Masters Degrees (School of Nursing)
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Item Open Access Psigiatriese onderrig aan gesinslede van geestesongesteldes as terapeutiese hulpbron(University of the Free State, 1975-12) Poggenpoel, M.; Steyn, V.; Loots, I.Abstract not availableItem Open Access 'n Ondersoek na wangebruik van geneesmiddels by bejaardes te Bloemfontein: 'n verpleegkundige studie.(University of the Free State, 1980-01) Van der Lingen, Estelle Christine; Viljoen, M. J.; Pistorius, G. J.Afrikaans: Slot: Die navorsingsbevindings word ten slotte aan die hand van die volgende beskrywing saamgevat: Die gemiddelde bejaarde persoon te Bloemfontein wat voorgeskrewe geneesmiddels gebruik, kan beskryf word as 'n 70-jarige dame wat haar geneesmiddels slegs by die polikliniek by die Nasionale Hospitaal ontvang. Sy is self verantwoordelik vir die neem van haar geneesmiddels, maar neem egter nie al haar geneesmiddels korrek volgens voorskrif nie, want sy maak slegs op haar geheue staat en vergeet soms om dit te neem. Ander geneesmiddels beskou sy weer as onnodig om gereeld te neem en sommige veroorsaak reaksies indien dit gereeld gebruik word. In verband met laasvan die geneesmiddels is in onbruik omdat die geneesheer dit gestaak het of die simptome verdwyn het. Sy is van plan om die geneesmiddels wat in onbruik is terug te neem na die polikliniek. Verder hou sy nie die geneesmiddels in die oorspronklike pakkies nie omdat die pakkies breek en sy dit geriefliker vind as die geneesmiddels in botteltjies is. Sy plaas dit in afsonderlike houertjies maar bring nie etikette op almal aan nie omdat sy die geneesmiddels goed ken en tog net volgens die voorkoms onderskei omdat die naam niksseggend is. Ongelukkig kan sy nie goed sien nie, want sy moet 'n nuwe bril kry. Laasgenoemde veroorsaak dat dit soms moeilik is om die geneesmiddels van mekaar te onderskei. Sy sal nooit van haar geneesmiddels aan iemand anders gee nie omdat sy dit as gevaarlik beskou. Wat die geneeshere aanbetref, verkies sy om elke keer by dieselfde geneesheer 'n afspraak te kry omdat sy voel dat hy haar dan leer ken en verstaan. Laastens verlang sy van 'n geneesheer om vriendelik te wees, opregte belangstelling te toon, deeglik te wees in sy werk en haar eerlik mee te deel wat fout is. Volgens die bevindings van die ondersoek is die wangebruik van geneesmiddels wel 'n probleem by die bejaardes te Bloemfontein. Hierdie ondersoek was, soos reeds bespreek, daarop gerig om die omvang van die probleem en die oorsake daarvan te bepaal. 'n Verdere studie en ondersoek word egter benodig in verband met die wyse waarop voorligting aan die bejaarde gegee moet word en die metodes wat aan die bejaarde gedemonstreer kan word om hulle in staat te stel om die geneesmiddels korrek te neem.Item Open Access 'n Verpleegkundige begeleidingsprogram vir persone wat infektering met die menslike immuniteitsgebrekvirus vermoed(University of the Free State, 1992-05) Basson, Petro Magdalena; Van Wyk, N. C.; Viljoen, M. J.Afrikaans: VIGS is 'n wesenlike probleem in Suid-Afrika. Indien die verspreiding van die Menslike Immuniteitsgebrekvirus (HIV) nie gestop word nie, kan die siekte epidemiese afmetings aanneem. Diegene wat hoë risiko seksgedrag beoefen moet gelei word om dit te staak. VIGS is 'n gevreesde siekte omdat HIV infeksie 'n chroniese infeksie is en gekenmerk word deur die progressiewe agteruitgang van die menslike immuunsisteem. Daar bestaan geen geneesmiddel teen die siekte nie en die verloop daarvan eindig altyd in die dood. Persone wat hoë risiko seksueelgedrag openbaar, vermoed dikwels dat hulle moontlik met HIV geïnfekteer kan wees. Met aanmelding vir evaluering ter bevestiging van hul vermoedens, benodig hulle reeds verpleegkundige tussentredes. ' Die tussentredes behoort daarop gerig, te wees om hulle in staat te siel om hul kommer te hanteer. Indien die persone egter nie ook gelei word om hul gedrag te verander nie, kan hulle weer met die virus in aanraking kom of dit selfs versprei. Omdat verpleegkundiges dikwels die ondersteuning van hierdie persone hanteer, kan aanvaar word dat 'n verpleegkundige begeleidingsprogram wat deur empiriese navorsing ontwikkel is, 'n positiewe bydrae tot optimale ondersteuning kan maak, aangesien daar geen gepubliseerde Suid-Afrikaanse verpleegkundige begeleidingsprogram in die literatuur gevind kon word nie. Dit is dus die doel van die studie om 'n begeleidingsprogram vir persone wat HIV infektering vermoed, te ontwikkel wat hulle in staat stelom: - feitelike kennis oor VIGS te bekom, - die psigologiese gevolge van HIV infektering te begryp, en - die nodige gedragsverandering te begryp en te bemeester. 'n Beskrywende studie met 'n nie-eksperimentele navorsingsontwerp is gebruik. Na 'n omvattende, intensiewe literatuurstudie is 'n voorlopige begeleidingsprogram vir persone wat hoë risikogedrag openbaar, saamgestel. Daarna is dit aan domeinkundiges, wat oor spesiale kennis op die gebied van VIGS beskik, vir evaluering volgens die Delphi-tegniek voorgelê. Beskrywende statistieke is gebruik in die ontleding van die data wat verkry is. Uit die bevindinge is dit duidelik dat die domeinkundiges met die afdelings sowel as items van die voorlopige program saamstem. Die finale program is na 'n herorganisasie van die items ten einde 'n logiese geheel te verkry, saamgestel. Vir die volgende afdelings en inhoud is voorsiening gemaak: - Inligting oor VIGS -- Oorsprong -- Patogenese -- Epidemiologie -- Spektrum -- Kliniese tekens en simptome -- Oordraging van HIV -- Hoë risikogedrag - Psigososiale reaksies van persone wat mv infektering vermoed - Verpleegsorg -- Ondersteuning -- Motivering tot gedragsverandering Die verpleegkundige wat die program gebruik moet deurentyd bewus wees van die kliënt se uniekheid en slegs toepaslike gedeeltes gebruik. Die program is dus as hulpmiddel vir die verpleegkundige ontwikkel en nie as 'n inligtingstuk vir persone wat HIV infektering vermoed nie.Item Open Access 'n Verpleegkundige ondersteuningsprogram vir vroue met primêre karsinoom van die mammae(University of the Free State, 1995-11) Nel, Elizabeth Cornelia; Van Wyk, N. C.; Van Rhyn, L.English: All women with breast cancer need support to deal with the combined impact of the diagnosis of cancer, breast loss, adjuvant treatment and the possible recurrence of the disease. The women need to adjust to live with and accept these factors. As discussed in the literature, nursing staff do not always give the necessary emotional support. Research results show that there is a difference between women's need for support and that which is given by the nursing staff. The aim of the study is to develop