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1
Mainland, Ingrid L. « An evaluation of the potential of dental microwear analysis for reconstructing the diet of domesticated sheep (Ovis aries) and goats (Capre hircus) within an archaeological context ». Thesis, University of Sheffield, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.582143.
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SOMENZI, ELISA. « INVESTIGATION ON SMALL RUMINANTS BIODIVERSITY AND ADAPTATION ». Doctoral thesis, Università Cattolica del Sacro Cuore, 2022. http://hdl.handle.net/10280/119859.
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Le specie zootecniche costituiscono un elemento chiave della biodiversità agraria. In questa tesi si è contribuito al processo di caratterizzazione e conservazione del patrimonio genetico dei piccoli ruminanti tramite lo studio della demografia e struttura di popolazione, della diversità molecolare e dell’adattamento ambientale di diverse razze ovi-caprine. In questo contesto sono stati perseguiti cinque differenti obiettivi. In primo luogo, è stato sviluppato un algoritmo per la selezione di marcatori genetici in grado di identificare i soggetti ibridi originati dall’incrocio di pecora per muflone. Successivamente è stata analizzata da un punto di vista genetico la popolazione di capre ferali dell’isola di Montecristo e nonché l’impatto di diverse pratiche di gestione sul livello di inbreeding delle popolazioni caprine Italiane. Il focus sull’adattamento dei ruminanti a differenti ambienti climatici ha portato a un’approfondita revisione di metodologie ed approcci nonché all’identificazione di geni associati all’adattamento ambientale razze ovine locali Europee.Livestock species constitute a key component of agricultural biodiversity. In this thesis a contribute to the process of characterization and conservation of small ruminants genetic resources was given with the study of the population history, structure, genetic diversity and environmental adaptation of sheep and goats local breeds. In this context, were addressed five specific goals. Firstly, the development of an algorithm for the selection of ancestry informative markers for the identification of feral x domestic sheep hybrids, secondly the assessment of molecular diversity, history and relationship of the feral goat of Montecristo, as well as the investigation of the impact of different management practices on genomic inbreeding on Italian goat populations. The focus on environmental adaptation allowed to carefully review methods and approaches for detecting adaptation in ruminants and, consequently, to detect genes associated to environmental adaptation in European local sheep breeds.
3
Hodkinson, Peter William. « Developing a patient-centred care pathway for paediatric critical care in the Western Cape ». Doctoral thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/17259.
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Includes bibliographical referencesBackground: Emergency care of critically ill or injured children requires prompt identification, high quality treatment and rapid referral. This study examines the critical care pathways in a health system to identify preventable care failures by evaluating the entire pathway to care, the quality of care at each step along the referral pathway, and the impact on patient outcomes. Methods: A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation until paediatric intensive care unit admission or emergency centre death, using a modified confidential enquiry process of expert panel review and caregiver interview. Outcomes were expert panel assessment of quality of care, avoidability of death or PICU admission and severity at PICU admission, identification of modifiable factors, adherence to consensus standards of care, as well as time delays and objective measures of severity and outcome. Results: The study enrolled 282 children: 85% medical and 15% trauma cases (252 emergency admissions, and 30 children who died at referring health facilities). Global quality of care was graded poor in 57(20%) of all cases and 141(50%) had at least one major impact modifiable factor. Key modifiable factors related to access and identification of the critically ill, assessment of severity, inadequate resuscitation, delays in decision making and referral, and access to paediatric intensive care. Standards compliance increased with increasing level of healthcare facility, as did caregiver satisfaction. Children presented primarily to primary health care (54%), largely after hours (65%), and were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 74% of children, indicating room for improvement. Conclusions and Relevance: The study presents a novel methodology, examining the quality of paediatric critical care across a health system in a middle income country. The findings highlight the complexity of the care pathway and focus attention on specific issues, many amenable to suggested interventions that could reduce mortality and morbidity, and optimize scarce critical care resources; as well as demonstrating the importance of continuity and quality of care throughout the referral pathway.
4
Jaffer, Khadija. « Child safety in day care centres within the Western Cape ». Master's thesis, University of Cape Town, 1998. http://hdl.handle.net/11427/27004.
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The aim of the study is to explore aspects of child safety in registered day care centres situated in a lower socio-economic area of the Cape Town Metropole. This can be achieved by: a) describing the physical environment in day care centres b) assessing the infrastructure of day care centres to deal with potential injurjes c) reviewing injury reporting systems already in place d) highlighting the issue of child safety in the course of conducting the study.
5
Achmat, Asma. « Professional health care workers' experiences of care at two Community Day Clinics on the Cape Flats ». University of the Western Cape, 2016. http://hdl.handle.net/11394/4896.
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Magister Artium (Social Work) - MA(SW)Primary Health Care (PHC) is the cornerstone of health care globally, nationally and locally and, therefore, should be regarded as the foundation of health care provision. In South Africa, Community Day Clinics (CDCs) are part of the bouquet of services that is being offered at a PHC level. There are various factors that generate inconsistency in the provision of care to people accessing these CDCs. The purpose of this study was to identify and explore how these factors impact on the care practices that health care professional’s provide. Research suggests that the majority of health care workers are women, who play a double role as carers in their professional and private lives. Therefore, the political ethics of care, a feminist theoretical approach, was utilized to understand care practices in these health settings. The aim of the study was to develop an in-depth understanding of the care practices of health care workers at two CDC facilities on the Cape Flats. A qualitative research methodology was used to explore and identify the phenomenon under study. The research project followed an explorative and descriptive research design, as the researcher sought to understand the care practices of health care workers and how their values and ethics further influenced care practices at these two CDC settings. The data was gathered using semi-structured one-on-one interviews, and later analysed using qualitative thematic analysis. The research findings were grouped in terms of the values entrenched in the political ethics ofcare, which are attentiveness, responsibility, competence, responsiveness and trust. The research findings identified various aspects that, either negatively or positively, impact on these values. Finally, recommendations were made to management, as well as care workers. These recommendations were in terms of implementing care services that are attentive to service-users and care-workers; providing a service that takes into consideration the value of responsibility; the provision of competent services; and finally creating trusting relationships within the CDC.
