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Clinical governance implementation challenges in the Department of Health, Mpumalanga, South Africa

  • Authors: Maduna, Patrick Hawkins https://orcid.org/0000-0002-4926-1661
  • Date: 2022-09
  • Subjects: Clinical competence , Health services administration
  • Language: English
  • Type: Doctoral theses , text
  • Identifier: http://hdl.handle.net/10353/27275 , vital:66532
  • Description: Clinical governance (CG) is the system through which health authorities are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which clinical excellence flourishes. South Africa is one of the countries where CG has not been successfully implemented. This study sought to explore the CG implementation challenges in the Mpumalanga province, South Africa. The study objectives included the seven pillars of CG. The study was a qualitative and exploratory, using purposive sampling technique to select study participants. A total of twenty-two (22) individuals were selected for the study. Semi-structured interviews were used for data collection. Each interview was transcribed verbatim by the researcher. Confidentiality was ensured through the coding of interviewee names. The content analysis technique was used for data analysis, using the study objectives as themes. The study found general lack of understanding of the concept of CG, poor performance of clinical audits, sub-standard clinical performance and effectiveness, poor clinical risk management, poor patient and public involvement in patient care, lack of evidence-based practice and research, inadequate training and development of healthcare workers, and sub-standard health information management across the department. The researcher recommends that the CG policy be prioritised by the Mpumalanga DOH, that systems be put in place to facilitate policy implementation, and that the departmental staff establishments at all levels, prioritise healthcare professionals in key leadership positions. In conclusion, there are numerous challenges that confront the Mpumalanga Department of Health regarding the implementation of clinical governance, requiring urgent attention. , Thesis (PhD) -- Faculty of Health Sciences, 2022
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Clinical governance implementation challenges in the Department of Health, Mpumalanga, South Africa

  • Authors: Maduna, Patrick Hawkins https://orcid.org/0000-0002-4926-1661
  • Date: 2022-09
  • Subjects: Clinical competence , Evidence-based medicine , Health services administration
  • Language: English
  • Type: Doctoral theses , text
  • Identifier: http://hdl.handle.net/10353/23600 , vital:58194
  • Description: Clinical governance (CG) is the system through which health authorities are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which clinical excellence flourishes. South Africa is one of the countries where CG has not been successfully implemented. This study sought to explore the CG implementation challenges in the Mpumalanga province, South Africa. The study objectives included the seven pillars of CG. The study was a qualitative and exploratory, using purposive sampling technique to select study participants. A total of twenty-two (22) individuals were selected for the study. Semi-structured interviews were used for data collection. Each interview was transcribed verbatim by the researcher. Confidentiality was ensured through the coding of interviewee names. The content analysis technique was used for data analysis, using the study objectives as themes. The study found general lack of understanding of the concept of CG, poor performance of clinical audits, sub-standard clinical performance and effectiveness, poor clinical risk management, poor patient and public involvement in patient care, lack of evidence-based practice and research, inadequate training and development of healthcare workers, and sub-standard health information management across the department. The researcher recommends that the CG policy be prioritised by the Mpumalanga DOH, that systems be put in place to facilitate policy implementation, and that the departmental staff establishments at all levels, prioritise healthcare professionals in key leadership positions. In conclusion, there are numerous challenges that confront the Mpumalanga Department of Health regarding the implementation of clinical governance, requiring urgent attention. , Thesis (PhD) -- Faculty of Health Sciences, 2022
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Safe handling, storage, and management of vaccines at selected primary health care facilities in Buffalo City Metropolitan, Eastern Cape Province

  • Authors: Mazwembe-Hoho, Andiswa Zimkitha
  • Date: 2022-04
  • Subjects: Vaccines , Pharmaceutical policy
  • Language: English
  • Type: Master's theses , text
  • Identifier: http://hdl.handle.net/10353/27942 , vital:70902
  • Description: Background The World Health Organization has a standardized tool for assessing vaccine handling and management. South Africa has adopted WHO tools to suit its own conditions of supply and storage of vaccines, the WHO tool is a guideline for managing vaccines. Importantly, every person handling or supervising handling of vaccines should own this manual (s) and use it as a reference for the handling, storage, and management of vaccines and related items. Aim The aim of this study was to examine safe handling, storage, and management of vaccines by health care workers in PHC facilities of BCM Municipality. Methodology A quantitative research approach and descriptive design was used to assess the safe handling, storage, and management of vaccines in PHC facilities in BCM in EC. Results The results showed that safe handling, storage, and management of vaccines in PHC facilities in BCM does not comply fully on safe handling, storage, and management of vaccines. The overall compliance rate was 86%, and this indicated that healthcare workers have knowledge of what is required to be compliant with safe handling, storage, and management of vaccines. Conclusion Safe handling, storage, and management ovaccines in PHC facilities in BCM is conditionally compliant as the healthcare workers have moderate-to-satisfactory knowledge. , Thesis (MPH) -- Faculty of Health Sciences, 2022
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Leadership competencies of primary health care facility managers at Buffalo City Metropolitan District in the Eastern Cape Province

