A best practice guideline for screening and managing chorioamnionitis
- Authors: Du Plessis, Allison Herlene
- Date: 2020
- Subjects: Bacterial diseases
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/46374 , vital:39575
- Description: Due to the complex nature of chorioamnionitis, women are often misdiagnosed, undiagnosed or only diagnosed after birth when it is too late to prevent maternal and neonatal complications. A lack of a comprehensive best practice guidelinefor screening and managing women withchorioamnionitis resultsin delayed treatment and management that could minimise maternal and neonatal complications. Saving Babiesreported that unexplained intra-uterine deathsremained the main primary (obstetric) cause of death for babies with a weight above 1000g (24.4%of all deaths). Of these unexplained uterine deaths, 33% are of normal birth weight (>2500g), and,therefore,most likely term gestation. Saving Babies further reported that 22.9% of all live births in South Africa was premature and 22.8% of birthswere unexplained intra-uterine deaths. Prematurity is one major complication of chorioamnionitis. When susceptibility for chorioamnionitis is considered during early pregnancy, it is possible to intervene and prevent or even reduce the incidences and complications of chorioamnionitis.A qualitative research study was conducted in three phases. In Phase One(Part One), a theoretically constructed patient scenario of chorioamnionitis was presented to ten midwives,and semi-structured individual interviews were done to elicit information regarding how they screen for and manage chorioamnionitis. In Phase One(Part Two), experienced medical practitioners in the field of obstetrics and gynaecology were individually interviewed, also using semi-structured individual interviewsto gain their views regarding chorioamnionitis as a contributing factor to maternal morbidity and mortality. Qualitative findings in Phase Oneindicated that there is a general lack of knowledge regarding chorioamnionitis among midwives, resulting ininadequate screening, misdiagnosis and mismanagement of the condition. Experienced medical practitioners confirmed that chorioamnionitis is underdiagnosed, misdiagnosed or undiagnosed and underreported,and they hold views that it is difficult to treat and control pregnancy-related infections according to current practice.An integrative literature review was conductedin Phase Twoand literature regarding diagnostic biomarkers, screening options to diagnose chorioamnionitis and management of chorioamnionitis were extracted. After evidence synthesisofPhase Oneand Phase Twodata, a best practice guidelinefor screening and managing viiwomen withchorioamnionitiswas developed usingthe National Institute for Health and Clinical Excellence guideline development approach in Phase Three. The purpose of the best practice guideline for screening and managing women with chorioamnionitis was to provide a guideline onhow to manage women who are at risk and those who present with signs and symptoms of chorioamnionitis at any stage during their pregnancy. Five recommendations were made that involve screening for chorioamnionitisand causative factors, biomarkers to diagnose chorioamnionitis, management of chorioamnionitis that includes pharmacological and non-pharmacological management, and health education to women.Ethics for this research study were guided by the ethical principles and guidelines of the Belmont Report. The trustworthiness of this research study was adopted from Ravitch and Carl,and was based on criticality, reflexivity, collaboration, and rigour. An independent coder and reviewer wereto verify the data that were included in the best practice guideline. Expert reviewersappraised the best practice guidelineusing Appraisal of Guidelines for Research and Evaluation II tools.
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- Date Issued: 2020
A psychobiographical case study: Amelia Dyer in a search for glory
- Authors: April, Heather
- Date: 2020
- Subjects: Serial murderers--Psychology
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/50857 , vital:43008
- Description: The study is a psychobiographical case study based on the life of a Victorian baby farmer Amelia Dyer (1837-1896). She was executed for the murder of babies who were placed in her care over a period of 30 years. Psychobiography is a qualitative method of enquiry which explores the life of a unique individual subject through the lens of a psychological theory for the purpose of creating a coherent psychological case study. The psychoanalytic theoretical lens of Karen Horney was used to trace the evolution of Amelia Dyer’s sense of self within the Victorian culture of respectability. Baby farming referred to an unregulated business of adoption and fostering of infants, mostly illegitimate infants for a fee. Insufficient social structures and support for unwed mothers and children encouraged the business practice as women had very little choice for childcare. Baby farming was open to abuse and exploitation and hundreds of babies lost their lives due to insufficient care or infanticide. Amelia Dyer showed special talents and creativity from a young age, was ambitious and wanted to be self-reliant in a culture that did not provide women with opportunities to live out their ambitions. Baby farming became a business venture for her in the early stages of her life which later evolved into sadistic abuse and murder of the infants. Her evolution from a creative and hardworking young girl to a sadistic murderer of children is what qualifies her as a suitable subject for the exploration of Karen Horney’s dynamic theory of neuroses and the development of the neurotic self within culture. Extensive biographical data was collected and processed into salient themes. The study integrates the theory of Karen Horney, the life experiences of Amelia Dyer and Victorian respectability and demonstrates the value of using psychobiography as the method of inquiry into the exploration of the unique individual. The findings of the study demonstrated that Amelia Dyer and her social context were inextricably bound by a vicious cycle of psychic and emotional vi conflicts related to fear, control and self-hatred by the internalization of gender stereotypes and norms. The contribution of the study as a whole rests with its demonstration of the value of a holistic and reflexive exploration of the unique individual woman. It demonstrates the value of Horney’s in-depth theoretical understanding of the ambivalent core of selfhood that lies behind observable acts of behavior. The study as a whole contributes towards building upon holistic and integrative therapeutic frameworks in the understanding of diversity amongst women and mothers in culture.
