Guidelines for the management of patients with diabetes mellitus at health care clinics in the Cacadu region of the Eastern Cape Province of South Africa
- Authors: De Mendonça, Hester Magdalena
- Date: 2009
- Subjects: Diabetics -- Treatment -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: vital:10011 , http://hdl.handle.net/10948/1017 , Diabetics -- Treatment -- South Africa -- Eastern Cape
- Description: Diabetes Mellitus (DM) is the new epidemic in the world with 246 million people suffering from the disease at the moment and a projected increase to 380 million in 2025 (IDF, 2007b:36). The developing countries are the most vulnerable. Statistics state that SA and Egypt have the most diabetics on the continent. Globally, each year 3,8 million deaths are attributable to DM (IDF, 2007a). The Department of Health (DOH) and the Cacadu District Municipality (Eastern Cape) are serving a population of 102 721 in the Kouga and Koukamma areas, which covers an area of 5 992 km², with health care. There are 22 clinics with 28 registered nurses for all the clinics and between 3 and 9 lay health workers (LHWs) per clinic. For the purpose of this research study, the persons suffering from DM (±3550) in this area were taken into consideration (Strydom, 2005). DM is a chronic disorder and therefore patients should be able to manage their disease pattern for the rest of their lives (Healthline, 2008, Mbanya, 2006:12). In order to achieve this, continuous and effective patient education by health care providers are necessary. This disease affects more and more people each passing day, because of the rapid westernisation of the South African population, leading to more people attending clinics in the public health sector (Bonnici, 2002:32). There are specific guidelines laid down by the Department of Health (DOH) pertaining to the control and management of DM. Guidelines include the early diagnosis, treatment and patient education regarding DM (Department of Health, 1997, [revised 2004]). Evidence from previous research studies showed that not all registered nurses are aware of these guidelines and most have not been educated regarding the utilisation of these guidelines (O’Brien, van Rooyen & Carlson, 2006:36-40). In the clinics, the health care givers are confronted with a number of difficulties, such as a lack of funds to enable them to order adequate equipment and medicine. Another problem is the migration of registered nurses out of the country thus; there is also a shortage of staff to operate these clinics (Mkhize, 2004). The organisational structure in the clinics does not function optimally and there is a lack of communication between provincial, district and clinic level. Due to the above-mentioned challenges there is also a lack of efficient auditing systems to ensure quality assurance. Furthermore, a knowledge deficit pertaining to DM and the management thereof in all the groups participating in this study, namely the registered nurses, the lay health workers (LHWs) and the diabetic patients was found. The empowerment process of the LHW is not explored fully and therefore not executed to its full potential. To be able to improve the management of DM in this region, it is important to know what the difficulties are that the health care givers as well as the patients experience in relation to this issue. This study therefore explored and described these difficulties. The research was based on a qualitative, quantitative, explorative, descriptive and contextual research design. Health care givers as well as diabetic patients attending clinics in the Cacadu region of the Eastern Cape have been requested to complete questionnaires pertaining to their knowledge of Diabetes Mellitus. The current organisational structure of the provincial department of health was explored and findings analysed using the activities of the management process (Muller, 2006:106). The SA Government is committed to combining the national human resource development strategy with the rapid upgrading of service delivery to all of the nation’s communities. Stemming from this undertaking, suitable members of the community are to be trained as LHWs. LHWs are to play an integral role in strengthening the abilities of the community to empower themselves to participate and take responsibility for their own health and wellness (Department of Health, 2001a:4). From the research, it was found that the above-mentioned national plan had been implemented, but is not functioning at optimum level due to several shortcomings/deficits. Proposed guidelines were therefore designed to address the shortcomings and fragmentation of the plan. As specific knowledge deficits in DM were identified during this research study, general educational guidelines were included for the registered nurses and the diabetic patients. The LHW was identified as an indispensable link in the chain of efficient health care and therefore, specific educational guidelines on DM were generated to prepare her for the role. With her knowledge, insight into DM and the management thereof and newly required skills in educating and supporting of the patient, she could be an asset in the road to optimum self-care for the diabetic patient.