  • Authors: Makinana, Noxolo Beauty
  • Date: 2020-02
  • Subjects: Primary health care -- Leadership , Facility management
  • Language: English
  • Type: Master's theses , text
  • Identifier: http://hdl.handle.net/10353/22033 , vital:51954
  • Description: The study explored and described the perceptions and experiences of Primary Health Care facility managers regarding their leadership and management competencies in the Buffalo City Metro Health District in the Eastern Cape Province. The objectives of this study were to explore and describe the leadership competencies required for facility managers to exercise their leadership in Primary Health Care facilities and to bring about the recommendation. The population of this study comprised of facility managers who are appointed in facility management position permanently or on acting basis during the time of the study, in rural, urban, and semi-urban Primary Health Care facilities (clinics) in Buffalo City Health District. Non-probability convenience sampling was used to select the participants. Two focus group interviews with 10 participants per group were held to collect data. Thematic data analysis was used to analyze the data. The findings were discussed according to themes and subthemes. Four themes and 9 subthemes were identified from the data. Themes include departmental factors, individual factors, and political factors. The subthemes include managers lack of support, need for capacitation of staff, lack of uniformity in exercising leadership, work positions, infrastructure, staff shortages, lack of involvement in decision making, lack of resources, feeling of being a failure, not meeting expectation (workload) role of managers, pressure, the resistance of staff members to change, absenteeism, teamwork, compliance to policies, the 80/20 principle, nurse-patient ratio, and consultation. The trustworthiness of the findings was ensured by focussing on dependability, confirmability, transferability, and credibility. The study concluded that facility managers receive very limited supervision to perform their management duties in their facilities. They also need adequate resources, induction, training and a habitable work environment to ensure that quality care is provided. The study recommended that the Department of Health should have a program for supervision, mentorship, and guiding the facility managers in the Primary Health Care facilities. It should also establish a training and development program on leadership, finance management and technology. Lastly, there should be more accountability by facility managers at the different departmental levels i.e. national, province, district subdistrict, and other internal and external stakeholders. , Thesis (MPH) -- Faculty of Health Sciences, 2020
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Perceptions of patients about poor attitudes and behaviours of midwives in the maternity sections in a public hospital of East London South Africa

  • Authors: Lawrence, N W
  • Date: 2019-11
  • Subjects: Midwifery , Nursing ethics , Nurse and patient
  • Language: English
  • Type: Master's theses , text
  • Identifier: http://hdl.handle.net/10353/26918 , vital:66099
  • Description: Midwives are largely responsible for maternity care in hospitals. As such, they play a significant role in ensuring the health and well-being of pregnant women and newborn babies. To perform that duty effectively, midwives need to be professional in their conduct. However, there are reports that midwives have displayed poor attitudes and behaviour in South Africa. The main research question was “what are the perceptions of patients about attitudes and behaviours of midwives in the maternity section in a public hospital in East London, South Africa?” The aim of the study was to explore the reasons behind poor attitudes and behaviour of midwives in midwifery practice and suggest interventions that can be introduced to promote professional attitudes and behaviour by midwives in a public hospital in East London. This study used a qualitative approach to collect data. The research instrument that was used for this study was semi-structured interviews. The sample of 20 participants which was purposively selected consisted of women that have used the East London public hospital maternity section. Data was collected using coding and themes emanating from the data generated. Midwives are valued and play a very significant role in providing maternal care. Be that as it may, midwives exhibit poor attitudes and behaviours such as being rude, lack sympathy, and lack of empathy. On the other hand, midwives act professionally and are supportive of patients. There is, therefore, a need for the provision of professional etiquette training services, stress counseling, use of work development strategies and performance management systems, technical training, linkage system of traditional and modern midwives, and the use of internet platforms to increase interaction between midwives and those that need maternity care services. , Thesis (MPA) -- Faculty of Health Sciences, 2019
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Perceptions of patients about poor attitudes and behaviours of midwives in the maternity sections in a public hospital of East London South Africa

  • Authors: Lawrence, N W
  • Date: 2019-11
  • Subjects: Midwives , Maternity nursing
  • Language: English
  • Type: Master's theses , text
  • Identifier: http://hdl.handle.net/10353/23521 , vital:58085
  • Description: Midwives are largely responsible for maternity care in hospitals. As such, they play a significant role in ensuring the health and well-being of pregnant women and newborn babies. To perform that duty effectively, midwives need to be professional in their conduct. However, there are reports that midwives have displayed poor attitudes and behaviour in South Africa. The main research question was “what are the perceptions of patients about attitudes and behaviours of midwives in the maternity section in a public hospital in East London, South Africa?” The aim of the study was to explore the reasons behind poor attitudes and behaviour of midwives in midwifery practice and suggest interventions that can be introduced to promote professional attitudes and behaviour by midwives in a public hospital in East London. This study used a qualitative approach to collect data. The research instrument that was used for this study was semi-structured interviews. The sample of 20 participants which was purposively selected consisted of women that have used the East London public hospital maternity section. Data was collected using coding and themes emanating from the data generated. Midwives are valued and play a very significant role in providing maternal care. Be that as it may, midwives exhibit poor attitudes and behaviours such as being rude, lack sympathy, and lack of empathy. On the other hand, midwives act professionally and are supportive of patients. There is, therefore, a need for the provision of professional etiquette training services, stress counseling, use of work development strategies and performance management systems, technical training, linkage system of traditional and modern midwives, and the use of internet platforms to increase interaction between midwives and those that need maternity care services. , Thesis (MPH) -- Faculty of Health Sciences, 2019
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An assessment of school food and nutrition environments for strengthening the integrated school health policy in the Eastern Cape, South Africa