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- Date Issued: 2020
A psychobiography of Viktor Emil Frankl
- Authors: Bushkin, Hanan
- Date: 2020
- Subjects: Frankl, Viktor Emil
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/46440 , vital:39566
- Description: The first study conducted in South Africa of a prominent figure traces back as far as 1939. Since then, extensive research has been done in the field of psychobiography, resulting in a growing interest in this field and evolving into an established research genre in South Africa. Despite the increase in the use of psychobiographies as a research approach internationally and specifically in South Africa, its use is still considered relatively under-utilised and, therefore, the pursuit of further development of psychobiographies in South Africa is required. In light of South Africa’s effort to promote and advance the use of psychobiographies, South African researchers may be motivated to continue studying significant and exceptional lives in South Africa and abroad. Viktor Frankl was selected for this study based on his uniqueness, significance and his interesting life. He is also considered an exceptional individual who has shaped modern psychological thinking. Frankl had written over 40 books on his theory and many studies have been conducted based on his existential theory. Frankl’s contribution to the academic world has been recognised and acknowledged by significant institutions through his own and others’ research. Although much has been written on the life and work of Frankl, none of the literature utilises specific psychological focus and no psychobiographical study of the life of Frankl exists. Therefore, the researcher selected Frankl as the subject for this psychobiography through purposive sampling. The aim of the study was to provide a psychological exploration and description of Frankl’s life against the backdrop of his socio-cultural context. In order to achieve this aim, the researcher employed two psychological frameworks to guide in the description and exploration of his life. The psychological frameworks included Levinson’s life structure theory of adult development and Frankl’s existential theory. The study aimed to describe Frankl’s development with the use of Levinson’s theory while describing how he attained meaning in his life with the use of his own existential theory. Due to the exploratory-descriptive nature of this study, the objective fell within the inductive research approach. The researcher utilised a systematic coding method to arrange the data. The theoretical framework of Levinson’s life structure theory guided the coding system, as well as the key concepts of Frankl’s existential theory. In addition, the researcher utilised Alexander’s guidelines for the extraction of salient data, together with McAdam’s methods and recommendations for managing the data. Lastly, the researcher followed the 12-step method of conducting a psychobiography, as proposed by Du Plessis. Findings from this study found a correlation between Frankl’s life and the eras and transitional periods as theorised by Levinson’s theory. The findings of this study, therefore, support the use of Levinson’s theory with regards to the time frames and its use in understanding Frankl’s development. Also, the researcher found that Levinson’s theory was useful in understanding Frankl’s personality development within his context throughout his lifespan. With regards to Frankl’s existential theory, the researcher found that the use of the theory was suitable in understanding Frankl’s search for meaning. Frankl’s concepts of freedom of will, will to meaning, meaning of life, existential vacuum, supra-meaning, dimensional ontology, the three triads and noö-dynamics assisted in explaining Frankl’s drive to find meaning in his life, take responsibility to attain such meaning and to strive for transcendence beyond his suffering. The researcher found Frankl’s theory useful in explaining his drive, motives, needs and patterns of behaviour within this context. The holistic and integrative approach of the study allowed for an in-depth exploration and description of Frankl’s life and development within his socio-historical context. In addition to contributing to the existing body of knowledge on Frankl, his life and his theory, the study also contributed to the growing field of psychobiographical research. The study acknowledged and highlighted that further in-depth examination of the lives of extraordinary personalities could significantly contribute to psychobiographical studies. Based on the psychological frameworks used to explore and describe Frankl’s life, recommendations are made for future research.
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- Date Issued: 2020
Mothers’ perceptions of the effects of the babies in mind programme on maternal mental health and mother-infant attachment: a South African narrative study
- Authors: Naicker, Samantha , Cronje, Johan
- Date: 2020
- Subjects: Mother and infant
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/46414 , vital:39590
- Description: The focus of this study is on mothers, motherhood and the Babies in Mind programme as an early intervention strategy for mothers in South Africa. The rate of maternal mental ill health in our country is alarming. Research consistently confirms that maternal mental health directly affects infant and child mental health. One of the major determinants of mental health is mother-infant attachment. Studies have indicated the range of deleterious effects that maternal mental ill-health and mother-infant attachment issues have on offspring from infancy to adulthood. This has implications for the mental health of future generations and society at large. Researchers have called for evidence-based interventions that address maternal mental health and mother-infant attachment, especially in developing countries. South Africa has no national prevention or treatment programme to address these needs. This study investigated the Babies in Mind programme as an early intervention option to address the gap in promoting maternal mental health and mother-infant attachment. A social constructionist, narrative study was employed to meet the objectives of the study. The aim was to explore mothers’ perceptions of the impact of the Babies in Mind programme, with particular reference to their mental health and their relationships to their infants. Focus was placed on understanding the social constructions of motherhood at the community level and how these constructions were reconstructed through the programme. Purposive sampling was employed and focus groups were conducted to collect the relevant data. The data was analysed using thematic analysis. The findings indicated that mothers’ experiences of the Babies in Mind programme were positive and there were improvements in their mental health and relationships to their infants. A relationship model for mothers was developed based on the themes that emerged from the data analysis. A platform for continued support and discussion was organised via a social media (Whatsapp) support group. Twelve 7guidelines were suggested for the implementation of intervention programmes such as the Babies in Mind programme at the community level.
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- Date Issued: 2020
Psychological and emotional effects of repeated exposure to violent crimes on victims residing in a high crime community in Nelson Mandela Metropolitan in the Eastern Cape
- Authors: De Klerk, Ulricha
- Date: 2020
- Subjects: Post-traumatic stress disorder
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/46413 , vital:39582
- Description: Traumatic Stress Disorder (PTSD). While the literature provides detailed and comprehensive approaches and counselling modalities to working with clients who experience traumatic events, there is not much evidence on the experiences of individuals who reside in high crime communities. It follows, that the psychological and emotional experiences, as well as needs of such individuals may present with specific requirements from the therapeutic alliance. This study aimed to explore the psychological and emotional effects of repeated exposure to high crime and violence and the implications this posed to traumatic experiences. The study further aimed to develop a set of guidelines that can be drawn upon when working therapeutically with clients who reside in high crime communities. The study draws on a qualitative methodology and 17 participants were interviewed. The transcripts were analysed using thematic analysis and five themes were identified, relevant to the aims and objectives that were set. The findings suggest that the psychological and emotional experiences of individuals who reside in high crime communities, is experienced at a more heightened and prolonged period, thus making the psychotherapeutic intervention employed, more specific. To this effect, the guidelines developed provide specific strategies and approaches thatwere developed based on the themes identified and verified by a panel of psychological experts. The study contributes to the field of trauma, counselling and violence, in that it focuses on an area of trauma that has not been adequately focused on withinthe South African context, as well as in global contexts.
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- Date Issued: 2020
Socio-ecological, contextual effects in Raven’s Colour Progressive Matrices scores: Developing an index for guiding test selection and interpretation
- Authors: August, Justin Oswin
- Date: 2020
- Subjects: Ecological Systems Theory
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/46401 , vital:39563
- Description: With the changing landscape in South Africa to a full democracy, increased research has been undertaken in the psychometric field on local and national normative studies regarding various assessment measures. Given that the Raven’s Coloured Progressive Matrices (CPM)is purported to be culture-free and not heavily dependent on verbal and language skills;it has been extensively normed throughout the world for various population groups. While norms for normal populations of children have been developed in South Africa, these studies were based on race and gender predominantly and without taking into consideration the effects of socio-ecological factors on test performance. The research study aimed to understand the influence of socio-ecological factors on the expression of cognitive scores amongst a geographically diverse sample of South African learners. Through this study, research on the interplay between context and cognition was to be located within the Ecological Systems model of Bronfenbrenner. A secondary aim of the study was to develop an index that will guide test selection and interpretation of assessment results, taking into account the influence of socio-ecological factors and providing a conceptual framework for future test development. The study employed a quantitative methodology on a South African sample consisting of primary school children aged between the ages of 6 years to 11 years. The sample was drawn from schools in the Port Elizabeth areain South Africa that wereclassified into low, medium and high opportunity, based on context. The results indicated that the type of school had a significant impact on test performance, suggesting that contextual factors were influential in this process.The item analysisconductedfurther indicated that learners from a low opportunity school performed significantly lower than the other two schoolsin the sample. The index development provides a foundation for further research that would enhance the interpretation of test results. In the South African context, this is considered important, given our political history and our diversity wherea“one size fits all” approach is not possible.
