senti, Nomandithini Innocent
- Date: 2018
- Subjects: Nursing -- Study and teaching Nursing -- Study and teaching -- Simulation methods
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: http://hdl.handle.net/10353/10997 , vital:36128
- Description: A comprehensive academic support at the public nursing college is important. Despite this, there is no such support in public nursing colleges in the Eastern Cape Province of South Africa. The aim of the study was to develop an academic support programme for students in order to improve their success in Higher Education. The study endeavoured to answer the following questions: What are the academic support needs of students at the public nursing college in the Eastern Cape of South Africa? What conceptual framework can be developed for the academic support programme of students? What academic support programme can be developed for students at the public nursing college? What guidelines can be developed for implementation of academic support programme of students? The objectives were: to describe academic support needs of students at the public nursing college in the eastern Cape Province of South Africa; to develop a conceptual framework for the academic support programme for students at the public nursing college in the Eastern Cape of South Africa; to develop an academic support programme for students at the public nursing college in the Eastern Cape in south Africa and lastly to describe guidelines for implementation and evaluation of the academic support programme. The research design used in this study was quantitative, qualitative, descriptive, evaluative, and theory generation. The study was conducted according to four phases. Phase one focussed on academic supports needs of the student. Phase two focussed on development of conceptual framework for the students at the public nursing college in Eastern Cape Province. Phase three focussed on the development of the academic support programme for the students, whereas phase four focussed on description of guidelines for implementation and evaluation of the academic support programme. The population of the study consisted of students undergoing training in a four-year programme at the Public Nursing College. The target population was the students in the same programme from level one to level four of training. The sampling technique used was a probability sampling with multi-stage and cluster sampling techniques being utilized. The total sample was n=333 participants. A quantitative self-developed questionnaire was used to collect empirical data. The questionnaire consisted of eight sections. Descriptive data was analysed using Statistic Package of Social Sciences (SPSS) version 24. Exploratory factor analysis was conducted on the descriptive data collected in phase one. Concept analysis and identification were done through the utilisation of exploratory factor analysis. The conceptual framework for the academic support programme was identified through the analysed factors. Fifteen factors were derived from the descriptive data. The conceptual framework of the academic support programme discussed in Chapter 5 was used also in the development of the academic support programme. It is in this chapter that assumptions, context, stakeholders, process, outcome, dynamics and, lastly, the recipient were discussed, along with a description of the programme. The programme was evaluated in accordance with the criteria for programme evaluation. The recommendations brought forward for the academic support programme were: The guidelines have to be tested for the implementation of the programme; benchmarking should be done to compare with other institutions of higher learning regarding their academic support programmes; an academic brochure regarding academic support must be available in the college and should be given to students on arrival as part of a package; and neutral researcher should conduct the same research in the same college.
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- Date Issued: 2018
A strategy to enhance the role of the church as a social service delivery agent in fighting poverty in contemporary South Africa
- Authors: Lujabe, Busisiwe Tando Tabiso
- Date: 2018
- Subjects: Community-based social services Community development
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: http://hdl.handle.net/10948/17876 , vital:28477
- Description: The possible role and involvement of the Church in social development has reemerged as an important focus of contemporary academic and religious development discourse in South Africa. There are strong voices arguing for churches and other Faith-Based Organisations to be regarded as strategic in contributing to addressing the challenge of poverty as agents of social development. Yet, as church congregations multiply throughout South Africa, they appear to be less responsive to the challenge of poverty facing South African communities, contrary to the rich history of churches in the past. The need for churches to be involved in sustainable community-driven development initiatives to fight poverty in their local communities cannot be denied nor be met with just rhetoric and scholarly dissertations by theologians and academics. The vicious cycle of poverty in our communities must be eradicated as it represents a social injustice in terms of South Africa‘s Constitution and speaks to deep structural inequalities inherent in our society. Whilst researchers have made several proposals for churches to move from social welfare and relief, there appears to be little research with a clear practical strategy which congregations can implement to enhance their social service delivery role from social relief to sustainable community development. This has left a considerable gap which the current research sought to address. This study thus responds to the call by previous research for churches to implement strategies other than mere relief. Hence, this study contributes to the religious development discourse in South Africa, by developing a strategy to enhance Church-based social service delivery initiatives from social relief efforts which are not sustainable, to community development efforts which are sustainable and which will be consistent with the current social development policy context and contextually relevant to the socio-economic challenges of poverty and its consequences in South Africa. The study was conducted in two phases. During phase one, the main purpose was to gain a deeper understanding of the historical and current involvement of the Church in providing social services which address poverty in communities, to enhance understanding of the factors which influence the provision of social services by churches, as well as to understand participants views of how church-based social service delivery can be improved in order to fight poverty. For phase two, the goal was to develop a strategy to enhance church-based social service delivery from being social relief to being community development oriented. The following objectives guided the research process: To review selected and applicable literature to gain a deeper understanding of the