Dissertations / Theses on the topic 'Tge cafe'

Thesis (MCUR)--University of Stellenbosch, 2003.
ENGLISH ABSTRACT: South Africa has a proud history of a high standard of health care delivery in State funded hospitals. This implies that high standards of education and care in both medical and nursing training have been achieved. The care of sick and premature newborn infants by nurses is a speciality that has evolved worldwide over the last forty years as a result of various technological developments. In order to ensure the standard of care delivered, protocols of care should be available for nurses to refer to and to measure their work against. There were no protocols of care available in the two Neonatal Units (NICUs) used in this study. Using a non-experimental, exploratory descriptive design, the researcher set about measuring the quality of nursing care in the NICUs. Standards (structure, process and outcome) were written by the researcher, and validated. The results showed that the standards were not met at an acceptable level in various areas. One of the areas of great concern was the lack of effective hand washing. Outcome standards which reflect the consequences of care indicated serious shortages of staff in some cases and insufficient staff training. Recommendations are that a Quality Assurance Program should be introduced with training and education of the nurses working in the NICUs and the introduction of evidencebased practice. Future research should aim at showing the way to improve the service delivered.
AFRIKAANSE OPSOMMING: Suid-Afrika het ‘n trotse geskiedenis van ‘n hoë standard van gesondheidsorgdienslewering in Staatsbefondsde hospitale. Dit impliseer dat hoë standaarde in mediese en verpleegopleiding bereik is. Die versorging van siek en premature pasgebore babas deur verpleegkundiges is ‘n spesialiteit wat oor die afgelope veertig jaar wêreldwyd ontwikkel het as gevolg van verskeie tegnologiese ontwikkelings. Ten einde te verseker dat ‘n hoë standard van sorg gelewer word, moet protokolle beskikbaar wees vir verpleegkundiges om te gebruik en hulle werkverrigting teen te meet. Daar was geen protokolle beskikbaar in die twee neonatale eenhede wat in hierdie studie gebruik is nie. ‘n Nie-eksperimentele, verkennende, beskrywende ontwerp is deur die navorser gebruik om die gehalte van verpleegsorg in die neonatale eenhede te evalueer. Standaarde (struktuur, proses en uitkoms) is deur die navorser opgestel en gevalideer. Die resultate toon aan dat die standaarde in verskeie areas nie aanvaarbaar nagekom word nie. ‘n Kommerwekkende bevinding was die afwesigheid van effektiewe was van hande. Uitkomsstandaarde wat die resultaat van sorg weerspieël, het aangedui dat daar ernstige tekorte aan personeel in sommige gevalle bestaan het asook onvoldoende opleiding van personeel. Aanbevelings is dat ‘n Gehalteversekeringsprogram ingestel behoort te word en met die opleiding van verpleegkundiges werksaam in die neonatale eenhede en evidence-based practice aangespreek moet word. Toekomstige navorsing behoort aan te dui hoe om die diens wat gelewer word, te verbeter.

Thesis (MA)--Stellenbosch University, 2003
ENGLISH ABSTRACT: Ageing is a fact of life. It often gives rise to unfortunate consequences. Physical infirmities; senile dementia; emotional disturbance. Indeed, the effects of the ageing process can be such as to render a person incapable of performing the ordinary and normal functions of life. In such a case, institutionalisation presents itself as a prospect to enable an aged person to cope with the ordinary day-to-day activities of living. The purpose of institutionalisation is to improve the quality of life of the elderly. In considering the process, a number of important facets need to be borne in mind. Firstly, the process must be seen in relation to the condition of the person being institutionalised. Secondly, the process must be seen as a matter of extraordinary change in the life of the aged person. This implies a detailed explanation and full disclosure of the process envisaged, and, if needs be, appropriate counselling of the person concerned. Thirdly, there must be sympathetic and sensitive assistance given to the aged person in adapting to a new situation. Fourthly, a continuing and intimate interest in, and concern for, the aged person on the part of the family must be accentuated and impressed. This gives rise to the importance of visitation on the part of the family. Its meaning and purpose must be understood. The need for meaningful visitation must be stressed, and the status of a respected member of the family must be emphasised. The aged person must never be cut-off, separated or neglected. Visits must not be a coincidental, haphazard and aimless occurrence. Visitation must always be directed at improving the quality of life of the aged person. The aged person, despite her advanced years and debilitated condition, remains a person with thoughts, feelings, emotions, difficulties and problems. She needs time and attention. The normal or regular pattern of visitation does not, by and large, accomplish these ends. Something more is required. Specialised visitation. This is something different from ordinary, normal, social visitation. It is more intense, more concentrated and more regular. It embodies consistent and continuous contract. It is directed at effectiveness. It is never haphazard or aimless and always has as its objective an improved quality of life for the aged. The specialised visitor and the resident come to know each other well; they come to trust each other, and they come to realise that the object of the visit is more than an exchange of frivolities. Specialised visitation manifests a concern for the aged; it offers them support, stability, certainty and security. This is so because the specialised visitor responds to an inner conviction, an infinite calling, and an earnest urging. It is not a task but a vocation. Many factors contribute to the enhancement of the quality of life of the elderly : three may be mentioned. Institutionalisation, visitation and the role undertaken by the specialised visitor.
AFRIKAANSE OPSOMMING: Veroudering is 'n gegewe feit wat dikwels tot ongelukkige toestande soos fisiese swakhede, seniliteit en emosionele versteuring lei. Die gevolge van veroudering kan inderdaad 'n persoon verhinder om die alledaagse en normale funksies van lewe uit te voer. In sulke gevalle bied institusionalisering die moontlikheid dat 'n bejaarde persoon wel kan handel met die gewone dag-tot-dag aktiwiteite van die lewe. Die doel van institusionalisering is die verbetering van die kwaliteit van lewe van die bejaarde. In die beskouing van hierdie proses moet 'n aantal fasette in aanmerking geneem word. Eerstens, moet die proses in verhouding tot die toestand waarm die persoon wat geïnstitusionaliseeer word verkeer, gesien word. Tweedens, die proses verteenwoordig 'n buitengewone verandering in die lewe van die bejaarde persoon. Om dit te vergemaklik moet 'n gedetaileerde verduideliking en volle openbaarmaking van die proses wat voorlê aan die persoon gegee word en, indien nodig, toepaslike berading aan die persoon verskaf word. Derdens, die persoon moet simpatieke en sensitiewe bystand in die proses van aanpassing tot die nuwe situasie verleen word. Vierdens,die gesin van die persoon moet baie duidelik onder die indruk gebring word van die belang van voortgesette en intieme belangstelling in die persoon deur hulself Hierdie aspek bring die belangrikheid van besoek deur die gesin na vore. Die betekenis en doel van besoek moet deeglik verstaan word. Die behoefte van betekenisvolle besoek moet benadruk word en die status van die persoon as gerespekteerde lid van die gesin beklemtoon word. Die bejaarde mag nooit afgesny, afgesonder of verwaarloos word nie. Besoeke mag nie toevallig, planloos en doelloos geskied nie. Besoeke moet altyd gerig wees op die verbetering van die kwaliteit van die lewe van die bejaarde. Ten spyte van haar gevorderde jare en afgetakelde toestand bly die bejaarde persoon iemand met eie denke, gevoelens, emosies, moeilikhede en probleme. Sy benodig tyd en aandag. Die gewone of gereelde patroon van besoek bereik oor die algemeen nie hierdie doeleindes nie. Iets meer word vereis, naamlik gespesialiseerde besoek. Dit is duidelik verskillend van die gewone, normale sosiale besoek. Dit is meer intensief, meer gekonsentreerd en meer gereeld. Dit beliggaam bestendige en deurlopende kontak. Dit is gerig op doelbereiking. Dit is nooit planloos of doelloos nie en het altyd as oogmerk om die kwaliteit van lewe van die bejaarde te verbeter. Die gespesialiseerde besoeker en die inwoner leer mekaar goed ken sodat hulle mekaar vertrou, en besef dat die oogmerk van die besoeke meer behels as 'n uitruil van beuselagtighede. Gespesialiseerde besoek druk 'n besorgdheid VIT die bejaarde uit. Dit gee aan hulle ondersteuning, stabiliteit, sekerheid en sekuriteit. Dit is so omdat die gespesialiseerde besoeker vanuit 'n innerlike oortuiging, 'n onbegrensde roeping en 'n ernstige lewensdrang optree. Dit is nie 'n taak nie maar 'n roeping. Baie faktore dra by tot die verhoging van die kwaliteit van lewe van bejaardes. Drie hiervan is institusionalisering, besoek en die rol wat die gespesialiseerde besoeker onderneem.

This study investigates the perceived heritage significance of township churches. This is done by means of a case study which focuses on early churches in Langa, particularly the Wesleyan Methodist and the African Methodist Episcopal churches. The hypothesis is that heritage values are attached to certain churches of Langa and that these are regarded as heritage resources as a result of a particular character or built form. In support of this hypothesis, the intellectual realm of churches and heritage values was explored and the historical and spatial context which informed the development of the churches, investigated. A strong emphasis was placed on ascertaining the heritage values of the Langa community in a series of interviews. To understand the values attached to churches, views have been solicited from community members residing in the neighbourhood of the identified churches, members of the clergy and congregants and a number of 'experts’ - people who have been involved in the study of heritage in Langa, either from an academic or community perspective. Sixteen interviews, which took the form of focused, semistructured discussions, were conducted.

Thesis (MPhil) -- Stellenbosch University, 2004.
ENGLISH ABSTRACT: Background: Cloning is a topic that has long fascinated people. It has imbedded itself into popular culture, but studies show that the general public has, at best, only a vague understanding of what cloning entails. Alternatively, their perception has been skewed by that very same popular culture. However, cloning is a complex scientific subject that has considerable ethical implications. It is the kind of topic that people in a deliberate democracy should know about. The media play an important role in the education of the public with regards to science and technology. However, the media have the potential to do more than provide the basic facts. In fact, the media can play an important role in influencing the actions and opinions of the public. It is therefore a responsibility of the media to provide accurate information on scientific developments, such as cloning. Objective: An analysis of three daily newspapers in the Western Cape was carried out to determine how cloning is reported. The broad topics addressed were whether the coverage focused on the ethical or scientific aspects of cloning, if the subject was reported in a positive or negative tone, and whether the science of cloning was adequately explained. Methodology: A quantitative content analysis was completed of a sample of 69 articles. These articles were all those relating to cloning that appeared in three daily newspapers (Cape Argus, Cape Times and Die Burger) over a period of one year from 10 November 2002 to 10 November 2003. Findings: Of all the articles analysed 34% focused on the scientific aspects, 21% focused on the ethical aspects, 6% focused on both ethics and science, while 39% focused on neither. Fifty two percent of articles dealing specifically with animal cloning focused on the science, while only 4% focused on the ethics. However, in articles dealing specifically with human cloning, more (30%) emphasised ethical aspects than scientific aspects (20%). With regards to tone of coverage, 32% of all the articles analysed were positive, 28% negative, and 40% neutral. Sixty percent of articles dealing specifically with animal cloning featured a positive tone, while only 13% of articles exclusively about human cloning had a positive tone. This 13% was comprised of articles on therapeutic rather than reproductive cloning. In terms of explaining the science associated with cloning, only 30% of articles provided an explicit explanation. Potential threats to the accuracy of explaining science were found to exist. Conclusions: While the overall findings were somewhat indistinct it seemed that when the media of the Western Cape reported on the cloning of animals it was done with a positive tone and emphasised the scientific aspects. Reporting on human cloning tended to feature a negative tone and emphasised the ethical aspects. The large number of ‘neutral’ results for both the ‘tone’ and 'science or ethics’ variables could indicate that the media were wishing to remain neutral. However, the large number of neutral articles relating to the ‘science or ethics’ variable could have a negative impact on public understanding. The small number of articles explaining cloning and an emphasis on ‘breakthrough’ news stories could also have a negative impact on public understanding.
AFRIKAANSE OPSOMMING: Agtergrond: Kloning is ‘n onderwerp wat die mensdom lank interesseer. Maar selfs al vorm kloning ‘n deel van ons populere kultuur, wys navorsing dat die groot publiek maar vaagweg verstaan wat die onderwerp behels. Dit is ook moontlik dat hul persepsie negatief bemvloed is deur dieselfde populere kultuur. Maar kloning is ‘n komplekse wetenskaplike onderwerp met aansienlike etiese gevolgtrekkings. Dit is ‘n onderwerp waarvan mense in ‘n demokratiese samelewing moet weet. Die media speel ‘n belangrike rol in die groot publiek se opleiding in wetenskap. Maar die media het die potensiaal om meer te doen as net die basiese feite deur te gee. Die media het die potensiaal om die gedrag en menings van die publiek te beTnvloed. Daarom is dit die verantwoordelikheid van die media om akkurate inligting oor wetenskaplike ontwikkelings, soos kloning, te voorsien. Dolewit: Drie daaglikse koerante in die Weskaap is geanaliseer om te bepaal hoe kloning gedek word. Daar is bepaal of die artikels op die etiese of wetenskaplike aspekte van kloning fokus, of die onderwerp in ‘n positiewe of negatiewe toon gedek is, en of die wetenskaplike aspekte doeltreffend verduidelik is. Metode: ‘n Kwantitatiewe inhoudsanalise van 69 artikels is voltooi. Die geanaliseerde artikels is al die oor kloning wat in drie daaglikse koerante (Cape Argus, Cape Times en Die Burger) tussen 10 November 2002 en 10 November 2003 verskyn het. Bevindinge: Van die artikels het 34% net op die wetenskaplike aspekte van kloning gefokus, 21% net op die etiese aspekte, en 6% op beide etiek en wetenskap. Geen van die twee aspekte is in 39% van artikels beklemtoon nie. Van die artikels wat spesifiek oor dierkloning geskryf is, het 52% op die wetenskaplike aspekte gefokus. Net 4% het op die etiese aspekte gefokus. In die geval van artikels oor die kloning van mense, het meer (30%) die etiese aspekte as die wetenskaplike aspekte (20%) beklemtoon. Met betrekking tot die toon, was 32% van al die artikels positief, 28% negatief, en 40% neutraal. In die geval van artikels uitsluitlik oor dierkloning het 60% ‘n positiewe toon gedui, terwyl net 13% van artikels oor menslike kloning in ‘n positiewe toon geskryf was. Die 13% het bestaan uit artikels oor terapeutiese kloning. Geen artikels oor reproduktiewe kloning was met ‘n positiewe toon geskryf nie. Net 30% van artikels het ‘n uitdruklike verduideliking van die geassosieerde wetenskap gegee. Daar is moontlike bedreigings tot die akkuraatheid van wetenskaplike verduidelikings gevind. Gevolgtrekkings: Die algemene bevindinge is ietwat onduidelik maar dit blyk dat die daaglikse koerante van die Weskaap ‘n positiewe toon in hul dekking van dierkloning gebruik het. Die wetenskaplike aspekte van dierkloning was in die artikels beklemtoon. Berigte oor menskloning was in ‘n negatiewe toon geskryf en het die etiese aspekte daarvan beklemtoon. Die groot hoeveelheid ‘neutraal’ resultate vir die ‘toon’ en ‘wetenskap of etiek’ veranderlikes dui moontlik dat die media probeer het om neutraal te bly in hul dekking. Die groot hoeveelheid ‘neutraal’ artikels vir die ‘wetenskap of etiek’ veranderlike kan dalk ‘n negatiewe invloed op publieke begrip van kloning he. Die klein hoeveelheid artikels wat kloning verduidelik, en ‘n klem op ‘deurbraak’ nuusstories kan ook dalk ‘n negatiewe invloed op publieke begrip he.