  • Authors: Okeyo, Alice Phelgona
  • Date: 2019
  • Subjects: Nutrition policy -- South Africa -- Eastern Cape School health services -- South Africa -- Eastern Cape
  • Language: English
  • Type: Thesis , Doctoral , DPhil
  • Identifier: http://hdl.handle.net/10353/17039 , vital:40836
  • Description: The 2012 Integrated School Health Policy (ISHP) offers a framework for adequate school food environment. It aims to contribute to the improvement of the general health of school-going children and to address health barriers to learning in order to improve education outcomes. This study assessed the school food and nutrition environment and critically appraised the position of nutrition within ISHP in order to make recommendations for best practice and promotion of healthy-eating in quintiles 1 – 3 secondary school learners of the Eastern Cape, South Africa. Areas evaluated included the school food environment (National School Food Nutrition Programme, NSNP, tuck-shop, vendor, lunch box, and school vegetable garden); eating practice; nutrition knowledge; and nutrition status. A quantitative and qualitative cross-sectional design was applied in data collection. Data was collected from 1,357 learners at 18 secondary schools in three districts: Buffalo City Metropolitan Municipality, Chris Hani and OR Tambo, using semi-structured questionnaires. Five major food items provided in the school food and nutrition environment included: beans, pap, sour-milk, rice, and samp (maize) (NSNP); chips, sandwich, pap, biscuits, and cake (tuck-shop); chips, sandwich, pap, cake, and pop-corn (vendor); and samp (maize), noodles, fat-cake, chips, and Russian/Viennas (lunch boxes). Only three of the 16 schools had school vegetable gardens which produced vegetables and no fruits. Five most frequently eaten foods for breakfast were porridge, rusks, stiff-pap, bread-with-spread, eggs, and polony. Learners from quintile 3 (60.8percent) significantly ate more cooked porridge than learners from quintiles 1 and 2 (51.9percent) (p = 0.015). Leaners from quintile 3 (59.4percent) significantly ate more brown bread-with-spread than learners from quintiles 1 and 2 (50.4) (p = 0.022). The majority of learners (72.7percent) ate breakfast; more male learners (24.4percent) than female learners (29.1percent) skipped breakfast. The majority (62.2percent) of learners had poor nutritional knowledge; significantly, more male (35percent) than female (27percent) learners had poor nutritional knowledge (p = 0.003). Nutritional knowledge increased with age; significantly more grade 8 learners had poor (42.6percent) nutritional knowledge than grade 12 learners (14.1percent) (p < 0.001). Leaners from quintile 3 had good (23.5percent) nutritional knowledge than learners from quintiles 1 and 2 (15.7percent) (p < 0.001). School lessons, books and television were the most important source for nutritional information to learners. The most significant source was lessons (72.0percent; p < 0.001); followed by television (69.4percent; p < 0.001) and books (67.8percent; p = 0.014), in that ranking order. The majority of learners (64percent) had normal body weight. The prevalence of underweight, overweight and obesity was 13.0percent, 15.0percent and 8.0percent, respectively. The prevalence of overweight and obesity was higher in females than males (21.3percent vs 5.3percent; overweight; p < 0.001)) and (11.6percent vs 1.2percent; obesity; p < 0.001), respectively; while the prevalence in terms of underweight was significantly higher in male (21.3percent) learners than in female learners (8.1percent); p < 0.001. The study indicated that the school food environment was not supported by ISHP. The Integrated School Health Policy did not include on-site package for nutritional assessment, thus, there is need to offer nutritional interventions in schools.
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Competencies of Qualified Primary Health Care professional nurses in Assessing, Diagnosing and Managing clients in health facilities in Buffalo City Metro”

  • Authors: Falati, Patience Yoliswa
  • Date: 2019
  • Subjects: Primary health care
  • Language: English
  • Type: Thesis , Masters/Doctoral , MPH
  • Identifier: http://hdl.handle.net/10353/16716 , vital:40766
  • Description: The study investigated the competencies of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities. Aim: The study aimed to explain the competences of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities. The research study followed a descriptive and qualitative design. Data was collected from qualified PHC professional nurses in 79 clinics (both urban and rural), 4CHC’s and 4 hospital casualties. A structured questionnaire with closed ended questions was used. Data analysis was done by means of descriptive statistics. The study showed that the overall percentage of 90% denotes that these PHC professional nurses are competent in all the aspects of competences. Assessing competences of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities is of vital importance for quality health care/ improving service delivery and client satisfaction. Recommendation were made to influence the implementation of policies and guidelines for quality service delivery
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A model for retention-to-graduation of undergraduate nursing students at universities in the Eastern Cape Province, South Africa

  • Authors: Nkutu, Nonyaniso Trustina
  • Date: 2018
  • Subjects: Universities and colleges--South Africa--Eastern Cape College students--South Africa--Eastern Cape Nursing students--South Africa--Eastern Cape
  • Language: English
  • Type: Thesis , Doctoral , Nursing
  • Identifier: http://hdl.handle.net/10353/15946 , vital:40566
  • Description: The retention of nursing students in the undergraduate programme in universities is a global concern for the health care system, because of the low rate of nurse graduates. The strategies for retention for nursing students in undergraduate programmes in South African universities arguably have limited success in curbing failure to graduate. The failure to graduate rate of nursing students is a global phenomenon, where for example in 2009, the rate of failure to graduate in the United States of America was 30%. However, countries like Jamaica and Australia reported good retention rates through the use of various successful initiatives, such as student bursaries, student loans, scholarships and academic assistance. Previous studies in South Africa have showed that the incidence of nursing students’ failure to graduate rate is an ongoing challenge since the 1960s. Further, research has found that, despite the high annual enrolment of students into universities, only few nursing students graduate on time, while others fail to graduate. This phenomenon affects the rendering and quality of services to patients and clients in the health care facilities. When students fail to graduate from the programme, patients and clients get deprived of the services they would have got, had the students completed and graduated from the programme. On the other hand, the students themselves get frustrated due to the failure to complete the programme. Nursing Education Institutions (NEIs) also share in the disappointment and the loss of even one student who fails to graduate, because it is their obligation to graduate more nurses. Previous studies have sought to understand why students fail to complete their studies, and many factors have been identified. Therefore, there is need to further understand the factors associated with nursing student failure to complete their programme in different contexts such as South Africa. It is for this reason that the aim of this study was to develop a model for retention of nursing students in order to facilitate progression towards graduation in the undergraduate programme at the universities in the Eastern Cape Province of South Africa. The study endeavoured to answer the following research questions: What are the factors associated with retention-to-graduation of nursing students from the undergraduate nursing programme in the Eastern Cape Province, South Africa? What are the strategies to enhance retention to graduation of nursing students in universities in the Eastern Cape Province, South Africa? What conceptual framework can be developed for retention-to-graduation of nursing students from the undergraduate programme in the Eastern Cape Province, South Africa? What model could be developed for retention-to-graduation of nursing students from the undergraduate nursing programme in the Eastern Cape Province, South Africa? What guidelines should be formulated for the implementation of the model for retention-to-graduation of nursing students from the undergraduate nursing programme in the Eastern Cape Province, South Africa? To answer these questions, quantitative research approach with a descriptive, contextual and theory generation design was used. The study was conducted in four phases. Phase 1 used deductive concept identification to describe factors and strategies to enhance retention –to-graduation of nursing students in the undergraduate nursing programme. Phase 2 used inductive concept analysis for the development of a conceptual framework. In phase 3 reasoning strategies (inductive, deductive, derivation, synthesis and analysis) informed by data as well as the literature were used in order to generate a theory for model development. In phase 4, the guidelines for developing a preliminary model were formulated for theory implementation. The study setting was in the Eastern Cape universities, within faculties of Health Sciences. The researcher adapted Jeffreys’ Nursing Undergraduate Retention and Success (NURS) 2012 model as a data collecting instrument, which was pilot tested for reliability and validity. Permission to utilize the model was obtained. The targeted population was full time nursing students in the undergraduate nursing programme. A multistage stratified random sample from first year to fourth year level was used. The inclusion criterion was based on one being full time nursing student, aged between 18 and 50 years and from the Eastern Cape Province universities. Student nurses in colleges and part-time students were excluded from this study. The study adhered to research ethics and procedures by for example obtaining ethical clearance from the ethics committee of the University of Fort Hare and the other two selected universities. The ethical components were met: The Ethical clearance based on the following aspects: written consent to undertake the study; approval from the two of the selected universities; and permission to conduct a pilot study from the University of Fort Hare. Permission was also sought and obtained from Quality Assurance Unit in the Eastern Cape Province, in Bisho. The principle of beneficence; respect for human dignity; the right to self-determination based on the ethical principle of respect for persons; the principle of self-determination; the principle of justice, the right to fair treatment, the right to privacy, the right to informed consent were all considered. Data analysis was done through Statistical Analysis Systems (SAS) version 9.3 for quantitative data and Atlas Ti was used to analyse and quantify the open-ended section of the questionnaire. The results showed multidimensional factors associated with retention-to-graduation of the nursing students in the undergraduate programme. Strategies to enhance retention –to graduation were also indicated although there was no one perfect example since they were not evaluated for effectiveness. A retention-to-graduation model for nursing students in the undergraduate nursing programme was developed based on the results.
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A model of support for divorced professional nurses in the Eastern Cape, South Africa