historical and current involvement of the Church in the delivery of social services in order to fight poverty; To explore and describe the perceptions of church leaders and congregation members of the historical and current involvement of the Church in the delivery of social services in order to fight poverty; To explore and describe the factors which influence Church-based social service delivery in fighting poverty; To explore the views of church leaders and congregation members on how church-based social service delivery can be improved in their churches to inform the development of a strategy to enhance church-based social service delivery in fighting poverty. This study employed a qualitative research approach grounded in the interpretivist social science paradigm. The qualitative research approach necessitated an exploratory, descriptive and contextual method of inquiry. A descriptive case study method was also used, with the Methodist Church of Southern Africa selected as the main case of focus. The target population in this research comprised of Christian churches with a historical involvement in social service delivery in pre-apartheid South Africa. Purposeful sampling of 5 churches was undertaken, namely; Roman Catholic Church (RCC), Anglican Church (AC), Dutch Reformed Church (DRC), KwaSizabantu Mission (KSB) and Methodist Church of Southern Africa (MCSA). Data collection was conducted in two phases. Phase one comprised a literature review; Phase two comprised gathering empirical evidence by conducting face to face semi-structured interviews with clergy and from conducting one focus group interview with congregants. The information obtained from participants was transcribed, coded and analysed using content analysis and by a computer-assisted qualitative data analysis software (CAQDAS), namely ATLAS.ti. Findings revealed a marked difference between the historical and current churchbased social service delivery suggestive of decline, accompanied by the lack of empowerment opportunities for current church leaders and congregation members in community development facilitation. Further evidence suggest the lack of cooperation between church leaders and congregation members; as well as the lack of sustainability of interventions owing to an absence of resources and the lack of capacity to create sustainable economic opportunities. Findings also revealed that church congregations are rich with people with various assets - skills, strengths, capabilities, passions, gifts, talents in various fields, which they can share with one another as congregations and communities. The discussion of findings reflected that historically, Church-based social service provision involved holistic intervention mechanisms, empowerment, collaborations and sustainability of interventions suggestive of second generation strategies of community development, while currently, Church-based social service provision involves mostly social relief and social welfare efforts suggestive of first generation strategies. The findings suggest a holistic strategy for ―reawakening the co-operativeness‖ of congregations to facilitate sustainable Church-based social service delivery towards fighting poverty in local communities. The strategy which was then developed and described with its sub-strategies, namely: Establishment of collaborative relationships Creation of empowerment opportunities Facilitation of holistic interventions The goal of the strategy is to guide church leaders and congregation members in facilitating sustainable Church-based social service programmes to fight poverty.
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- Date Issued: 2018
An intervention study for low risk pregnant women and high risk pregnant women with GDM in Buffalo City Metropolitan Municipality, Eastern Cape, South Africa
- Authors: Vellem, Nonceba Mercy
- Date: 2018
- Subjects: Diabetes in pregnancy -- South Africa Nursing services -- South Africa -- Eastern Cape -- Administration Pregnancy -- Complications
- Language: English
- Type: Thesis , Doctoral , Nursing
- Identifier: http://hdl.handle.net/10353/9723 , vital:34891
- Description: Low risk and high risk pregnant women (HRPW) with gestational diabetes mellitus (GDM) who practise sedentary life style are at risk of overweight and obesity that predispose to gestational diabetes mellitus (GDM). The purpose of the study is to describe the effectiveness of an intervention strategy of modified diet and planned physical activity implemented amongst low-risk and high-risk pregnant women with GDM in Buffalo City Metropolitan Municipality in the Eastern Cape, South Africa. Quantitative experimental intervention design and stratified random sampling was used for drawing a sample of low-risk and high risk pregnant women with GDM. A sample size 291 of LRPW and n=34 HRPW were eligible for the study. The sample frame of the study was taken from the registers of the CHCs, Frere Hospital and Cecilia Makiwane Hospital (CMH). Questionnaires were used to collect data from the low and high risk pregnant with GDM. Descriptive statistics (frequency, percentages, mean and standard deviation) were used for categorical variables. A p-value of < 0.05 was considered statistically significant. The total analysed of LRPW were n=135 and HRPW n=34 all in control group due to miscarriages, phone loss and relocation. LRPW had some risk factors of overweight (6.2 percent), obesity (15.5 percent), family history of diabetes (16.5 percent). HRPW also had overweight and obesity of (14.7 percent) and family history of (26.4 percent) as the Pvalue was statistically significant of weight was 001, MUAC Pvalue of 000 and Pvalue of BMI 000. There were alarming abnormalities of urinalysis of protein, glucose, leucocytes and blood in urine. The LRPW and HRPW had consumption of high content of carbohydrates, vegetables, fats and low in fruit, vegetables and fibre diet. Both LRPW and HRPW were also interested on the education about modified diet benefits (95.1 percent) and modified diet programs networks (87.5 percent). The barriers showed that LRPW and HRPW were low motivation (90 percent) minimal knowledge and benefits of modified diet (93 percent) and socio-cultural issues (86 percent). The majority of participants both LRPW and HRPW showed the interest in the planned physical activity benefits especially frequent education (96.9 percent) and encouragement of social support networks (90.2 percent) and convenient location (89.4 percent). But the HRPW had lower engagement than the LRPW in planned physical activity and is associated with risk of GDM. Although pregnant women were faced with fatigue and low energy (98.6 percent), as pregnancy progresses, minimum information regarding benefits of planned physical activity (87.6 percent) and the socio-cultural influence (77.8 percent). The recommendations are education on frequent use of modified diet and planned physical activity that is available, less economical and within their context. Frequent screening of all pregnant women during pregnancy of BMI, MUAC and weight and educate accordingly. The availability of dietician and physical activity speciality is needed.