Master of Public Health - MPH
Tuberculosis (TB) continues to be a major cause of ill health and the leading cause of death from a single infectious agent worldwide. Furthermore, young children, especially those under five years old and infants, are at risk of developing more severe forms of TB. TB cases continue to cluster among disadvantaged groups such as the poor whose lives are characterised by adverse living conditions. Defaulting from treatment poses a severe threat to children’s health because untreated TB or breaks in treatment could lead to a child developing more severe forms of TB, or worse, could result in mortality. Currently, long-term hospitalisation has the most successful TB treatment outcomes. Therefore, to ensure compliance, children are taken out of their social environment and admitted to hospital. However, being separated from one’s family, especially at a crucial stage of development, could have long-terms effects on the child’s development. The study explored, factors influencing access to care that caregivers of children; who are five years and younger, who received prolonged treatment at a specialised TB hospital in the Western Cape, South Africa experienced. A qualitative approach allowed the researcher to use personal interactions as a focus for studies and was suitable when aiming to understand health behaviour in its everyday context as experienced by the participant. The study results indicated the factors that enable caregiver visitation, is largely dependent on availability of finances. Furthermore, the hospital itself was identified as being accommodating with regards to visiting hours, telephonic calls and served as important mediator between health service provider, the children, their caregivers and the rest of the staff. Visitation depended on availability of finances, and this was the main barrier that was identified by caregivers. The challenges that hampered visitation were unemployment, lack of access to private and public transport and challenges related to farm-workers. A large number of caregivers work on farms in the Cape Winelands and many of them are dependent on seasonal work which results in inconsistent income. This limited availability of finances for visitation. Furthermore, the working conditions, long shifts and lack of employment benefits which were associated with farming, prevented caregivers from visiting. This study revealed that there are a series of factors which influence access to care of caregivers; this is especially the case in children hospitalised for TB. These factors need to be considered by policy makers as well as the Specialised Tuberculosis facility when dealing with children under five as the best way to ensure that treatment is completed through hospitalisation. Therefore, the strategies to assist families of children with TB need to be explored to assist in the continuity of care as well as the child’s development.

Thesis (DPhil)--Stellenbosch University, 2002.
ENGLISH ABSTRACT: The study describes and analyses changes in women's reproductive behaviour ID developing communities. These changes took more than hundred years to occur ID Western communities but only two to three decades in developing communities such as Taiwan and Barbados. The population of Victoria East district of the Eastern Cape province of South Afiica was chosen as a case study of these changes. Changes in the reproductive behaviour of women are described over a period of twenty-two years. The base year for the study is 1978 and data were collected up to 2001. Changes increased in particular since 1988. Statistical descriptive analyses were undertaken with regard to patterns of changes in variables such as age at the onset of births, child spacing, the mean number of births per woman, fertility regulation, and the number of children ever bom. Variations in patterns were analysed according to age cohorts, occupation and marital status. Information regarding these variables was collected from records at hospitals and clinics. Focus group interviews were held to reflect women's own descriptions and experiences regarding these variables. The research design thus combines the quantitative and qualitative approaches. The findings confirm a pattern of fertility decline that Caldwell described as the African pattern, which is different from that seen in Europe and Asia. It is characterized by a progressive delay in onset of childbearing and reductions in the mean number of childbirths that occur across all age cohorts and are associated with contraceptive accessibility. The high incidence of non-marital childbearing in the Victoria East district however sets the population studied apart from the polygamous Afiican societies on which Caldwell based the African transition. In this respect the population considered resembles the scenarios seen in Latin America, the Caribbean, Botswana and in recent years Europe. The study population shows a divergence in the patterns of marital and non-marital childbearing, with marital childbearing following the African pattem. Because of its high incidence, non-marital childbearing is dominant and the major contributor to the fertility decline that is afoot. The implications of this pattern needs much more in-depth study before comparisons with the above-mentioned communities can be made.
AFRIKAANSE OPSOMMING: Die studie beskryf en ontleed veranderinge in vroue se reproduktiewe gedrag in ontwikkelende gemeenskappe. Hierdie veranderinge het in Westerse gemeenskappe meer as honderd jaar geneem om plaas te vind maar slegs twee tot drie dekades in ontwikkelende gemeenskappe soos Taiwan en Barbados. Die bevolking van die landelike Victoria-Oosdistrik: in die Oos-Kaapprovinsie is gekies as 'n gevalstudie daarvan in Suid- Afrika. Veranderinge in die reproduktiewe gedrag van vroue in hierdie gemeenskap word oor 'n periode van twee-en-twintigjaar beskryf Die basisjaar van die studie is 1978 en data is ingesamel tot en met 2001. Veranderinge het veral toegeneem vanaf 1988. Statistiese-beskrywende ontleding is gedoen ten opsigte van patrone van verandering in veranderlikes soos die ouderdom by die skenk van geboorte, geboorte-spasiëring, die gemiddelde aantal geboortes per vrou, fertiliteitsregulering en die aantal kinders ooit gebore. Variasies in patrone is ook na aanleiding van huwelikstaat en beroep bepaal. Inligting aangaande hierdie veranderlikes is verky vanaf rekords wat by hospitale en klinieke gehou word. Fokusgroeponderhoude is ook onderneem waarvolgens vroue se eie beskrywings en ervarings aangaande die genoemde veranderlikes verkry is. Groepe is saamgestel volgens verskeie ouderdomskohorte en huwelikstaat. Die navorsingsmetodologie behels dus 'n kombinasie van kwantitatiewe en kwalitatiewe benaderings. Die bevindings bevestig 'n patroon van fertiliteitsafhame wat deur Caldwell as die Afrikapatroon beskryf word en afwyk van die Europese en Asiatiese patroon. Dit word gekenmerk deur 'n progressiewe vertraging in die aanvang van geboorte-skenk, afhame in die gemiddelde aantal geboortes oor al die ouderdomskohorte en word geassosieer met kontraseptiewe toegankliheid. Die hoë voorkoms van buite-egtelike geboortes in die Victoria-Oosdistrik onderskei egter die bestudeerde bevolking van die poligame Afrika gemeenskappe waarop Caldwell die Afrika-oorgangstipe gebaseer het. In hierdie opsig vertoon die bevolking eerder ooreenkomste met ontwikkelende gemeenskappe m Suid-Amerika, die Karibbiese Eilande, Botswana en die meer onlangse Europa. Die bestudeerde bevolking vertoon uiteenlopende patrone van binne-egtelike en buite-egtelike geboortes met die binneegtelike patroon meer in ooreenstemming met die Afrika-patroon. Die hoë voorkoms van buite-egtelike geboortes domineer egter die algehele patroon en kan beskou work as die hoof bydraende faktor in the afhemende fertiliteit wat waargeneem is. Die implikasies hiervan moet egter veel dieper studie ondergaan alvorens verdere vergelykings met die bogenoemde gemeenskappe gemaak kan word.

Housing provision plays a vital role in meeting basic needs. Dwellings provide the security required for basic functioning and are thus essential for both human development and the alleviation of poverty. This study examines the levels and quality of basic infrastructural service delivery (electricity, water and sanitation) at local government level, focusing on housing. The local government areas studied include Grahamstown Fort Beaufort and Duncan Village. This was done for the purposes of analyzing the effectiveness of the existing housing policy with regard to the adequacy of scale, its developmental logic, implementation and coordination. Justification for basic infrastructural service delivery is based on the Basic Needs Approach [BNA] which forms the cornerstone of the World Bank’s delivery framework. The paper makes use of two methods: firstly, secondary sources are used to provide an impression of the broad policy framework focusing around basic service delivery with housing as the centrepiece. Specific attention is thus given to Integrated Development Plans (IDPs) as this is the level of policy-making responsible for the delivery of these services to communities. Secondly, previously un-analysed data drawn from a household social exclusion survey (2005-2006) conducted in three Eastern Cape municipalities (Buffalo City, Makana and Nkonkobe – representing respectively urban, small town, and rural areas) are evaluated. The data are analysed two ways – graphically and through a regression analysis – to test four hypotheses regarding basic service delivery. Graphical analysis demonstrates that services differ according to housing type and location. It was found that brick houses seem more likely to have better basic services than either shacks or mud dwellings. The results also show that there are inequalities in the provision of certain basic services such as water and sanitation between Duncan Village and Grahamstown. Overall, the results of this study show that government is still faced with major challenges in addressing housing backlogs.

This study investigated the planning, implementation and monitoring of sustainability principles in Buffalo City Municipality (BCM), in the Eastern Cape Province. It also analysed how reporting on sustainability principles was done at this municipality. The research was conducted as a qualitative case study that used analyses of documents, questionnaires and interviews to gather data. All respondents were involved with BCM, some as municipal officials in key positions in the different directorates and others as councillors. The study was contextualised within the area of sustainable development at local government level. The focus was on how the mandate of sustainable local development at local government level was met in BCM. The focus was on the planning, implementation and monitoring of stipulations of Local Agenda 21 and sustainability principles. The study focused on the provision of basic services; inter-generational equity; integration of economic, social and environmental aspects; community involvement; institutional capacity building; partnerships, and global links. The study established that Buffalo City Municipality incorporated sustainability in its vision. There was a lack of common understanding of the meaning of sustainability. Sustainability principles featured prominently at the integrated development planning phase but were less explicitly mentioned in the implementation, monitoring and reporting phases. Sustainability principles were subsumed in the developmental goals of the municipality. The study also highlighted the need for a strategy to have an institution-wide implementation of sustainability principles which would incorporate raising awareness about sustainability and its value.

Thesis (MEdPsych (Educational Psychology)--University of Stellenbosch, 2007.
As primary caregivers (such as residential youth-care workers) are the first teachers of children and spend much more time with the child than any other service provider, educational psychologists need to implement programmes that include primary caregivers in actively working with the youth in their care. This calls for educational psychologists to gain a rich understanding of the experiences of youth-care workers in order to work collaboratively in rehabilitating youth at risk within the youth’s ecosystem. The study attempts to explore the experiences of youth-care workers in residential facilities, using the ecosystemic perspective. A proposed outcome of the research is to contribute to the skills and interventions educational psychologists can use in collaborating with and supporting youth-care workers in residential facilities to rehabilitate youth who are at risk successfully. Qualitative research within the interpretive/constructivist paradigm was employed as the research design. Research was based at two residential facilities in an outlying area of Cape Town, from which four youth-care workers and two youths were drawn as a sample. The data was collected through six semi-structured interviews, observations over a 10-month period at one of the facilities, and photographs of youth-care workers and children. The review of literature and the findings of this research uncovered many experiences that appear to typify residential youth care. These experiences include the multifaceted nature of the role that youth-care workers fulfil in a residential facility; three types of emotional affect experienced by youth-care workers working in facilities; the significance of healthy youth-care worker-child relationships and the importance of these relationships in the successful rehabilitation of youth at risk; and the levels of support and training required in order to perform the task of successfully rehabilitating youth at risk in residential settings.

This thesis is an exploratory ecological study of the role of the family environment as it relates to a number of variables under investigation in the Vancouver Day Care Research Project's extensive contextual study of children enrolled in family day care settings. These variables include child language scores, indices of socio-economic status, conditions of maternal employment and attitudes related to maternal employment, other measures of the home environment, and parental attitudes to childrearing. In addition, the family environments of the family day care caregivers were examined in relation to the quality of care provided. The Moos Family Environment Scale (1986) was administered to parents and caregivers enrolled in the study. Scores from its ten subscales were correlated with measures of the variables of interest and then tested for significance. Data was then analyzed for important trends, patterns and highlights. Results showed that exposure of family members to stimulating ideas and activities is facilitative of child language skills, while an emphasis on achievement seems to have a negative effect. Families from higher socio-economic status homes seemed to be more likely to provide these opportunities for their children, particularly if they are well-educated. Findings also indicate that mothers who are satisfied with their employment tend to provide more positive family environments for their children than those who are working reluctantly. Mothers who worked part-time also appeared to provide better family environments than did those who experienced the increased stress of full-time employment. Adult-centered parenting values which stressed obedience were associated with family environments which were less facilitative of child cognitive development, whereas homes with child-centered parenting values appeared to be more positive. Family day care caregivers who provided superior childcare were found to be more organized in their own families, more supportive of one another, and more able to allow their family members to function independently than were other caregivers. There was considerable overlap in the results for each variable of interest; many similar features were found in the environments which were considered optimal in terms of language development, socio-economic factors, conditions of maternal employment, attitudes to childrearing, and high quality care for children. The study results strongly support the importance of exposure to a wide range of intellectual and cultural stimuli, participation in activities outside the home, expression of feelings amongst family members, and well-organized family functioning in the creation of optimal family environments; an emphasis on achievement, and the use of rigid rules and doctrine were found to be deleterious to the creation of positive home environments.
Education, Faculty of
Educational and Counselling Psychology, and Special Education (ECPS), Department of
Graduate

South Africa became a democracy after its election in April 1994. Thereafter, the country faced the daunting task of trying to fast-track economic growth and addressing social challenges. The Department of Trade and Industry was mandated by the newly elected government to spearhead economic development in order to address these challenges. Trade policy instruments such as industrial development zones formed part of government’s strategic economic instruments to achieve economic reform. The Coega Industrial Development Zone (CIDZ) near Port Elizabeth was one of many economic development zones created principally to promote export orientated manufacturing. The Coega Development Corporation (CDC) was registered as a company to develop, operate and manage the CIDZ. The literature suggests that strategic leadership is important for organizational success. Strategic leadership is described as the ability to influence others to make day-to-day voluntary decisions that enhance long-term viability while maintaining short term financial stability. Literature further suggests that strategic leaders deal with the evolution of organizations and their changing aims and transform them through their capabilities and strategic leadership roles such as being a figurehead, spokesperson, team builder, design school planner and so on. The aim of this research is to analyse the role of strategic leadership with the objectives to ascertain whether strategic leadership contributed to the success of the development of CDC, and identify possible challenges they are confronted with in the execution of their leadership duties. This research was conducted from an interpretivist perspective as the researcher attempted to develop insight into how the strategic leadership of CDC viewed and understood their role. The strategic leadership of CDC, who were the focus of this study, consisted of the executive management team of the organization, including the Chief Executive Officer (CEO). The research design was in the form of a case study of the CDC leadership, with data collected through semi-structured interviews and documents. The most prominent roles exercised by the leadership of CDC included creating a vision and strategy development and inculcating a teamwork corporate culture. Other roles identified include that of team builder, fostering innovation and developing human capital etc. A lack of stakeholder management as well as managing the culture of the organization as it expands and grows, remain critical challenges. Finally recommendations are made together with suggestions for future research.