  • Authors: Murray, Daphne
  • Date: 2018
  • Subjects: Divorce counseling -- South Africa -- Eastern Cape Divorce -- Social aspects -- South Africa -- Eastern Cape Employees -- Counseling of -- South Africa -- Eastern Cape
  • Language: English
  • Type: Thesis , Doctoral , Nursing
  • Identifier: http://hdl.handle.net/10353/10028 , vital:35293
  • Description: The purpose of this research study was to develop a support model for divorced professional nurses in the health-care facilities of the Department of Health, Eastern Cape, with guidelines to operationalise the model. Divorce is a process with psychological as well as social implications, and with a series of economic causes it also has implications in terms of the society and culture in which individuals operate. The main causes for divorce are adultery and domestic violence, especially against women and children (Lurea, 2011:99). A need for support from managers in the health-care facilities of the Department of Health, Eastern Cape during the process of divorce was identified by divorced professional nurses, since a lack of support and all the negativity that encompasses divorce could lead to severe depression, which will later have a negative effect on work performance (Abdul Kadir & Bifulco, 2010:858). The literature in this field of study, along with experience, indicates that it is imperative for divorced professional nurses to be supported in the workplace to help them to cope emotionally with their work demands, as prescribed by the South African Nursing Council. An explorative, descriptive and contextual qualitative design with theory generation was used to achieve the purpose of the study. Snowball sampling was employed to select participants, namely divorced professional nurses who were unknown to the researcher. A sample of 21 divorced professional nurses who work in health-care facilities in the Buffalo City Metropolitan Municipality in the Eastern Cape participated in the study. Data was collected by means of individual face-face interviews with divorced professional nurses. The interviews continued until data saturation was reached. Field notes supplemented data that could not be portrayed by audio-taped interviews, such as non- verbal communication in observed interactions. Data analysis was done using Tesch’s approach to open coding in qualitative research. Themes, categories and sub-categories emerged from the data analysis and were fully discussed, becoming fundamental units in the development of the conceptual framework as well as in the model. The researcher did a thorough literature review to conceptualise the identified concepts on which the model was based. The description and evaluation of the model, along with guidelines to operationalise the model, were done in accordance with the method described by Chinn and Kramer (2011:197). The justification of the research, the limitations, and the recommendations for operationalisation of the model of support for divorced professional nurses working in the Buffalo City Metropolitan Municipality of the Department of Health, Eastern Cape Province, and South Africa were indicated accordingly.
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An intervention study for low risk pregnant women and high risk pregnant women with GDM in Buffalo City Metropolitan Municipality, Eastern Cape, South Africa