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- Date Issued: 2018
Application of health belief model in developing contextual guidelines for adherence to antiretroviral treatment among adolescents and youths in Buffalo City Metropolitan Municipality District, East London, South Africa
- Authors: Mayeye, Bulelwa
- Date: 2018
- Subjects: HIV-positive children--Treatment--Management AIDS (Disease) in adolescence HIV-positive youth
- Language: English
- Type: Thesis , Doctoral , Nursing
- Identifier: http://hdl.handle.net/10353/15572 , vital:40472
- Description: Background: Adhering to the treatment instructions for a long-term illness poses a great challenge to the client especially adolescents and youths. In public health centers it is observed that most adolescents and youths on Ante Retroviral Treatment (ART) do not continue taking ART and do not honor their Art related scheduled appointments at the clinic. An increase loss to follow up among these cohorts is noticeable in Buffalo City Metropolitan Municipality district. Inconsistent adherence to ART may result in the development of resistance mutations. Purpose: The purpose of the study was to develop and describe context – specific antiretroviral treatment guidelines based on the biomedical, cognitive and psychosocial needs of the adolescents and youths at the Buffalo City Metropolitan Municipality district. Methodology: The study was conducted in two phases, phase one consisted of quantitative and qualitative approaches. For phase one an explanatory sequential mixed method of quantitative and qualitative designs was employed. The study was guided by Health Belief Model. The target population were adolescents and youths receiving ART from the selected health facilities in Buffalo City Metropolitan Municipality District in the Province of the Eastern Cape. Participants were chosen based on purposive sampling. A convenience sample of 206 adolescents and youths between the ages of 14 to 24 attending ARV clinics were approached. Ethical considerations, that is, the rights of all the participants were honoured. Data was collected using self administered questionnaires followed by semi-structured interview where face to face interviews were conducted. Reliability validity and trustworthiness of the research was ensured. Quantitative data was analysed through descriptive statistics. For qualitative approach transcrips were coded thematically. In Phase 2, context – specific antiretroviral treatment guidelines were developed to promote adherence to ART by adolescents and youths of Buffalo City Metropolitan Municipality district. Results: About 35percent of the participants indicated low adherence, 31percent for moderate adherence and 34percent for high adherence. A strong correlation between interpersonal relationship and adherence (p = 0.008), a correlation between aspect of care related to clinic and adherence (p = 0.028), a significant correlation between social support and adherence to ART (p = 0.006) and a significant relationship between self- efficacy and adherence to ART (p = 0.000) were obtained. No correlation between demographic status and adherence except for race. Results from the interviews revealed that barriers to adherence were more evident than enabling factors. Recommendations: Health service providers should strengthen ART adherence programmes for adolescents and youths by applying principles as they appear in the context – based guidelines.