The provision of housing is a developmental practice and development cannot prevail without public participation. This is echoed in the Manila Declaration on People‟s Participation and Sustainable Development, 1989 as follows, “Public participation is an essential part of human growth that is the development of self-confidence, pride, initiative, responsibility, cooperation. Without such development within the people themselves, all efforts to alleviate their poverty will be immensely more difficult, if not impossible” (Burkey, 1993:56). Housing provision plays a vital role in meeting basic needs; dwellings provide the security required for basic functioning and are thus essential for both human development and the alleviation of poverty. South Africa has one of the most progressive constitutions in the world. It includes the municipal legislative framework that provides for community participation in decision-making at municipal level. However, in practice, citizens have had little experience of this, which is particularly relevant in contexts of severe poverty and failure by the state to provide basic services. This case study demonstrates the challenges faced by the Centre for Public Participation (CPP), a national NGO, when working to influence central government policy on citizen participation. It also explores the role and influence of international donors in promoting this agenda. From the literature review, it was evident that service delivery is essential in the communities, and, as such, government departments and municipalities have a critical role to play. In order to achieve this goal, an interview was conducted with various interviewees. The participants ranged from the youth to the elderly citizens in the community as well as government officials. The main patterns that emerged from the collected data related to the dissatisfaction of the community about the lack of consultation. It would be advisable for government, especially municipalities, to take cognizance of the results and concerns, in an effort to improve and ensure the effective service delivery, as stipulated in the Reconstruction and Development Programme (RDP) document.

This dissertation provides an account of 'Batho Pele' (People First) and 'new public management' as applied in two government call-centres in the Eastern Cape. Focusing on the workers at these call-centres, this research examines the workplace organisation of these call-centres based in the Nelson Mandela Metropolitan Municipality. The study involved interviews with managers, call-centre operators and trade unionists. The findings show how the work environment is not conducive to the goals of customer satisfaction as presented in the Batho Pele policies. The research investigates the conditions of workers as one explanatory factor for poor call-centre service. If workers are a key element in the success of the 'new public management', their work environment and conditions have to facilitate their job satisfaction and their improved customer service. The research demonstrated the evident lack of professionalism in the call-centre, customer care designed as a matter of compliance rather the need to change the culture and the persistent lack of discipline and supervision. The call centre operator's experiences include issues of surveillance, stress, emotional labour, lack of training, internal conflicts and bad 'customer service' as perceived by the citizens of the Metro.

Thesis (MEdPsych (Educational Psychology))--University of Stellenbosch, 2009.
This thesis focused on three adults with Autistic Spectrum Disorder (ASD) who are living in a group home in Cape Town. The purpose of this exploratory study was to explore and describe the three occupants' perceived quality of life and their experiences of living in the group home. The group home was established in 2005 as a pioneering project by Autism Western Cape, a regional non-profit organisation (NGO). It is designed for adults with high-functioning ASD who require low care. In this interpretative study, a multiple case study method of enquiry was used. The Personal Wellbeing Index – Intellectual Disability (PWI-ID), as developed by Cummins and Lau (2005), was used as the primary subjective outcome measure of quality of life. In addition, the study made use of participant observations undertaken during two semi-structured interviews with each participant and two focus group interviews. All three participants felt that they had enjoyed a higher level of quality of life, especially in the domain of 'personal relationships', since their arrival at the group home. However, they expressed a desire for more independence; a higher income; female companionship and better security at the home. These suggestions have been made available to the relevant sponsors of the housing project.

Thesis (MMed)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Objective: The aim of the study was to determine the outcome of critically ill neonates and children admitted to a general intensive care unit in a large regional hospital (Worcester) in the Western Cape. A secondary aim of the study was to determine the risk factors for death in these neonates and children. Methodology: This was a retrospective descriptive survey of all paediatric admissions (under 13 years of age; July 2008 till June 2009) to an intensive care unit at a large regional hospital in Worcester, South Africa. Data collected included: demography, admission time, length of stay, diagnoses, interventions and outcome. Outcome was defined as successful discharge, death or transfer to a central hospital. Results: There were 194 admissions including children and neonates. The files of 185 children and neonates were analysed, while 8 children were excluded due to incomplete data set and one patient was a surgical admission. The male: female ratio was 1.3: 1 and the majority of patients (83%) admitted, were younger than 12 months of age at admission with a mean age of 8.5 months (median age 3.7 months; range 0 to 151 months). The majority (70%) of admissions were successfully discharged, nearly a quarter (24%) transferred to central hospitals in Cape Town and only 6% died (all younger than 5 years of age). Causes of death included acute lower respiratory tract infections (33%), acute gastroenteritis (25%), birth asphyxia complicated by pulmonary hypertension (16%) and prematurity (16%). Patients requiring airway assistance, were more likely to experience an adverse event (p=0.0001) and invasive ventilation was associated with an increased risk for a poor outcome (p=0.00). Conclusion: The majority of children requiring access to a paediatric ICU are younger than one year of age. The common causes of death are acute lower respiratory tract infections, acute gastroenteritis, prematurity and neonatal asphyxia. A regional hospital in South Africa should offer intensive care to children as the majority of their admissions can be successfully cared for without transfer to tertiary hospitals. To our knowledge, this is the first study reporting admissions and outcome of neonates and children cared for in a mixed intensive care unit in a large regional hospital in South Africa. This study suggests that large regional hospitals in South Africa should have mixed intensive care units to improve child survival.

The global threat of climate change is one of the most crucial environmental issues facing the world in modern times. In response to this threat, international governments have drafted the Kyoto Protocol which included the Clean Development Mechanism (CDM). The CDM is a scheme which invited developing countries, like South Africa, to become involved in climate change mitigation projects. While South Africa has been identified as an attractive host country for CDM projects, research has revealed that it lags behind other developing countries in this regard. This study provides a theoretical background to the CDM and grounds the subject within the field of Environmental Economics. Following a literature review of factors that could influence the involvement of a municipality in CDM projects, this thesis undertook a case study of the barriers and drivers to CDM implementation within the Nelson Mandela Bay Municipality (NMBM). Use was made of semi-structured interviews, where a questionnaire was used to guide the researcher’s interview process. Five NMBM officers, who were likely to have been involved with CDM project implementation, were interviewed. Data collected was analyzed using a coding technique and was compared and contrasted to the literature in a process of explanation building. It was possible to elicit 14 factors that acted as CDM-barriers; seven that acted as CDM-drivers; and 10 that were required to change within the NMBM to encourage greater CDM involvement. Of the barriers, lack of awareness, poor political will and lack of funding emerged as the most inhibiting. Of the CDM-drivers, the potential financial benefits; ownership of infrastructure capable of producing carbon assets; and technology transfer emerged as the factors most likely to promote CDM involvement. With regards the factors that require change, it emerged that a positive response would result from a proactive stance by National Government on the CDM; the use of Public-Private-Partnerships to facilitate CDM projects; and improved communication and capacity building within the NMBM and the Nelson Mandela Bay business community. The main recommendation offered to the NMBM was for it to draft a Sustainable Development Policy as well as a formal sustainable development strategy to drive a coherent and consolidated approach to the Municipality’s involvement with CDM projects. Further, it was proposed that the NMBM should, lobby National Government for it to promulgate enabling legislation and a framework which would encourage CDM investment in South Africa; and engage with local business to promote the active involvement of the Nelson Mandela Bay with the implementation of CDM projects. Keywords: Global Warming, Kyoto Protocol, Clean Development Mechanism, Sustainable Development, Environmental Economics, Public Sector, Nelson Mandela Bay Municipality.

This thesis presents a first analysis of how the South African fisheries authority (MCM) has utilised its fisheries management toolbox and governance framework in response to the emerging biological, economic and social challenges of post-apartheid fisheries in the Eastern Cape Province. Despite recognition of the socio-economic circumstances of traditional subsistence fishers in the region, the national fisheries management authority implemented a 'target resource orientated' management approach similar to that used for South Africa's rights-based commercial fisheries. Anecdotal evidence of entrenched illegal fishing for abalone, spiny lobster, and species targeted by subsistence fishers however suggested that MCM's management approach was encountering serious problems, as the needs and circumstances of inshore fishers and fishing communities were not adequately being understood and addressed. A review of fisheries management literature therefore shaped the hypothesis that an underlying governance problem was responsible for the symptoms of management failure being observed. In this regard, management is seen as more concerned with the technical and regulatory measures of the day-to-day operations of regulated fisheries, while fisheries governance needs to take account of "the sum of legal, social, economic and political arrangements used to manage fisheries ... ". Thus, governance includes policy making and management decision-making, with simultaneous recognition of issues outside of the fisheries sector. It thus appeared that the underlying problem was rather one of broader fisheries governance and inappropriate governance objectives with consequent inappropriate resource management arrangements. This thesis set out to gather evidence to test this hypothesis.

The problem of this study was to determine if employee child care difficulties were related to absenteeism. A case study was conducted among sixty-three employees at a north Dallas bank using a survey questionnaire. Descriptive statistics were used to analyze child care difficulties. A majority of employees experienced difficulty when co-workers had child care problems. A majority of the parent employees had difficulty finding sick or emergency/temporary child care, affording child care, and working overtime due to child care. The majority of parents had child care related absences and work interruptions and thirty-nine percent of them considered quitting their jobs due to child care problems. This study implied the need for employer-supported child care options for the bank employees.

This study explores what happens in a reading class where grade 3 learners from specific cultural and ethnic backgrounds are taught to read in a language other than their mother-tongue. The research takes place at a primary school in the Eastern Cape, South Africa where English is the Medium of Instruction (MOI).The report on the findings of this research reveals that the teaching strategies and reading theories of the teacher, the literacy backgrounds of the learners, as well as the language preferences of the parents, are some of the contextual factors that impact on reading. One of the major findings in the study constitutes the debilitating effects of the learners' socio- economic circumstances on their reading performances in the classroom. The socio-political factors that impact on the learners, the teacher, and the school as a social unit, proved to be the factors that are remnants of the Apartheid segregation polices as well as the educational policies of the present government, especially, those pertaining to mother-tongue Instruction. Although it is difficult to generalize from a small-scale study like this, its benefits lie in the evidence that confirms the influence of specific contextual factors on reading proficiencies, the evidence that identifies poor and effective teaching practices and the evidence that elucidate the implications of non-mother tongue instruction. This research may thus serve to raise the consciousness of practitioners in reading instruction, parents and policy makers.
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Since the introduction of Outcomes Based Education (OBE) as a preferred method of teaching and learning with Curriculum 2005 in 1997, its existence has come under continuous threat for the past thirteen years. Its teething experiences included a revision in 2004 which saw the introduction of the Revised National Curriculum Statements (RNCS) and most recently, we are now standing on the threshold of the implementation of the Curriculum Assessment Policy Statements (CAPS) in 2012. Throughout the turbulent educational milieu, social constructivism has always been upheld as the preferred teaching and learning methodology and millions of rands have been invested in this regard. This study is thus premised on the concern that now after all the years of actively promoting social constructivist methodologies, the implementation of the CAPS could seriously negate reasonable strides made in this regard. Triggered by these curricular issues, a qualitative case study was conducted at a school in Grahamstown in the Eastern Cape, South Africa, investigating the learning processes occurring in group work sessions during lessons involving practical work in electricity using circuit boards in grade 8. Underpinned by an interpretivist paradigm, the study took place in two phases. The data was mainly generated through audio and video recording of two focus groups. An open coding system was employed to derive analytical categories and frequency tables were used to establish trends. In order to validate the data, two observer teachers were involved throughout the research process and this was followed up with semistructured interviews after the second phase. The two case studies, involving learners fitting a similar profile in respect of mother-tongue and age group, were engaged in a similar activity for almost a year apart. This study anticipated the revelation of the extent to which group practical activities in electricity promoted learning, how knowledge is constructed in group-settings and whether practical activities involving electrical circuit boards in grade 8 enhance learning? The main findings of my study revealed that these practical activities can promote learning and therefore should remain a preferred method of teaching.

Nel Noddings’ 1984 publication, Caring: A Feminine Approach to Ethics and Moral Education was the first formal introduction of the concept of an “ethic of care”. It is a concept that stresses the importance of compassion in any relationship. For the purpose of this dissertation, the ethic of care was studied in a specific educational community. This research focused on the role of care ethics in a secondary school (The Ransom School for Boys) from 1903 to 1974. The researcher identified this school as one that operated with an ethic of care and collected and analyzed data from historical school documents as well as from 60-90 minute individual interviews with six alumni, five retired faculty, and two administrators. The case study addressed how students and faculty experienced care ethics within the school and how it has been maintained throughout the adult lives of alumni. An a priori coding rubric was used to examine the presence of care ethics at the Ransom School for Boys and in the adult lives of its alumni. This rubric was generated using information taken from the literature review and encompasses 36 different words to identify the presence of care ethics. The primary research question was: How have alumni incorporated care ethics into their personal and professional lives? Secondary questions included: How did the ethic of care present itself over the span of 71 years? Was character education part of the formal curriculum at the Ransom School? Was character education part of the hidden curriculum at the Ransom School? Did the presence of care ethics support the values being taught in the home? While there has been research done on the importance of care ethics in an educational institution, the research is void of direct evidence associated with care ethics in a school community, specifically, an all-boys, private school. Through deductive analysis, care ethics was found to be present and utilized at the school. The interviews and historical documents suggested that moral education was an integral part of the informal curriculum and helped to integrate the ethic of care within the community.