  • Authors: Vellem, Nonceba Mercy
  • Date: 2018
  • Subjects: Diabetes in pregnancy -- South Africa Nursing services -- South Africa -- Eastern Cape -- Administration Pregnancy -- Complications
  • Language: English
  • Type: Thesis , Doctoral , Nursing
  • Identifier: http://hdl.handle.net/10353/9723 , vital:34891
  • Description: Low risk and high risk pregnant women (HRPW) with gestational diabetes mellitus (GDM) who practise sedentary life style are at risk of overweight and obesity that predispose to gestational diabetes mellitus (GDM). The purpose of the study is to describe the effectiveness of an intervention strategy of modified diet and planned physical activity implemented amongst low-risk and high-risk pregnant women with GDM in Buffalo City Metropolitan Municipality in the Eastern Cape, South Africa. Quantitative experimental intervention design and stratified random sampling was used for drawing a sample of low-risk and high risk pregnant women with GDM. A sample size 291 of LRPW and n=34 HRPW were eligible for the study. The sample frame of the study was taken from the registers of the CHCs, Frere Hospital and Cecilia Makiwane Hospital (CMH). Questionnaires were used to collect data from the low and high risk pregnant with GDM. Descriptive statistics (frequency, percentages, mean and standard deviation) were used for categorical variables. A p-value of < 0.05 was considered statistically significant. The total analysed of LRPW were n=135 and HRPW n=34 all in control group due to miscarriages, phone loss and relocation. LRPW had some risk factors of overweight (6.2 percent), obesity (15.5 percent), family history of diabetes (16.5 percent). HRPW also had overweight and obesity of (14.7 percent) and family history of (26.4 percent) as the Pvalue was statistically significant of weight was 001, MUAC Pvalue of 000 and Pvalue of BMI 000. There were alarming abnormalities of urinalysis of protein, glucose, leucocytes and blood in urine. The LRPW and HRPW had consumption of high content of carbohydrates, vegetables, fats and low in fruit, vegetables and fibre diet. Both LRPW and HRPW were also interested on the education about modified diet benefits (95.1 percent) and modified diet programs networks (87.5 percent). The barriers showed that LRPW and HRPW were low motivation (90 percent) minimal knowledge and benefits of modified diet (93 percent) and socio-cultural issues (86 percent). The majority of participants both LRPW and HRPW showed the interest in the planned physical activity benefits especially frequent education (96.9 percent) and encouragement of social support networks (90.2 percent) and convenient location (89.4 percent). But the HRPW had lower engagement than the LRPW in planned physical activity and is associated with risk of GDM. Although pregnant women were faced with fatigue and low energy (98.6 percent), as pregnancy progresses, minimum information regarding benefits of planned physical activity (87.6 percent) and the socio-cultural influence (77.8 percent). The recommendations are education on frequent use of modified diet and planned physical activity that is available, less economical and within their context. Frequent screening of all pregnant women during pregnancy of BMI, MUAC and weight and educate accordingly. The availability of dietician and physical activity speciality is needed.
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Assessment of the effect of the down-referral chronic medication distribution system on patients' adherence to chronic medication in the Buffalo City sub-district

  • Authors: Ndwandwe, Miriam
  • Date: 2018
  • Subjects: Health services accessibility Pharmacology Patient compliance
  • Language: English
  • Type: Thesis , Masters , MPH
  • Identifier: http://hdl.handle.net/10353/13248 , vital:39626
  • Description: The purpose of the study is to determine the effect of the down­ referral chronic medication distribution system on patient's adherence to chronic medicine in Buffalo City sub - district by ensuring that chronic patients receive their correct medication on time and in correct quantities every month so that they can take the medication as recommended by the health professional. Adherence to chronic medication lead to better health outcome and reduced hospital re-admission. A non-experimental and descriptive quantitative research methodology was used. A data abstraction form developed by the researcher was used to record data from the medical records of chronically ill patients. The results of the study revealed that most of the chronically ill patients who were admitted to hospital were not adherent to their chronic medication. Patients are non-adherent even if they have chronic medication with them. This was evident in the number of patients who do not remember how many days did they not take their treatment. Others indicated that they share their medication with other family members who suffer from the same chronic condition. The patients' lack of understanding of their chronic condition and the consequences of not taking medication as instructed by the health professional contribute to non-adherence. Strengthening of health promotion programmes to educate the patients about their chronic condition would improve adherence. Most of the chronic conditions are life-style modifiable diseases. Patients must be educated about the changes they can make to improve their quality of life.
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Developing a model for promoting physical fitness and healthy lifestyle of primary school learners in the Eastern Cape Province, South Africa