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- Date Issued: 2018
Black South African men’s adjustment to divorce: a divorce-stress-adjustment model
- Authors: Muchena, Kudakwashe Christopher
- Date: 2018
- Subjects: Divorce -- Psychological aspects , Social psychology Men -- Psychology
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: http://hdl.handle.net/10948/50121 , vital:42048
- Description: The decision to divorce marks a turning point for each individual involved. It can be viewed as more than just a legal process. From a psychological perspective, it does not matter who initiated the divorce, it always comes with emotional ramifications for all those involved. Statistically there is a high rate of divorce in South Africa and there have been significant shifts in trends over time. However, black South African men’s experience of, action in, and adjustment to divorce has been relatively neglected in the divorce research, yet it is important for understanding contemporary social arrangements and processes, as well as for broadening the understanding of black South African men’s lives. How black South African men describe their situations and respond to marital dissolution may point to their positions in the gender-structured community and to how they interpret the nature of social practice, marriages, divorce and their position in society. The present study aimed at exploring black South African men’s experience of, and adjustment to, divorce. More specifically, the study developed a divorce-stress-adjustment model for divorced black South African men. The theoretical framework underpinning this study was that of Symbolic Interactionism that was complemented and enhanced by Erikson’s Psychosocial Theory, focusing specifically on identity development in adulthood. This was a qualitative study using an Interpretative Phenomenological Analysis (IPA) as both the research design and data analytic theory and process. The eight participants were volunteers who were recruited purposively. In accordance with IPA guidelines, data for the study was collected using biographical questionnaires and semi-structured interviews. The emerging themes were grouped into four superordinate themes, that is, pre-divorce experiences, experiencing divorce, adjustment process and post-divorce experience. Each superordinate theme had corresponding subordinate themes and subthemes. The themes were then used to develop the divorce-stress adjustment model indicating that the experience of divorce is an interconnected process. Weed’s recommendations for interpretative synthesis of interview data were used.
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- Date Issued: 2018
Black South African men’s adjustment to divorce: a divorce-stress-adjustment model
- Authors: Muchena, Christopher Kudakwashe
- Date: 2018
- Subjects: Divorced men -- Psychological aspects , Adjustment (Psychology)
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: http://hdl.handle.net/10948/17933 , vital:28543
- Description: The decision to divorce marks a turning point for each individual involved. It can be viewed as more than just a legal process. From a psychological perspective, it does not matter who initiated the divorce, it always comes with emotional ramifications for all those involved. Statistically there is a high rate of divorce in South Africa and there have been significant shifts in trends over time. However, black South African men’s experience of, action in, and adjustment to divorce has been relatively neglected in the divorce research, yet it is important for understanding contemporary social arrangements and processes, as well as for broadening the understanding of black South African men’s lives. How black South African men describe their situations and respond to marital dissolution may point to their positions in the gender-structured community and to how they interpret the nature of social practice, marriages, divorce and their position in society. The present study aimed at exploring black South African men’s experience of, and adjustment to, divorce. More specifically, the study developed a divorce-stress-adjustment model for divorced black South African men. The theoretical framework underpinning this study was that of Symbolic Interactionism that was complemented and enhanced by Erikson’s Psychosocial Theory, focusing specifically on identity development in adulthood. This was a qualitative study using an Interpretative Phenomenological Analysis (IPA) as both the research design and data analytic theory and process. The eight participants were volunteers who were recruited purposively. In accordance with IPA guidelines, data for the study was collected using biographical questionnaires and semi-structured interviews. The emerging themes were grouped into four superordinate themes, that is, pre-divorce experiences, experiencing divorce, adjustment process and post-divorce experience. Each superordinate theme had corresponding subordinate themes and subthemes. The themes were then used to develop the divorce-stress-adjustment model indicating that the experience of divorce is an interconnected process. Weed’s recommendations for interpretative synthesis of interview data were used.
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- Date Issued: 2018
Black women’s narratives of womanhood: before and after hysterectomy
- Authors: Kota-Nyati, Phumeza Patricia
- Date: 2018
- Subjects: Hysterectomy -- psychological aspects , Women -- psychological aspects Gender identity Intersectionality (Sociology)
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: http://hdl.handle.net/10948/29995 , vital:30807
- Description: The removal of the uterus, medically referred to as a hysterectomy, is a permanent and irreversible procedure that potentially results in a number of immediate and significant effects. Performing a hysterectomy is at times the only medical option to a long and traumatic history of pelvic pains and surgeries. The decision to undergo this very costly, painful, and life-changing procedure can have an influence on the way women view themselves. Women’s narratives of womanhood before and after hysterectomy need to be understood within the context of women’s socially constructed identities. Gendered identity has been closely linked to genital and/or reproductive organs and the removal of these organs may influence the way women and societies define womanhood.The interpretive paradigm of constructionism with a narrative inquiry design was used as the lens to examine the women’s experiences. In-depth interviews were analysed through thematic analysis. The findings of this research revealed negative experiences resulting from severe symptoms before hysterectomy, exposed multi-layered structures of power and dominance during treatment, and indicated positive outcomes of hysterectomy. The findings should inform medical and allied practitioners regarding hysterectomy as a treatment option and add to the theoretical debate on the relationships between hysterectomy, womanhood, and identity.