The potential of community-based organisations (CBOs) to provide lasting solutions in the field of Human Immune Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has long been recognised. As interest in the role of CBOs has increased, so have attempts to build their capacity and increase their stability and sustainability. Capacity-building initiatives which aim to strengthen CBOs as if they were identical to formal, more established organisations have often proved ineffective, and even at times destructive, because they have ignored the very differences that make CBOs potentially the most effective agents of development change at community level. This study is a qualitative exploration of a new mentoring-based approach to CBO capacity-building, which is currently being used extensively with CBOs in the Eastern Cape of South Africa. The research is inductive, beginning with an exploratory, descriptive and contextual study of the personal experiences and perceptions of CBO leadership team members from four sample CBOs which have graduated from the Barnabas Trust mentoring programme. Data was collected using a combination of face-to-face unstructured interviews and focus group discussion, with the objective of exploring the subjects’ experiences and their perceptions of the impact of the Barnabas Trust mentoring programme on the sustainability of their organisations. The insights and findings arising from the research process are then applied as the basis for a series of recommendations for the adaptation of the Barnabas trust mentoring approach and materials. The findings of this study appear to show that the mentoring-based approach has been an effective strategy for capacity-building towards sustainability for the CBOs in the sample, bringing positive change at the individual, organisational and community levels.

This study set out to examine whether the Eastern Cape Tourism Board (ECTB) had the capability to cope with change. The tourism industry is very dynamic and for the organization to survive, it must be able to adapt itself in a constantly changing environment. The research question was derived from a study done by Human and Horwitz (1992), in which they examined how South African companies cope with change. They developed a model and a questionnaire to measure the capabilities of coping with change. Their model and questionnaire were based on the following four dimensions: strategic orientation, control orientation, social focus and institutional focus. This model classified organizations into four types, namely: the Boardroom organization, the Technocracy organization, the Hardhat organization as well as the Missionary organization. These typologies are discussed in Chapter 2. A modified version of the Human and Horwitz questionnaire was used to conduct this research. The original questionnaire has 32 items, and the questionnaire used in this study has the same number of items. The modification was done to nine questions, to ensure that they were of specific relevance to the organization being researched. The questions were slightly modified taking care to ensure that they still fit within the original dimensions measured by Human and Horwitz (1992). The questionnaires were distributed within the organization, particularly to those employees in the Tourism section, as the organization also had a Conservation section. The Conservation section was excluded due to the fact that a policy decision had already been taken to separate the two sections, thereby creating two organizations. When the questionnaires were returned, they were analyzed using 'Statistica' , a computerized statistics program. The results showed that the ECTB does not have the capability to cope with change as it lacked the critical strategic orientation that Human and Horwitz (1992) suggest is a key requirement for coping. The profile of the organization showed that the ECTB could be classified as primarily being a Technocracy organization, and secondarily a 'Hardhat' organization. (See details in Chapter 4). Human and Horwitz (1992) suggest that an organization to be able to cope with change, must be a 'hybrid' of these four types. The implications of these results suggest that the organization is lacking in the dynamism brought about by having a strategic orientation. Human and Horwitz argue that the profile of an organization coping well with change should show a 'balance' in terms of orientation (strategic orientation and control orientation). The ECTB's profile does not show this balance, and can therefore be said not to have the capability to cope with change. The results of the profile are discussed in Chapter 4.

Thesis (MBA)--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: The aim of the study was to assess the adult patients' perception of the quality of care received, following a visit to a doctor at Mthatha General Hospital Outpatients Department to establish whether it meets the patients' expectations, and to derive recommendations to improve the quality and assure that it is maintained. A cross-sectional survey was used to obtain the relevant data. A structured interview questionnaire was administered to a systemic sample of 204 adult patients attending the General Outpatients clinic at Mthatha General Hospital after a consultation with a doctor. Data was gathered and analyzed on the 204 patients' records using a Statistical package for Social sciences. This study has revealed that most patients are female (59%), aged between 16 and 70 years, with the majority in the 41 to 50 year age group. The majority of patients are unemployed (55.4%), with grade 1-8 level of education, have presence of long-standing illness or disability (54.9%), and are married (53.4%). The patients' perception of the quality of care was positive. The interpersonal aspects of care was judged by patients to be the most important, followed by technical aspects. Socio-demographic influences on perception of care were significant in those patients with long-standing illness or disability in respect of outcome aspects of care. It is recommended that patients' perception of the care provided to them be periodically assessed to ascertain if it meets their needs.
AFRIKAANSE OPSOMMING: Die doel van die studie was om die volwasse pasient se persepsie van die kwaliteit van versorgingsdiens, soos ervaar na 'n besoek aan 'n dokter by die Mthatha Algemene Hospitaal Buitepasiente Afdeling, te bepaal om gevolglik vas te stel of aan die pasient se verwagtinge voldoen is en om aanbevelings hiervan af te lei om kwaliteit te verbeter en te verseker dat dit volgehou word. 'n Deursnee peiling is gebruik om toepaslike data te bekom. 'n Gestruktureerde onderhoud-vraelys is aan 'n sistemiese monster van 204 volwasse pasiente by die algemene buitepasiente kliniek van die Mthatha Algemene Hospitaai gedoen na 'n besoek aan 'n dokter. Data uit die 204 pasienterekords is versamel en analiseer deur middel van 'n statistiese pakket vir die sosiale wetenskappe. Resultate toon dat die meerderheid pasiente vroulik (59%) en tussen 16 en 70 jaar oud is en oorwegend in die 41 tot 50 jaar ouderdomsgroep val. Die meerderheid pasiente is werkloos (55.4%), het 'n graad 1-8 vlak-opvoeding, vertoon met 'n langtermyn siekte toestand of ongeskiktheid (54.9%) en is getroud (53.4%). Die pasiente se persepsie van die kwaliteit van versorging was positief. Interpersoonlike aspekte van versorging is deur pasiente as die belangrikste beskou, gevolg deur tegniese aspekte. Sosiodemografiese invloede op die persepsie van uitkoms-verwante aspekte van versorging was betekenisvol by pasiente met langtermyn siekte toestande of ongeskikthede. Daar word aanbeveel dat pasiente se persepsie aangaande die versorging wat hulle ontvang periodiek beoordeel word om vas te stel of aan hulle behoeftes voldoen word.

Thesis (M.A.)--Stellenbosch University, 2001.
ENGLISH ABSTRACT: This study deals with crime prevention within the criminal justice system in response to the current crime situation in the Western Cape. It describes the structure and function of the criminal justice system and assesses crime prevention processes with specific reference to the role of social work within the criminal justice system. It further examines the criminal justice system as practised in the Western Cape, paying specific attention to the role of the police, criminal courts and prisons in the prevention of crime. In line with the nature of the study an exploratory approach was used. The data was collected from both primary and secondary sources. Interviews and observations were the main research techniques used for gathering primary data. Secondary data + was gathered by means of a study of the literature. Structured and unstructured interviews were conducted with social workers, magistrates, police officers, prosecutors, victims, offenders, community workers and other officials of the criminal justice system. These interviews were mainly conducted at Wynberg magistrates' court, Drakenstein Prison (formerly known as Victor Verster Prison) and organisations based in the metro areas and on the Cape Flats. The study was conducted over a period of three years with the interview schedule administered between May and August 2000. A sample of 21 respondents was selected on the basis of a purposive approach and procedure. The comprehensive interview schedule consisted of mainly open-ended and a few closed questions, generating information on the profiles of respondents, crime dynamics in the Western Cape, the sentencing process and prevention strategies, matters related to the criminal justice system and corrections, and the role of community justice in the prevention of crime. The generated qualitative data was analysed and interpreted. The findings suggested the necessity for social work to make a contribution to the prevention of crime in a sensitive and proactive way. The analysis has shown that criminal justice approaches can significantly enhance the process of crime prevention, but that the criminal justice system requires combined strategies and approaches for crime prevention to be effective. It is in this context that the contribution of social work can be much more effective. The recommendations of the study have demonstrated a need for social workers to promote approaches that are premised on a broader understanding of the role of the criminal justice system in the prevention of crime. It is important to state that the study's recommendations for the prevention of .crirne can also be implemented by other role-players, particularly within the criminal justice system.
AFRIKAANSE OPSOMMING: Hierdie ondersoek handeloor misdaadvoorkoming deur die strafregstelsel in reaksie tot die huidige misdaadsituasie in-die Wes-Kaap. Dit beskryf die struktuur en funksie van die stafregstelsel en beoordeel misdaadvoorkomingsprosesse met besondere verwysing na die rol van maatskaplike werk binne die strafregstelsel. Dit ondersoek verder die strafregstelsel soos beoefen in die Wes-Kaap deur veral aandag te gee aan die rol van die polisie, die howe en gevangenisse in die voorkoming van misdaad. Die aard van die ondersoek vereis dat 'n eksplorerende benadering gevolg is. Data is versamel uit primêre sowel as sekondêre bronne. Onderhoude en waarnemings + was die hoof navorsingstegnieke wat gebruik is om primêre data te versamel. Sekondêre data is weer verkry deur 'n studie van die literatuur. Gestruktureerde en ongestruktureerde onderhoude is gevoer met maatskaplike werkers, landdroste, polisie beamptes, openbare vervolgers, slagoffers, gevonnisde misdadigers, gemeenkapswerkers en ander beamptes van die strafregstelsel. Hierdie onderhoude is hoofsaaklik gevoer by die Wynbergse landdroshof, Drakenstein Gevangenis (voorheen Victor Verster Gevangenis) en organisasies werksaam in die metropolitaanse gebiede en die Kaapse Vlakte. Die ondersoek is onderneem oor 'n periode van drie jaar met die onderhoude gevoer tussen Mei en Augustus 2000. 'n Steekproef van 21 respondente is geselekteer op die grondslag van 'n doelgerigte benadering en prosedure. Die omvangryke onderhoudskedule bestaan uit oorwegend oop en 'n beperkte aantal geslote vrae, en het inligting gegenereer oor die respondent-profiel, misdaad-dinamika in die Wes-Kaap, die vonnisopleggingsproses en voorkomingstrategieë, sake rakende die strafregstelsel en korrektiewe optrede, en die rol van gemeenskapsreg in die voorkoming van suggereer die noodsaaklikheid daarvan vir maatskaplike werk om 'n bydrae te lewer ,- tot die voorkoming van misdaad op 'n sensitiewe en proaktiewe wyse. Die ontledings het aangetoon dat strafregbenaderings die proses van misdaadvoorkoming beduidend kan verhoog maar om misdaadvoorkoming effektief te laat geskied, vereis die strafregstelsel gekombineerde strategieë en benaderings. Dit is binne hierdie verband dat die bydrae van maatskaplike werk baie meer effektief kan wees. Die aanbevelings van die ondersoek wys op 'n behoefte by maatskaplike werkers om benaderings te bevorder wat gebaseer is op 'n breër begrip van die rol van die strafregstelsel in die voorkoming van misdaad. Dit is van belang om te stel dat die ondersoek se aanbevelings vir die voorkoming van misdaad ook geïmplementeer kan word deur ander rolspelers, veral binne die strafregstelsel.

This descriptive case study of the transformation in medical care at the community level was carried out with a triangulation approach. Data from documents and surveys using both semi-structured and unstructured interviews were gathered to evaluate and explain how medical care delivery changed from a primarily public system to one predominantly private.

Basic Antenatal Care (BANC) is a way of training or upgrading the knowledge and skills of all nurses, midwives and doctors involved in antenatal care at the primary health care level so that the minimum care can be provided effectively. This study was conducted to investigate the implementation of the BANC program by midwives in the Mdantsane clinics during February 2009. Methods: A descriptive study design was undertaken targeting midwives providing antenatal care to pregnant women, in 14 clinics of Mdantsane. Data was collected from 25 midwives in the clinics, and from 140 ANC cards of women attending ANC on the day of their visit to the clinic. Results: The majority of midwives providing BANC in Mdantsane clinics were not trained in BANC. There were 10 trained midwives and 15 not yet trained. A total of twenty five midwives were involved in the study. The number of visits according to the BANC schedule was well known by the midwives in the study. The content of the visits was well known for the first visit, but for subsequent visits, the participating midwives could not state exactly what they do on these visits. They perceived BANC as something beneficial for both midwives and pregnant women with 24 of the participating midwives rating BANC as advantageous. In completing an ANC card, the midwives scored between 48 percent and 100 percent. Under examination, they scored between 52 percent and 100 percent. Lastly on interpretation and decision making, they scored between 0 percent and 92 percent. This could have troubling consequences for the health status of the mother and baby. Weaknesses in providing antenatal care identified in the study included participating midwives failing to fill in the last normal menstrual period (LNMP) and the estimated date of delivery (EDD), which was a worrying observation. Plotting of the gestational age at first visit was also not carried out well as only 47 percent of the midwives in the study did this, meaning that there would be a miscalculation of the gestational age thereafter throughout the pregnancies. The body mass index (BMI) was not calculated as the maternal height and weight were not written on the ANC card. This should be completed in order to check the nutritional status of the pregnant woman to help supplement, if malnourished, and educate on diet, if overweight. Only 17 percent of the midwives in the study plotted the foetal presentation. Failure to plot foetal presentation could lead to complications during delivery because women with abnormal presentations could end up delivering in a clinic instead of the hospital.Conclusion: This study showed that even though midwives are implementing BANC among pregnant women, it is not being carried out correctly. Therefore the programme will not be as beneficial as it would be if put into practice correctly. This is highlighted by the lack of knowledge from the untrained midwives regarding the content of care on subsequent visits. Thus there is an urgent need for BANC training to be conducted and monitored at various sites.

Background: The Malawi government in 2002 embarked on an innovative health care financing mechanism called Service Level Agreement (SLA) with Christian Health Association of Malawi (CHAM) institutions that are located in areas where people with low incomes reside. The rationale of SLA was to increase access, equity and quality of health care services as well as to reduce the financial burden of health expenditure faced by poor and rural communities. This thesis evaluates the implications of SLA contracting out mechanism on access, utilization and financial risk protection, and determines factors that might have affected the performance of SLAs in relation to their objectives. Methods: The study adopted a triangulation approach using qualitative and quantitative methods and case studies to investigate the implications of contracting out in Malawi. Data sources included documentary review, in-depth, semi-structured interviews and questionnaire survey. The principal agent model guided the conceptual framework of the study. Results: We find positive impact on overall access to health care services, qualitative evidence of perverse incentives for both parties to the contracting out programme and that some intended beneficiaries are still exposed to financial risk. Conclusion: An important conclusion of this study is that contracting out has succeeded in improving access to maternal and child health care as well as provided financial risk protection associated with out of pocket expenditure. However, despite this improvement in access and reduction in financial risk, we observe little evidence of meaningful improvement in quality and efficiency, perhaps because SLA focused on demand side factors, and paid little attention to supply factors: resources, materials and infrastructure continued to be inadequate.