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Carré, Sonia. « Développement de réactions modèles pour la caractérisation de l'acido-basicite de catalyseurs et d'adsorbants ». Poitiers, 2008. http://theses.edel.univ-poitiers.fr/theses/2008/Carre-Sonia/2008-Carre-Sonia-These.pdf.
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Les alumines sont très largement utilisées dans les procédés industriels, les propriétés acido-basiques de ces solides jouent un rôle dans le développement de nouveaux catalyseurs, il est donc important de bien connaître leurs propriétés. Ces oxydes sont généralement caractérisés par des méthodes physico-chimiques classiques, la plus employée étant l’adsorption (désorption) de molécules sondes suivie par spectroscopie infrarouge. Cependant les conditions étant assez éloignées des conditions de catalyse, il est souvent difficile de prévoir le comportement réel d’un catalyseur. L’utilisation de réactions modèles, dont les conditions de caractérisation sont plus proches de la catalyse, permet de mieux appréhender les propriétés acido-basiques des catalyseurs. L’objectif de cette étude est de développer des réactions modèles permettant de caractériser simultanément l’acidité et la basicité de diverses alumines de transition. Des études ont montré que les réactions de transformation du mélange cyclopentanol et cyclohexanone permettent d’estimer l’acido-basicité de catalyseurs. En effet deux réactions se produisent, d’une part un transfert d’hydrogène (TH) sur les sites basiques, et d’autre part les deux alcools présents se déshydratent sur les sites acides (DES). Les résultats ont montré qu’à 250°C, il est possible en une seule réaction de déterminer les propriétés acide et basique des alumines de transition et qu’il est possible de distinguer les alumines en 2 groupes : d’une part les alumines ŋ, γ et δ qui possèdent un caractère acido-basique voisin, et d’autre part les alumines θ et α qui possèdent un caractère basique plus marquéOxides are important materials as industrial catalyst support, adsorbent or catalyst, and are often characterized by physicochemical methods. The most technique commonly used is adsorption-desorption of acid and base probe molecules followed by IR spectroscopy. However, the experimental conditions are far from conditions used in catalysis, the results obtained are not always in agreement with the catalytic performance. Model reactions, for which the experimental conditions are close to that for catalysis use, allow a better understanding for the acid-base properties of catalysts. The aim of this work was to develop model reactions to estimate simultaneously the acidity and the basicity of transition aluminas. Cyclopentanol/cyclohexanone mixture transformation makes it possible in simple reaction to estimate the acidic and basic properties of catalyst. Indeed two reactions take place: hydrogen transfer (HT) between cyclopentanol and cyclohexanone to form cyclopentanone and cyclohexanol on basic sites, and alcohol dehydratation (cyclopentanol and cyclohexanol) (DEH) on acid sites. The HT/DEH ratio is also characteristic of the acid-base properties of catalyst. From this transformation, different crystallographic phases of transition aluminas can be divided into two groups: one,θ and alpha, which possess a basic character close to the one observed on MgO and η, γ and δ, which appear less basic, and possess an acidic character
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Rohard, Dominique. « Le centre ville du Caire : émergence d'un centre d'affaires dans un cadre hérité ». Phd thesis, Université François Rabelais - Tours, 1995. http://tel.archives-ouvertes.fr/tel-00503158.
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Durant la deuxième moitié du XIXème siècle, la ville du Caire se dédouble sous l'impulsion urbanistique du Khédive Ismaïl. Ce cadre haussmannien a pu accueillir l'essentiel des fonctions du tertiaire supérieur jusqu'à la veille de la Seconde guerre mondiale. Depuis, il est devenu trop étroit pour répondre aux besoins d'espace sans cesse accrus de ces fonctions. La ville s'est très vite développée horizontalement d'une manière tentaculaire. La multiplicité des sites tertiaires a abouti à un polycentrisme. Le centre ville ne perd cependant pas sa primauté à l'échelle du Grand Caire. La dualité entre les deux rives du Nil se retrouve, à l'intérieur du Centre ville, entre les pôles financiers et touristiques des secteurs situés soit en contact avec la vieille ville soit sur la Corniche. Même si le Caire ne fait pas partie des grandes places financières internationales, le secteur financier reste très attaché à ce coeur urbain dont l'architecture ne correspond plus aux normes contemporaines des activités de bureau. Plutôt qu'une destruction systématique, une tendance se dégage pour conserver ce site en l'état. Plusieurs sièges sociaux sont maintenant reconstruits à la périphérie immédiate du centre ville. Celui-ci peut retrouver une vocation touristique en reliant la Corniche à la vieille ville.
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Saulse, Bernice. « Interpreting within the Western Cape health care sector : a descriptive overview ». Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/4213.