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- Date Issued: 2018
Determinants of Type 2 diabetes mellitus among HIV/AIDS patients on antiretroviral drugs in the OR Tambo District, South Africa
- Authors: Bam, Nokwanda Edith
- Date: 2018
- Subjects: HIV/AIDS Diabetes mellitus (DM) -- Patients Antiretroviral drugs -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , PhD Health Sciences
- Identifier: http://hdl.handle.net/11260/1476 , vital:35976
- Description: Type 2 diabetes mellitus (DM) is a frequent adverse effect of antiretroviral drugs for those who are on ARVS. People with type 2 DM can suffer multiple complications that hinder the quality of life. In South Africa research has shown significant increase in neuropathy, heart and kidney diseases among patients living with type 2 DM and HIV/AIDS compared to DM without HIV. Accessed knowledge lacked consistency on the predictors of DM in HIV/AIDS patients with regards to the type of ARVS with higher risks of DM. Research needed to be done to find the determinants of type 2 DM in HIV/AIDS context. The purpose of this study was to describe the determinants of type 2 DM among HIV/AIDS patients on ARVS in the OR Tambo District, SA in order to develop intervention strategies to mitigate the long-term effects of type 2 DM. A quantitative research methodology using a case control retrospective study was used. A sample of 177 (33%) cases with HIV/AIDS and type 2 DM was selected using a one stage stratified sampling with allocation proportional to size of each stratum of the four sub-districts of OR Tambo District. Two non-diabetic patients with HIV/AIDS were selected as controls per case unpaired and totalled up to 354 (67%) controls. A self-administration questionnaire adopted from the WHO (2011) STEPwise surveillance tool for chronic diseases was used for data collection. Stata (standard version 13.0, Stata Corp., Lakeway Drive USA) was used for data management and analysis. Findings of the study revealed determinants of type 2 DM grouped as the socio-demographic determinants; tertiary education and marital status, levels of physical activities; lack of vigorous activity and sport, types of diets; high fruits and vegetables and healthy eating out at restaurants, arterial blood pressure; lack of routine BP check and known HPT and types of ARVS used in HIV/AIDS therapy. Compared with patients who received FDC, the risk of type 2 DM was 43 times and 22 higher when a tri-therapy regimen contained Ritonavir and Lopinavir respectively . The majority of DM patients (n=177) were diagnosed type 2 DM after ARVS at n=108 (61%). In managing the diabetic patients a shift from a single disease to multiple-chronic disease focus is required to mitigate the complex drug interactions that exist in the control of NCDs such as HIV/AIDS, DM, HPT and other long-term diseases. The HIV/AIDS and type 2 DM awareness and care intervention strategy is recommended as healthy lifestyle, monitoring of side effects and drug interactions, enhanced FDC roll out and elimination of unsafe ARVS to improve the health outcomes of type 2 DM patients in an HIV/AIDS context in OR Tambo District.
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- Date Issued: 2018
Developing a model for promoting physical fitness and healthy lifestyle of primary school learners in the Eastern Cape Province, South Africa
- Authors: Gomwe, Howard
- Date: 2018
- Subjects: Physical fitness for children -- South Africa Physical education for children Schools -- Health promotion services
- Language: English
- Type: Thesis , Doctoral , Nursing
- Identifier: http://hdl.handle.net/10353/10050 , vital:35307
- Description: The challenge of low level participation in physical activity and, consequently, limited physical fitness has been acknowledged as being a national public health concern in South African schools. The main aim of this study was to develop a behavioural model for promoting physical fitness and healthy lifestyle of primary school learners in the Eastern Cape Province in South Africa. The first thing was to determine their physical fitness level and body composition then develop a behavioural model based on the findings. The study was conducted in three phases. A quantitative, qualitative and theory-generating research design was conducted using questionnaires, deductive and inductive strategies and literature triangulation. The study involved primary school learners: 356 boys and 520 girls aged 9-14 years old, who were randomly selected. Anthropometric assessments were conducted using ISAK (Marfell-Jones et al., 2006) and EUROFIT (1988) test batteries.The following measurements of body mass, stature, skinfolds (triceps and subscapular), waist circumference and gluteal were taken. The percent BF was calculated from a sum of two skinfolds (triceps and subscapular), using Slaughter et al.