SPAR Eastern Cape is a special organisation. It is an extraordinary place to work and have fun at. The organisation celebrated its twentieth “birthday” in 2013. Operating in a very difficult sector, this business has done extremely well in establishing itself as one of the leading businesses in the Eastern Cape. The success of this incredible business is driven by employees from all levels. With an extreme conviction in the apothegm that “none of us is as smart as all of us”, the organisation is built around high performance teams through a unique culture called: Amafela Ndawonye (referred to as Amafela hereafter). “Amafela” has been in operation at SPAR Eastern Cape since the organisation’s inauguration in 1993. Organisational cultures are dynamic. Organisational cultures shift, incrementally and constantly, in response to external and internal changes. Trying to assess an organisational culture is therefore complicated by the reality that one is trying to hit a moving target. However, a possibility exists that culture enhancement can be managed as a continuous process rather than big shifts (often in response to a crisis). A stable destination with regards to organisational culture should never be reached. The culture of an organisation should always be learning and developing. This prompted the researcher to ask the question, as an organisation responds to internal and external changes; can it lose its relevancy in the process? The primary objective of this research is to determine whether the commitment to the culture of “Amafela” and relevancy thereof at SPAR Eastern Cape is declining. The first step in achieving this objective was an in-depth theoretical study. The second step, and in order to achieve this objective, was an empirical survey conducted to canvas the opinions of (N= 149) respondents at SPAR Eastern Cape. The main findings of this research conducted at SPAR Eastern Cape can be summarised as follows: The organisational culture was assessed according to how respondents interpret the organisation’s existing organisational culture, and thus underlining areas in need of enhancement. In general the outcome of the survey exhibited that a large number of employees at SPAR Eastern Cape denoted that the culture of “Amafela” is still strong and is still relevant in the organisation. In this research, good to excellent levels of consistency for all eleven factors of “Amafela” were achieved. The items are therefore parallel in the test. Organisational leaders will influence the function of the people within the organisation. Moreover, leadership will set the present and future course of the company. This research articulates a correlation between leadership and “Amafela” factors. The eleven dimensions of the “Amafela” factors ranked according from favourable to less favourable. Customer focus emerged as the factor which most respondents agreed and strongly agreed with. It can be concluded then, that the culture of “Amafela Ndawonye” at SPAR Eastern Cape has the full support of the employees and is still relevant in the organization.

Thesis (MCur)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: Controversy was observed regarding the opinions of nursing managers on the role of patient care workers (PCWs) in private hospitals. These opinions ranged from praise for their contribution towards patient care to serious concerns about the impact of their role on patient safety. The aim of this study was therefore to explore the role of PCWs in private hospitals in the Cape Metropole, South Africa. A qualitative approach with a descriptive design was applied to explore the role of PCWs as perceived by unit managers, nurses and patient care workers. Purposive sampling was used to select participants from medical and surgical wards from three different private hospitals, one each from the three major private hospital groups in South Africa (n=15). Permission to conduct the study was obtained from the Health Research Ethics Committee of the Stellenbosch University, as well as from the private hospital organisations. Fifteen semi-structured interviews were conducted, transcribed and analysed. Six themes emerged from the data. These included PCW activities, care organisation, position in the patient care team, training, reasons for employment and concerns about the PCW role. The findings indicated strong similarities with the health care asistant role as described in the literature study. The activities of PCWs are focused on direct patient care and they spend much time with patients. They are close observers of the patient’s condition and report to nurses. PCWs seem to be well integrated into the patient care team and are mostly seen as nurses. Yet, there are concerns about their evolving role despite their limited training programmes and the lack of direct supervision. The researcher recommends that the work of PCWs should be regulated, but that the nursing profession should critically evaluate the need for another nursing category in addition to that of the enrolled nurse auxiliary.
AFRIKAANSE OPSOMMING: Teenstrydigheid is waargeneem met betrekking tot die opinies van verpleegbestuurders oor die rol van pasiёntsorgwerkers (PSWs) in privaat hospitale. Hierdie opinies het variëer van waardering vir hul bydrae tot pasiёntsorg tot ernstige besorgdheid oor die impak van hulle rol op pasiënt veiligheid. Die doel van hierdie studie was dus om die rol van PSWs in privaat hospitale in die Kaapse Metropool in Suid Afrika te ondersoek. ‘n Kwalitatiewe benadering met ‘n beskrywende ontwerp is gevolg om die rol van PSWs, soos waargeneem deur eenheidsbestuurders, verpleegsters en PSWs self, te ondersoek. Doelgerigte steekproeftrekking is gebruik om deelnemers van mediese en chirurgiese sale uit drie verskillende privaat hospitale, een uit elk van die drie grootste privaat hospitaal organisasies in Suid Afrika, te kies (n=15). Toestemming om die studie te doen is verkry van die Etiek Komitee vir Gesondheidsorgnavorsing van die Universiteit van Stellenbosch sowel as van die privaat hospitaal organisasies. Vyftien semi-gestruktureerde onderhoude is gevoer, woordeliks getik en ge-analiseer. Ses temas het uit die data na vore gekom. Dit sluit die aktiwiteite van PSWs, die organisering van sorg, plek in die pasiёntsorg span, opleiding, redes vir indiensneming en besorgdheid oor die rol van PSWs. Die bevindinge toon ‘n sterk ooreenkoms met die rol van die gesondheidsorg assistent soos beskryf in die literatuur. PSWs fokus op direkte pasiёntsorg en spandeer baie tyd met pasiёnte. Weens hulle nabyheid aan die pasiёnt, kan hulle die pasiёnt se toestand waarneem en bevindings rapporteer aan verpleegsters. PSWs is oёnskynlik goed geїntegreer in die pasiёntsorgspan en word meesal as verpleegsters beskou. Tog is daar besorgdheid oor die uitbreiding van hulle rol ten spyte van beperkte opleidingsprogramme en ‘n gebrek aan toesighouding. Die navorser stel voor dat die werk van PSWs gereguleer behoort te word, maar ook dat die verpleegprofessie die nodigheid van ‘n addisionele kategorie tot die assistent verpleegster, krities moet evalueer.

Thesis submitted in fulfilment of the requirements for the degree Master of Technology in Information Technology in the Faculty of Informatics & Design at the Cape Peninsula University of Technology
Research on health informatics has seen a steady increase during this decade as the role of information technology in the health sector becomes pertinent. Findings of previous research in this domain have uncovered vast information needs of health workers, particularly in developing countries. However, there is a need to continue with multidisciplinary research in priority areas such as midwifery practice and in the environment of marginalised settings. This study explores the significance of the information needs and information-seeking behaviour or practice of midwives during the antenatal and intrapartum care within the environment of a midwifery unit. Additionally, the researcher obtained permission from Faculty of Informatics and Design – CPUT and Health department authority – Western Cape Government in South Africa, to conduct research in the Elsies River Midwifery Obstetric Unit (ERMOU). The research was carried out as case study in a Midwifery Obstetric Unit in the Western Cape, South Africa. The investigator conducted semi-structured interviews and observations to collect qualitative data of the antenatal and intrapartum care environment. The data was transcribed and analysed using thematic analysis and essomenic modelling. The findings comprehensively point to the importance of this research context. The study found that midwives acquired patients’ information from a handwritten Maternity Case Record (MCR) book and midwives’ colleagues, and often during handovers. In addition, midwives also communicate with each other during care activities in the ERMOU. It was apparent that the use of such communication practices is inadequate, and midwives did not always have sufficient information to make appropriate decisions in the ERMOU. All patient information, referral notes, and reporting is paper-based. In addition, essomenic models were used to depict the midwives’ work activities in the antenatal and intrapartum care environment in the Unit. Furthermore, essomenic models defined all the systematic processes that occur in the ERMOU which is described by midwives’ activities and work environment. To improve communication, future research is recommended to consider the importance of the continuity of the education of midwives. Further research will be on the implementation of nursing informatics and the electronic health record system in the Elsies River Midwifery Obstetric Unit.

Thesis (MA)--University of Stellenbosch, 2002.
ENGLISH ABSTRACT: The aim of this pilot study was to do a needs analysis with a selected group of nurses with regard to the following three aspects: nurses' experiences of their involvement in termination of pregnancy (TOP) services, the effects of their involvement in TOP service provision on a personal, familial and career level, as well as their needs with regard to support. An important aspect of the needs analysis was to develop a questionnaire which can be used as basis for future research purposes. A qualitative, explorative, descriptive and contextual research design was applied in order to conduct this study. Participants were recruited from a health care facility in the Western Cape, v~ and the small sample group (seven out of a possible fifteen) consisted of a selected group of nurses who are currently involved in performing TOPs, as well as nurses involved in pre- and/or post-procedure care of patients. Each participant completed a self-administered biographical dataand semi-structured questionnaire, which was compiled specifically for the purpose of the pilot study. Specific guidelines according to previous research findings were incorporated. The results of the pilot study revealed that most of the participants experience some sort of cognitive, emotional and/or behavioural reaction before, during and after TOP procedures are performed. -Feelings of anxiety, sadness, anger, depression and guilt were reported in some cases, as well as moral-ethical conflicts. With regard to the effect on a personal, familial and career level, it was confirmed that the work has an effect on the majority of respondents' personal life and career to a certain extent, although family life did not seem te be affected significantly. The results conveyed that the majority of the nurses experienced that the impact of their work with TOPs seemed to be different from that of their other nursing duties. It was found that participating nurses are in need of some sort of support service, and that the practicality of the services which are currently provided, should be investigated further. Although the ability to generalise the results, was limited by the small research sample, valuable information was gained with regard to nurses' needs for support, as confirmed by other South African research findings. Suggestions for improvements in the questionnaire, as well as other further research possibilities, are provided.
AFRIKAANSE OPSOMMING: Die doel van hierdie loodsstudie was om 'n behoeftebepaling te doen met 'n geselekteerde groep verpleegpersoneel met betrekking tot die volgende drie aspekte: verpleegpersoneel se ervaring van hul betrokkenheid by terminasie van swangerskap (TOP) dienste, die effek van hul betrokkenheid by TOP diensvoorsiening op 'n persoonlike, gesins- en beroepsvlak, sowel as hul behoeftes met betrekking tot ondersteuning. 'n Belangrike aspek van die behoeftebepaling was om 'n vraelys saam te stel wat as basis vir toekomstige navorsingsdoeleindes sou kon dien. 'n Kwalitatiewe, eksploratiewe, beskrywende en kontekstuele navorsingsontwerp is toegepas ten einde hierdie loodsstudie uit te voer. Deelnemers is gewerf by 'n gesondheidsorgfasiliteit in die Wes-Kaap en die klein steekproef (sewe uit 'n moontlike vyftien) het bestaan uit 'n geselekteerde groep verpleegpersoneel wat tans betrokke is by die uitvoering van terminasie van swangerskappe, sowel as verpleegsters wat betrokke is in pre- en/of post-prosedurele versorging van pasiente. Elke respondent het 'n selfgeadministreerde biografiese en semi-gestrulctureerde vraelys voltooi, wat spesifiek vir die doel van die loodsstudie saamgestel is. Spesifieke riglyne op grond van vorige navorsingsbevindinge is geinkorporeer. Die resultate van die loodsstudie het aan die lig gebring dat die meeste van die respondente een of ander kognitiewe, emosionele en/of gedragsreaksie ervaar voor, tydens en na die uitvoering van TOP prosedures. Gevoelens van angs, hartseer, woede, depressie en skuld is gerapporteer in sornmige gevalle, sowel as moreel-etiese konflikte. Wat betref die effek op 'n persoonlike, gesins- en beroepsvlak, is dit ook bevestig dat die werk 'n effek blyk te he op respondente se persoonlike en beroepslewe tot 'n sekere mate, alhoewel dit geblyk het dat gesinslewe nie beduidend bemvloed word nie. Dit het ook uit die resultate van die studie geblyk dat die meerderheid van verpleegsters die impak van hul werk met TOP as anders as die van hul ander verplegingstake ervaar. Daar is bevind dat deelnemende verpleegpersoneel 'n behoefte het aan een of ander tipe ondersteuningsdiens en dat die praktiese aspekte van die dienste wat tans voorsien word, verder ondersoek behoort te word. Alhoewel die veralgemeenbaarheid van die resultate deur die klein steekproef beperk word, is waardevolle inligting bekom met betrekking tot verpleegpersoneel se behoeftes aan ondersteuning, soos bevestig deur ander Suid-Afrikaanse navorsingsbevindinge. Aanbevelings vir verbeteringe aan die vraelys, sowel as verdere navorsingsmoontlikhede word gemaak.

Bibliography: pages 296-303.
This dissertation involves a case study in the application of job evaluation in the City Council of Cape Town. The purpose was to gain insight into the dynamics of the process in a local government environment from the point of view of principal actors - political office bearers, senior officials, trade unions, compensation specialists and employees at large. The methodology was that of "participant-as-observer" and "complete participant". Complementing this was extensive use of primary documentation. A survey using a structured questionnaire was administered to other major local authorities to identify job evaluation usage. The introductory chapter provides an overview of the concept of job evaluation, its principles and practice and the different methods employed. The historical and contemporary usage of job evaluation both abroad and in South Africa is covered in the following chapter. The most prevalent systems are described including the Five Factor System applied in the City Council. Methodological issues are aired in the following chapter whilst Chapter 4 provides context to the study through an analysis of the structure and function of the constituent organisational parts and a review of policies and practices relevant to the personnel/remuneration process. In Chapter 5 the background to formal job evaluation in the organisation is traced by focusing on the salary and wage negotiating process 'leading in' to the decision to introduce formal job evaluation. A review of an earlier evaluation of senior management posts using the Hay method is also presented. Chapter 6 provides an overview of the principles and practice of Council's job evaluation programme, primarily from the perspective of the compensation specialists. It describes the rationale for the choice of procedures and provides further insight into the method adopted. Each phase is considered in the light of accepted practice. Chapters 7, 8 and 9 are focal points in the study and deal with senior management response, union perspectives and employee reaction to the plan. The analysis oscillates between micro and macro issues, examining the interplay of system content, procedures and differing value orientations. Perspectives of senior management are critically examined and assessed where possible against objective evidence. Discussion of the issues brought forward by management is pursued in order to place these within a framework of principle and practice. The contrasting roles of the two trade unions provide the central focus in Chapter 8. One adopted a participative approach aimed at monetary benefit; the other showed a preference for negotiation based on results of the job evaluation, emphasising factors not included in the formal system. Chapter 9 examines employee grievances as an indicator of employee acceptance applying equity theory. Grievance factors are analysed and mini case studies of responses to perceived inequity are illustrated. In the concluding chapter some specific recommendations for improvement to the system and its application are made as well as conclusions applicable to job evaluation in general. The overall conclusion reached is that deficiencies in systemic, procedural and value dimensions led to partial attainment of objectives - this attributable to an absence of commitment. The absence of organisational consensus created tension in the equilibrium of the organisation. With the new structure installed, secondary benefits of a more conscious corporate approach are being manifested through system maintenance.