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Thesis (MPhil (Afrikaans and Dutch))--University of Stellenbosch, 2010.ENGLISH ABSTRACT: Over the past decade many studies have shown that ad hoc interpreting services are still the norm for the health care sector in the South African context. The health care sector of South Africa, specifically in the Western Cape, is characterised by primarily Afrikaans- and English-speaking doctors, or medical practitioners in general, who do not understand Xhosaspeaking patients. In order to bridge this language gap, ad hoc interpreting services are employed, which are rendered by family members of a patient, nurses, or at times, even by porters or cleaners. As a result of the fact that these ad hoc interpreters lack training in interpreting theory and practice, they tend to distort communication, which impact negatively on the quality of the health care that the patient receives. This consequent lack of quality in health care can therefore directly be related to the quality of the interpreted utterances or product that the interpreter renders. Even though ad hoc interpreters are generally more used in the health care sector, some hospitals employ professionally trained interpreters to relieve the burden of a language barrier. In 1996, due to the erratic nature of health care interpreting services and language barriers between medical practitioners and patients, the National Language Project trained 22 community interpreters to be placed in hospitals within the boundaries of the Western Cape. Three of these interpreters were placed at Tygerberg Hospital, three at Groote Schuur Hospital, and three at Red Cross War Memorial Children’s Hospital. By 2008 none remained in Tygerberg Hospital, one was still employed by Groote Schuur Hospital, and two employed by Red Cross War Memorial Children’s Hospital. In 2007, Groote Schuur Hospital identified a need to train and place interpreters within the hospital, due to the language barrier between medical practitioners and patients, as well as to optimise health care. These trainees were formerly employed by the hospital in positions such as cleaners. Even though they were then professionally trained, they were still remunerated as cleaners, for example. In addition to the two interpreters employed at Red Cross War Memorial Children’s Hospital, another interpreter was employed on a full-time basis. Some departments within the hospital make use of their own interpreters, who are not employed by the hospital. Tygerberg Hospital has one officially employed interpreter who is a nursing assistant by profession, and who has received no training in interpreting whatsoever. The aim of this study was firstly to investigate interpreting practices within these three tertiary hospitals, and secondly to investigate the quality of the interpreted product delivered by the interpreters at these hospitals, whether on an ad hoc basis or as professionally trained interpreters. The outcomes of the quality of the interpreted product, measured against a quality table, were compared with the attitudes of medical practitioners, interpreters and patients present in an interpreting session. This was done to determine whether the actual quality of the interpreted product took precedence over the attitudes of the role players, or vice versa.
AFRIKAANSE OPSOMMING: Oor die afgelope dekade het ’n aantal studies aangedui dat ad hoc-tolkdienste steeds die norm vir die gesondheidsektor binne die Suid-Afrikaanse konteks is. Die Suid-Afrikaanse gesondheidsektor, veral in die Wes-Kaap, word hoofsaaklik gekenmerk deur Afrikaans- en Engelssprekende dokters, of mediese praktisyns oor die algemeen, wat nie hul Xhosasprekende pasiënte verstaan nie. Om hierdie taalgaping te oorbrug, word ad hoc-tolkdienste gebruik wat gelewer word deur ’n pasiënt se familielede, verpleegsters en soms selfs portiers of skoonmakers. Omdat hierdie ad hoc-tolke geen opleiding in tolkteorie en -praktyk ontvang het nie, is hulle geneig om kommunikasie te verdraai. Dit lei daartoe dat die gesondheidsorg wat die pasiënt kry, nie na wense is nie. Die gebrek aan kwaliteit van die gesondheidsorg wat die pasiënt ontvang, hou dus direk verband met die kwaliteit van die tolkuitinge of -produk wat die tolk lewer. Ten spyte daarvan dat ad hoc-tolke meer algemeen in die gesondheidsektor gebruik word, het sommige hospitale tolke aangestel wat professioneel opgelei is om die taalgaping te verminder. As gevolg van die wisselvallige gehalte van tolking in die gesondheidsektor en taalgapings tussen mediese praktisyns en pasiënte, het die National Language Project (NLP) in 1996 22 gemeenskapstolke opgelei wat in hospitale binne die Wes-Kaap geplaas sou word. Drie van hierdie tolke is by die Tygerberg Hospitaal geplaas, drie by die Groote Schuur Hospitaal en drie by die Rooikruis Kinderhospitaal. In 2008 was daar nie meer een van hierdie tolke by die Tygerberg Hospitaal nie, een was steeds in diens by die Groote Schuur Hospitaal en twee by die Rooikruis Kinderhospitaal. In 2007 het die Groote Schuur Hospitaal ’n behoefte geïdentifiseer om tolke op te lei en binne die hospitaal te plaas omdat daar ’n taalgaping was tussen mediese praktisyns en pasiënte, asook om gesondheidsorg te optimaliseer. Hierdie persone wat opleiding ontvang het, was voorheen in diens van die hospitaal as byvoorbeeld skoonmakers. Selfs nadat hulle professionele tolkopleiding ontvang het, het hulle steeds besoldiging as skoonmakers ontvang. Buiten die twee tolke wat by die Rooikruis Kinderhospitaal in diens is, is nog ’n tolk voltyds aangestel. Sommige departemente binne die hospitaal gebruik hul eie tolke wat nie deur die hospitaal aangestel is nie. Tygerberg Hospitaal het een amptelike tolk, wat eintlik ’n verpleegassistent is, en wat hoegenaamd geen tolkopleiding ontvang het nie. Hierdie studie het dit ten doel om tolkpraktyk eerstens binne bogenoemde drie tersiêre hospitale te ondersoek, en tweedens om die kwaliteit van die tolkproduk by hierdie hospitale te ondersoek, hetsy die opleiding op ’n ad hoc- of professionele basis geskied het. Die kwaliteit van die tolkproduk, gemeet teen ’n kwaliteitstabel, is vergelyk met die sienswyses van die mediese praktisyns, tolke en pasiënte wat teenwoordig was in ’n tolksessie, om te bepaal of die kwaliteit van die tolkproduk voorkeur geniet het bo die sienswyses van die rolspelers, en omgekeerd.
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Daniels, Alexandra. « Paediatric Palliative Care - describing patient needs and the experiences of caregivers and health care workers in a Cape Town Paediatric Intermediate Care Facility ». Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33603.
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Aim: The study describes the population (and care needs) of children admitted to the facility, the experiences of their primary caregivers and the health care workers caring for them. Methodology: This was a descriptive study that utilised elements of both prospective and crosssectional design. The health records of 25 patients were reviewed and matched caregivers partook in a three-part questionnaire. Focus group discussions were conducted with 15 health care workers at a single point during the study. Results: The majority (48%) of patients were referred to the facility for transitional care, the average length of stay was calculated at 97 days and pain was identified as the most prevalent symptom. Despite significant degrees of worry, most primary caregivers derived emotional strength and spiritual meaning from the experience of caring for their child. Health care workers valued access to training, appropriate resources, and support to meet the challenge of caring for children and families with specific care needs. Conclusion/Recommendations: These results conclude that children living with LL or LTC's and their families have complex holistic care needs that require a comprehensive approach. In order to best meet these needs, at ICF level, health care workers need to be assured access to a range of skills, resources and support.