a nursing support program for women with primary breast cancer. A descriptive study was done using a qualitative research design. Free attitude interviews were used to collect data from women with primary breast cancer who are being treated by private oncologists and radiation oncologists in the Pretoria area. The phenomenalogical perspective of Haase and Van Kaam were used in combination for data analysis. According to the data it clearly appears that the support of the nursing 'staff consists of direct nursing support initiated by the nursing staff with the woman, in order to assist the woman to adjust to her illness, and the effects thereof. The core of the direct nursing support is communication, accompaniment and information. The woman's external environment is involved during indirect nursing support. Although the women's needs can be generalised, each woman requires specific and individual care. These support needs vary at times. A nursing support program for women with primary breast cancer was developed after comparing the collected data with the literature. By following this program, the nursing staff can teach the women to adjust to and to accept the emotional as well as the social impact of the diagnosis, breast loss and the adjuvant treatment. The women learn to live with a diagnosis of cancer despite a fear for recurrence.Item Open Access The identification of community needs for AIDS health education(University of the Free State, 1997-09) Khokho, Sylvia Rejoice Olebile; Basson, P. M.; Visser, L.English: AIDS is a fatal disease which mostly affects the economically productive age-group (25-50 years). It therefore adversely affects the economy of the country. It is also expensive to treat as it affects the immune system of the body, thereby rendering the person critically ill and requiring intense and expensive nursing and medical care. AIDS is also seen as a disease of attitude and behaviour, as it is closely associated with sexual behaviour, where a person has more than one sexual partner. This practice, in the form of polygamy (as seen today) and concubinage, is still accepted as normal cultural practice in most black communities in spite of the effect of social change on many tribal customs. There is a drastic increase in the number of persons infected with AIDS in spite of existing efforts to combat the disease. This increase is not specific to a particular racial group, country, community or town. It is a worldwide problem. However, most new cases of AIDS are found among the black population. Health education seems to be the only strategy available as a measure for controlling the spread of AIDS in the absence of a cure. There is therefore a definite need to investigate the requirements for the development of a health education program for the control of AIDS. The aim of this study was to identify the needs of the community for AIDS health education. This entailed eliciting their perceptions of AIDS, establishing their preference regarding the AIDS educator, identifying topics/aspects to be addressed in the educational program, as well as establishing principles with which ethnicspecific health educational programs should comply to be acceptable to communities. Interviews were conducted with clients visiting health services In Mangaung. Trained fieldworkers were used to help with the implementation of the structured interview schedule. The data were analysed and the findings were compared and discussed in terms of the literature review. Reliability of the data collection instrument was ensured by training fieldworkers to ask questions correctly. The conduction of a pilot study to identify possible problems and address these before the major study helped to ensure reliability. For the purpose of validity, the interview schedule was submitted to experts in research. This ensured face validity. Content validity was ensured by submitting the measuring instrument to a domain expert. It was also handed to an expert working at the AIDS Training, Information and Counselling Centre (ATICC) for evaluation. These experts were asked to evaluate the interview schedule in terms of whether the questions were correctly and objectively worded and whether they matched the objectives of the study. Conclusions and recommendations were made and guidelines, based on findings, were set for the development of a health education program for the control of AIDS.Item Open Access Stressors experienced by student nurses during clinical placement in psychiatric units in a hospital(University of the Free State, 1998-11) Gontsana, Maphosa Ruth; Van Rhyn, LilyEnglish: Psychiatric nursing students find themselves in a situation in which they are confronted by stressors in their personal and professional enviromnent, as well as stressors caused by their inexperience in psychiatric nursing. An exploratory study was conducted with the aim of discovering and describing possible stressors experienced by psychiatric nursing students during clinical placement in a psychiatric unit. The study had two objectives: firstly, to identify factors experienced by student nurses as stressful while working in psychiatric units and secondly, to recommend guidelines to minimise stress, for inclusion in the psychiatric clinical nursing curriculum. For the purpose of the study an unstructured interview was conducted with each participant during their first placement in a psychiatric unit to identify the factors experienced as stressful. The results indicated that all eight participants experienced average to high stress. Sources of stress identified included, among others, ineffective teaching and learning programmes, poor managerial governance of the service, detachment of professional nurses from their teaching role, poor relationships among staff, over-reliance on the medical model of care and patient neglect. Psychiatric nursing students sampled indicated universal support for in-service education and training for professional nurses, attitude change of professional nurses towards students, support for student initiatives, student involvement in patient care and adequate allocation of resources for patient care and nurse training. Arising from the findings, guidelines were established for the guidance of psychiatric nursing students. The exploration and description of stressors experienced by the psychiatric nursing students will help nurse educators plan clinical learning opportunities in such a way that they are less stressful, thus ensuring that psychiatric nursing students are equipped to utilise themselves as therapeutic instruments.Item Open Access Evaluation of problem-based