Thesis (PhD)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: Background A need for primary care practitioners to utilise clinical research evidence in practice has been identified and is well described. However a chasm between evidence and practice still exists in primary health care (PHC). Although clinical practice guidelines have been shown to improve the quality of clinical practice and attempt to bridge the gap between evidence and practice, practitioners are often not aware of practice guidelines and fail to access, adopt or adhere to evidence-based recommendations contained in them. Central question How can the implementation of clinical research evidence, using the example of the national evidence-based guideline on asthma, be improved in the PHC sector in the MDHS of the Cape Town metropole? Aim This research aimed to improve the implementation of clinical research evidence in PHC, by learning from the specific example of the national evidence-based asthma guideline in PHC practice in the Metro District Health System (MDHS) of the Cape Town metropole, and to make recommendations to key stakeholders regarding the future implementation of evidence-based guidelines. Objectives  To gain insight into the current quality of asthma care in PHC in the MDHS of the Cape Town metropole.  To determine whether the process of implementation of the new asthma guideline contributed to an improvement in the quality of care in the MDHS.  To explore ways of improving the process of implementation of the national asthma guideline in PHC in the MDHS.  To gain insight into the perceptions, attitudes and knowledge of asthmatic patients regarding their asthma management.  To explore how EBP is understood and perceived by doctors in PHC. Stellenbosch University https://scholar.sun.ac.za  To understand how PHC doctors in the public and private health sectors gain access to and use guidelines.  To explore the experiences, perspectives and understanding of family physicians (FPs) (academic, private and public sector) with regard to EBP and the implementation of guidelines in PHC practice.  To gain insight into the understanding of FPs regarding the perceived problems and main barriers to EBP and their views of the process of guideline implementation in PHC.  To gain insight into the knowledge, perceptions and attitudes of clinical nurse practitioners in the public sector with regard to EBP and the process of guideline implementation. Methodology This study was conducted in the PHC setting of the Cape Town metropole. This research was conducted in three phases and used cross-sectional surveys, quality improvement (QI) cycles, qualitative research methods, such as interviews with FPs, and participatory action research (PAR). Phase 1 involved a cross-sectional survey, which looked at the knowledge, awareness and perspectives of doctors, regarding evidence-based practice (EBP) and guideline implementation using the national evidence-based asthma guideline published in 2007. It also involved QI cycles conducted over a period of five years to assess the baseline quality of asthma care in the PHC sector and to evaluate improvement in asthma care as a result of the QI cycles and associated educational workshops. Phase 2 involved interviews conducted with FPs in academia as well as in the private and public health care sectors who were responsible for clinical governance in PHC in the Cape Town metropole. During this phase of the research the experiences, perspectives and understanding of FPs (academic, private and public sector) with regard to EBP and the implementation of guidelines in PHC practice were explored. Phase 3 involved PAR with primary care practitioners at community health centres (CHCs) using a co-operative inquiry group (CIG) to improve asthma guideline implementation in PHC. The CIG investigated how to improve the implementation of the asthma guideline in their respective CHCs and completed four cycles of planning-action-observation-reflection. The four cycles focused on implementation of an asthma self-management plan (ASMP), exploring the capability of clinical nurse practitioners to implement the guidelines, exploring the views of patients on their asthma care and implementing better patient education. A final consensus of the CIG’s learning was then constructed. Results With regard to quality improvement of asthma care in PHC: The first objective of the study was largely addressed through the baseline audits conducted in 2007 and 2008. This showed that the baseline quality of asthma care, with specific reference to the assessment of the patient’s level of control, measuring the patient’s peak expiratory flow rate (PEFR), assessing the patient’s inhaler/ spacer technique, recording the smoking status, the adequate prescription of controller and reliever metered dose inhalers (MDI) refills during visits and particularly the issuing of an ASMP during visits, was poor. The second objective was addressed through the annual audits conducted in 2007, 2008, 2010 and 2011 during the period of implementation. This showed that although clear cause and effect reasoning cannot be inferred, overall statistically and clinically significant improvements in the quality of care occurred in conjunction with the process of asthma guideline implementation. Despite the improvement in structural and process criteria there was no corresponding improvement in the outcome criteria and in fact the utilisation of facilities for emergency visits significantly increased, while the hospitalisation of patients remained constant. The third objective was to explore ways of improving the process of implementation of the national asthma guideline in PHC in the MDHS. This was largely addressed through the action-research process at selected CHCs. This showed that implementation could be improved by ongoing educational support and formal interactive training workshops with the staff members who were directly involved with patients. The development and use of educational aids and ASMPs based on the guideline recommendations were useful and encouraged patient participation in decision making regarding their care. The fourth objective, specific to asthma care, addressed by means of a survey and showed that even though the majority of asthma patients participated in decisions regarding their asthma and felt satisfied with the quality of care they received, the prevalence of smoking among asthma patients was high and opportunities for smoking cessation counselling were missed. Even though documentation of peak flow recordings and patients’ knowledge of the difference between the reliever and controller MDIs were good, patients’ perceptions with regard to education on the inhaler technique, the assessment of the level of control, the issue of written information regarding asthma and the use of ASMPs remained poor and could be improved. With regard to EBP and asthma guideline implementation in PHC: The fifth objective of the study was addressed by means of a survey which showed that the doctors in PHC used evidence in clinical decision making and agreed on the usefulness and importance of EBP in improving the quality of patient care in South Africa. There was a difference in the engagement with activities related to EBP between the public and private sector PHC doctors and there is a need for formal training in the skills and processes of EBP. The sixth objective was addressed by means of a survey which showed that a good proportion of both public and private sector doctors in the Cape Town metropole were well aware of the asthma guideline, had used the guideline and had adopted, acted on and adhered to specific guideline recommendations. There was a high level of general awareness of the asthma guideline and recommendations were being adopted in practice, although the lack of formal disease registers, monitoring and evaluation of asthma care and the utilisation of an ASMP could be improved on. The seventh objective was addressed by qualitative research which showed how the views and perspectives of FPs regarding EBP and the process of guideline implementation contributed to the development of a conceptual framework for the process of guideline implementation. The eighth objective was addressed by qualitative research, which identified barriers present in each step of the implementation process. Time constraints, practitioner workload, lack of financial resources, lack of ownership, the lack of timeous organisational support and practitioner resistance to change were important barriers to guideline implementation in an already overburdened PHC setting. A conceptual model was developed which showed that the process of guideline implementation should be tailored to the barriers identified. The ninth objective was addressed by means of a survey which showed that the concept of EBP was fairly new to CNPs in PHC and identified a need to learn more about it. CNPs agreed that clinical research evidence is useful in the daily management of patients, that their decision making is based on evidence, that evidence-based nursing can improve the quality of patient care, that there is a place for evidence-based nursing in their practices at their respective CHCs, that EBP will make a difference in the quality of care of their patients and that evidence-based nursing practice has an important role to play in South Africa. Although the awareness of CNPs with regard to the asthma guideline was poor, the vast majority reported that they personally educated patients on the difference between reliever and controller MDIs, recorded the smoking status of patients in the records, demonstrated the inhaler technique to all their asthma patients, assessed the level of control and agreed that inhaled corticosteroids are the mainstay of treatment in patients with chronic persistent asthma. However only a small minority (mainly at the CHCs where action research occurred) started issuing patients with ASMPs. In answering the central question: “How can the process of implementation of clinical research evidence, using the example of the national evidence-based guideline on asthma, be improved in the PHC sector in the MDHS of the Cape Town metropole?”, this thesis concludes that the process of guideline implementation can be improved in the PHC sector by an in depth understanding and systematic approach to the whole process. A conceptual framework is provided as a model which attempts to guide and make sense of this process of guideline implementation. A stepwise approach is presented and provides a summary of the main research findings. The model shows that the initial process of evidence creation should not only deal with research evidence of high quality, but should incorporate research evidence that is relevant to the particular context of care. In addition the model shows that guideline development should be inclusive and involve a wider spectrum of stakeholders as well as patients; that guideline contextualisation, dissemination and implementation should be carefully planned. Special consideration should be given to local decision making about adoption or prioritisation of specific recommendations as part of ongoing quality improvement cycles and the conversion of published guidelines into practical tools for practitioners to use in consultation, prior to dissemination. Implementation should anticipate that members of the PHC staff will differ in their readiness to change and that strategies should consciously embrace principles of behaviour change and build up a sense of ownership, choice and control over local adoption of the guidelines. Academic centres, such as universities and professional bodies, have a role to play in identifying, appraising and synthesising the evidence, and giving input into guideline development. They can also assist by innovating and evaluating practical tools as part of the contextualisation stage and by providing continuing education during implementation as part of their social responsibility. The health care organisation (HCO) should prevent unnecessary delays in guideline implementation by ensuring that policy, resources and recommendations are aligned during the contextualisation stage; that barriers encountered should be dealt with throughout the entire process, and that ongoing monitoring and evaluation of the quality of care occurs. Conclusion This research used different methods and innovative PAR to bridge the gap between evidence and practice. A new conceptual model for guideline implementation is recommended for use to assist with implementation and knowledge translation in PHC locally, nationally and in similar Low Middle Income Countries (LMIC) in Africa.
AFRIKAANSE OPSOMMING: Agtergrond ‘n Behoefte om kliniese navorsingsbewyse in die praktyk te benut, is by primêre – sorg praktisyns geïdentifiseer en word goed beskryf. Daar bestaan egter steeds ‘n gaping tussen bewyse en die praktyk in primêre gesondheidsorg. Alhoewel getoon kon word dat kliniese praktykriglyne die kwaliteit van kliniese praktyk verbeter, en poog om die gaping tussen bewys en praktyk te oorbrug, is praktisyns dikwels nie bewus van praktykriglyne nie, en faal daarin om toegang te verkry tot bewysgebaseerde aanbevelings wat daarin vervat is, asook om dit aan te neem en na te kom. Sentrale vraag Hoe kan die implementering van kliniese navorsingbewyse, deur die voorbeeld van nasionale bewysgebaseerde riglyne oor asma te gebruik, verbeter word in die primêre gesondheidsorgsektor in die Metropooldistrik – gesondheidstelsel van die Kaapstad – metropool? Doel Die doel van hierdie navorsing was om die implementering van kliniese navorsingbewyse in die primêre gesondheidsorg te verbeter, deur te leer vanuit die spesifieke voorbeeld van die nasionale bewysgebaseerde asmariglyne in die primêre gesondheidsorgpraktyk in die Metropooldistrik – gesondheidstelsel van die Kaapstad - metropool, en om aanbevelings aan sleutel – rolspelers te maak aangaande die toekomstige implementering van bewysgebaseerde riglyne. Doelwitte  Om insig te verkry in die huidige kwaliteit van asmasorg in die primêre gesondheidsorg in die Metropooldistrik – gesondheidstelsel van die Kaapstad – metropool.  Om vas te stel of die implementeringsproses van die nuwe asmariglyne bygedra het tot ‘n verbetering in die kwaliteit van sorg in die Metropooldistrik – gesondheidstelsel.  Om maniere te verken om die implementeringsproses van die nasionale asmariglyne in die primêre gesondheidsorg in die Metropooldistrik – gesondheidstelsel te verbeter.  Om insig te verkry in die opvattings, houding en kennis van asmatiese pasiënte met betrekking tot hul asma – bestuur.  Om te verken hoe bewysgebaseerde praktyk verstaan en deur dokters in primêre gesondheidsorg toegepas word.  Om te verstaan hoe primêre gesondheidsorgdokters in die openbare - en privaatgesondheidsektore toegang tot, en die toepassing van riglyne verkry.  Om die ervaringe, perspektiewe en begrip van gesinspraktisyns (akademies, privaat en openbare sektor) met betrekking tot bewysgebaseerde praktyk, en die implementering van riglyne in primêre gesondheidsorg, te verken.  Om insig te verkry in die begrip van gesinspraktisyns met betrekking tot die probleme wat waargeneem is, hoofhindernisse tot bewysgebaseerde praktyk, asook hul persepsies van die proses van riglyn – implementering in primêre gesondheidsorg.  Om insig te verkry in die kennis, persepsies en houding van kliniese verpleegpraktisyns in die openbare sektor, met betrekking tot bewysgebaseerde praktyk en die proses van riglyn – implementering. Metodologie Hierdie studie is uitgevoer in die primêre gesondheidsorg - instellings van die Kaapstad – metropool. Hierdie navorsing is in drie fases uitgevoer, en het deursnee – ondersoeke, kwaliteitverbeteringsiklusse, kwalitatiewe navorsingsmetodes soos onderhoude met gesinspraktisyns, en deelnemende aksienavorsing gebruik. Fase 1 het ‘n deursnee – ondersoek behels oor die kennis, bewusmaking en perspektiewe van dokters met betrekking tot bewysgebaseerde praktyk en riglyn – implementering , deur die nasionale bewysgebaseerde asmariglyne te gebruik wat in 2007 gepubliseer is. Dit het ook kwaliteitverbeteringsiklusse behels wat oor ‘n tydperk van vyf jaar uitgevoer is, om die basislyn – kwaliteit van asmasorg in die primêre gesondheidsorg te assesseer, en om die verbetering in asmasorg te evalueer as ‘n uitvloesel van die kwaliteitverbeteringsiklusse en geassosieerde opvoedkundige werkswinkels. Fase 2 het onderhoude behels met gesinspraktisyns in akademia, sowel as in die privaat - en openbare gesondheidsorgsektore wat verantwoordelik was vir kliniese staatsbestuur in primêre gesondheidsorg in die Kaapstad – metropool. Gedurende hierdie fase van die navorsing was die ervaringe, perspektiewe en begrip van gesinspraktisyns (akademia, privaat – en openbare sektor) met betrekking tot bewysgebaseerde praktyk, en die implementering van riglyne in primêre gesondheidsorg, verken. Fase 3 het deelnemende aksienavorsing met primêre sorg – praktisyns by gemeenskaps – gesondheidsentrums behels, deur ‘n koöperatiewe ondersoekgroep te gebruik om die asmariglyn – implementering in primêre gesondheidsorg te verbeter. Die koöperatiewe ondersoekgroep het ondersoek ingestel hoe om die implementering van die asma – riglyne in hul onderskeie gemeenskaps – gesondheidsentrums te verbeter, en het vier siklusse van beplanning – aksie – observasie – refleksie voltooi. Die vier siklusse het gefokus op die implementering van ‘n asma – selfbestuurplan, die bekwaamheid van kliniese verpleegpraktisyns om die riglyne te implementeer te verken, die persepsies van pasiënte oor hul asmasorg te verken, en die implementering van beter pasiënt – opvoeding. ‘n Finale konsensus van die koöperatiewe ondersoekgroep se studie was toe opgestel. Resultate Met betrekking tot gehalteverbetering van asmasorg in primêre gesondheidsorg: Die eerste doelwit van die studie is hoofsaaklik aangespreek deur die basislyn – oudit wat in 2007 en 2008 uitgevoer is. Dit het getoon dat die basislynkwaliteit van asmasorg, met spesifieke verwysing na die assessering van pasiënte se vlak van beheer, meting van die pasiënt se piek ekspiratoriese vloeitempo, assessering van die pasiënt se inhaleringstegniek, optekening van die pasiënt se rookstatus, die voldoende voorskryf van reguleerder - en verligter gemeterde dosis inhaleerderhervullers tydens besoeke, en veral die verskaffing van ‘n asma – selfbestuurplan tydens besoeke, swak was. Die tweede doelwit is aangespreek deur die jaarlikse ouditte wat uitgevoer is in 2007, 2008, 2010 en 2011 gedurende die periode van implementering. Dit toon dat, hoewel duidelike oorsaak en effek – argumentering nie afgelei kan word nie, algehele statisties en klinies - beduidende verbeterings in die kwaliteit van sorg voorgekom het, in samewerking met die proses van asmariglyn – implementering. Ten spyte van die verbetering in strukturele – en proseskriteria, was daar geen ooreenstemmende verbetering in die uitkomskriteria nie. In werklikheid het die benutting van fasiliteite vir noodbesoeke aansienlik verhoog, terwyl die hospitalisasie van pasiënte konstant gebly het. Die derde objektief was om maniere te verken om die implementeringsproses van die nasionale asmariglyne in primêre gesondheidsorg in die Metropooldistrik – gesondheidstelsel te verbeter. Dit was hoofsaaklik aangespreek deur ‘n aksienavorsingproses by geselekteerde gemeenskaps – gesondheidsentrums. Dit het getoon dat implementering verbeter kon word deur deurlopende opvoedkundige ondersteuning en formele interaktiewe opleidingswerkswinkels met die personeellede wat direk betrokke was met die pasiënte. Die ontwikkeling en gebruik van opvoedkundige hulpmiddels, en asma - selfbestuurplanne gebaseer op die riglyn – aanbevelings was nuttig, en het pasiëntdeelname in besluitneming rakende hul sorg, aangemoedig. Die vierde doelwit, spesifiek met betrekking tot asmasorg, is aangespreek by wyse van ‘n opname. Dit het getoon dat, alhoewel die meerderheid van asma – pasiënte deelgeneem het aan besluite rakende hul asma, en tevrede was met die kwaliteit van sorg wat hulle ontvang het, die voorkoms van rook onder asma – pasiënte hoog was, en geleenthede vir rookstaking – berading was gemis. Alhoewel dokumentasie van piekvloei – opnames en pasiënte se kennis van die verskil tussen die verligter en kontroleerder - gemeterde dosis inhaleerders goed was, was pasiënte se persepsies met betrekking tot opvoeding in die inhaleringstegniek, die assessering van die vlak van beheer, die uitreiking van geskrewe inligting ten opsigte van asma, en die gebruik van asma – selfbestuurplanne steeds swak en kon dit verbeter word. Met betrekking tot bewysgebaseerde praktyk en asmariglyn – implementering in primêre gesondheidsorg: Die vyfde doelwit van die studie is aangespreek by wyse van ‘n opname wat getoon het dat die dokters in primêre gesondheidsorg bewyse in kliniese besluitneming gebruik het, en saamgestem het met die nuttigheid en belangrikheid van bewysgebaseerde praktyk in die verbetering van die kwaliteit van pasiëntsorg in Suid – Afrika. Daar was ‘n verskil in omgang met aktiwiteite wat verband hou met bewysgebaseerde praktyke tussen die openbare – en privaatsektordokters. Daar is dus ‘n behoefte aan formele opleiding in die vaardighede en prosesse van bewysgebaseerde praktyke. Die sesde doelwit is aangespreek by wyse van ‘n opname wat getoon het dat ‘n goeie proporsie van beide openbare en privaatsektordokters in die Kaapstad- metropool wel bewus was van die asmariglyn en het spesifieke riglyn – aanbevelings aangeneem, daarop gereageer en nagekom. Daar was ‘n hoë vlak van algemene bewustheid van die asmariglyn, en aanbevelings was aangeneem in die praktyk, alhoewel daar verbeter kon word op die gebrek aan formele siekteregisters, monitering en evaluering van asmasorg, en die benutting van ‘n asma – selfbestuurplan. Die sewende doelwit is aangespreek deur kwalitatiewe navorsing wat getoon het hoe die persepsies en perspektiewe van gesinspraktisyns ten opsigte van bewysgebaseerde praktyk en die proses van riglyn – implementering bygedra het tot die ontwikkeling van ‘n konseptuele raamwerk vir die proses van riglyn – implementering. Die agste doelwit is aangespreek deur kwalitatiewe navorsing, wat hindernisse in elke stap van die implementeringsproses identifiseer het. Tydbeperkings, praktisynswerklading, gebrek aan finansiële hulpbronne, gebrek aan eienaarskap, die gebrek aan tydige organisasie – ondersteuning en praktisynsweerstand ten opsigte van verandering, was belangrike hindernisse in riglyn – implementering in ‘n reeds oorlaaide primêre sorg – omgewing. ‘n Konseptuele model is ontwikkel wat getoon het dat die proses van riglyn – implementering aangepas moet word by die geïdentifiseerde hindernisse. Die negende doelwit is aangespreek by wyse van ‘n opname wat getoon het dat die konsep van bewysgebaseerde praktyk betreklik nuut was vir kliniese verpleegpraktisyns in primêre gesondheidsorg, en het ‘n behoefte geïdentifiseer om meer hieroor te leer. Kliniese verpleegpraktisyns het saamgestem dat kliniese navorsing nuttig is in die daaglikse bestuur van pasiënte, dat hul besluitneming gebaseer moet wees op bewyse, dat bewysgebaseerde verpleging die kwaliteit van pasiëntsorg kan verbeter, dat daar ‘n plek is vir bewysgebaseerde verpleging in hul praktyke by hul onderskeie gemeenskap-gesondheidsentrums, dat bewysgebaseerde praktyk ‘n verskil sal maak in die kwaliteit van sorg van hul pasiënte, en dat bewysgebaseerde verpleegpraktyk ‘n belangrike rol kan speel in Suid – Afrika. Alhoewel die bewustheid onder kliniese verpleegpraktisyns met betrekking tot die asmariglyne swak was, het die oorgrote meerderheid verslag gegee dat hulle die pasiënte persoonlik opgevoed het oor die verskil tussen verligting – en beheerder gemeterde dosis - inhaleerders, die rookstatus van pasiënte in die verslae opgeteken het, die inhaleringstegniek aan al hul pasiënte gedemonstreer het, die vlak van beheer geassesseer het, en saamgestem dat geïnhaleerde kortikosteroïede die staatmaker van behandeling is in pasiënte met chroniese, aanhoudende asma. Slegs ‘n klein minderheid (hoofsaaklik by die gemeenskap – gesondheidsentrums waar aksienavorsing geskied) het egter begin om pasiënte van asma – selfbestuurplanne te voorsien. In die beantwoording van die sentrale vraag: “Hoe kan die proses van implementering van kliniese navorsingsbewyse, deur die voorbeeld van die nasionale bewysgebaseerde riglyne oor asma, verbeter word in die primêre gesondheidsorgsektor in die Metropooldistrik - gesondheidstelsel van die Kaapstad – metropool?”, kom hierdie tesis tot die gevolgtrekking dat die proses van riglyn – implementering in die primêre gesondheidsorg verbeter kan word deur ‘n in – diepte begrip en sistematiese benadering tot die hele proses. ‘n Konseptuele raamwerk word voorsien as ‘n model wat poog om te lei en sin te maak van hierdie proses van riglyn – implementering. ‘n Stapsgewyse benadering word aangebied en verskaf ‘n opsomming van die hoof – navorsingbevindinge. Die model toon dat die aanvanklike proses van bewyse – skepping nie slegs navorsingbewyse van hoë kwaliteit moet oorweeg nie, maar navorsingbewyse moet inkorporeer wat relevant is tot die bepaalde konteks van sorg. Boonop toon die model dat riglyn – ontwikkeling inklusief behoort te wees, en behels dit ‘n wyer spektrum van rolspelers sowel as pasiënte; dat riglyn – kontekstualisering, verspreiding en implementering versigtig beplan behoort te word. Spesiale oorweging moet gegee word aan plaaslike besluitneming oor die aanneming of prioritisering van spesifieke aanbevelings as deel van volgehoue kwaliteitverbeteringsiklusse, en die omskakeling van gepubliseerde riglyne na praktiese hulpmiddels vir praktisyns om te gebruik in die konsultasiefase, alvorens verspreiding daarvan plaasvind. Implementering behoort te verwag dat lede van die primêre gesondheidsorg sal verskil in hul gereedheid om te verander, en dat strategieë doelbewus die beginsels van gedragsverandering sal insluit en ‘n gevoel kweek van eienaarskap, keuse en beheer oor plaaslike aanneming van die riglyne. Akademiese sentrums, soos universiteite en professionele liggame, het ‘n rol om te speel in die identifisering, gehalteversekering en sintetisering van die bewyse, en om insette te lewer in die riglyn - ontwikkeling. Hulle kan ook behulpsaam wees deur praktiese hulpmiddels te innoveer en te evalueer as deel van die kontekstualiseringfase, en om deurlopende opvoeding te verskaf gedurende implementering as deel van hul sosiale verantwoordelikheid. Die gesondheidsorg – organisasies moet onnodige vertragings in riglyn – implementering voorkom deur te verseker dat beleid, bronne en aanbevelings in lyn is gedurende die kontekstualiseringsfase; dat hindernisse wat teëgekom word, regdeur die hele proses hanteer word, en dat volgehoue monitering en evaluering van kwaliteitsorg plaasvind. Gevolgtrekking Hierdie navorsing het van verskillende metodes en innoverende deelnemende aksienavorsing gebruik gemaak om die gaping tussen bewyse en praktyk te sluit. ‘n Nuwe konseptuele model vir riglyn – implementering word aanbeveel vir gebruik om behulpsaam te wees met die implementering en kennis -translasie in primêre gesondheidsorg plaaslik, nasionaal en in soortgelyke lae - en middel - inkomstelande in Afrika.