  • Authors: Gomwe, Howard
  • Date: 2018
  • Subjects: Physical fitness for children -- South Africa Physical education for children Schools -- Health promotion services
  • Language: English
  • Type: Thesis , Doctoral , Nursing
  • Identifier: http://hdl.handle.net/10353/10050 , vital:35307
  • Description: The challenge of low level participation in physical activity and, consequently, limited physical fitness has been acknowledged as being a national public health concern in South African schools. The main aim of this study was to develop a behavioural model for promoting physical fitness and healthy lifestyle of primary school learners in the Eastern Cape Province in South Africa. The first thing was to determine their physical fitness level and body composition then develop a behavioural model based on the findings. The study was conducted in three phases. A quantitative, qualitative and theory-generating research design was conducted using questionnaires, deductive and inductive strategies and literature triangulation. The study involved primary school learners: 356 boys and 520 girls aged 9-14 years old, who were randomly selected. Anthropometric assessments were conducted using ISAK (Marfell-Jones et al., 2006) and EUROFIT (1988) test batteries.The following measurements of body mass, stature, skinfolds (triceps and subscapular), waist circumference and gluteal were taken. The percent BF was calculated from a sum of two skinfolds (triceps and subscapular), using Slaughter et al.‘ s (1988) equation to predict body fat. Physical fitness measurements included sit and reach, push-ups, sit-ups and a 20 metre shuttle run. Physical activity level and sedentary behaviour were assessed by means of self-report questionnaires. Demographic, psychological and environmental variables were also measured by a self-report questionnaire. Six focus group discussions were conducted with school learners. The physical fitness levels were categorized as hypoactive, minimal active and inactive. Sedentary behaviours were categorized by number of minutes spent on sedentary activities. Dietary intake was assessed by a Food Frequency Questionnaire (FFQ). Food intake was classified as healthy, unhealthy/junk and traditional food. Body composition was measured by calculating body mass index (BMI) (weight/height2) and waist-to-hip ratio, respectively. Categories: underweight: 0<18, normal weight: 18, 5<25, overweight: 25<30 or obese: 30 and blood pressure measurements were classified as healthy and unhealthy. The main findings were as follows: underweight 60, 25 percent: normal weight 30, 54 percent: overweight 4, 18 percent: and obese 5, 02 percent: for the peri-urban school learners. Underweight 64, 78 percent: normal 31, 52 percent: overweight 2,83 percent: and obesity 0,87 percent:for the rural school learners. 56,25 percent underweight: 36,93 percent normal weight: 5,68 percent overweight: and 1,14 percent obese for the urban school learners. The mean body mass of learners from three locations were urban 40.0±10.185; peri-urban 39.8±10.181 and rural 38.7±10.279, respectively. (Chi-square = 3.3107; P=0.191). The mean values stature of all the three residences are urban; 144.1 ±10.400 peri-urban 144.4±9.187 and rural 143.7±12.617 (Chi-square = 1.2651; P=0.5312). The mean waist circumference for urban was (78.4±9.493), peri-urban (78.4±9.399) and rural was (77.1±10.214), respectively (Z=2.474;p=0.2903). The triceps value (z=21.4565p <.0001). Urban (13.9±5.589), (12.5±6.023) for peri-urban and (12.1±6.390) for rural. Subscapular (z=4.1151;p=0.1278). Urban area had (9.3±5.426), (9.3±5.463) for peri-urban and (8.9±6.381) for rural. The mean systolic blood pressure of urban school learners was (109.2±19.512), (107.9±19.273) for peri-urban and (107.4±19.488) for rural school learners. Lumbar and hamstring flexibility (z= 57.733; p<.0001). (25.3±5.507) for urban, (23.0±6.435) for peri-urban and (26.9±6.854) for rural. Sit-up (z=9.8414;p=0.0073). (18.3±12.571) for urban, (19.7±12.323) for peri-urban and (21.7±13.782) for rural area. Push-ups (z= 37.7591p=<.00001). (15.8±10.285) for urban, (18.5±11.086) for peri-urban and (20.9±9.981) for rural area. Maximal oxygen intake (z= 163.186p=<.0001). (25.0±6.454) for urban, (29.9±7.225) for peri-urban and (35.5±11.085) for rural area. PA enjoyment (4.1±0.698) for urban, (4.0±0.764) for peri-urban, (4.0±0.799) for rural. With regard to health-related physical fitness, the learners in the rural and peri-urban better than those in urban areas. PA attitude (z=7.5507;p=0.0563), (2.5±0.792) for urban area, (2.6±0.802) for peri-urban and (2.7±0.890) for rural area. Parental role modelling in PA (z=0.3083; p=<.000). (3.1±1.008) for urban area, (3.3±0.916) for peri-urban (3.1±0.981) for rural area. Peer encouragement (z=2.5367; p=0.2813) (3.4±0.893) for urban, (3.3±1.064) for peri-urban, (3.3±1.005) for rural area. Parental encouragement (z= 7.2266p=0.027),(3.7±0.985) for urban area, (3.5±0.906) for peri-urban and (3.7±0.774 ) for rural area. Teacher encouragement (z=2.0069p=0.3668).The mean values for three residences are (3.5±0.802) for urban area, (3.4±0.784) for peri-urban, (3.5±0.733) for rural areas. Most of the school learners in all the three residences prefer unhealthy/junky food. Based on the results, an exploratory factor analysis was conducted on data to identify and analyse the factors for model development. The findings indicated that there is evidence of low level of physical fitness and high prevalence of excessive weight and obesity among primary school learners, the study, therefore, suggests the development of the behavioural model to enhance physical fitness and prevent or reduce overweight/obesity among school learners.
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Development of health promotion guidelines for weight management among primary health care nurses in the Eastern Cape Province, South Africa

  • Authors: Monakali, Sizeka
  • Date: 2018
  • Subjects: Health promotion Body weight -- Regulation Obesity -- prevention and control
  • Language: English
  • Type: Thesis , Doctoral , Nursing
  • Identifier: http://hdl.handle.net/10353/10006 , vital:35285
  • Description: Overweight and obesity have become significant public health threats both globally and in South Africa. PHC professional nurses are first contact to patients and the community as well as key stakeholders in the management and education of obese patients. However, anecdotal evidence seems to question their suitability as good models of the advocated healthy lifestyle behaviours and weight management, as overweight and obesity is also prevalent among the professional nurses. This study examines the prevalence and determinants of overweight and obesity among PHC professional nurses in the Eastern Cape (EC) Province of South Africa. This was a workplace, cross-sectional study involving 203 PHC professional nurses conveniently selected across 41 PHC facilities in EC, South Africa. A WHO STEP wise questionnaire was used to collect demographic and behavioural data. Anthropometric (weight, height and waist circumference [WC]) measurements were taken following a standard protocol. Overweight and obesity was defined as a BMI of 25-29.9kgm-2, and BMI ≥ 30kgm-2, respectively. Seventy six percent of the nurses were obese. An additional 18 percent were overweight. Age, gender, marital status, duration of practice, alcohol use and smoking were significantly associated with obesity. There was no association between physical activity and obesity. After adjusting for confounders, only age more than 30 years (OR=5.2, 95 percentCI=1.6-16.4) and not using alcohol (OR= 4.0 95 percentCI= 1.7-9.1) were significant and independent predictors of obesity among the nurses. In conclusion is an alarmingly high prevalence of obesity among primary healthcare professional nurses in Eastern Cape, South Africa. This shows that PHC professional nurses in EC are not good models of the healthy behaviours, judge be BMI indicator, if they do advocates for healthy weight management to patients. This constitutes a future risk for an increased prevalence of chronic diseases and a handicapped healthcare workforce. There is a need to implement measures to promote healthy lifestyle behaviour and weight management among professional nurses in this setting.
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Factors affecting patient perceptions of service delivery in Postmasburg Hospital in the Z.F. McGawu District, Northern Cape Province, South Africa