learning in an undergraduate nursing education programme(University of the Free State, 1999-05) Becker, Susanna; Viljoen, M. J.; Botma, Y.English: The aim of this study was to evaluate problem-based learning in an undergraduate nursing education programme. The School of Nursing at the University of the Orange Free State implemented problem-based learning as a teaching and learning strategy in the undergraduate programme in 1997. The 1998 course was evaluated to determine the success of this innovative method of instruction. It was done by administration of an audit to determine whether the methodology and process of PBL were followed; all the variables (internal and external) were considered during programme development, and whether requirements for outcomes as required by the South African Qualifications Authority were met. Student satisfaction was determined by means of a perception questionnaire and changes that took place in learning styles were determined by means of a learning style inventory that was developed in Lancaster. The grades students obtained in problem-based learning subjects were compared to the grades they obtained in subjects that were instructed by means of traditional lectures, as well as their grade 12 results secondary schooling. The audit revealed that this course was carefully planned and implemented to be one of exceptional quality. An action research model was used to monitor the integrated curriculum model with an emphasis on the PBL philosophy. This curriculum was found to be successful in portraying the South African health context in a lifelike and comprehensive manner, as the design was community-based. This curriculum addressed the tendency to overload and divided curricula in the disciplines, which bears little resemblance to the reality of the South African health context. A deficiency found is the lack of a formal quality assurance programme, which will enhance the maintenance of the high standard. Students in the course were under a lot of stress as they had to leave the comfort zones of traditional learning and some reacted with anger and resentment. Learning did take place in spite of all the hurdles students were confronted with. Superiority in meaning orientation, intrinsic motivation, deep approaches and comprehension learning was detected by the LAS! when results were compared to the scores of similar studies done in first-world countries (see Appendix J). Unfortunately a decrease in student-centredness took place, which could be ascribed to group sizes that were too large, fear of failure (as bursaries would be forfeited if students did not perform up to certain standards) and a heavy workload. Assessment results of PBL subjects were very positive in spite of students' indications that they found the course difficult. Assessment scores were much higher for PBL subjects than for traditional lecturing subjects, as well as Anatomy, which was instructed by means of video-assisted instruction. Nearly half the students obtained better assessment results in PBL than in their matriculation examinations. The most positive aspect of the first-year nursing course was the fact that students became self-directed learners and that a pattern of lifelong learning was created to equip them for the challenges that lie ahead in the 21st century.Item Open Access Cultural congruent nursing care of black patients in the maternity section of public hospitals in Bloemfontein(University of the Free State, 1999-05) Sesing, Agnes Seatile; Van den Berg, R.; Venter, I.Afrikaans: Die inwoners van die Republiek van Suid-Afrika is vanaf verskeie kulture afkomstig en toon 'n multikulturele aard. Die gesondheidsorg wat in alle gesondheidsorginstansies gelewer word, is op die westerse gesondheidsorgmodel geskoei. Die westerse gesondheidsorgmodel sluit geen kulturele gesondheidsbehoeftes, soos geopenbaar deur Afrika-etnosentriese bevolkings, in nie. Kulturele konflik en wanbegrip wat gekenmerk word deur geen samewerking tussen pasiënte en praktisyns, die nienakoming van die sorgplan deur pasiënte en die stereotipering van pasiënte deur verpleegkundiges, kom algemeen tussen pasiënte en gesondheidsorg praktisyns . Die doel van die studie was om vas te stelof vroedvroue oor die nodige kennis beskik rakende en sensitief is vir die kulturele gesondheidsbehoeftes van swanger- en lakterende vroue wanneer verpleegsorg verleen word. Die navorsingsontwerp is nie-eksperimenteel met 'n beskrywende en verkennende aard. Die opnaine-metode is gebruik om die data mee in te samel. Die volgende navorsingstegnieke is gebruik: 'n vraelys is deur die verpleegkundiges voltooi; 'n gestruktureerde onderhoud is met die moeders gevoer en die nodige gesondheidsorgdokumente (beleide en verpleegsorgverslae) is geouditeer. Die verwerking van alle oop-einde vrae is volgens die metode soos deur Tesch beskryf, gedoen. Alle data is op die nominale beskrywende vlak geanaliseer. Die resultate toon dat daar geen verband bestaan tussen kennis oor verpleegsorgpraktyke rakende kultuur-kongruente verpleging en die verpleegsorg wat pasiënte verwag en kry. Hierdie tendens word ook in die gesondheidsorgdokumente vergestalt daar kultuur-kongruente verpleegsorg nie onderskryf word nie en ook nie aangeteken word nie.Item Open Access The reasons why some patients suffering from schizophrenia miss clinic appointments(University of the Free State, 1999-05) Mogodie, Mamusi Frances; Van Rhyn, Lily; Venter, IdaliaEnglish: Missed clinic appointments among the patients who are suffering from schizophrenia has been identified through the statistical records at Botshabelo psychiatric clinic. Missed clinic appointments remain a world-wide problem which results from the nature of the illness, the patient, the family, health services, culture, employment and other environmental factors. A conceptual model which is based on the principles of the system theory has been discussed and indicated that the patient as part of the system is easily influenced by the environmental factors and the illness itself to stop visiting the clinic for treatment. During missed clinic appointments there is a break or cut between the patient and the clinic due to subsystems which play the negative role within a system (Fawcett, 1989:63). The purpose of the study was to determine the possible reasons for missed clinic appointments for patients who are suffering from schizophrenia and to suggest nursing guidelines to enhance clinic attendances. Quantitative research methodology usinq descriptive and exploratory designs was chosen. The population consisted of the patients who are suffering from schizophrenia referred to the