Thesis (MMed)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: BACKGROUND Post anesthesia discharge criteria scoring systems have been used successfully to aid discharge from the post anesthetic care unit (PACU) for over 40 years. They do not replace, but rather act in conjunction with good clinical judgment, and provide concise, standardized documentation of a patient’s readiness for discharge. 1,2,3,4,5 In order to improve patient safety, provide clear documentation and to aid future audit, a discharge criteria scoring system was developed for use in our PACU (Addendum A). It is a modification of the Aldrete Scoring System and the modified Post Anesthetic Discharge Scoring System (PADSS) proposed by Chung.1 There is a steadily increasing patient burden on the existing medical infrastructure in South Africa. Tygerberg Academic Hospital is no exception, and because of the high demand on our theatre services, optimal efficiency is essential. We speculated that our discharge criteria scoring system might increase the efficiency of our PACU when compared to the traditional time based system. The more healthy patients, undergoing minor procedures, could potentially spend less time in PACU, allowing the nurses to focus on problem cases. Increasing the speed of transit might also help prevent delays in theatre due to lack of bed space in PACU. Our primary endpoint was to compare the duration of time spent by patients in the PACU at Tygerberg Academic Hospital, from the moment they are admitted, to the time they are discharged to the ward, before and after the introduction of a discharge criteria scoring system. While planning the audit, one of the factors that staff identified as contributing to delayed discharge from PACU, was the time it took for the wards to collect their patients. A secondary objective, therefore, was to assess the amount of time that elapsed between calling the ward to collect the patient, and the patient leaving PACU. METHODS AND MATERIALS Prior to commencing the audit, approval was obtained from the Human Research Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch and Tygerberg Academic Hospital. The Audit, its purpose and possible benefits, was discussed with representatives of the nurses working in PACU, and written consent was obtained from those who would be involved in the data collection (Addendum B). Audit forms (Addendum C), collection boxes, and posters reminding staff to participate in the audit were prepared. Our first audit was performed over approximately a week in August 2012. During this period, the traditional time-based discharge system was still in operation. Data was captured from 327 patients. Audit forms were placed in a collection box, which was cleared daily by the primary investigator. The discharge criteria scoring system was introduced to the PACU staff in January 2013. The nurses were trained in its use, and a one month period was allowed for all involved to become accustomed to the new system. A second audit was performed in February 2013, again over a week, during which we gathered data from 313 patients. RESULTS The median value of the time spent by patients in the PACU decreased from 1 hour 25 minutes, to 1 hour 15 minutes, after introduction of the discharge criteria scoring system. This was statistically significant (p-value = 0.003). The median time between calling the ward to collect a patient, and the patient leaving recovery, was 15 minutes. CONCLUSION The main finding of the study was that the introduction of a discharge criteria scoring system decreased the median duration of time spent by patients in the post anesthetic care unit at Tygerberg Academic Hospital.
AFRIKAANSE OPSOMMING: AGTERGROND Puntestelsels as ontslag kriteria na narkose, word vir die afgelope 40 jaar suksesvol gebruik as maatstaf om pasiënte uit die herstelkamer te ontslaan. Hierdie kriteria vervang nie goeie kliniese oordeel nie, maar is ’n addisionele hulpmiddel om te bepaal of die pasiënt gereed is vir ontslag en om noukeurige, gestandardiseerde dokumentasie te verseker. 1,2,3,4,5 'n Nuwe puntestelsel vir ontslag is vir die herstelkamer van Tygerberg Akademiese Hospitaal ontwikkel om pasiëntesorg en dokumentasie te verbeter, asook om ouditering in die toekoms te vergemaklik (Addendum A). Hiervoor is die Aldrete Scoring System en die gemodifiseerde PADSS, voorgestel deur Chung, aangepas. 1 Die bestaande mediese infrastruktuur in Suid-Afrika beleef tans ‘n geleidelike toename in die getal pasiënte. Tygerberg Akademiese Hospitaal is geen uitsondering nie en as gevolg van die hoë aanvraag na ons teaterdienste, is uiterste doeltreffendheid noodsaaklik. Ons vermoede was dat hierdie aangepaste puntestelsel doeltreffendheid in die herstelkamer sou verbeter in vergelyking met die meer tradisionele tyd-gebaseerde sisteem. Gesonde pasiënte wat kleiner prosedures ondergaan, sal waarskynlik na ’n korter periode ontslaan kan word wat die verpleegpersoneel in staat sal stel om meer aandag aan probleem gevalle te gee. Bespoediging van die pasiëntvloei behoort onnodige vertragings van teatergevalle weens 'n tekort aan beddens in die herstelkamer, te beperk. Die primêre doel van die studie was om te bepaal of die gebruik van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal, die tydperk wat die pasiënt in die herstelkamer deurbring, verkort. Die herstelkamer verpleegsters het beweer dat die saal personeel ‘n lang tyd gevat het om hulle pasiente in herstelkamer te kom haal. Vervolgens is 'n sekondêre doelwit ingesluit om die tydperk te bepaal vandat die saalpersoneel in kennis gestel word, totdat die pasiënt die herstelkamer verlaat. METODE Goedkeuring is verkry van die Menslike Navorsing en Etiese Komitee van die Gesondheidswetenskap Fakulteit van die Universiteit van Stellenbosch en Tygerberg Akademiese Hospitaal voor die aanvang van die studie. Die studie, asook die doel en moontlike voordele daarvan is vooraf bepsreek met verteenwoordigers van die herstelkamer verpleegpersoneel en skriftelike toestemming is verkry van al die deelnemers wat betrokke sou wees by die data versameling (Addendum B). Oudit vorms (Addendum C), versamelhouers en inligtingsplakkate vir die betrokke personeel is voorberei. Die aanvanklike oudit is in Augustus 2012 oor 'n periode van ongeveer een week uitgevoer. Tydens hierdie oudit is die tradisionele tydgebaseerde sisteem gebruik. Inligting van 327 pasiёnte is versamel. Die oudit vorms is in die versamelbokse geplaas en is daagliks deur die primêre navorser verwyder. Die aangepaste puntestelsel as ontslag kriteria, is in Januarie 2013 in die herstelkamer geïmplementeer. Die verpleegpersoneel het opleiding ontvang waarna die aangepaste puntestelsel vir een maand gebruik is om te verseker dat die personeel vertroud is daarmee. In Februarie 2013, is ‘n tweede oudit oor ‘n tydperk van een week uitgevoer, waartydens inligting van 313 pasiёnte versamel is. RESULTATE Na die implementering van die aangepaste puntestelsel as ontslag kriteria, het die mediane tyd wat pasiënte in die herstelkamer deurbring afgeneem van 1 uur en 25 minute tot 1 uur en 15 minute. Hierdie afname is statities betekenisvol (p-waarde = 0.003) Die mediane tyd vandat die saal in kennis gestel is totdat die pasiënt die herstelkamer verlaat, was 15 minute. GEVOLGTREKKING Die hoof bevinding van die studie is dat die mediane tydperk wat die pasiënte in die herstelkamer deurbring verminder is deur die implementering van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal.