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- Date Issued: 2020
Strategies for the facilitation of implementation of best practice guidelines in operating theatres at public hospitals
- Authors: Owolabi, Olukemi Olufunmilayo
- Date: 2020
- Subjects: Operating rooms—Safety measures
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/46422 , vital:39594
- Description: Best practice guidelines (BPGs) are the use of scientific evidence to direct patient care and guide clinical care to integrate best patient outcomes. The implementation of BPGs in operating theatre nursing improves patient safety and quality of care and enhances patient outcomes. Although BPGs are crucial, the implementation thereof is not well operationalised in clinical practice, especially in an area such as the operating theatres in public hospitals in the Nelson Mandela Bay Health District(NMHD)in the Eastern Cape Province. The study thus developed strategies that could be used to facilitate the implementation of best practice guidelines in the operating theatres at public hospitals in the NMBHD. Understanding registered nurses’ knowledge, attitudes, and practices (KAP) with regard to implementing BPGs in the operating theatre is important, as it will assist in the development of strategies to facilitate the implementation of BPGs.The study was conducted in three phases. Phase One comprised of a quantitative approach. Data collection was achieved by means of a self-administered questionnaire which was distributed to registered nurses in the operating theatres of public hospitals in the NMBHD. The purpose of the questionnaire was to establish their knowledge, attitude and practice with regard to best practice guidelines and the implementation thereof. Recommendations made by participants for strategies to facilitate the implementation of BPGs in operating theatres were also explored. Descriptive and inferential statistics were utilised to analyse and describe the data. Descriptive statistics were used to describe the profile of the sample, including the demographic data measures of central tendency, for example the mean and standard deviation (SD) and correlation techniques.Chi²analysis was performed to test for significance of the associations between the registered nurses’ demographic variables and their KAP. Data were categorised into three levels, namely lower (score < quartile 1 i.e. bottom 25%). Middle (quartile1 ≤ score ≤quartile i.e. in the middle 50%) and higher (score > quartile 3 i.e. top 25%).Findings from this research study revealed the limited knowledge, attitude and practice of OT nurses about BPGs. During Phase Two an integrative literature review approach was followed in order to identify the best available evidence with regard to the facilitation of the implementation of best practice guidelines in operating theatres. Lastly, Phase Three: strategies that could be used to facilitate the implementation of best practice guidelines in operating theatres were developed. The researcher developed the conceptual framework using the six elements of Dickoff, James and Weidenbach (1968:422). The conceptual framework informed the development of strategies. The strategies are a synthesis of the conclusions drawn from the research findings (phase one and two) and the conceptualization thereof. The strategies were reviewed by six-panel members. Each panel member was supplied with the format for evaluation of the strategies which was based on the criteria established by Chinn and Kramer (2018:156) the results of which included in chapter 7. The researcher ensured that the data obtained was valid and reliable, necessary to assist the researcher to produce quality research. Ethical considerations were maintained throughout. In general, the results of this thesis indicate that the developed strategies that could be used to facilitate the implementation of best practice guidelines, in operating theatres at public hospitals in the NMBHDare unique and could be implemented in theatres in public hospitals. The researcher succeeded in achieving the purpose for this study, because the strategies which are understandable, clear, simple, applicable and significant to operating theatre unit has been developed for use by operating theatre nurses, to facilitate the implementation of best practice guidelines in operating theatres at public hospitals in the NMBHD.
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- Date Issued: 2020
The development of a set of guidelines for the revision of psychological tests and the use of revised psychological tests
- Authors: Cronje, Johan Herman
- Date: 2020
- Subjects: Psychological tests
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/46350 , vital:39567
- Description: The psychological testindustry has produced a wide variety of psychological tests that are used by professionals to facilitate measurement and decision-making. Tests are updated and revised periodically in order to remain current, valid and reliable in what is a competitive psychometric industry. Despite the prevalence of test revisions, especially in recent years, a number of authors have commented on the lack of comprehensive guidelines for test revision. Guidelines shouldcover aspects such as what the different types of revision are, when to embark on a revision, whatprocessto followand how test users should use revised tests. Test revision differs from test construction in a number of ways. There are external factors that affect the regularity with which a test should be revised. Test revision also involves more role players than test construction, including the opinions of those test users who may be resistant to any change in the previous test edition. Finally, revised tests sometimes have to contend with requirements from the test publisher who purchased the test or distribution rights from the developer. Test revision is expensive and time consuming, which leaves little scope for experimentation or trial-and-error. The availability of expertise, as well as the human and financial resources required to complete test revisionscan make such projects unaffordable, especiallyforprofessionals indeveloping countries, such as South Africa.It may be more feasible for such professionalsto collaborate with international revision projects. By doing so they cangain experience in test revision, contribute indigenous information that could shapethe revision ofan international test, increase opportunities to engage with international users, and potentially source international funding for research in their own country. The current studydevelopeda comprehensive and practical set of 30 guidelines to assist those involved in test revision. These guidelines were peer-reviewed and refined. Finally, the guidelines were field-tested using a case study of a recently revised ivdevelopmentaltest, the Griffiths III. Professionals from South Africa, including the present researcher,formed part of the international team for the extensive revision of the Griffiths III, which makes this test an ideal case study from both the perspectives of the developed test revision guidelines as well as collaboration of professionals from a developing country in an international test revision. The knowledge gainedfrom the development of guidelines and international collaboration in test revision is reflected on.
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- Date Issued: 2020
Culturally-informed coping strategies of posttraumatic stress disorders among the black Africans in the greater Accra region of Ghana and black Africans in the eastern cape of South Africa
- Authors: Thompson, Sandra
- Date: 2019
- Subjects: Posttraumatic stress disorder
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/44625 , vital:38154
- Description: The influence of culture in coping with Posttraumatic Stress Disorders (PTSD) has been highlighted in literature. However, these culture specific coping strategies are not as yet, extensively explored. The research sought to explore and describe the culturally - informed coping strategies of PTS D among the black Africans in the Greater Accra Region of Ghana and black Africans in the Eastern Cape of South Africa. A qualitative methodological approach was used to explore the phenomenon under study. Purposive non - probability sampling was employed to obtain access to participants who could inform the objectives of the study. Data was collected using semi - structured interviews with traumatised individuals and focus group discussions with cultural leaders. All interviews were audio - recorded, transcribed, translated and analysed using thematic content analysis to facilitate the description and comparison of the similarities and distinctive features emerging from the two African communities. The findings indicated that a number of cultural factors influence interpretation of symptoms of PTSD and the adopted coping strategies. Participants’ understanding of symptoms of PTSD relied heavily on Christian Religious and African cultural understandings. It was evident that almost all explanations were purely spiritual and minimal knowledge was expressed on cognitive interpretations. A great deal of emphasis by the Ghanaians and isiXhosa of South Africa, was on dreams and such interpretations were deferred to an authoritative individual (especially the traditional healer). An obvious hierarchy for coping emerged with the traditional healer playing a major role for the Ghanaian and isiXhosa participants. Performing rites and the use of plants were essential to healing for these group of individuals. Whereas, the Coloured - Afrikaans made reference to a higher power “God”. An outstanding observation was the extent to which Ghanaian and isiXhosa participants have incorporated Christian and traditional practices (i.e. praying to God, performing rites and using herbs or plants). Even where an individual did not wish to mix practice because of upbringing, they acknowledged the existence and effectiveness of these practices. Colonisation was drawn on as an explanation for such mixed practices. The advent of Christianity was explained as having established Western culture (specifically Christianity) that is incorporated by participants. The Coloured - Afrikaans on the other hand, were consistent with the Christian practices “prayers to God”. A great deal of consistency however existed among all participants. Social support was considered very important. Talking with family and friends were relevant to the healing process as it gets rid of distorted thought patterns and avoids isolation considered as a serious current threat to healing. While there was an element of cognitive understanding, Western based treatment using cognitive restructuring was not a treatment option. Clinical practitioners or Psychologists that come into contact with the black Ghanaians and black South Africans should consider collaborative treatment strategies using the draft checklist as a guide.