clinics between January 1995 and January 1996, and missed clinic appointments twice or more within a period of 12 months, both females and males, ages from 19 years and above were included. Sampling procedure was purposive consisting of two groups. Group A were patients who are suffering from schizophrenia and missed clinic appointments twice or more and Group B consisted of one immediate family member for each patient who was identified in the patient's record, and who live with the identified patient. A pilot study was done to test the reliability and validity of the data-collecting instrument. Two patients and two family members were selected for the pilot study and were not included in the main study. To verify reliability and validity of the instrument some of the experts were contacted as follows: • Nursing Research Committee at the University of the Orange Free State. • Ethics Committee at the Faculty of Health Sciences, University of Orange Free State. • Computer Science personnel at the same university. • Clinical psychiatric nursing personnel who are experienced In the psychiatric field. • The researcher herself who acquires necessary skills in psychiatric nursing and experience played an important role to ensure reliability and validity of the instrument. Data collection was done using a semi-structured interview aided by a questionnaire. Both closed and open-ended questions were designed to obtain the required information. Questionnaires used were completed by the researcher to counteract illiteracy among the respondents. Data was coded by the computer centre at the University of Orange Free State. Analysis and interpretation of data was done by the researcher using graphs and tables. Ethical consideration was maintained. Informed consent was obtained from the respondents. Privacy, confidentiality, person with diminished autonomy and right to protection from discomfort and harm was maintained throughout the study. The results indicated that the major reason for missed clinic appointments among patients who are suffering from schizophrenia, is a fear of medication side-effects. This occurs to the patients who have been on treatment before, and experienced side-effects of medication [28.1 %J. The other reasons which appear to be caused by a lack of knowledge about the importance of aftercare management are as follows: - Feeling well when not on treatment - The patient stayed at home with no apparent reason - Poor nurse-patient relationship - Substance abuse - Stigma attached to mental illness All these reasons remain problem, which require immediate and long-term solutions. Recommendations to address these problems were made by the researcher and the nursing quide-lines as explained.Item Open Access The willingness of traditional healers regarding collaboration with Western psychiatric health care.(University of the Free State, 1999-11) Mototo, Onica Matlhodi; Venter, Idalia; Pretorius, A.English: Traditional healers treat many black patients with mental illness. particularly those living in rural areas. There is considerable literature to support this statement. The purpose of the study was: to explore and describe the willingness of traditional healers regarding collaboration with western psychiatric health care; and the willingness of traditional healers regarding a possible change in their own practice as a result of collaboration with western psychiatric health care. From these it would be possible to make recommendations with regard to possible areas of collaboration. The study is qualitative, explorative, descriptive and contextual in approach. It was therefore necessary to use a semi-structured interview to collect data from traditional healers. The sample consisted of fourteen traditional healers residing in the rural areas of Mafikeng. Entrance was established through a written permission to the chairman of the North West Traditional Healers Association to conduct research on traditional healers. Before data collection, traditional healers were given information regarding the purpose of the study. Giorgi and Teeh's methods were used to analyse data. To ensure trustworthiness, Guba and Lincoln's approach was applied. The services of an independent coder were also sought. The findings of the study indicated that traditional healers are willing to collaborate with western psychiatric health care and to exchange information although they also have some reservations, particularly concerning aspects of their methods of practice. Four main themes were identified: broad scope of recognition and treatment of mental illness: feelings of confidence: acknowledging collaboration between traditional healers and western psychiatric health care: feelings of fear of change. The process of the study showed that with mutual respect and understanding, it is possible for western psychiatric health care to work with traditional healers for the purpose of rendering effective mental health care to patients. Recommendations regarding inclusion of traditional healers in the westem psychiatric health care were made with the aim of ensuring a holistic approach in rendering mental health service to the community.Item Open Access Identification of factors leading to job dissatisfaction among nurses working in critical care units public and private hospitals in Bloemfontein(University of the Free State, 2000-06) Tlaba, Faith Mpho; Van den Berg, H.English: Job satisfaction as a phenomenon has been researched intensively over the years because both the employee and the organization benefits from it. On the other hand, job dissatisfaction as human experience has only recently been identified as a phenomenon that is not the opposite of job satisfaction nor a subdivision of job satisfaction. Job dissatisfaction as a phenomenon is a real life situation and human experience that needs to be researched. The purpose of this study was to identify the factors that lead to job dissatisfaction among nurses working in the critical care units. The research design was non-experimental of a descriptive and explanetory nature. The survey method was used to obtain the necessary data. The data were obtained by use of a structured questionnaire which was completed by all professional nurses and all nurse managers working in the critical care units of the private and public hospitals in Bloemfontein. The responses to all open-ended questions was analysed according to the method described by Tesch. All data was analysed on a nominal descriptive level. Grounded on the results, professional nurses expressed that they were motivated by selfactualisational values to work in the critical