Background: Antenatal care is essential care that assists in maintaining a state of good health for the woman and her unborn baby. Globally the use of antenatal care services remains a challenge and this tendency is closely associated with maternal and neonatal mortalities and morbidities. South Africa has adopted a free service policy for pregnant women, their infants and for children up to the age of six. Despite this policy, the problem of limited utilisation of antenatal care services by pregnant women is still observed in this country and is associated with increased maternal and neonatal mortalities and morbidities.The purpose of the current proposed study was to explore and describe the reasons for limited utilisation of antenatal care services in the Mnquma sub-district, and to develop guidelines to assist the midwives to encourage the use of antenatal care services. Objectives:To explore and describe the reasons for the limited utilisation of antenatal care services by pregnant women at Mnquma sub-district.To explore and describe the knowledge of antenatal care services by the pregnant women.To develop guidelines to facilitate empowerment of midwives to enhance utilisation of antenatal care services by pregnant women in the Mnquma sub-district in Eastern Cape Province. The study was conducted in Mnquma sub-district during the months of July to January in 2016 using a qualitative, exploratory, descriptive and contextual research design. The research population were post-delivery women and the purposive sampling was used to identify women who met the stated criteria. One-on-one audio-taped semi-structured interviews were conducted and field notes were kept to justify some of the themes identified. Thirteen interviews were conducted and transcribed verbatim. Collected data was analysed using Tesch’s data analysis method. Trustworthiness was maintained through the standards of truth value, credibility, transferability, dependability and conformability. The ethical considerations of beneficence, justice, autonomy, non-maleficence and veracity were maintained. From the findings it emerged that the participants raised various concerns with regard to barriers influencing limited utilization of antenatal care services. The participants had limited knowledge of antenatal care services. Furthermore, participants recommended some solutions to enhance utilization of antenatal care services. Recommendations were made with regard to clinical practice, nursing education and nursing research. Guidelines were formulated to assist midwives to enhance the utilization of antenatal care services by pregnant women in the Mnquma sub-district in the Eastern Cape.

Esta tese é o resultado de um estudo empírico relativo à interrelação entre defesa da concorrência e regulação no Brasil, com ênfase nos setores de infraestrutura que enfrentam a falha de mercado conhecida como monopólio natural. A hipótese de investigação reside em afirmar que, apesar do fato de que nestes mercados geralmente há um único agente econômico, e que os mesmos encontram-se sujeitas à regulação estrita por uma agência especializada, ainda há espaço para a intervenção das autoridades de defesa da concorrência. A fim de confirmar essa hipotese, examinamos as decisões da autoridade brasileira de defesa da concorrência (CADE) nos setores de infraestrutura, e fim de avaliar se o CADE efetivamente intervém em tais mercados. A pesquisa incluiu a análise de atos de concentração, bem como as decisões acerca de condutas anticompetitivas envolvendo agentes atuantes nos setores de concessão de ferrovias, rodovias, portos, transmissão e distribuição de energia elétrica, telefonia fixa, saneamento, distribuição de gás canalizado e transporte de gás natural. A pesquisa comprovou que não há diferença significativa entre a percentagem de intervenções em atos de concentração observados nos setores regulados de infraestrutura e a percentagem de casos em que o CADE determinou o desfazimento ou impôs restrições à aprovação de operações na generalidade dos mercados. Em matéria de infrações às regras de concorrência, a percentagem de condenações e acordos de cessação de práticas, considerados em connjunto, observados nos setores de infraestruturas foi superior àquela obervada nos mercados não regulados. O resultado da pesquisa confirma que as autoridades de concorrência devem continuar a ser as principais implementadoras da política de defesa da concorrência em setores regulados de infraestrutura. Embora as intervenções CADE tenham ficado restritas a setores de meios de transporte e de telefonia fixa, a jurisprudência mostra que as preocupações antitruste verticais e de natureza conglomerada que podem surgir nos mercados regulados de infraestrutura justifica essa intervenção. A última parte da tese é dedicada a discutir as perspectivas da defesa da concorrência nos mercados de infraestrutura, no Brasil, incluindo a aprovação da nova Lei de Defesa da Concorrência (Lei 12.529/2011), e discutir a que compete decidir acerca de conflitos de competência ou de interpretações confliantes e irreconciliáveis entre o CADE e as agências reguladoras.
This thesis is the result of an empirical study that addresses the intersection between competition and regulation policies in Brazil, especially involving industries that face the market failure known as natural monopoly. The hypothesis investigated is that, despite the fact that in these markets there is usually only one economic agent and that they are subject to strict regulation by a specialized agency, there still remains room for intervention by the competition authority. In order to confirm this, we have reviewed the case law of the Brazilian competition authority (CADE) on public utility sectors, aiming at assessing whether CADE had intervened in such markets. The survey included mergers and acquisitions, as well as investigations regarding infractions to competition rules, involving agents active in railroad, road, port, electric power transmission and distribution, fixed telephone, sewage, gas transportation and distribution markets. The research revealed that there is no significant difference between the percentage of interventions in concentration acts observed in these regulated markets (jointly considered) and the percentage of cases that CADE has not approved or has imposed restrictions to their approval in all markets. In terms of investigations regarding offences to competition rules, the percentage of condemnations and agreements to cease practices in regulated markets actually overcome that observed in unregulated markets. The result of the investigation confirms that competition authorities should remain to be the primary enforcers of competition law in regulated sectors. Although CADEs interventions were actually restricted to markets involving means of transportation and fixed telephone, we could observe that the case law provides evidence that antitrust vertical and conglomerate concerns may arise in public utility regulated markets generally considered. The final part of the thesis is dedicated to debate the perspectives of competition defense in public utility markets in Brazil, especially in view of the passing of the new competition statute (Rule 12,529/2011), as well as to discuss who is the authority empowered to decide conflicts of understandings between competition and regulation authorities.

From 2004 the Eastern Cape Department of Health (ECDoH) started implementing the new community health worker (CHW) programme in all its clinics, but so far little is known about its implementation process, its successes and challenges. The aim of this study was to assess the implementation of the new government funded CHW programme at three clinics of the Eastern Cape Province.

This research study examines the psychological and emotional experiences of children and parents as they embark on a permanent placement living arrangement. A permanent placement living arrangement is entered into when a child is no longer able to reside with their family of origin. Three family groups participated in the study and separate interviews were conducted with both the children and placement parents. Overall, three interviews were conducted, with the first interview taking place prior to the child’s transition into the family. A further two interviews were conducted with the participants after the transition had taken place. The findings of this study indicate that both the parents and children were profoundly affected by the experience of permanent placement. The common themes that emerged from the data were the hopes, anxieties and coping strategies of the participants which became the focal point of analysis. The parents experienced a mixture of fulfilment, tempered with anxieties of whether they would be able to provide adequate care for the child placed with them. Whereas, the children appeared to find it difficult to trust that this experience would be any different from their previous experiences. The study concludes that further attention is needed in the preparation for the transition into permanent placement. It further concludes that ‘after transition’ support is important to the stability of the placement.

With a view to understanding how curriculum is interpreted at classroom practice level, the study examined three stories of how the environmental discourse of the National Curriculum Statements (R-9) was recontextualised using school gardens in the Life Orientation Learning Area for the Senior Phase. To understand how the curriculum is recontextualised, I used Bernstein's theory of recontexutalisation where he explained how official pedagogic discourse (OPD) (in this case the environmental discourse is first delocated once it is transferred from the field of production (FOP) and relocated in the recontextualising field (where teacher educators and departmental officials mediate the discourse) and in the field of reproduction (FOR) which is the classroom and school. Bernstein explained that as the discourse is delocated and relocated it undergoes transformation. This transformation is influenced by practitioners' prior-knowledge, experience, culture and beliefs and other factors. To understand how transformation of the environmental discourse takes place, Bernstein's conceptual constructs of selective appropriation and ideological transformation were applied to an interpretation of three lesson processes, to explain how the discourse was changed. Each lesson was reviewed in terms of the selective appropriations and ideological transformations which took place. All three of the lessons observed took place in one school, and as such the study is designed as an interpretive case study where I have tried to make meaning from a rich, thick description of a specific case context. The school is located in Bizana, one of the villages in the O.R. Tambo District Municipality in the Eastern Cape Province,, and is currently in the process of implementing South Africa’s new National Curriculum Statement (NCS) like all other schools in South Africa. In conducting the research I observed lessons, interviewed the learners and teachers, and a community member and the manager of the SANBI greening project, and I also analysed documents which included the NCS for Life Orientation, and teachers planning documents and learners work produced in the lessons. I started the study by conducting a document analysis of the NCS, through which I identified dimensions of the Official Pedagogic Discourse. This was used as a framework to review the lessons to understand how the OPD was being recontextualised. The study concludes by discussing the key findings of the study in the form of a set of analytical statements. Some of the findings indicate that teachers have not been given adequate training for understanding and implementing the NCS which affects the recontextualisation process. The study shows that there is a dire need for professional development if the OPD is to be interpreted adequately by teachers so that its implementation at the meso and micro- levels becomes clear and effective.

Magister Curationis - MCur
The purpose of the study will be to explore the discharge referral pathway for patients that have been discharged from hospital to home in the Western Cape Province. A mix of quantitative and qualitative research, using a descriptive design will be undertaken. Quantitatively, following the patient paper trail from Tertiary Hospital to grassroots level. Qualitatively, to identify whether the referral pathway was user friendly. Records of discharged patients from the Tertiary Hospital will be used as the study population. Patient information will be accessed from patient files at the hospital. Interviews will be conducted with the relevant discharge liaison officers at the Tertiary Hospital, and Primary Health Care level. Relevant staff members within the non–governmental –organisations (NGOs), will also be interviewed in order to determine their perception of the discharge referral pathway. The findings of the study will be used to inform policy guidelines. Challenges encountered by staff members in referring patients for continuum of care, and the perception of consumers will also be described and documented.

Magister Psychologiae - MPsych
An epidemiological study was conducted with the main goal of describing the occurrences of the various STIs in the Eastern Cape province as well as biographical factors such as age, gender, and geographical location influencing them. Ten primary health care (PHC) centres located throughout the province served as sentinel sites for surveillance data collection for a period of 3 months using Daily and Monthly Report Forms. The surveillance data was analysed using relative frequencies to determine STIs prevalence. The main findings from the present study suggest that the most frequently encountered female syndromes were vaginal discharge and lower abdominal pains and most frequent male syndrome was Urethral discharge. Other syndromes accounted for less than 10% of the STI cases observed at the PHC centres during the study. The study also indicate that more STI patients were seen at urban PHC centres compared to rural ones and that most of the STI patients seen at PHC centres were women. These findings are helpful for the Health Department in the Eastern Cape Province to effectively plan for the control and prevention of all STIs including HIV I AIDS.

Thesis (MFamMed) Stellenbosch University, 2011.
ABSTRACT: Background: The initiation of antenatal care (“booking”) is universally recommended in the first trimester. While working in the Michael Mapongwana antenatal clinic (ANC) in Khayelitsha, the researcher noticed that late booking was prevalent, with consequent impaired antenatal care and increased potential for adverse outcomes. The objective of this qualitative study was to understand why women book late at this specific ANC. Methods: Twenty-three in-depth, open-ended interviews were conducted with 23 late bookers (i.e. who booked after 18 weeks) who attended the ANC between June and October in 2009. The interviews were recorded, transcribed, and analysed according to the “Framework” model. Results: The mean gestational age at booking was 26,4 weeks (range: 20 to 34 weeks). The majority were multigravid, unmarried and unemployed. A high incidence of previous or current obstetric problems was noted. Important personal barriers included ignorance of purpose of antenatal care, ignorance of ideal booking time, and denial or late recognition of an unplanned pregnancy. Provider barriers appeared to be significant, especially the cumbersome booking system, absence of an ultrasound service, and perceived poor quality of care. Conclusion: A combination of personal and provider barriers contributed to late booking at this clinic - it seems that the perceived effort of attending this antenatal service outweighed the perceived value thereof. Provider barriers should be addressed by accommodating patients’ needs, optimising nurse-patient interaction, provision of an ultrasound service and improvement of the booking system. Public awareness of early booking and the holistic value of antenatal care should also be enhanced.