‘ s (1988) equation to predict body fat. Physical fitness measurements included sit and reach, push-ups, sit-ups and a 20 metre shuttle run. Physical activity level and sedentary behaviour were assessed by means of self-report questionnaires. Demographic, psychological and environmental variables were also measured by a self-report questionnaire. Six focus group discussions were conducted with school learners. The physical fitness levels were categorized as hypoactive, minimal active and inactive. Sedentary behaviours were categorized by number of minutes spent on sedentary activities. Dietary intake was assessed by a Food Frequency Questionnaire (FFQ). Food intake was classified as healthy, unhealthy/junk and traditional food. Body composition was measured by calculating body mass index (BMI) (weight/height2) and waist-to-hip ratio, respectively. Categories: underweight: 0<18, normal weight: 18, 5<25, overweight: 25<30 or obese: 30 and blood pressure measurements were classified as healthy and unhealthy. The main findings were as follows: underweight 60, 25 percent: normal weight 30, 54 percent: overweight 4, 18 percent: and obese 5, 02 percent: for the peri-urban school learners. Underweight 64, 78 percent: normal 31, 52 percent: overweight 2,83 percent: and obesity 0,87 percent:for the rural school learners. 56,25 percent underweight: 36,93 percent normal weight: 5,68 percent overweight: and 1,14 percent obese for the urban school learners. The mean body mass of learners from three locations were urban 40.0±10.185; peri-urban 39.8±10.181 and rural 38.7±10.279, respectively. (Chi-square = 3.3107; P=0.191). The mean values stature of all the three residences are urban; 144.1 ±10.400 peri-urban 144.4±9.187 and rural 143.7±12.617 (Chi-square = 1.2651; P=0.5312). The mean waist circumference for urban was (78.4±9.493), peri-urban (78.4±9.399) and rural was (77.1±10.214), respectively (Z=2.474;p=0.2903). The triceps value (z=21.4565p <.0001). Urban (13.9±5.589), (12.5±6.023) for peri-urban and (12.1±6.390) for rural. Subscapular (z=4.1151;p=0.1278). Urban area had (9.3±5.426), (9.3±5.463) for peri-urban and (8.9±6.381) for rural. The mean systolic blood pressure of urban school learners was (109.2±19.512), (107.9±19.273) for peri-urban and (107.4±19.488) for rural school learners. Lumbar and hamstring flexibility (z= 57.733; p<.0001). (25.3±5.507) for urban, (23.0±6.435) for peri-urban and (26.9±6.854) for rural. Sit-up (z=9.8414;p=0.0073). (18.3±12.571) for urban, (19.7±12.323) for peri-urban and (21.7±13.782) for rural area. Push-ups (z= 37.7591p=<.00001). (15.8±10.285) for urban, (18.5±11.086) for peri-urban and (20.9±9.981) for rural area. Maximal oxygen intake (z= 163.186p=<.0001). (25.0±6.454) for urban, (29.9±7.225) for peri-urban and (35.5±11.085) for rural area. PA enjoyment (4.1±0.698) for urban, (4.0±0.764) for peri-urban, (4.0±0.799) for rural. With regard to health-related physical fitness, the learners in the rural and peri-urban better than those in urban areas. PA attitude (z=7.5507;p=0.0563), (2.5±0.792) for urban area, (2.6±0.802) for peri-urban and (2.7±0.890) for rural area. Parental role modelling in PA (z=0.3083; p=<.000). (3.1±1.008) for urban area, (3.3±0.916) for peri-urban (3.1±0.981) for rural area. Peer encouragement (z=2.5367; p=0.2813) (3.4±0.893) for urban, (3.3±1.064) for peri-urban, (3.3±1.005) for rural area. Parental encouragement (z= 7.2266p=0.027),(3.7±0.985) for urban area, (3.5±0.906) for peri-urban and (3.7±0.774 ) for rural area. Teacher encouragement (z=2.0069p=0.3668).The mean values for three residences are (3.5±0.802) for urban area, (3.4±0.784) for peri-urban, (3.5±0.733) for rural areas. Most of the school learners in all the three residences prefer unhealthy/junky food. Based on the results, an exploratory factor analysis was conducted on data to identify and analyse the factors for model development. The findings indicated that there is evidence of low level of physical fitness and high prevalence of excessive weight and obesity among primary school learners, the study, therefore, suggests the development of the behavioural model to enhance physical fitness and prevent or reduce overweight/obesity among school learners.