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- Date Issued: 2019
Physiological and mechanistic characteristics of all-out running using the critical speed concept
- Authors: Kramer, Mark
- Date: 2019
- Subjects: Aerobic exercises , Physical fitness Running Exercise
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/40511 , vital:36178
- Description: The studies described in this thesis, as far as could be ascertained, were the first to investigate the physiological and mechanistic characteristics of all-out running using the critical speed concept specifically applied to field-sport athletes. In the first study the oxygen uptake (𝑉̇𝑂2) kinetics of linear and shuttle all-out running were investigated. The 𝑉̇𝑂2 kinetic parameters were also related to parameters derived from a graded exercise test. No differences were observed in all 𝑉̇ 𝑂2 kinetic parameters between all-out linear and shuttle running, even though differences in all-out testing parameters were evident. The study was novel in that it was, as far as could be ascertained, the first to implement and investigate differences in 𝑉̇𝑂2 kinetics applied to all-out running. The second study investigated whether the parameters derived from all-out linear and shuttle running were representative of aerobic fitness, and the extent to which the all-out test (AOT) related to already established evaluations of aerobic fitness (e.g., graded exercise test [GXT] and the Yo-Yo intermittent recovery test [YYIR1]). It was also investigated whether the parameters from the AOTs could be used to predict the time to completion (tLIM) of shuttle-based performances. The outcomes of this study showed that both the linear and 50-m AOTs were indeed valid for the aerobic assessment of fitness by showing high correlations with maximal pulmonary oxygen uptake (𝑉̇𝑂2𝑚𝑎𝑥). Both the linear and 50-m AOT could therefore be used as surrogates for the evaluation of aerobic fitness. Interestingly, in terms of the tLIM prediction, the 25-m AOT showed the greatest utility. This study was novel on several fronts in that it was the first to: (1) investigate the physiological link between linear and shuttle AOTs and the GXT, (2) investigate the difference between AOTs and the YYIR1, and (3) investigate the application of the AOT methodology to field-based athletes such as rugby players. The third study investigated the energetic cost (EC) of locomotion as well as the metabolic power (𝑃̇) required to run at given speeds. The energetic approach provides a more robust evaluation of the differences between linear and shuttle running due to the all-out nature of the tests. Conventional methods of energy assessment often fall short due to the preclusion of a physiological steady-state, hence requiring more robust mathematical models to evaluate all-out running performance. The results of this study showed that differences between linear and shuttle AOTs are more likely neuromuscular as opposed to physiological. Peak EC and 𝑃̇ were significantly greater for shuttle running compared to linear running, showing clear non-linear increases with each successive increase in running speed. However, the mean EC and 𝑃̇ were not different, showing that all-out shuttle running ‘balances’ the lower running speeds (implying a lower physiological load compared to linear running) with the higher metabolic load imposed by the intense directional changes. This study was novel as it was, as far as could be ascertained, the first to apply the energetic approach to all-out running as well as investigate the differences in energetics between linear and shuttle AOTs. The fourth study provided a means by which the speed-time characteristics of all-out running could be objectively quantified. A novel bi-exponential model was applied to both the linear and shuttle speed-time curves and allowed various mechanistic aspects of the speed-time curve to be characterized. Conventional assessment of the AOT allows for the derivation of only two key parameters, namely critical speed (CS) and the finite distance achievable at speeds exceeding CS (D’). The application of the bi-exponential model expands the number of useful parameters that can be derived from an AOT to seven. The additional useful parameters include: maximum speed [𝑆𝑚𝑎𝑥], time to maximum speed [𝑡𝑐], amplitude of the difference between 𝑆𝑚𝑎𝑥 and CS [𝐴𝑑], curvature constant of the exponential decay [𝜏𝑑] and the asymptote of the exponential decay function [𝑆0], fatigue index showing the percent decline between 𝑆𝑚𝑎𝑥 and CS [FI%], and the finite capacity for running at speeds exceeding CS [D’; representing the area under the curve that is above CS]. The CS and D’ parameters derived from the bi-exponential model were not different to the CS and D’ parameters derived using the conventional method of analysis, thereby showing that the bi-exponential model is a valid means of assessing the curvature characteristics of the AOT, as well as providing additional information that cannot be gleaned from the traditional approach.