care units. According to the critical nurses most important job dissatisfiers are embedded in the human resource management process and as such have to be rectified to enhance job satisfaction. The managers on the other hand, indicated that factors in the general management process lead to the job dissatisfaction experienced by critical care nurses and as such need to be rectified. In the light of these findings, the recommendations for minirnisingjob dissatisfiers and enhancing job satisfiers were made. Further research into phenomenon of job dissatisfaction was also recommended.Item Open Access Belewenisse van tuisversorgers van pasiënte met Alzheimer se siekte(University of the Free State, 2000-11) Venter, Annelie; Van Rhyn, W. J. C.English: The ageing of the population and the diminishing of subsidies to old aged homes has lead to the aged staying in the community and being cared for. The care and supervision of patients with a chronic condition such as Alzheimer's disease demands a great deal of time and is usually given by the same person. The purpose of this study was to investigate and describe the experiences of caregivers who care for patients with Alzheimer's Disease at home, as well as to describe the caring environment and the profile of the caregiver in order to develop guidelines that would·support these persons. This is a qualitative study with a quantitative component that is contextual with the purpose to explore and describe. The phenomenological approach is used in the study. Caregivers that meet with the following criteria were included in this study: Persons that are primarily responsible for the caregiving of patients who have been clinically diagnosed with Alzheimer's disease. Afrikaans or English mother tongue speakers, enabling the researcher to easily understand the described experiences of the caregivers Ethical matters were discussed with the respondents before informed consent was obtained. Data collection was done in two phases. In phase I, the qualitative section, a phenomenological interview was done with the caregiver, in which a description of the experience as caregiver was given. In phase II, the qualitative component, a questionnaire was completed by the researcher, to establish the caregiving environment and the profile of the caregiver. A pilot study was done beforehand and no problems concerning the execution of the study were identified. Data collection was sustained until saturation of data was reached. Saturation was reached after nine interviews. A recording was made during. each interview and transcribed thereafter. The transcription of the interview was analysed by using a systematic process as explained by Tesch in Creswell (1994:155). The SAS-computer programme was used in the analyzing of the questionnaires. The scientific trustworthiness of the study was ensured by credibility, transferability, reliability and confirmability. It became clear during data analyzing and review of the literature that these caregivers had negative experiences of home care of Alzheimer's patients. Information obtained from the data and literature made it possible to compose guidelines for support to the caregivers. The guidelines focussed on emotional and practical assistance.Item Open Access Experiences of pregnant unmarried adolescents in Maseru(University of the Free State, 2000-11) Lehana, Tjoetso Veronica; Van Rhyn, LilyEnglish: The transition to motherhood is accompanied by a number of social and psychological consequences that place pregnant adolescents at risk in terms of later life adjustment. A qualitative study was undertaken to explore and describe the experiences of pregnant unmarried adolescents in Maseru district; and if necessary, to develop guidelines for an educational and counseling program for them. Pregnant unmarried adolescents, aged 13 to 19 years, from 10 randomly selected clinics in Maseru, were allowed to give detailed descriptions of their experiences with their first pregnancy. The meanings that those experiences had for them were also explored. Sixteen individual phenomenological and two focus group interviews were conducted. Tesch's (1990) method of analysis was used to analyse the data. Results: The respondents reported to have met the confirmation of their pregnancy with a mixture of disbelief, confusion and shame. They also experienced fear to disclose the pregnancy to their next of kin. Emotionally they reacted with misery, depression and anger. They experienced rejection and scorn by their families and friends. Although most respondents' pregnancy was later accepted by parents, support granted was mainly material with minimal social support. The majority of their boyfriends were reported to have denied parentage. A" respondents who were still in school had to drop out. Guidelines for an educational and counseling programs were made. Recommendations included: every pregnant adolescent who comes to the clinic or outpatient department should receive or be referred for counseling. Prenatal education should provide anticipatory guidance related to maternal role issues.Item Open Access Male reproductive health in Lesotho: needs, knowlegde, attitudes and practices(University of the Free State, 2002-05) Phoofolo, Agnes Moelo; Van den Berg, R. H.Most reproductive health programmes in Lesotho are designated for women only, such as the family planning programmes, which focus only on women and children and exclude men. Male reproductive health programmes do not exist in Lesotho. Yet men, like women, have different reproductive health needsand problems at different stages of their development. The purpose of this study was to determine men's needs, knowledge, attitudes and practices regarding reproductive health. A non-experimental design of a descriptive nature was used. The survey method was used to gather data. Probability sampling techniques were used to select the sample of 794 male respondents from the 10 districts of Lesotho. Focus group discussions and structured interviews were used to collect data from the respondents aged 15 to 60 years and older, living in the rural and urban areas of Lesotho. Ethical principles as relevant to the conduct of research involving human subjects was adhered to, such as obtaining the necessary permission and complying with the human rights of the respondents. All data was analysed on a nominal descriptive level. The results of the study showed that men needed more knowledge and information related to male reproductive health; their attitudes towards their own reproductive health and the services to be delivered varied; they did not possess adequate information