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- Date Issued: 2009
Strategies to facilitate collaboration between allopathic and traditional health practitioners
- Authors: Tembani, Nomazwi Maudline
- Date: 2009
- Subjects: Alternative medicine -- South Africa , Healers -- South Africa , Physicians -- South Africa
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: vital:10012 , http://hdl.handle.net/10948/1283 , Alternative medicine -- South Africa , Healers -- South Africa , Physicians -- South Africa
- Description: The formal recognition of traditional healing has been controversial for some time with traditional healers being labelled by those of conventional medical orientation as a medical hazard and purveyors of superstition. The support for the development of traditional medicine and establishment of co-operation between traditional healers and allopathic heath practitioners was first promoted in the international health arena by the World Health Organisation. Estimating that 80% of the population living in rural areas of many developing countries was using traditional medicine for the primary healthcare needs, this organisation advocated for the establishment of mechanisms that would facilitate strong cooperation between traditional healers, scientists and clinicians. The study was undertaken in the Amathole District Municipality, Province of the Eastern Cape based on Chapter 2, Section 6(2) (a) of the Traditional Health Practitioners Bill 2003, which required regulation and promotion of liaison between traditional health practitioners and other health professionals registered under any law. The purpose of the study was to develop and propose strategies to facilitate collaboration between traditional and allopathic health practitioners to optimise and complement healthcare delivery. The conceptual framework guiding the study was derived from Leininger’s theory of Cultural Care Diversity and Universality chosen because of its appropriateness. The terms used throughout the study were defined to facilitate the reader’s understanding. Ethical principles were adhered to throughout the research process. To ensure trustworthiness of the study, Guba’s model (in Krefting,1991:214-215) was used where the four aspects of trustworthiness namely, truth value, applicability, consistency and neutrality were considered. A qualitative, exploratory, descriptive and contextual research design was used which assisted in articulating the appropriate strategies to develop to facilitate v collaboration between allopathic and traditional health practitioners. The study was done in two phases. Phase one entailed data collection using unstructured interviews, a focus group interview, literature control and modified participant observation. In Phase two strategies to facilitate collaboration between allopathic and traditional health practitioners were developed. The population in this study comprised three groups of participants. Group 1 consisted of allopathic health practitioners, Group 2 comprised traditional healers and Group 3 was composed of participants who were trained as both traditional healers and allopathic health practitioners. All participants had to respond to three research questions which aimed at: exploring and describing the nature of the relationship between allopathic and traditional health practitioners before legalisation of traditional healing and their experience as role-players in the healthcare delivery landscape in the Amathole District Municipality. eliciting the viewpoints of allopathic and traditional health practitioners regarding the impact on their practices of legalisation of traditional healing and developing strategies to facilitate collaboration between allopathic and traditional health practitioners. Data obtained from each group was analysed using Tesch’s method as described by Creswell (2003:192). Themes emerging from data and the corresponding strategies to address the themes were identified for each group. The participants’ responses to the three research questions revealed areas of convergence and divergence. Of significance was the reflection by the participants on their negative attitude towards each other. They also highlighted that there was no formal interaction between traditional and allopathic health practitioners in the Amathole District Municipality. Their working relationship was characterised by a one-sided referral system with traditional healers referring patients to allopathic health practitioners but this seemed not to be reciprocated vi by the latter group. The exception was the case of traditional surgeons whose working relationship with allopathic health practitioners was formally outlined in the Application of Health Standards in the Traditional Circumcision Act, Act No.6 of 2001. Allopathic health practitioners attributed their negative attitude as emanating from the unscientific methods used by traditional healers in treating patients, interference of traditional healers with the efficacy of hospital treatments and delays by traditional healers in referring patients to the hospitals and clinics. Traditional healers stated that they were concerned about failure of allopathic health practitioners to refer patients who talked about “thikoloshe” and “mafufunyana” to the traditional healers. Consequently, these patients presented themselves to the traditional healers when the illness was at an advanced stage. A reciprocal referral system was perceived by the traditional healers as the core element or crux of collaboration. There were ambivalent views regarding the impact of legalisation of traditional healing on the practices of both traditional and allopathic health practitioners. Elimination of unscrupulous healers, economic benefits, and occupational protection were benefits anticipated by traditional healers from the implementation of the Act. The possibility of having to divulge information regarding their traditional medicines, monitoring of their practice resulting in arrests should errors occur were however, cited by traditional healers as threatening elements of the Act. A lack of understanding the activities of each group with an inherent element of mistrust became evident from the participants’ responses. Ways of fostering mutual understanding between them were suggested which included holding meetings together to discuss issues relating to healing of patients, exposing both groups of health practitioners to research, as well as training and development activities. The participants also highlighted areas of collaboration as sharing resources namely, budget, physical facilities, equipment and information and role clarification especially pertaining to disease management. The participants vii strongly suggested that there should be clarity on the type of diseases to be handled by each group. The need for capacity building of traditional and allopathic health practitioners in preparation for facilitating collaboration was advocated by all and the relevant activities to engage into were suggested. Analysis, synthesis and cross referencing of the themes that emerged from the data culminated in the identification of three strategies that were applicable to all groups of participants and which would assist in facilitating collaboration between allopathic and traditional health practitioners. The researcher coined the three strategies “Triple C” strategies abbreviated as the TRIC strategies. The first “C” of the three “Cs” stands for “change attitude”, the second “C” for “communication” and the third “C” for “capacity building.” Each of the proposed three strategies is discussed under the following headings:- Summary of findings informing the strategy Theory articulating the strategy Aim of the strategy Suggested implementation mechanism As the strategies had to be grounded in a theory which would serve as a reference point, the researcher used the Survey List by Dickoff, James and Wiedenbach (1968:423) as a conceptual framework on which to base the proposed three strategies. The results of this study and recommendations that have been made will be disseminated in professional journals, research conferences and seminars.