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- Date Issued: 2019
Simulation as a teaching methodology in midwifery education
- Authors: Rall, Nadine
- Date: 2019
- Subjects: Midwifery -- Study and teaching
- Language: English
- Type: Thesis , Doctorate , PhD
- Identifier: http://hdl.handle.net/10948/43013 , vital:36724
- Description: Increased rates of maternal and perinatal deaths remain a challenge in many countries. According to the National Committee on Confidential Enquiries into Maternal Deaths report maternal deaths in South Africa are also related to avoidable factors that could be among other reasons, because of poor performance by midwives. Since such poor performance is further associated with the different forms of clinical practice being taught by nurse educators in midwifery education at different nursing Education Institutions. Thus a revised common clinical teaching methodology, in the form of strategies, utilized in all the training nursing education institutions of final-year undergraduate midwifery students is needed. It would have an impact on how well midwifery students are uniformly prepared for role-taking in clinical practice. The overarching aim of the study was to develop strategies to facilitate simulation as a teaching methodology in midwifery education. The objectives for this study were to:•explore and describe the perceptions of midwifery students with regard to their preparation for role-taking in clinical practice;•explore and describe the perceptions of nurse educators with regard to simulation as a teaching methodology in midwifery education;•provide a literature context with regard to simulation as a teaching methodology in midwifery education, and•develop strategies to facilitate simulation as a teaching methodology for midwifery education. The study followed a qualitative, exploratory, descriptive and contextual research approach design, applying Kolb’s theory (1984) of experiential learning as the paradigm in four phases. In Phase one, the researcher collected data from two groups of participants using semi-structured one-on-one and focus group voice recorded interviews. Focus group interviews were arranged with 27final-year undergraduate midwifery students(Group 1) and individual interviews were conducted with 12 nurse educators (Group 2) in midwifery education and were inclusive of those in the pilot study. viThe participants were purposefully selected across three provinces of South Africa in four nursing Education Institutionsusing set inclusion criteria. Data analysis was done using Saldaña’s (2009) method of content analysis. The researcher and an independent coder analysed and coded the data independently from each other and concurrently for both groups of participants. From the results, three main themes and eight sub-themes emerged. Theme One combined the experiences of both groups and highlighted their experience of simulation as being beneficial. Theme Two addressed the barriers encountered by the participants of both groups when the simulation was used as a teaching methodology. Theme Three addressed the various recommendations that were suggested by both groups of participants on how to strengthen simulation as a teaching methodology. In Phase Two, a contextual description was provided about simulation as a teaching methodology in midwifery education through the use of related literature. The contextual description included the macro-, meso-and micro-environments as related to the use of simulation as a teaching methodology in midwifery education. In Phase Three, following contextual description of the concept of simulation as a teaching methodology the main concept of the study had to be identified and served as a foundation for strategies. The research themes became foundational content for the conceptual framework which was developed using the principles of Dickoff, James and Wiedenbach (1968) as a guide towards the needed strategies for the study. Lastly, in Phase Four three strategies were developed for the facilitation of simulation as a teaching methodology in midwifery education. The three main strategies developed were as follows:•mobilise resources, to facilitate the implementation of simulation in midwifery education;•create an environment conducive to supporting simulation education; and •design a relevant midwifery programme that accommodates simulation within the clinical module. The developed strategies will assist nurse educators to be better prepared to implement midwifery simulation as a teaching methodology in midwifery education. The three principles of research ethics according to The Belmont Report namely, respect for human dignity, beneficence and justice were adhered to throughout the study. Trustworthiness was ensured according to the four principles indicated by Lincoln and Guba’s (1985) Model of Trustworthiness which included credibility, dependability, transferability and neutrality.
- Full Text:
- Date Issued: 2019
Socio-ecological, contextual effects in Raven’s Colour Progressive Matrices scores: developing an index for guiding test selection and interpretation
- Authors: August, Justin Oswin
- Date: 2019
- Subjects: Psychological testing
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/50214 , vital:42071
- Description: With the changing landscape in South Africa to full democracy, increased research has been undertaken in the psychometric field on local and national normative studies regarding various assessment measures. Given that the Raven’s Coloured Progressive Matrices (CPM) is purported to be culture-free and not heavily dependent on verbal and language skills; it has been extensively normed throughout the world for various population groups. While norms for normal populations of children have been developed in South Africa, these studies were based on race and gender predominantly and without taking into consideration the effects of socio-ecological factors on test performance. The research study aimed to understand the influence of socio-ecological factors on the expression of cognitive scores amongst a geographically diverse sample of South African learners. Through this study, research on the interplay between context and cognition was to be located within the Ecological Systems model of Bronfenbrenner. A secondary aim of the study was to develop an index that will guide test selection and interpretation of assessment results, taking into account the influence of socio-ecological factors and providing a conceptual framework for future test development. The study employed a quantitative methodology on a South African sample consisting of primary school children aged between the ages of 6 years to 11 years. The sample was drawn from schools in the Port Elizabeth area in South Africa that were classified into low, medium, and high opportunity, based on context. The results indicated that the type of school had a significant impact on test performance, suggesting that contextual factors were influential in this process. The item analysis conducted further indicated that learners from a low opportunity school performed significantly lower than the other two schools in the sample. The index development provides a foundation for further research that would enhance the interpretation of test results. In the South African context, this is considered important, given our political history and our diversity where a “one size fits all” approach is not possible.
- Full Text:
- Date Issued: 2019
A best-practice guideline for facilitating adherence to anti-retroviral therapy for persons attending public hospitals in Ghana
- Authors: Agyeman-Yeboah, Joana
- Date: 2017
- Subjects: HIV infections -- Treatment -- Ghana , Health services administration -- Ghana Public health -- Ghana Hospital care -- Ghana
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/13603 , vital:27256
- Description: The retention of persons on an HIV programme has been a global challenge. The success of any strategy to optimize adherence to anti-retroviral therapy (ART) depends on the intensive and effective adherence counselling and strategies. It is important to research whether persons receiving anti-retroviral therapy in public hospitals in Ghana are receiving the needed service that would optimize their adherence to the anti-retroviral therapy. Therefore, this study explored and described the experiences of healthcare professionals providing care, support and guidance to persons on ART at public hospitals in Ghana, as well as the best-practice guideline that could contribute to facilitating the ART adherence of patients. This study also explored and described the experiences of persons living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) on ART, regarding their adherence to the therapy. The study was organized into three phases. In Phase One: a qualitative, exploratory, descriptive and contextual design was employed. The research population included healthcare professionals, providing services at the HIV clinic at the public hospitals in Ghana, namely the Korle-Bu Teaching Hospital; the 37 Military Hospital and the Ridge Hospital. The healthcare professionals comprised of doctors, nurses, pharmacists and trained counsellors employed in any of the three public hospitals. Persons receiving ART at any of the three public hospitals were also part of the research population. Semi-structured interviews were conducted with healthcare professionals and persons receiving ART. Data were collected from healthcare professionals in relation to their experiences regarding the provision of ART services, their understanding of evidence-based practice and best-practice guidelines, as well as data on the experiences of persons receiving ART in relation to their adherence to the therapy. The data were analysed using Creswell’s six steps of data analysis; and the coding of the data was done according to Tesch’s eight steps of coding. Trustworthiness was ensured by using Lincoln and Guba’s framework which comprised credibility, transferability, dependability, confirmability and authenticity. Ethical principles such as beneficence and non-maleficence, respect for human dignity, justice, veracity, privacy and confidentiality were considered in the study. In phase two, the literature was searched by using an integrative literature review approach and critically appraising the methodological quality of the guidelines in order to identify the best available evidence related to adherence to ART. In Phase Three, a best-practice guideline for facilitating adherence to ART was developed for public hospitals in Ghana based on the findings of the empirical research of Phase One and the integrative literature review in Phase Two. The guideline was submitted to an expert panel for review; and it was modified, according to the recommendations of the panel.