related to safe reproductive health practices and indicated that they (men) would utilise male reproductive health services provided they existed. Basedon the above, recommendations were made that health care programme managers in Lesotho should design men friendly programmes and services. The education of health care providers should be modified to include male reproductive health and all health care providers should be trained to render quality male-friendly reproductive health care. Furthermore the need for further research into male reproductive health was emphasized. Lastly, a proposed male reproductive health programme has been outlined as a qutdellne for health care managers.Item Open Access The needs of HIV positive patients and their families(University of the Free State, 2002-05) Ndaba, Baliwe Semly; Basson, P. M.; Honiball, S.English: HIV infection is a global problem affecting individuals of all racial groups, socioeconomic backgrounds, cultures, sex and age The statistical information available at all governmental levels shows only a tip of an iceberg, because of the small number of people who present themselves for HIV blood tests. In South Africa, for example projected statistical information at provincial levels is based on the results of antenatal women attending the public primary health care facilities (who volunteered to be tested for HIV) (refer to Figure 1.1). The aim of the study was to identify the needs of HIV positive patients and their families. A qualitative study was done that captured the unique experiences of the interviewed subjects, by tape-recording the unstructured interviews of both the HIV positive individuals and their family members. Purposive sampling was done from the attendance register, with the assistance of the primary health care centre personnel and specialized Auxiliary Officer at Koffiefontein. Subjects participated voluntarily in the research, after signing an informed consent form. The sample comprised both adult males and females. Saturation. was reached after interviewing four patients and three members of their families. Giorgi's method of data analysis was used (See Appendix II) Identified needs were classified into themes/constituents and groups using activities of daily living as described by Uys (1999). The groups were further categorised into major categories according to Maslow's hierarchy of needs. Under the physiological needs, the needs identified included nutrition, sleep, rest, respiration, exercise, water and hygiene. The emotional support, empowerment and financial support form the pillars for the safety and security needs. In the love and belonging needs category, the communication and self concept needs of subjects were identified. The self-esteem and self-actualization needs revealed the needs for emotional support, understanding and compassion towards the HIV positive individuals and their families. HIV infection affects not only those who have the virus, but also those who irrationally fear infection, those who are at risk of being infected (who fear infection), friends, families, professionals and volunteer care givers, and neighbours of HIV infected individuals alike. The elderly are also included, because this disease affects their children who are economically active. HIV infected individuals are normally taken care of by their relatives during their final stage of the disease (AIDS). On their death the elderly take care of their children. Where there are no relatives the children may be taken to orphanages, hospitals and for foster caring. The disease per se is a multifaceted challenge that needs a multi-disciplinary approach from grass roots level to the highest authority in the country to fight against its spread (intersectoral collaboration). People living with AIDS and their families need understanding and compassionate community members to support them emotionally, thereby removing the burden of the stigma associated with this disease.Item Open Access The perceptions of voluntary aids caregivers concerning hospice managers' provision of support(University of the Free State, 2003) Gxabuza, Rosina Nomathamsanqa; Joubert, AnnemarieEnglish: The challenge of HIV/AIDS is a global issue. Instead of decreasing the number of people infected with the disease is increasing. Fortunately we have men and women who volunteer to fight the increase of this pandemic. These heroes and heroines are voluntary AIDS caregivers who are the mainstay of care of people with AIDS. However, the fact that caregivers suffer from loneliness and social isolation related to stigma and discrimination cannot be ignored (cjFlaskerud & Tabora, 1998:21). Voluntary caregivers could benefit from the opportunity to express basic emotions concerning financial, emotional, physical issues and an open line of communication should be in place. Providing an avenue for emotional expression may enhance both physical and mental health to voluntary AIDS caregivers. This is a qualitative study undertaken to explore the perceptions of voluntary AIDS caregivers concerning hospice managers' provision of support. An explorative, descriptive, contextual and qualitative design was used to determine the perceptions of AIDS caregivers concerning hospice managers. Voluntary AIDS caregivers were selected from hospices of the Motheo District. A pilot study was conducted prior to the commencement of the main study. This resulted in paraphrasing the central question as in the "grand tour" (Spradley, 1980:49), Marrow and Smith (1995:42) who ask question such as; "Tell me about your self." Initially two focus groups were selected, comprising of ten participants in each group. Participants were requested without leading them to give detailed information during interviews. Saturation principle was not reached with the two focus groups, as there was no redundancy of information. Subsequently two more focus groups were selected in an endeavor to reach the required saturation point. Eventually four focus groups participated in the study. Data collected was analysed according to Tesch [1990] in Creswell (1994:155) and also by making use of the N VIVO program, a design for qualitative research used to ensure that the complex data was correctly and systematically analysed. The data analysis was followed by a literature control. The findings with regard to the perceptions of voluntary AIDS caregivers concerning hospice managers' provision of support did not differ significantly in personal and vocational support that were identified as main categories. The researcher made recommendations and suggestions were made by voluntary AIDS caregivers are