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- Date Issued: 2018
Development and evaluation of the coach-athlete relationship enhancement intervention
- Authors: Kuit, Wim
- Date: 2018
- Subjects: Interpersonal relations , Coaching (Athletics) -- Psychological aspects Sports -- Psychological aspects
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: http://hdl.handle.net/10948/22508 , vital:29989
- Description: An expanding body of sport psychology theory and research has highlighted the central role of the coach-athlete relationship (CAR) in the performance, satisfaction and well-being of coaches as well as athletes. Models have been developed that identify the key dimensions of CAR quality and the interpersonal behaviour that maintains it, but there remains a need for interventions that support coaches and athletes to optimise their interpersonal skills. This can be done by harnessing recent advances in personality theory which emphasise a more holistic and developmental view of the person and provide a basis for greater mutual understanding and adaptive interpersonal behaviour change in the CAR. The aims of this study were to develop the Coach-Athlete Relationship Enhancement (CARE) intervention through an integration of the Enneagram personality typology with current models of the CAR, and then to evaluate the impact of the CARE intervention on CAR quality. Sixty-two university-level athletes and their nine coaches participated in the study. Quantitative and qualitative results indicate that the CARE intervention significantly enhanced CAR quality, including direct and meta-perceptions of closeness, commitment and complementarity, as well as co-orientation. Intervention outcomes included enhanced mutual understanding in the CAR, enhanced self-awareness, enhanced team relationships, and adaptive interpersonal behaviour change. These outcomes were associated with a shared awareness between coaches and athletes of their Enneagram personality type traits and motivations. Coach-athlete relationship quality was further enhanced by re-constructing coaches’ and athletes’ personal narratives based on self-descriptions of Enneagram type strengths, and a redefinition of individuals’ core motivations to incorporate adaptive interpersonal behaviour change.
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- Date Issued: 2018
Development of a community pharmacy experiential learning programme in a South African context: a design research approach
- Authors: Kritiotis, Lia Costas , Thesis Advisor
- Date: 2018
- Subjects: Pharmacists -- Training of , Experintial training , Community development -- South Africa
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: http://hdl.handle.net/10948/17481 , vital:28353
- Description: Application of the design research approach to devise, develop and optimise an experiential learning programme and adaptation of the Volunteer Functions Inventory (VFI) to understand community pharmacists’ motives, are unique contributions to the global pharmacy education setting. This study generated new theory, in the form of substantive and procedural claims (design principles) regarding experiential learning programmes and preceptor and student motivation in a South African pharmacy educational context, which can be added to the existing international landscape and more importantly, plant the foundational seeds of insight that can be utilised as guiding tools by other South African pharmacy faculties.
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- Date Issued: 2018
Development of health promotion guidelines for weight management among primary health care nurses in the Eastern Cape Province, South Africa
- Authors: Monakali, Sizeka
- Date: 2018
- Subjects: Health promotion Body weight -- Regulation Obesity -- prevention and control
- Language: English
- Type: Thesis , Doctoral , Nursing
- Identifier: http://hdl.handle.net/10353/10006 , vital:35285
- Description: Overweight and obesity have become significant public health threats both globally and in South Africa. PHC professional nurses are first contact to patients and the community as well as key stakeholders in the management and education of obese patients. However, anecdotal evidence seems to question their suitability as good models of the advocated healthy lifestyle behaviours and weight management, as overweight and obesity is also prevalent among the professional nurses. This study examines the prevalence and determinants of overweight and obesity among PHC professional nurses in the Eastern Cape (EC) Province of South Africa. This was a workplace, cross-sectional study involving 203 PHC professional nurses conveniently selected across 41 PHC facilities in EC, South Africa. A WHO STEP wise questionnaire was used to collect demographic and behavioural data. Anthropometric (weight, height and waist circumference [WC]) measurements were taken following a standard protocol. Overweight and obesity was defined as a BMI of 25-29.9kgm-2, and BMI ≥ 30kgm-2, respectively. Seventy six percent of the nurses were obese. An additional 18 percent were overweight. Age, gender, marital status, duration of practice, alcohol use and smoking were significantly associated with obesity. There was no association between physical activity and obesity. After adjusting for confounders, only age more than 30 years (OR=5.2, 95 percentCI=1.6-16.4) and not using alcohol (OR= 4.0 95 percentCI= 1.7-9.1) were significant and independent predictors of obesity among the nurses. In conclusion is an alarmingly high prevalence of obesity among primary healthcare professional nurses in Eastern Cape, South Africa. This shows that PHC professional nurses in EC are not good models of the healthy behaviours, judge be BMI indicator, if they do advocates for healthy weight management to patients. This constitutes a future risk for an increased prevalence of chronic diseases and a handicapped healthcare workforce. There is a need to implement measures to promote healthy lifestyle behaviour and weight management among professional nurses in this setting.