- Full Text:
- Date Issued: 2017
Best practice guideline for the nursing management of women with gestational diabetes mellitus in military health institutions in Ghana
- Authors: Mensah, Gwendolyn Patience
- Date: 2017
- Subjects: Diabetes in pregnancy -- Ghana , Diabetics -- Treatment -- Ghana Nursing services -- Ghana -- Administration Public health -- Ghana
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/14036 , vital:27409
- Description: Pregnancy is a normal physiological process for the majority of women. These women, their families and significant others normally expect a successful period of pregnancy, labour, delivery and arrival of a normal and healthy baby. However, some of these pregnant women may develop Gestational Diabetes Mellitus (GDM) during this period and if not managed properly, the mother and the foetus in utero are affected in a negative way: there is a likelihood of the mother and baby developing Type 2 Diabetes in the future and also, other risks such as preterm labour, and foetal macrosomia. In order to prevent such occurrences, I set out to develop a best practice guideline for the nursing management of GDM in military health institutions in Ghana in order to help enhance nursing care. The design for this research was qualitative, explorative, descriptive and contextual in nature. The research is organised in three phases: Phase one deals with the data analysis and discussion of the interviews with professional nurses and midwives and women with a history of GDM. The data collected from the interviews were transcribed, analysed and extracted with Tesch’s eight steps of coding used for the coding. The services of an independent coder were employed to assist with the coding process which led to the formulation of key themes. Semi-structured individual interviews provided a means of exploring the perceptions of professional nurses and midwives on the nursing management of GDM: in addition, women with a history of GDM were interviewed so as to elicit their views on the management they had experienced from professional nurses and midwives before and after being diagnosed with GDM. The trustworthiness of the study was ensured by conforming to Lincoln and Guba’s framework of credibility, transferability, dependability, confirmability and authenticity. An independent coder assisted with the coding process. Phase two deals with the Integrative literature review of available evidence-based clinical practice guidelines for the nursing management of GDM. Evidence-based clinical practice guidelines were searched and appraised with assistance from an independent appraiser and themes were then formulated. In Phase three, the themes from Phase one and Phase two were integrated for the development of a draft best practice guideline for the nursing management of GDM in military health institutions in Ghana. The draft guideline was given to an expert panel of reviewers for their comments and recommendations. These were considered in the development of the final best practice guideline for the nursing management of GDM.
- Full Text:
- Date Issued: 2017
Evaluation of self-efficacy in clinical performance of nurses initiate and management of anti-retroviral therapy by South African professional nurses
- Authors: Mangi, Nozuko Glenrose
- Date: 2017
- Subjects: Nursing assessment -- South Africa -- Eastern Cape Self-efficacy Nursing -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10353/4492 , vital:28344
- Description: Self-efficacy in clinical performance is a very important aspect in quality of health care, because it is the ability of the person to produce the desired outcomes. The aim of the study was to evaluate self-efficacy in clinical performance of NIMART programme by professional nurses in Buffalo City Metropolitan in Eastern Cape Province South Africa. A quantitative, descriptive survey design was used to examine self-efficacy in clinical performance during implementation of NIMART programme. A purposive sample of 358 NIMART programme trained professional nurses was included in the study. Analysis of the finding was done using SPSS version 21.0. Descriptive statistics (frequencies, percentage, mean and standard deviations) were used to analyse categorical variables. To reduce data volume, factor analysis was used to identify six variable clusters: Evaluation; planning, assessment, implementation, and patient care mentoring. Factor 1 (evaluation) was highly loaded on patient driven results (0.63); nursing interventions (0.70); breakdown point location (0.80); prognosis based care decisions (0.79); prognosis based outcome monitoring (0.70); and prognosis based settings adjustment (0.70). These items collectively define evaluation of self-efficacy clinical performance of the participants. Factor 2 (planning) was termed planning of patient care in a clinical setting was significantly loaded on these items: data driven nursing diagnosis (0.51); patient driven nursing diagnosis (0.52); settings based nursing diagnosis (0.49); overall care plan formulation (0.52); short-term patients care formulation (0.58); long-term patient care formulation (0.66); goal based measurable outcomes (0.80); goal based daily patient care plan (0.79); settings based daily patient care plan (0.73). Factor 3 (assessment) which was termed assessment in clinical performance was not significantly loaded in some of the items: physical assessment (0.64); patient history (0.65); energy restoration (0.56); time management (0.71); objective patient health data (0.61); subjective patient health data (0.49); data collection documentation (0.44). Factor 4 (implementation) data source correlation; patient health data analysis (0.45); patient strength (0.46); nurse-patient/family communication (0.55); nurse patient collaboration (0.64); Experience driven decision making (0.58). Factor 5 (patient care) patient care plan adherence (0.65); setting based overall patient care (0.74); resource based overall patient care (0.59). Factor 6 (mentoring) patient’s concerns identification (0.48); patient problems prioritisation (0.46); mentor/colleague advice (0.43); mentor/colleague feedback use (0.61); patient discharge strategies (0.71); continuous reporting/documenting (0.63). The mean scores produced by the Kruskal-Wallis test showed the lowest scoring pattern as follows: 20122013201120142010. This order was the same for all the variables, confirming that the 2010 group scored significantly higher than any other group on all the variables. The overall results of the study revealed that professional nurses have high self-efficacy in clinical performance in implementation of NIMART programme, except in evaluation aspect of self-efficacy where they scored lessor. Professional nurses trained by FPD scored higher in the aspects of self-efficacy in clinical performance compared to RTC trained; but scored lower in evaluative ability of self-efficacy in both institutions (FPD and RTC). The findings of this study showed that the overall self-efficacy of the professional nurses trained on NIMART programme performed clinically satisfactorily. It is recommended that in-service education or continuous professional development for professional nurses working in PHC’s should not only concentrate on updating clinical skills, but also create opportunity for reflection and strengthening of professional nurses’ self-efficacy in clinical performance. Also, further study on other processes of goal realisation will aid our understanding of self-efficacy in achieving the desirable goals of the professional nurses for patient quality care. Further research is also needed to evaluate clients’ satisfaction during care based on the NIMART intervention programme.