easy to follow and implement. Limitations encountered are discussed.Item Open Access Unmarried female adolescents' knowledge and attitudes towards the use of contraceptive services in the Maseru Health Service Area(University of the Free State, 2003-06) Moletsane, Matšepo Lydia; Venter, I.English: Adolescent reproductive health has become a major concern on the international agenda. Understanding adolescents' views about the use of contraceptives and contraceptive services is critical in developing effective strategies to prevent unwanted adolescent pregnanciesand abortions that are on the increase in Lesotho. The purpose of the study was to explore and describe the knowledge and attitudes of unmarried female adolescents towards the use of contraceptive services. A non-experimental exploratory and descriptive design was used. A survey method was used to gather data. The relevant literature and focus group interviews were used to compile a questionnaire, which was the primary research technique. Probability sampling with a proportional representation was used to select a sample of 969 respondents between 13 and 21 years from 29 high schools in the rural and urban areas of the Maseru Health Service Area. All the data collected were analysed on a nominal descriptive level. The findings of the study and the conclusions reached showed that there is inadequate knowledge of reproductive health and contraceptives; misconceptions; lack of knowledge regarding contraceptive services; contradicting attitudes towards the use of contraceptives; lack of adolescentfriendly services; a discrepancy between sexual activity and the use of contraceptives; and under-utilization of contraceptives and contraceptive services. Based on the above, recommendations were made that adolescents should be empowered with knowledge regarding contraceptives and reproductive health; misconceptions should be corrected; contraceptive services should be advertised; and adolescent-friendly services created, thereby improving the utilization of contraceptives and contraceptive services. In the last place the need for further research was emphasized.Item Open Access The effect of three types of endotracheal tubees on ventilator-associated pneumonia(University of the Free State, 2004-11) Phillips, Maria Jacoba Johanna; Botma, Y.English: Ventilator-associated pneumonia is associated with a high mortality, morbidity and medical cost and is common and has major complications. Prevention of ventilator-associated pneumonia is dependent on how well we understand the pathogeneses of the disease. The pathogeneses starts with the colonization of the upper airway and the gastrointestinal tract, pooling of secretions in the subglottic space and aspiration of this contaminated secretions past the endotracheal cuff (endogenous source of pathogens). As the host’s defences are overcome, tventilator-associated pneumonia develops. Newer types of endotracheal tubes were designed with a dorsal lumen for the removal of subglottic secretions. This prevents the aspiration of contaminated secretion into the lower sterile airways. The aim of this research was to determine the effect of three types of endotracheal tubes on ventilator-associated pneumonia. A single center, blind, prospective, controlled clinical trial has been selected to investigate the effect of three types of endotracheal tubes on ventilator-associated pneumonia. Prior to the commencement of the study, approval for the performance of the study was obtained from the Ethics Committee of the Faculty of Health Sciences of the University of the Free State, the Universitas hospital, the manager of the intensive care units and neurosurgical intensive care unit as well as from the head of the neurosurgical department. Informed consent was obtained from candidates or if the candidates were unable to provide consent from their spouse, child or parent and information regarding the purpose, procedure, and possible adverse effects relevant to the study, were provided. Written consent was obtained. If the candidates was unable to give consent themselves and their family was unavailable, the researcher obtained telephonic consent from above-mentioned family members. The consent forms were available in Afrikaans, English and South-Sotho. If the subject did not understand English or Afrikaans, the researcher made use of a registered nurse as a translator to explain the purpose, procedure, and possible adverse effects relevant to the study. A witness co-signed all consent forms. Seventy-one candidates that met the inclusion criteria were screened for enrolment into the study. Thirty-four of these candidates were successfully enrolled. Subjects were consecutively allocated into three study groups. Each study group was intubated with the type of endotracheal tube for the specific study group and studied for the development of ventilator-associated pneumonia. The two experimental groups were subjected to two hourly subglottic suctioning. One experimental group’s cuff pressures were measured and maintained within normal limits, whereas a Lanz™ valve maintained the other experimental group’s cuff pressures. The control group was intubated with the conventional type of endotracheal tube. The implementation took place over a period of 18-months. Data was statistically analysed and presented by means of frequencies, medians and comparison of 95% confidence intervals. This study has found that none of the subjects in the experimental groups (received subglottic suctioning) developed late-onset ventilator-associated pneumonia compared to 16.67% in the control group. The incidence of early-onset ventilator-associated pneumonia was also much higher (75%) in the control group than the experimental groups. The relative risk for late-onset ventilator-associated pneumonia indicated that subglottic suctioning was not a preventative factor in the prevention of late-onset ventilator-associated pneumonia in the experimental groups. The time of intubation of the control group was longer than the two experimental groups. No significant difference was found in the morbidity and the mortality of the three study groups. Recommendations are that the study should be repeated with a larger study group and the subjects should be ventilated for a longer period. The benefits of subglottic suctioning may present it more clearly. The benefits of the LanzTM valve have not been investigated sufficiently in this study. In closing a repetition of some wise words: “Keep an open mind toward pneumonia. Our grandchildren will be interested and are likely to have as many differences of opinion…as we have.” William Osler. 