10
Martin, Sedeeka. « Quality care during childbirth at a midwife obstetric unit in Cape Town, Western Cape : Women and midwives’ perceptions ». University of the Western Cape, 2018. http://hdl.handle.net/11394/6892.
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Magister Curationis - MCurGlobally, there has been significant progress in reducing preventable maternal deaths and disability, and growing attention on improving the quality of care in maternal health care facilities. The World Health Organization (WHO) describes quality care as delivering healthcare that is effective, efficient, accessible, acceptable, patient–centred, equitable and safe (WHO, 2014). Midwives are the backbone of midwifery and therefore the primary care giver for pregnant women accessing maternal care and women’s ability to access quality midwifery care during the antenatal, labour and postnatal period is the key component in midwifery care. The Primary Level Protocol of South Africa is under the umbrella of the Primary Health Care System, and according to this system low risk women are expected to seek antenatal, intrapartum and postnatal care from the nearest Midwife Obstetric Unit (MOU). The choice a woman makes regarding access to maternity care depends on the social norms in her society and what services are offered. However, the services that are available may not meet the needs of pregnant women. Women may need detailed information about the availability of the maternity care system in order to make an informed decision on where to access the health system. The gap between the perceived needs of pregnant women and the care provided by midwives can be bridged by listening to women to create a reciprocal understanding of quality care. In South Africa, limited research has been conducted on midwives and women’s perceptions of maternity care. In the absence of such information, this study was conducted at an MOU in the Western Cape, with the aim of exploring women and midwives’ perceptions of quality care during childbirth.
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Nathan, Lisa. « Noise levels in a neonatal intensive care unit in the Cape Metropole ». Thesis, Stellenbosch : University of Stellenbosch, 2007. http://hdl.handle.net/10019.1/2339.
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Thesis (MScMedSc (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy))--University of Stellenbosch, 2007.Noise is a noxious stimulus with possible negative physiological effects on the infant, especially in the Neonatal Intensive Care Unit (NICU). The present study conducted a detailed noise assessment in a NICU of a state hospital in the Cape Metropole and documented 6 infants’ physiological responses to noise levels. Noise levels ranged from 62.3-66.7dBA (LAeq), which exceed all American and British standards (50dBA -60dBA) for a NICU. Continuous exposure to noise of these levels is potentially harmful to the infants’ auditory system and health stability. The general well-being of the staff working in the NICU may also be compromised. Analysis of the noise events revealed that staff conversations were the largest single contributor to the number of noise events, while the largest single non-human contributor was the alarm noise of the monitors. No significant correlations were found between the heart rates and noise levels and the respiratory rates and the noise levels for any of the participants in either room. The NICU was found to be an extremely reverberant environment, which suggested that the NICU noise levels were largely a result of reverberant noise reinforcements. NICU nursing staff’s most common suggestion for noise abatement strategies was reduction of staff conversation. Results of this study highlight the need for NICU noise abatement to optimise newborn patient care, reduce the risk of acoustic trauma and to improve the neonate’s quality of life, thus enhancing the infant’s physiologic stability, growth and health.
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Cornick, Ruth. « 'You must tune your TB programme well...' : integrating TB, HIV and ARV care in Cape Town primary care setting ». Master's thesis, University of Cape Town, 2007. http://hdl.handle.net/11427/9328.
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Includes bibliographical references (leaves 86-91).This study occurred in the context of three problems that have arisen within the South African HIV/AIDS crisis: the prevalent HIV and tubertulosis (TB) co-epidemic, the concern that antiretroviral (ARV) provision might compromise the existing TB control programme, and that the Western Cape's current limited vertical model of ARV roll-out will soon reach capacity. This study evaluated whether and how TB control changed following ARV introduction in a Cape Town primary care TB clinic and explored the process of integration of the TB and ARV services in the clinic.
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Zeeman, Celeste. « Exploring the barriers and facilitators of access to care as experienced by caregivers of children who were admitted to a specialised tuberculosis hospital ». University of the Western Cape, 2020. http://hdl.handle.net/11394/7269.
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Master of Public Health - MPHTuberculosis (TB) continues to be a major cause of ill health and the leading cause of death from a single infectious agent worldwide. Furthermore, young children, especially those under five years old and infants, are at risk of developing more severe forms of TB. TB cases continue to cluster among disadvantaged groups such as the poor whose lives are characterised by adverse living conditions. Defaulting from treatment poses a severe threat to children’s health because untreated TB or breaks in treatment could lead to a child developing more severe forms of TB, or worse, could result in mortality. Currently, long-term hospitalisation has the most successful TB treatment outcomes. Therefore, to ensure compliance, children are taken out of their social environment and admitted to hospital. However, being separated from one’s family, especially at a crucial stage of development, could have long-terms effects on the child’s development. The study explored, factors influencing access to care that caregivers of children; who are five years and younger, who received prolonged treatment at a specialised TB hospital in the Western Cape, South Africa experienced. A qualitative approach allowed the researcher to use personal interactions as a focus for studies and was suitable when aiming to understand health behaviour in its everyday context as experienced by the participant. The study results indicated the factors that enable caregiver visitation, is largely dependent on availability of finances. Furthermore, the hospital itself was identified as being accommodating with regards to visiting hours, telephonic calls and served as important mediator between health service provider, the children, their caregivers and the rest of the staff. Visitation depended on availability of finances, and this was the main barrier that was identified by caregivers. The challenges that hampered visitation were unemployment, lack of access to private and public transport and challenges related to farm-workers. A large number of caregivers work on farms in the Cape Winelands and many of them are dependent on seasonal work which results in inconsistent income. This limited availability of finances for visitation. Furthermore, the working conditions, long shifts and lack of employment benefits which were associated with farming, prevented caregivers from visiting. This study revealed that there are a series of factors which influence access to care of caregivers; this is especially the case in children hospitalised for TB. These factors need to be considered by policy makers as well as the Specialised Tuberculosis facility when dealing with children under five as the best way to ensure that treatment is completed through hospitalisation. Therefore, the strategies to assist families of children with TB need to be explored to assist in the continuity of care as well as the child’s development.