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- Date Issued: 2009
A holistic healthcare model for higher education campus health services
- Authors: Ricks, Esmeralda Jennifer
- Date: 2008
- Subjects: College students -- Health and hygiene -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: vital:10038 , http://hdl.handle.net/10948/666 , College students -- Health and hygiene -- South Africa -- Eastern Cape
- Description: Most students are adolescents and young adults, a group characterized by a new-found sense of independence, experimentation with sex and sometimes drugs and a feeling of invincibility (Gayle, Richard, Keeling, Garcia-Tunon, Kilbourne, Narkunas, Ingram, rogers and Curran, 1990:1538). These behavioural, developmental and environmental issues may contribute to premature morbidity, mortality and reduced quality of life for university students (Patrick et al., 1992:260). The ages of staff on the other hand range from young adults to retirement age. The types of health problems that exist among staff who use the campus health service include First Aid treatment on site for injuries on duty and more chronic health problems such as, for example, hypertension and diabetes mellitus. To date there is very little evidence as to whether or not the healthcare needs of students and staff are being met comprehensively or whether the practitioners rendering the service are knowledgeable and complying with the PHC norms and standards developed by the department of Health’s Quality Assurance Directorate. The lack of such empirical data can contribute to misconceptions and hamper the management of public health problems experienced in SA, for example sexually transmitted infections and the transmission of HIV. Thus the purpose of this research was to develop a model that would assist registered nurses employed at a higher education campus health service in the Western Region of the Eastern Cape Province to render a healthcare service relevant to the healthcare needs of the students and staff on campus.
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- Date Issued: 2008
Inter-level health service referral of women in labour
- Authors: Jantjes, Louisa
- Date: 2008
- Subjects: Childbirth -- South Africa , Medical referrals -- South Africa , Midwives -- South Africa , Labor (Obstetrics) -- Complications
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: vital:10010 , http://hdl.handle.net/10948/986 , Childbirth -- South Africa , Medical referrals -- South Africa , Midwives -- South Africa , Labor (Obstetrics) -- Complications
- Description: Although it is considered an everyday occurrence, childbirth is nonetheless an important and dramatic experience in the life of every woman. Childbirth, a normal physiological state in the life of a woman, can be an awe-inspiring and exciting experience, but sometimes disconcerting experiences may also occur. Women sometimes see labour as the end to a long drawn out process following pregnancy and therefore attribute great significance to all occurrences during labour. When complications occur in a usually uncomplicated process of labour, the health care provider must be able to make quick and effective management decisions and implement appropriate interventions. This may include the referral of women in labour to a level of care where complications can be dealt with more effectively, thereby ensuring the best maternal and neonatal outcomes. Patient referral is regarded as a fundamental component of the health care system therefore a well functioning system should ensure that patients are treated in the appropriate manner at the appropriate place at the lowest possible cost to the health system. The goal of this research study was to explore and describe the inter-level health service referral of women in labour by midwives, in order to design guidelines for midwives and other relevant health care providers involved in inter-level health service referral of women in labour in the South African public health care sector. The research design used for this study is a combination of qualitative and quantitative approaches. The paradigmatic perspective of this study was based on the World Health Organization’s Health for All Model. Appropriate data collection and analysis strategies were used for the different stages of the study. Data collection commenced only after permission to conduct the research had been obtained from relevant authorities and University of Port Elizabeth and the Nelson Mandela Metropolitan University structures. Informed consent was obtained from participants included in the study. In stage 1 of this research project, a profile of midwives at lower level maternity care centres was compiled and the perceptions and experiences of midwives working at lower level maternity services, who are responsible for inter-level health referrals of women in labour, were described. Stage 2 described, by means of analysis of maternity case records, aspects of the inter-level referral of women in labour including the profiles of women admitted to midwife obstetric units (MOUs) who are v referred to higher levels of care. Of significance in this study is the appropriateness of midwifery referrals and the maternity care implemented by health care providers during inter-level health service referral of women in labour. In stage 3 clinical guidelines for midwives and other relevant maternity care providers, to assist them in the inter-level health service referral of women in labour, were developed. Findings from stage 1 of this research study revealed that midwives were generally well qualified and sufficiently experienced in the management of women in labour who need referral. Disconcerting findings relating to human and material resource shortages were discovered; these included major problems with patient transportation and difficulties with communication relating to inter-level health service referral of women. These shortages adversely affected midwives’ ability to efficiently care for women during the inter-level health service referral of women in labour in the research area. Stage 2 of the study yielded results of questionable standards of care to women and infants included in the study. A further disturbing finding from the study is the poor state of record keeping. The development of the provisional guidelines in stage 3 of the study was informed by the four main themes identified from the research findings. Before embarking on guideline development, the researcher familiarized herself with theory related to the clinical guidelines. These included clarifying the concept ‘clinical guidelines’, justifying the need for developing clinical guidelines as well as giving consideration to concerns about clinical guidelines. The research findings as well as literature related to these findings informed the researcher on the development of the guidelines. Provisional guidelines were therefore developed on responsibilities of role players in inter-level health service referral of women in labour at first level of referral, namely the midwife obstetric units, transport personnel and maternity care providers at the referral hospital. Steps were taken throughout the study to adhere to ethical standards of research. The researcher will ensure that the research report is available to all health authorities involved, the participants included in the study and the health care providers who may benefit from the research findings.
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- Date Issued: 2008