1900 (Craven & Steger, 1995:1S)Item Open Access Experiences of mothers of pregnant unmarried adolescents in a community in Lesotho(University of the Free State, 2005-01) Matela, Matlhabeli Kananelo; Van Rhyn, LilyEnglish: The mothers of pregnant unmarried adolescents often go through various difficult situations as they attempt to support their adolescents through the pregnancy. Some of the problems they encounter can have harmful effects on their own health, on the health of the pregnant adolescents and/or even on the development of the expected baby. In Lesotho it is socially unacceptable for an unmarried adolescent to become pregnant. This state of illegitimacy usually carries a stigma or deformation of character that can affect the adolescent mother-to-be and her child before and/or after birth. The purpose of this study was firstly to explore and describe the experiences of mothers (or mother-figures) who lived with pregnant unmarried adolescents in a community in Lesotho. Secondly, to formulate appropriate guidelines for supporting the mothers of pregnant unmarried adolescents, depending on the findings, to promote, maintain and restore optimum health for themselves, the pregnant adolescents and their expected babies. An explanatory, descriptive, contextual qualitative research design was used. Data were collected by in-depth phenomenological interviews. Guba's model of ensuring trustworthiness was applied. The analysis of data was according to Tesch's (1990) model. The respondents were fourteen in all. Four themes that emerged from the analysis of the results were: emotions, relationships, physical/social problems and religion. The emotions that dominated in all the respondents were anger, hurt, worry and finally acceptance. The relationships between the respondents and the adolescents were supportive. However the relationships between the respondents and their spouses, relatives and the community were either supportive or non supportive. Some of the physical/social problems that the respondents experienced were fatigue, sleeplessness, financial shortages and discrimination. The religion of the some respondents gave them the courage to face their problems, while other respondents were embarrassed and discriminated against by their churches. The results thus revealed both the negative and positive experiences of the mothers. However, as the mothers were the primary caregivers of the adolescents and the source of material and emotional support, they had to carry all the problems related to the adolescents' pregnancies. Guidelines have been recommended in order to facilitate the mothers to mobilise their resources for better health for all, namely: the mothers themselves, the pregnant adolescents and their expected babies. The recommendations include providing counselling sessions for the mothers, in order to empower them with information on reproductive health. The mothers are the primary caregivers in the homes, therefore need constant counselling sessions to help them to carry their loads, since special issues like adolescent pregnancy place an additional burden on them. Mothers and adolescents are encouraged to form support groups each, where they can learn life skills. Counselling seminars for the fathers have been recommended, so that they can support the mothers and the adolescents. Family life education should be established and strengthened in the homes and schools.Item Open Access The experiences and expectations of registered nurses in Lesotho regarding perfomance appraisal(University of the Free State, 2005-05) Lethale, 'Mateboho Ntsoaki; Joubert, AnnemarieEnglish: There is a human tendency to make judgements about those one is working with, as well as about oneself. Performance appraisal seems to be both inevitable and universal. With its absence, people tend to judge the work performance of subordinates naturally, informally and arbitrarily. A qualitative study was undertaken to explore and describe the experiences and expectations of registered nurses in Lesotho regarding performance appraisal. Recommendations are made according to the results of the study and these will assist the NGOs which were part of this study and the Ministry of Health and Social Welfare in Lesotho in the planning and implementing of the performance appraisals of registered nurses. Six phenomenological focus group interviews were conducted within the selected institutions to ascertain the participants’ experiences and expectations in relation to performance appraisal. The meaning of these experiences and expectations was also explored. Basic steps in qualitative analysis as outlined by Ulin, Robinson, Tolly, & McNeill (2002) were used to analyse the data. The participants reported various experiences regarding performance appraisal. They reported experiences such as an increase in motivation and performance, receiving training, gaining insight into their own performance and being able to refer problems to supervisors as a result of performance appraisal. There were also feelings of dissatisfaction such as performance appraisal being seen as a threat, a lack of commitment, poor appraisal skills, unreliable instruments, no benefits, unclear purpose and the poor administration of performance appraisals. They also expressed their expectations regarding performance appraisal. Most of them would like the organisations to clarify the purposes of performance appraisals and their involvement in them. Both appraisers and appraisees should be trained in performance appraisal. The instruments should be reviewed, consistency in the appraisal process should be ensured and organisational decisions should be based on the results of the appraisal. The poor attitude and weak appraisal skills, inconsistencies in the appraisal process, the unclear purpose, the inability of appraisers to provide feedback and do follow-up, and also organisational decisions such as salary increments not based on the results of appraisal, were a concern across all the focus group interviews. Recommendations were made in view of both the experiences and expectations of these registered nurses. The organisation should define and clarify the purpose and the relationship between appraisal, performance and rewards, the results of the performance appraisal should be analysed and used for making organisational decisions. The full involvement of appraisees, the training of both appraisees and appraisers, more frequent appraisals throughout the year, the development and availability of standards of nursing care, the review and development of appraisal instruments, and further research are needed.