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Adam, Ferrial, Thomas Cousins, Belinda Breetzke et Mike Wood. « An initial evaluation framework for responsible tourism in Cape Town : based on a case study of the Cape Care Route ». Master's thesis, University of Cape Town, 2003. http://hdl.handle.net/11427/4830.
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Mabunda, Sikhumbuzo Advisor. « An evaluation of the role of an Intermediate Care facility in the continuum of care in Western Cape, South Africa ». Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15602.
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BACKGROUND: A comprehensive Primary Health Care approach includes clear referral and continuity of care pathways. South Africa lacks data that describe Intermediate Care (IC) services and its role in the health system. This study aimed to describe the model of service provision at an IC facility and the role it plays in the continuity of care in Cape Town. METHODS: Sixty-eight patients (65% Response Rate) were recruited in a prospective cohort design over a one-month period in mid-2011. Patient data were collected from a clinical record review and an interviewer-administered questionnaire, administered at a median interval between admission and interview of 11 days to assess primary and second ary diagnosis, knowledge of and previous use of Home Based Care (HBC) services, reason for admission, demographics and information on referring institution. A telephonic interviewer-administered questionnaire to patients or their family members post-discharge recorded their vital status, use of HBC post-discharge and their level of satisfaction with care received at the IC facility. A Cox regression model was run to identify predictors of survival and the effect of a Care-plan on survival. Seventy staff members (82%) were recruited in a cross-sectional study using a self-administered questionnaire to describe demographics, level of education and skills in relation to what they did for patients and what they thought patients needed. RESULTS: Of the 68 participants, 38 % and 24% were referred from a secondary and tertiary hospital, respectively, and 78% were resident of a higher income community. Stroke (35%) was the most common single reason for admission at acute hospital. The three most common reasons reported by patients why care was better at the IC facility than the referring institution was the caring and friendly staff, the presence of physiotherapy and the wound care. Even though a large proportion of the IC inpatients had been admitted in a health facility on the year preceding the study, only 13 patients (21%) had used a Community Health Worker (CHW) ever before and only 25% (n=15) of the discharged patients had a confirmed CHW visit post-discharge. The presence of a Care-plan was significantly associated with a 62% lower risk of death (Hazard Ratio: 0.380; CI 0.149-0.972). Notably, 46% of staff members reported performing roles that were outside their scope of practice and there was a mismatch between what staff reported doing and their actual tasks. In addition, of the 57 patients that could be traced on follow-up 21(37%) had died. CONCLUSION: Patients and family understood this service as a caring environment that is primarily responsible for rehabilitation services. Furthermore, a Care-plan which extends beyond admission could have a significant impact on reducing mortality. IC services should therefore be recognised as an integral part of the health system and it should be accessed by all who need it.
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Mafuwa, Edgar Ngonidzashe. « Experiences of Zimbabweans on the provision of health care at selected public health care centers in Cape Town, 1994-2009 ». University of the Western Cape, 2015. http://hdl.handle.net/11394/4856.
Texte intégralRésumé :
Magister Artium - MAThere is a widely held assumption that immigrants have difficulties in accessing public health care services in South Africa. This assumption derives from the experiences of some immigrants in accessing public health care services at some public health care facilities which are all required by law and policy to provide such services. The main aim of the study was to investigate the experiences of Zimbabwean immigrants in accessing public health care services at some public clinics and hospitals in Cape Town. Foucault’s theory on power was used to unpack the experiences of Zimbabwean immigrants at these public health care centers. Zimbabwean immigrant participants were all purposively sampled for the study and medical personnel were randomly sampled. The Zimbabwean immigrants sampled had used public health care facilities in Cape Town. Semi-structured interviews were used to collect data from the Zimbabwean immigrants which were qualitatively analysed using content analysis. Questionnaires were also used to collect data from both the Zimbabwean immigrants and medical personnel and subsequently open-ended questions from the questionnaires were also analysed using content analysis and closed questions were analysed using the Micro-soft excel package of data assessment and statistically presented using pie, bar and line graphs. Themes that were recurring from the semi-structured interviews and responses from questionnaires suggested that immigrants in their experiences at public health care facilities encountered barriers that included communication problems, negative attitudes and xenophobia from medical staff, policy and practice problems and preferential treatment offered to citizens over non-citizens. Recommendations of what needs to be done to reduce barriers to health care for immigrants were made to all involved in the provision of health care. The study contributed to our understanding of barriers that immigrants encounter in accessing public health care in South Africa as well as the role of citizens in this process.
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Hartmann, Andre. « An assessment of telemedicine services within the Western Cape public health care system ». Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86225.