  • Authors: Rakumakoe, Jacob Mogapi Chocky
  • Date: 2018
  • Subjects: Public health -- South Africa -- Northern Cape Medical care -- South Africa -- Northern Cape Health services accessibility
  • Language: English
  • Type: Thesis , Masters , MPH
  • Identifier: http://hdl.handle.net/10353/17805 , vital:41262
  • Description: Background: There is a requirement to provide proper and safe quality service to patients, hence a view from patients was deemed important as it can help the hospital to improve services rendered to them. There were two Provincial assessments done on National Core Standards in Postmasburg Hospital (overall scores were 32percent in 2013 and 48percent in 2014) and on both occasions, the Hospital failed to comply with the assessments and the implication were a suspected negative impact on the Hospital service delivery. The repercussions could be that the hospital might not be certified or not funded through National Health Insurance following a national assessment if the status quo remains. Aim: The aim of the study was to describe the factors affecting patients’ perceptions of service delivery in order to inform health policy decisions to improve service delivery. Methodology: A quantitative descriptive design was used to collect data on 133 adult patients admitted for a minimum of three days in the different hospital wards. Participants were administered a structured pre-tested questionnaire to collect data relating to their employment status, the number of hospital admissions and the reason for hospital admission. Results: About 41.4percent of participants were neutral or not sure whether the nurses/doctors came often to the ward where they were admitted. The majority (51.9percent) were neutral or not sure whether the quality of food in the hospital was good; 53.4percent expressed uncertainty concerning the adequacy of benches/chairs in the hospital for patients to sit while waiting to be seen by the health worker; and 55.6percent participants were neural or not sure whether the ward/room had enough space for consulting. Asked whether the hospital was user-friendly to disabled persons, 53.4percent participants were not sure. About 43.6percent participants expressed uncertainty regarding the registration satisfactory nature of the procedures in the hospital; the water cleanliness for patients in the hospital (42.1percent); whether their privacy was respected by all the staff within the hospital (51.9percent); permission to be examined and treated (51.1percent); the nurse/doctor who treated them being polite (53.4percent); and the nurse/doctor who treated them being able to answer all their questions about their illness (56.8percent). On whether they will visit the hospital again, 49.6percent participants were uncertain. The majority (69.7percent) agreed that all prescribed medicine was available in the hospital; the staff explained to them on how to use the medicine/pills (67percent); and they were told on how to store their pills/medication (47percent). Gender, education and employment status of the participants affect exactly one dimension each. Females, those with secondary education and employed were more satisfied on the respective dimensions. Conclusion: Patient involvement is an essential feature in healthcare services. Patients influence outcome quality through compliance, defining the right symptoms and physically experiencing treatment. Patient perceptions and satisfaction with service delivery is a multi-dimensional concept that should be studied by operationalising it within its context. Consequently, a conceptual model to understand and measure patient perception and satisfaction of service delivery and care quality in hospital health care services is proposed.
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Factors contributing to low supervision rate in Ugu District primary healthcare clinics

  • Authors: Mkhize, Ntokozo Clarice
  • Date: 2018
  • Subjects: Mentoring in medicine http://id.loc.gov/authorities/subjects/sh98003695 , Mentoring in nursing http://id.loc.gov/authorities/subjects/sh92002828 , Public health personnel--Supervision of
  • Language: English
  • Type: Master's theses , text
  • Identifier: http://hdl.handle.net/10353/19534 , vital:43136
  • Description: Among the threats, barriers and challenges impeding access to health services in developing countries, Primary Healthcare Supervision was reported as a critical link with complex interventions that are implemented in different ways (Bosch-Capblanch & Garner, 2008:369). Among the objectives of the KwaZulu-Natal Department of Health Policy for PHC Supervision; are increasing the PHC Supervision rate from 60 percent to 85 percent; improvement of community participation and inter-sectoral collaboration to achieve improved health services in all health clinics in the Province of KwaZuluNatal (KZN Department of Health PHC Supervision Policy, 2010:9). However, currently there is no policy guiding the PHC Supervision processes in the province albeit an adapted policy document from the National Health Department and set of supervision tools are used to date. It is therefore critical to examine the strength and weaknesses of the current adapted guidelines for PHC Supervision processes including the reasons for the current low PHC Supervision rate in the province. , Thesis (MPH) -- University of Fort Hare, 2018
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The perceptions of professional nurses about the introduction of the National Health Insurance in a private hospital in Gauteng

  • Authors: Molokomme, Victoria Khabonina
  • Date: 2018
  • Subjects: Health insurance Hospitals Primary health care
  • Language: English
  • Type: Thesis , Masters , MPH
  • Identifier: http://hdl.handle.net/10353/13057 , vital:39444
  • Description: The National Health Insurance is a relatively new concept in South Africa currently being piloted to ensure that all citizens have access to quality and affordable health care regardless of their socio-economic status. This study was prompted by concerns regarding the introduction of the NHI and its implications on the South African health system. Therefore it seeks to determine the professional nurses concerns about the introduction of the NHI in a private hospital in Gauteng and to describe recommendations based on these perceptions. This study used a qualitative, exploratory and descriptive design. Data was collected using a semi-structured individual interview schedule. The sample was purposive consisting of professional nurses employed in a private hospital in Gauteng. Thematic data saturation determined the number of professional nurses interviewed. Data analysis was done with the aid of Creswell’s theory (2014:1996). Ethical considerations were observed and trustworthiness maintained. The results of the study outlined that professional nurse’s perception about the NHI is centred on equal distribution of health services to benefit all South Africans. However, concerns were based on its financial implications for those mandated to pay towards the fund. The feasibility of its implementation in the midst of staff shortage, inadequate resources and its impact on the public health sector was seen as a major challenge. The notion of a joint effort between public and private health sector in creating one health system was anticipated by most participants. The NHI implementation raised concerns about the impact it will have on the private sectors viability in the future. Professional nurse’s non-involvement in policy making, poor communication, lack of transparency, concerns about governance and management were perceived to be stumbling blocks towards efficient and effective implementation of the NHI.
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Attitutes of professional nurses towards the dimensions of quality care in the community health centres of the King Sabatha Dalindyebo sub-district, Eastern Cape