- Full Text:
- Date Issued: 2017
Management of endotracheal tube cuff pressure in mechanically ventilated adult patients in intensive care units in Malawi
- Authors: Mpasa, Ferestas
- Date: 2017
- Subjects: Intensive care nursing -- Malawi Respiratory intensive care -- Malawi , Patient monitoring -- Malawi
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/19673 , vital:28930
- Description: Patients who are critically ill get often admitted to intensive care units (ICUs). The majority of these patients require support with their breathing and are thus connected to a mechanical ventilator. One aspect to consider in the mechanically ventilated patient is endotracheal tube cuff pressure (ETT) management. The management of ETT cuff pressure entails that nurses working in ICUs have the responsibility of ensuring that ETT cuff pressure is kept within normal range of 20-30 cmH20 for the safety of the patients in order to avoid complication of over and under inflation. Poor management of ETT cuff pressure places the mechanically ventilated patients under risk of tracheal injury. Tracheal injury may also be caused by over or under inflation of the ETT cuff. Over inflation of the ETT cuff can lead to the occlusion of capillaries lining the trachea at the cuff site, tracheal stenosis, and can also lead to the death of mucus membranes around the area, just to mention a few. On the other hand, under inflation of the ETT cuff, can lead to air leaks as well as aspiration of gastric contents into the tracheal tree. Therefore, in order to maintain ETT cuff pressure within normal ranges, evidence-based guidelines related to the management of ETT cuff pressure should be used. However, in Malawi the management of endotracheal tube cuff pressure in mechanically ventilated adult patients by nurses in ICUs is not well explored and it is not clear whether this practice is based on evidence-based guidelines. Furthermore, strategies on how to implement evidence-based guidelines in the ICU might not be known and poorly defined because of the complexity of the context. The study is therefore aimed at implementing and evaluating the effect of an evidence-based guideline on the management of ETT cuff pressure in mechanically ventilated adult patients by nurses in ICUs in Malawi using active (printed educational materials and monitoring visits) and passive (printed educational materials only) implementation strategies. The research study used a quantitative approach with multi-designs. Four phases were used in order to achieve the four objectives that were set. Phase one was the pre-test and used a survey design, two was the expert panel review of the evidence-based guideline, three was the implementation of the reviewed evidence-based guideline using a randomised controlled trial design and phase four was the post-test which used a survey design. The RCT included 25 participants from the control and 27 from the intervention group. Each group had three ICUs of which one in each group was from a private hospital and the other were government. Data collection in phases one and four was by a hand delivered pre-and post-questionnaire. In phase two the expert panel members with experience in critical care used the AGREE II Instrument to review the evidence-based guideline that was implemented. In order to gather data during the monitoring visits, the researcher recorded field notes. The applications that were developed by the University statistician consultant using visual basic applications in excel were used to analyse data. Two different implementation strategies were used to implement the evidence-based guideline. The control group used passive implementation strategy which was printed educational materials thus the evidence-based guideline and algorithm. The intervention group used both active and passive implementation strategies which was the printed educational materials thus the evidence-based guideline and algorithm plus monitoring visits by the researcher. In order to establish the effect of the implemented evidence-based guideline on the nursing care practice for the management of endotracheal tube cuff pressure an evaluative posttest survey was conducted in phase four of the research study. The results revealed that the majority of participants had gaps in both groups regarding nursing care practice for the management of endotracheal tube cuff pressure for the mechanically ventilated adult patients in the pretest but improved in the posttest. In the control group 52% had very low knowledge score, 16% had low score, 28% average, and 4% high score while in the category of very high score there was nobody. However, in the posttest those in the very low score were only 44% while the percentage in the low score remained 16%. There was an improvement in the average scores in the posttest such that only 44% were in this category. There was no one in the high and very high score in the pretest. On the other hand, in the intervention group, 78% had a very low score, 9% low score, and 13% were in the category of average score, while in the high and very high score category there was zero percent in the pretest. However, there was also an improvement in the posttest such that only 44% a very low knowledge score. But 19% had a low score, there were 37% in the average category and no one was in the high and very high score. Statistical analysis revealed that the results were not significantly different between and within groups. Improvements were observed in the two groups regarding the scientific knowledge scores for the nursing care practices in the posttest. Upon qualitative analysis of the data from the open-ended question, two main themes emerged thus the need for documentation of endotracheal tube cuff and the process of implementation the evidence-based guidelines. Sub themes such as lack of documentation; no part of routine care and monitoring not done at all were identified under the main theme of the need for documentation of ETT cuff pressure. The Guideline itself need to be clear; implementation strategies; follow up; incentives; supervision; incentives; time factor; resources or equipment required for successful implementation; nurses buy-in critical for the implementation; training detrimental to EBP implementation; nurses attitude crucial to implementation of EBGs and knowledge of nurses for guideline essential for the implementation were the sub themes identified under the main theme of the process of implementing the evidence-based guideline. All appropriate ethical considerations such as principles of autonomy and self-determination, confidentiality and anonymity, voluntary participation, right to receive treatment, informed consent, were adhered to throughout the research study. The research study was unique in nature because it was the first of its kind in Malawi and it contributed to the awareness of the recommended practice for management of endotracheal tube cuff pressure in the ICUs in the country by implementing an evidence-based guideline. The unique contribution of the study is that it is a challenge to implement evidence-based guideline in poor and resource constraint countries like Malawi.
- Full Text:
- Date Issued: 2017
Strategies to prepare and support the role transition of significant others in becoming caregivers of persons with dementia
- Authors: Smith, Lourett
- Date: 2017
- Subjects: Dementia -- Patients -- Care -- South Africa Caregivers -- Mental health -- South Africa
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/20856 , vital:29407
- Description: Significant others of persons with dementia face many challenges when caring for their loved ones in the home. I became aware of the challenges that significant others of persons with dementia face when caring for persons with dementia, when I was working as a registered nurse in a psychiatric hospital. As a junior registered nurse I found it challenging at times to manage persons with dementia due to the behavioural problems that they exhibited. It occurred to me at the time that significant others who became caregivers of persons with dementia must struggle with their role as caregivers, not having the necessary knowledge and skills to care for them. Literature confirms my observation that significant others need assistance when they experience the transition from being a significant other to being a caregiver of a person with dementia. Significant others often have to deal with many additional role transitions once they become caregivers. Such role transitions could include having to cope with empty nest syndrome and retirement among others, as well as having to deal with caring for their relative. They are prone to stress, burnout and other problems related to caring. By preparing significant others for their main role transition into becoming a caregiver and providing them with support, many of these problems could be prevented and the person with dementia would benefit as a result. Literature also highlights that there is a paucity of research dealing with the role transition of significant others who become the caregivers of persons with dementia. Therefore, the aim of the study was to provide an understanding of how significant others experience providing care to persons with dementia. The study also aimed to understand how significant others were prepared and supported in their role as caregivers as they went through their role transition. The study also aimed to develop strategies to enable psychiatric nurses (APNs), psychiatric nurses (PNs) and other healthcare professionals to prepare and support significant others during their role transition into caregivers of persons with dementia. The study followed a qualitative approach with an exploratory, contextual, descriptive design, applying the Middle-Range Transition Theory as the paradigm and phenomenology as the meta-paradigm. Visual narrative inquiry was utilised using collages and semi-structured individual interviews to collect the data from participants who were the caregivers of persons with dementia. They were purposefully selected from a non-profit Alzheimer’s clinic in the Nelson Mandela Bay Municipality (NMBM). A sample size of eight participants was included. A conceptual framework was used for the development of the strategies for APNs/ PNs and other healthcare professionals to prepare and support significant others during their role transition from significant others to caregivers of persons with dementia. The principles of professional research ethics were adhered to throughout the study.