Texte intégralRésumé :
Thesis (MEng)--Stellenbosch University, 2014.ENGLISH ABSTRACT: Telemedicine is de ned as an electronic exchange of medical information and/or the delivery of clinical health care over a distance, by means of Information and Communication Technology (ICT). South Africa is faced with the problem of providing health care to a population in urban, as well as across vast rural areas. In addition to this, the South African health care system must deal with economical imbalances and a shortage of human resources to provide quality health care. Telemedicine services could provide a solution. Since the introduction of the rst national telemedicine services initiative in the late 1990s, a number of South African telemedicine services have been implemented in the public health care system. The majority of these telemedicine services have been prone to failure and many were prematurely terminated. The circumstances which in uence the failure or success of these services are not unknown. The lack of insight, and the high failure rate of telemedicine services implemented in the South Africa were the reasons for conducting this study. The purpose of the study is to assess telemedicine services implemented in the Western Cape public health care sector. The purpose is also to provide recommendations for improving the current and future telemedicine services in the Western Cape and other provinces. A telemedicine services assessment was conducted on a total of 26 telemedicine services identi ed at 6 health care facilities located in the Western Cape. The assessments were based on the TeleMedicine Services Maturity Model (TMSMM), which was developed speci cally for the purpose of assessing telemedicine services. The TMSMM capability statements were used as a yardstick to assess the maturity of each of the elements of telemedicine services in terms of the three service level groups (micro-,meso- and macro-level) and ve telemedicine domains (man, machine, material, method and money). The assessment process included: (i) the identi cation of telemedicine services at the selected health care facilities; (ii) the gathering of the relevant telemedicine service data by means of structured interviews; (iii) the transformation of the complex ow of information into Data Flow Diagrams (DFDs); (iv) the loading of telemedicine services data into a data warehouse; and (v) the analysis of data by means of On-Line Analytical Processing (OLAP), as well as box-and-whisker plots and statistical correlations. Based on the results of the TMSMM assessment, an electronic questionnaire was developed and administered amongst health care workers throughout the entire Western Cape. The questionnaire con rmed that the ndings from the TMSMM assessment are indeed representative of the entire Western Cape. The assessment of the telemedicine services provides information about the elements which a ect the success or failure of these services. This therefore addresses the initial research problem and ful ls the purpose of the study. These results were used as an input to the analysis of strengths, weaknesses, opportunities and threats (SWOT) of the delivery of telemedicine services in the Western Cape public health sector. For future references and studies, the SWOT analysis provides a point of departure for a strategic telemedicine services framework for a province like the Western Cape.
AFRIKAANSE OPSOMMING: Telegeneeskunde, per de nisie, behels die deel van mediese inligting en/of die lewering van kliniese gesondheidsdienste oor 'n afstand, deur middel van inligting en kommunikasie tegnologie (ICT). Telegeneeskunde dienste is moontlik een van die oplossings vir die lewering van gesondheidsdienste vir 'n bevolking wat versprei is oor 'n groot landelike gebied binne 'n publieke gesondheidsektor wat mense hulpbronne kort om kwaliteit gesondheidsorg te lewer. Die publieke gesondeheidstelsel van Suid Afrika het 'n drie-dubbele las van siektes, ekonomiese wanbalans and 'n tekort aan mediese praktisyns. Sedert die eerste nasionale inisiatief vir telegeneeskunde dienste in die laat 1990s bekend gestel is, is 'n paar telegeneeskunde dienste in die publieke gesondheidsektor van Suid Afrika geïmplementeer. Die meerderheid van hierdie dienste blyk onsuksesvol te wees. The faktore wat die implementeringsukses beïnvloed is nog nie goed nagevors nie. Die doel van hierdie studie is om telegeneeskunde dienste wat in die Wes- Kaap publieke gesondheidsektor geïmplementeer is te ondersoek. Die doel is verdermeer om aanbevelings te maak met die oog op die verbetering van bestaande en toekomstige dienste in die Wes-Kaap asook ander provinsies. Eerstens is 'n telegeneeskunde diens assessering uitgevoer op 'n totaal van 26 dienste 6 fasiliteite. Hierdie assesserings is gebasseer of the Telegeneeskunde Diens Volwassenheidsmodel (TMSMM), wat ontwikkel is spesi ek met die doel om telegeneeskunde dienste te assesseer. Dit word gedoen deur die dienste te meet in terme van drie vlakke (mikro-, meso- en macrovlak) en vyf domeine (man, masjien, materiaal, metode en geld). Die TMSMM vermoeë-stellings word as maatstaaf gebruik. Die assesseringsproses sluit in (i) die identi sering van telegeneeskunde dienste by die aangewese gesondheidsfasiliteite; (ii) die versameling van relevante telegeneeskunde data deur middel van gestruktureerde onderhoude; (iii) die transformasie van komplekse inligtings vloei na data vloeidiagramme (DFDs); (iv) die laai van telegeneeskundige dinste data in 'n databasis; and (v) die analyse van data deur middel van aanlyn analitiese verwerking (OLAP) sowel as boxen- snorbaard gra k en statistiese korrelasies. Gebasseer op die resultate van die TMSMM assesseringsproses, is 'n elektroniese vraelys ontwikkel en geadministreer onder gesondheidswerkers regoor die Wes-Kaap ten einde te bevestig of die gevolgtrekkings van die TMSMM assessering die hele provinsie verteenwoordig. Die assessering van die telegeneeskundige dienste verskaf inligting in terme van die faktore wat die sukses van telegeneeskundie dienste beïnvloed. Sodoende word die aanvanklike navorsingsprobleem aangespreek. Hierdie resultate is toe gebruik as inset vir die analise van die sterk punte, swak punte, geleenthede en bedreigings (SWOT) in die publieke gesondheidsektor van die Wes-Kaap in terme van telegeneeskundige dienste. Hierdie SWOT-analise kan in die toekoms gebruik word as vertrekpunt vir die ontwikkeling van strategiese raamwerk vir die implementering van telegeneeskundige dienste in 'n provinsie soos die Wes-Kaap.
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Barlow, Hilary Joan. « An evaluation of neonatal nursing care in selected hospitals in the Western Cape ». Thesis, Stellenbosch : University of Stellenbosch, 2003. http://hdl.handle.net/10019.1/16253.