  • Authors: Ntuku, Nonzukiso Sheila
  • Date: 2017
  • Subjects: Community health services -- South Africa -- Eastern Cape Nursing services -- South Africa-- Eastern Cape
  • Language: English
  • Type: Thesis , Masters , MCur
  • Identifier: http://hdl.handle.net/10353/13989 , vital:39737
  • Description: The study focused on attitudes of professional nurses towards the dimensions of quality care. Quality care is the main focus of the Department of Health in the Republic of South Africa. The researcher believes that professional nurses form the backbone of the whole health care fraternity; hence they are central to the study of quality care dimensions. The aim of the study was to determine and describe the attitudes of professional nurses towards the dimensions of quality care in the community health centres of the KingSabatha Dalindyebo sub-district. A quantitative descriptive design was employed to meet the objectives of the study. The non-probability purposive sampling method was used to select participants to provide information on the attitudes of professional nurses towards the dimensions of quality care in the community health centres of the King Sabatha Dalindyebo sub-district, Eastern Cape. From the target of 84 professional nurses who were employed at the five community health centres of King Sabatha Dalindyebo sub-district of the O.R. Tambo District, Eastern Cape Province, 70 (83,3percent) professional nursesresponded to the questionnaires. A self-administered questionnaire written in simple English was used to collect data from the professional nurses regarding their attitudes towards dimensions of quality care. The researcher adhered to the ethical standards of nursing research as described by the Democratic Nursing Organisationof South Africa regarding anonymity, confidentiality, privacy and quality research, according to which the names of professional nurses were not recorded on the questionnaires. The data were analysed using the Statistical Package for the Social Sciences (SPSS) computer software. The distribution of the results has been presented in tables and a bar graph. The results of the study revealed that the professional nurses of these community health centres had positive attitudes towards the dimensions of quality care.
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Needs assessment in the development of a problem-based learning for paediatric nurse specialist programme at the University of Fort Hare Eastern Cape

  • Authors: Melitafa, Nomntu
  • Date: 2017
  • Subjects: Nursing assessment Problem-based learning Nursing -- Study and teaching
  • Language: English
  • Type: Thesis , Masters , MCur
  • Identifier: http://hdl.handle.net/10353/8921 , vital:33966
  • Description: The study seeks to assess the need for developing a post graduate child nursing science programme with a problem based learning approach at the University of Fort Hare East London Campus. The aim is to the aim of the study was to conduct a needs assessment in preparation for development of a PBL curriculum so as to produce reflective PNSs. Literature exposed the high mortality rates of children and the competency gaps of trained PNSs. A descriptive quantitative design was used to guide the study. The data were collected by means of self-administered survey questionnaires which constituted closed and open ended questions to yield both quantitative and qualitative data. Data were obtained based on demographic information, performance and importance of the PNS activities, competences of PNSs as well as the prevalence of child health problems at the rural, semi-urban and urban hospitals in the ECP. The purposive sampling technique was used to select participants. The sample size was 70 and 38 participants responded. Quantitative and qualitative data were obtained. Quantitative data were analyzed through use of the Statistical Programme for Social Science software (SPSS) Version 9.0.1 and qualitative data were analyzed manually. Quantitative results were presented with pie graphs, tables and frequencies. Four themes emerged, revealing factors prohibiting the service delivery of PNSs, special training needs of PNSs, prevalent health problems in children and personal interventions. The results showed that in essence there is a need to develop the envisaged Problem Based Learning (PBL) curriculum.
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Perceptions of unit managers regarding competencies of newly qualified registered nurses in East London health services

  • Authors: Bengu, Phindiwe Faith
  • Date: 2017
  • Subjects: Nurses -- In-service training -- South Africa -- Eastern Cape Community health nursing -- South Africa -- Eastern Cape
  • Language: English
  • Type: Thesis , Masters , MCur
  • Identifier: http://hdl.handle.net/10353/13597 , vital:39683
  • Description: The South African Nursing Council requires registered nurses to have the necessary knowledge, skills, attitudes and values which will enable them to render an efficient service (Morolong and Chabeli, 2005:39). The South African Education and training system, through its policy of outcomes- based education and training, has tabled competency as a national priority. In support of this, the South African Nursing Council (SANC) requires that the newly qualified registered nurse possess competency on the core functions of a registered nurse. The health system also demands competent nurse practitioners to ensure quality nursing care. Due to the fact that competency is a national priority and a statutory demand, the research question that guided the study is what are the perceptions of unit managers regarding competencies of newly qualified registered nurses in East London Health Care services. The study was aimed at describing the perceptions of unit managers regarding the competencies of newly qualified registered nurses in order to propose the recommendations to improve the competencies of such newly qualified registered nurses and to provide quality patient care. A quantitative descriptive non experimental design was used to evaluate the perceptions of unit managers regarding competencies of newly qualified registered nurses from a public nursing college. The sampling method of probability convenience sampling was used in this study. Data were collected by means of a questionnaire administered to ninety unit managers and only eighty one unit managers participated in the study. Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 22 software. Statistical methods enabled the researcher to reduce, summarize, organise, manipulate, evaluate, interpret and communicate quantitative data. Data were cleaned and coded and spoilt data were checked. Findings from the software were displayed in graphs or tables. Concerning the eighty one unit managers who participated in the study, age and sex matched respondents were selected according to their availability.The results showed that there is agreement that competence of the nurses affects the image, mission and staff utilisation in their units and/or institutions. There was no dominant opinion on the possible association between competency and environmental, physical and technological factors. There was unanimous agreement that newly qualified nurses need constant supervision and in-service training. There was moderate agreement on the use of acquired knowledge and skills by nurses and there was no dominant opinion about how newly qualified nurses tolerate differences and handle misunderstandings and shortcomings of other professions. In conclusion newly qualified registered nurses need coaching, mentoring, n-service training and constant supervision. Recommendations regarding strategies to be used to improve competencies of newly qualified registered nurses included exit evaluations of community service practitioners, stipulating the competency framework of newly qualified nurses and assessment criteria of competency. Mentoring and coaching of newly qualified registered nurses during community service, monthly or quarterly meetings with the community service candidate in order to identify their challenges were also recommended. Motivation strategies in order to boost their morale so that they can deliver quality patient care. The newly qualified registered nurses should hold meetings with the unit managers regarding the challenges the unit managers face when assessing competencies of newly qualified registered nurses.
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