- Full Text:
- Date Issued: 2017
The influence of corporatization on the professional identity of community pharmacists
- Authors: Kubashe, Nomachina Theopatra
- Date: 2017
- Subjects: Pharmacy -- Social aspects -- South Africa Pharmacist and patient -- South Africa , Communities of practice
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/18189 , vital:28586
- Description: As a potential main player in the primary health care sector and the impending National Health Insurance (NHI), community pharmacists could make a significant contribution to easing the health care burden in South Africa. Recent legislative and organizational changes related to the corporatization of pharmacy in South Africa have impacted significantly on the profession and stand to weaken the already ‘tenuous’ professional identity of pharmacists in the country. Since community pharmacists are viewed as potential main players in the primary health care sector, the influence of corporatization on pharmacists’ identities and their concomitant ability to contribute to easing the health care burden in South Africa need to be considered. In this regard, this study examined the influence that corporatization has had on the professional identity of community pharmacists practicing in the Nelson Mandela Bay area of South Africa. That is, in an effort to understand the influence that corporatization has had on changing professional identities and practices the attitudes, beliefs, and behaviours of community pharmacists regarding the philosophy and practice of pharmacy were explored. This included ascertaining community pharmacists’ self-perception of their professional identity and the perception of users of these community pharmacies. The study was conducted from an interpretative epistemological paradigm, based on a philosophy of pragmatism. Data collection was conducted in two phases and a qualitative approach, which included in-depth and semi-structured interviews, was adopted as a design. Phase one investigated the self-perceptions of sixteen community pharmacists, equally distributed between independent and corporate pharmacies in the Nelson Mandela Bay (NMB). Phase two examined the perceptions of thirty-two end-users of the pharmacies included in the study. Data from both phases were then analysed and interpreted. Following the identification of seven core professional identities, namely pharmacists as custodian or keeper of medicines; primary health care givers; confidante and carer; jaded; astute and credible; corporate; and independent, it was determined that corporatization has, to various degrees, had an effect on the undermining of Nelson Mandela Bay community pharmacists’ view of themselves as skilled professionals in the health care sector. In short, it was found that corporatization is believed to have blurred the boundaries related to what it means to be a pharmacist and what role pharmacists should play in the provision of public health care. Corporatization does not appear to have influenced the patients’ or pharmacy end-users’ perceptions of the pharmacist, and furthermore does not play a major role in their choice of pharmacy. It is the perception of pharmacists in this study that with the introduction of legislative changes, more so corporatization, they experienced an undermining of their professional skill and disregard for costs involved in becoming a pharmacist. The perceived undermining of the professional skill of pharmacists threatens the valuable contribution that community pharmacists can make to balancing the country’s socio-economic status by appropriately and efficiently assisting in preventing, managing and/or reducing the disease burden in South Africa. Corporatization of the community pharmacy sector seems to have realized the government’s intention of making medication affordable to its citizens, however, the certainty of whether corporatization benefits patients that are in need of access remains to be seen. Community pharmacists could in fact, capitalize on the identification and enactment of their clinical skill (pharmaceutical and social caregiving) as this skill appears to be a tool that will allow pharmacists meaningful transition to being real contributors of primary health care in the imminent introduction of the NHI. At the same time, recognition of the role a pharmacist plays in primary health care will be supporting the government in its endeavours to making medicine accessible and affordable to all South African citizens without compromising their health needs. Ultimately, pharmacists can assist in the balancing and/or improvement of the socio-economic status of our society and the country.
- Full Text:
- Date Issued: 2017
Impact of a holistic lifestyle management education programme on health and education outcomes of socioeconomically disadvantaged university students
- Authors: Morris-Paxton, Angela Ann
- Date: 2016
- Subjects: College students -- Mental health College students -- Health and hygiene Health promotion
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/11909 , vital:27003
- Description: Disorders of lifestyle are increasing globally; countries in transition are suffering the double burden of both contagious and chronic disorders. The utilization of health education to address these issues has had variable results, but the most successful have incorporated human contact. The aim of this study was to measure the quantitative and qualitative impact of a wellness promotion programme on university students. The objective was to provide a structured facilitated holistic wellness education programme to a sample of socioeconomically disadvantaged students in Higher Education in the Eastern Cape Province, South Africa. Using a pragmatic mixed methodological approach to this critical evaluation, the impact on both wellness and academic progress was measured. Initial demographic data was gathered via a biographical questionnaire, pre- and post-intervention measurement of wellness, using the Wellness Questionnaire for Higher Education, as well as a semi-structured qualitative questionnaire and transcripts of academic results. Quantitative data was analysed using SPSS analysis software and qualitative data using the NVivo analysis package. The findings were that all students improved throughout the year in their overall wellness scores, in particular in areas such as avoiding excessive sun exposure and increasing the amount of physical exercise. This corresponded with an increase in the value that the participants attached to information on these aspects of wellness, which was attributed to the programme. Results revealed that there was a weak correlation between student wellness measured at the year-end and academic success overall, but a strong correlation between student wellness and academic success for the students that gained the highest marks. Analysis of the dimensions of wellness that correlated best with student success revealed that there was a particularly strong correlation between year-end career wellness and year-end academic success. In conclusion it was found that a positive and holistic salutogenic wellness education programme increased levels of student wellness overall, which translated into student academic success. The link between wellness and success was particularly strong in students that gained higher marks. Recommendations include that first-year higher education students receive a positive wellness education programme built into the curriculum of their first year of study and that the overall impact be monitored across a broader spectrum of students over the duration of their diploma or degree programme.
- Full Text:
- Date Issued: 2016
Exploring the communication skills of community pharmacists in the Nelson Mandela Metropole
- Authors: Knoesen, Brent Claud
- Date: 2015
- Subjects: Communication in pharmacy , Pharmacist and patient
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10948/7981 , vital:24333
- Description: Pharmacy is an information-driven profession that requires effective face-to-face pharmacist-client communication. With the addition of corporate community pharmacies to traditional independent community pharmacies in South Africa (SA), new challenges may hamper pharmacist-client interactions. This study aimed to identify, adapt and improve the communication skills pharmacists require for a changing community pharmacy environment. Specific objectives were to identify basic communication skills, to evaluate the use of these skills by community pharmacists in the Nelson Mandela Metropole (NMM), to identify communication barriers, and to identify any differences in pharmacist-client communication in the two community pharmacy sectors. A mixed methods research design was implemented. The empirical activities consisted of three client focus groups (17 citizens from the NMM), a client survey (220 clients visiting seven independent and seven corporate community pharmacies in the NMM), a pseudo-client study (the same 14 community pharmacies in NMM), and a Delphi study. Twenty-one pharmacists from the 14 community pharmacies participated in Phase one of the Delphi study; nine academic pharmacists from five pharmacy departments/schools/faculties in SA participated in Phase two. Various qualitative and quantitative techniques were used to analyse and interpret the results. Results indicated that clients consult on many occasions with community pharmacists. Community and academic pharmacists listed listening and nonverbal skills as most important communication skills to ensure effective pharmacist-client communication. Counselling privacy and language barriers were listed as major problems influencing the interaction. The results obtained allowed the researcher to propose a practical communication model to assist future community pharmacists in communication skills training
- Full Text:
- Date Issued: 2015