Texte intégralRésumé :
Thesis (MCUR)--University of Stellenbosch, 2003.ENGLISH ABSTRACT: South Africa has a proud history of a high standard of health care delivery in State funded hospitals. This implies that high standards of education and care in both medical and nursing training have been achieved. The care of sick and premature newborn infants by nurses is a speciality that has evolved worldwide over the last forty years as a result of various technological developments. In order to ensure the standard of care delivered, protocols of care should be available for nurses to refer to and to measure their work against. There were no protocols of care available in the two Neonatal Units (NICUs) used in this study. Using a non-experimental, exploratory descriptive design, the researcher set about measuring the quality of nursing care in the NICUs. Standards (structure, process and outcome) were written by the researcher, and validated. The results showed that the standards were not met at an acceptable level in various areas. One of the areas of great concern was the lack of effective hand washing. Outcome standards which reflect the consequences of care indicated serious shortages of staff in some cases and insufficient staff training. Recommendations are that a Quality Assurance Program should be introduced with training and education of the nurses working in the NICUs and the introduction of evidencebased practice. Future research should aim at showing the way to improve the service delivered.
AFRIKAANSE OPSOMMING: Suid-Afrika het ‘n trotse geskiedenis van ‘n hoë standard van gesondheidsorgdienslewering in Staatsbefondsde hospitale. Dit impliseer dat hoë standaarde in mediese en verpleegopleiding bereik is. Die versorging van siek en premature pasgebore babas deur verpleegkundiges is ‘n spesialiteit wat oor die afgelope veertig jaar wêreldwyd ontwikkel het as gevolg van verskeie tegnologiese ontwikkelings. Ten einde te verseker dat ‘n hoë standard van sorg gelewer word, moet protokolle beskikbaar wees vir verpleegkundiges om te gebruik en hulle werkverrigting teen te meet. Daar was geen protokolle beskikbaar in die twee neonatale eenhede wat in hierdie studie gebruik is nie. ‘n Nie-eksperimentele, verkennende, beskrywende ontwerp is deur die navorser gebruik om die gehalte van verpleegsorg in die neonatale eenhede te evalueer. Standaarde (struktuur, proses en uitkoms) is deur die navorser opgestel en gevalideer. Die resultate toon aan dat die standaarde in verskeie areas nie aanvaarbaar nagekom word nie. ‘n Kommerwekkende bevinding was die afwesigheid van effektiewe was van hande. Uitkomsstandaarde wat die resultaat van sorg weerspieël, het aangedui dat daar ernstige tekorte aan personeel in sommige gevalle bestaan het asook onvoldoende opleiding van personeel. Aanbevelings is dat ‘n Gehalteversekeringsprogram ingestel behoort te word en met die opleiding van verpleegkundiges werksaam in die neonatale eenhede en evidence-based practice aangespreek moet word. Toekomstige navorsing behoort aan te dui hoe om die diens wat gelewer word, te verbeter.
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Matshikiza, Wonga. « Barriers to acute stroke care at a tertiary hospital in the Western Cape ». Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30928.
Texte intégralRésumé :
Background
Stroke guidelines recommend treatment of acute stroke as a medical emergency. In many countries prolonged delays occur before patients with acute stroke receive medical attention. Only a small percentage of patients are assessed in hospital within the time window for reperfusion therapy. There is limited available published data concerning barriers to acute stroke care in South African patients. The aim of this study was to determine the pre-hospital barriers and in-hospital delays to emergency care for patients presenting to Groote Schuur Hospital (GSH) with acute stroke.
Methods
Eligible patients included were those with a clinical and radiological diagnosis of acute stroke who presented to GSH Emergency Unit and required admission for more than 24 hours. The study was a prospective, observational study with two components: a semi structured interviewer administered questionnaire and a record review of ischaemic stroke patients’ clinical notes within 48 hours of admission to GSH. GSH is a tertiary/academic level hospital in Cape Town, Western Cape province, South Africa. Recruitment took place over a 6-week period.
Results
Demographics: 50 patients were included, with a median age of 61,5 (IQR 44,7 – 70,2) years; gender: females, 29 (58%). Ethnicity: Mixed African ancestry 38 (76%), Black 11 (22%).
Pre- hospital barriers: The median distance to hospital was 12,7 (IQR 10,2 – 17,6) km. Most patients 32 (64%) called for assistance immediately. Frequent reasons cited for delays: waiting for improvement, 7 (38,9%) and failure of symptom recognition 4 (22%). Most patients used their own private transport, 32 (64%) and half of the patients (25) presented directly to GSH. In- hospital delays: The median time interval from arrival at the Emergency Unit to doctor assessment for all the patients was 67,5 (IQR 19,75 – 128,5) minutes. The median door to CT brain time interval for all patients was 5,1 (IQR 1,7 – 10,2) hours and 3,1 (IQR 0,8 – 9,6) hours for those patients that arrived within the thrombolysis time window. Only 21 of 50 patients were referred and assessed by the stroke unit team. Only 3 of the 21 patients received intravenous thrombolysis and none received mechanical thrombectomy.
Conclusion: There majority of the patients who arrived at GSH early after symptom onset used their own private transport and lived close to hospital. Pre-hospital barriers were failure to recognize symptoms, patients hoping for clinical improvement, delays in ambulance transport and routing via secondary hospitals. In hospital delays were prolonged door to doctor assessment and door to CT Brain time intervals.
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Marepula, Lindiwe Oscarine. « Patient satisfaction with the care provided in a psychiatric hospital in Cape Town ». Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/3698.