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- Date Issued: 2018
Narcissistic defenses and alienation in the life of Howard Hughes: a case study
- Authors: Sandison, Alida
- Date: 2018
- Subjects: Hughes, Howard -- 1905-1976 , Narcissism Self psychology Personality disorders
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: http://hdl.handle.net/10948/35038 , vital:33609
- Description: Narcissism is a personality configuration which has both normal and pathological personality expressions. It is associated with a very broad field of literature and theoretical formulations, put forward to understand it. To add to this knowledge base, the aim of the research was to explore and describe narcissistic defenses and the consequent alienation of others within the narcissistic personality configuration. The aim was attained through the exploration of the life of Howard Hughes, by examining the interplay between Kernberg’s Object Relations Theory (1974; 1975; 1976; 1980; 1984; 1992; 2001) and Hughes’s lived experiences. Hughes was chosen as the subject as he is renowned for being an eccentric billionaire who was revolutionary in his effect on the world, but concurrently disturbed within his personal pathologies. The study took the form of a case study. Data was collected using Yin’s (1994) guidelines for data collection, which include using multiple sources of evidence, creating a case study database, and keeping and maintaining a reliable chain of evidence. Data was furthermore collected and analysed using Miles and Huberman’s (1994) strategy of data analysis which consists of three steps, namely data reduction, data display, and conclusion drawing and verification. Research findings confirmed the presence of primitive defense mechanisms associated with the lower level pathologies described by Kernberg within Hughes’ patterns. Findings confirmed the defense mechanisms as alienating others. Learnings produced were presented in a model to be used in clinical practice to support others in interaction with narcissistic individuals. Steps outlined included, understand, decontaminate and reconstruct, reaffirm reality, and find something positive.
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- Date Issued: 2018
Strategies to facilitate the use of birth care provided by skilled birth attendants in the rural areas of Ghana
- Authors: Adatara, Peter
- Date: 2018
- Subjects: Maternity nursing -- Ghana , Neonatal nursing -- methods Delivery (Obstetrics) Midwifery -- Ghana
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/23415 , vital:30541
- Description: Increasing skilled attendance during childbirth is well established in literature to play a significant role in averting the many preventable maternal deaths that occur in developing countries such as Ghana.Inadequate utilisation of skilled birth care services in Sub-Saharan Africa is believed to be a major hindrance to efforts aimed at improving the health of women, especially during delivery. There is low utilisation of birth care services provided by skilled birth attendants in the rural areas in Ghana. The purpose of this study was to develop strategies that could facilitate the utilisation of skilled birth care provided by skilled birth attendants in the rural areas of Ghana. The study adopted a qualitative, explorative, descriptive and contextual method to explore and describe women’s experiences regarding the utilisation or non-utilisation of skilled birth care services provided by skilled birth attendants in the rural areas in Ghana. The study was conducted in three phases: Phase One of this study described the research population, sampling method, data collection and analysis to obtain women’s experiences regarding the utilisation or non-utilisation of skilled birth care services. In this study, data were collected and analysed from the research population. The research population consisted of women who utilised skilled birth care attendants or unskilled care attendants during child birth. The data collection method used was individual interviews. Data collected from the interviews were transcribed verbatim and analysed according to the steps suggested by Tesch to identify themes and sub-themes. The study identified three themes and sub-themes: Theme 1: Experiences of participants related to the use of skilled birth care attendants; Theme 2: Participants expressed their reasons for choosing a home birth; Theme 3: Participants offered suggestions to improve skilled birth care at healthcare facilities. The findings in Phase one of this study formed the basis for the development of the strategies in Phase three. Phase Two of the research design focused on the development of a conceptual framework based on the research findings and utilized to develop strategies which skilled birth attendant may use to facilitate the use of skilled birth care services by women in the rural areas of Ghana where there is low utilisation of birth services provided by skilled birth attendants. The conceptual framework of Dickoff, James and Wiedenbach was used to provide a guide and a link between the different concepts in the research study. Phase Three of this study focused on the development of strategies that will facilitate an increased in the labouring women utilisation of the services provided by skilled birth attendants. The data obtained was used to developed three strategies such as collaboration, education and training, supportive supervision as well as community mobilisation and participation to guide skilled birth attendants to facilitate the utilisation of skilled birth care services during childbirth. The WHO Health for All model, the theoretical model underpinning this study, also guided the development of the strategies to facilitate labouring women utilisation of the services provided by skilled birth attendants. Recommendations regarding the implementation of a national collaborative, education and supportive supervision policies on a macro level are made, as well as recommendations for nursing practice, education and research. It is therefore concluded that the researcher succeeded in achieving the purpose for this study because the strategies which are understandable, clear, simple, applicable and significant to skilled birth care in rural areas has been developed for use by skilled birth attendants to facilitate the utilisation of skilled birth care provided by skilled birth attendants in the rural areas of Ghana.
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- Date Issued: 2018