Texte intégralRésumé :
Magister Curationis - MCurBackground: Patient satisfaction is a well-researched area in general medicine worldwide, yet a full exploration of patient satisfaction amongst psychiatric patients appears to be lacking in South Africa. Patient satisfaction has become important because of the awareness of the patient’s human rights. There is an increasing practice of applying a consumer viewpoint to health care, while safeguarding patients’ rights and taking their views into account. This has been brought about by the inception of the Mental Health Care Act no. 17 of 2002.Purpose: The purpose of this study was to describe psychiatric inpatients’ satisfaction with the care provided in a psychiatric hospital in Cape Town.Objectives : (1) To describe the psychiatric inpatients’ satisfaction with the care provided in a psychiatric teaching hospital in terms of their views on the: care provided by nurses (interpersonal/nurse-patient- interaction and technical skills); care provided by doctors (interpersonal/doctor-patient interaction and technical skills; and the nature of the environment of care, and (2) to describe the psychiatric inpatients’ overall satisfaction with the care received in a psychiatric teaching hospital in terms of the: quality of care received from nurses and doctors; nature of the environment of care; and the likelihood of future utilization of the hospital serviceMethod/Design: The study made use of the quantitative descriptive design using the Primary Provider Theory of patient satisfaction and the Batho Pele Principles served as the conceptual framework. Data were collected from discharged patients using a self-administered questionnaire which was mailed to individual participants. A five and a four point Likert scales were used for different sections in the questionnaire.The study made use of 120 participants between the ages of 18 and 60.Findings: Generally respondents were satisfied with the care provided in thispsychiatric hospital. Greater satisfaction was noted on aspects of staff-patient interactions. Low satisfaction scores were observed on nurses’ technical aspects of care. The Batho Pele principles of information, openness and transparency,consultation, access and redress seem not to have been adhered to.Conclusions: General inpatient satisfaction in psychiatric hospital care was good.However, more innovative methods for improvement in the areas of dissatisfaction need to be developed. Special attention should be given to the implementation of the Batho Pele Principles and the protection of the patients’ rights.
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Evans, Katya. « Prehospital care providers' decision to transport the patient with a suicide attempt refusing care in the Cape Town Metropole, Western Cape : A survey based on the Mental Healthcare Act of 2002 ». Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16478.
Texte intégralRésumé :
Includes bibliographical referencesAnecdotally incidents of inappropriate refusal of treatment or transportation by patients referred to hospital under the Mental Healthcare Act of 2002 have been noted. There is little documented about the knowledge and understanding of prehospital providers of the mental healthcare act, their responsibilities and the issues around patient competence and refusal of care. The transportation of patients presenting with a suicide attempt who have not yet been formally assessed for involuntary admission poses a particular problem. Aim: To determine the knowledge of prehospital providers with respect to the transport of patients presenting with suicide attempts and the mental health act and to describe their management of cases where these patients may refuse treatment. Methods: A cross-sectional survey and including open ended questions of 100 prehospital providers in the Western Cape both public and private. The questionnaire will include knowledge testing, vignettes describing patient management and open-ended questions regarding their opinions on suicidal patients. Simple descriptive statistics will be used for the knowledge test. Qualitative data will be coded using a grounded theory approach. Discussion: The findings of the study will be used to determine provider knowledge and attitudes regarding the prehospital management of patients presenting with suicide attempts. Recommendations will be made for provincial EMS guidelines and the results will be disseminated in an article for publication.
22
Mgwili, Victoria Nokwanele. « Experiences of the disabled women attending the state-provided reproductive health care services regarding the quality of care rendered by health care professionals in the Eastern Cape ». Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/11374.
Texte intégralRésumé :
The purpose of this study was to explore and describe the experiences of disabled women, attending the state-provided reproduction health services, regarding the quality of care rendered by health professionals in the Eastern Cape. The study was conducted on disabled women at Flagstaff and Lusikisiki self-help group project sites.
23
Rosant, Celeste. « Knowledge of and attitudes towards kangaroo mother care in the Eastern Subdistrict, Cape Town ». Thesis, University of the Western Cape, 2009. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_7613_1277072386.
Texte intégralRésumé :
Kangaroo mother care (KMC) was first initiated in Colombia due to shortages of incubators and the incidence of severe hospital infections of new-born infants during hospital stay (Feldman, 2004). Currently it is identified by UNICEF as a universally available and biologically sound method of care for all new-borns, particularly for low birth weight infants (Department of Reproductive Health and Research, 2003) in both developed and developing countries. The Western Cape Provincial Government implemented a policy on KMC as part of their strategy to decrease the morbidity and mortality of premature infants in 2003 (Kangaroo Mother Care Provincial task team, 2003). Essential components of KMC are: skin-to-skin contact for 24 hours per day (or as great a part of the day as possible), exclusive breastfeeding and support to the motherinfant dyad. Successful implementation of KMC requires relevant education of nurses, education of mothers on KMC by nursing staff, monitoring of the implementation of KMC by nurses, planning for a staff mix with varying levels of skill and experience with KMC, the identification of institution specific barriers to the implementation of KMC, and the implementation of institution specific strategies to overcome these barriers (Wallin,et al., 2005
Bergman &
Jurisco, 1994
Cattaneo, et al., 1998). This study aims to determine the knowledge of and attitude towards kangaroo mother care, of nursing staff and kangaroo mothers in the Eastern sub-district of Cape Town.
24
Aylward, Louise Annet. « Exploring the role of patient care workers in private hospitals in the Cape Metropole ». Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/97029.
Texte intégralRésumé :
Thesis (MCur)--Stellenbosch University, 2015.ENGLISH ABSTRACT: Controversy was observed regarding the opinions of nursing managers on the role of patient care workers (PCWs) in private hospitals. These opinions ranged from praise for their contribution towards patient care to serious concerns about the impact of their role on patient safety. The aim of this study was therefore to explore the role of PCWs in private hospitals in the Cape Metropole, South Africa. A qualitative approach with a descriptive design was applied to explore the role of PCWs as perceived by unit managers, nurses and patient care workers. Purposive sampling was used to select participants from medical and surgical wards from three different private hospitals, one each from the three major private hospital groups in South Africa (n=15). Permission to conduct the study was obtained from the Health Research Ethics Committee of the Stellenbosch University, as well as from the private hospital organisations. Fifteen semi-structured interviews were conducted, transcribed and analysed. Six themes emerged from the data. These included PCW activities, care organisation, position in the patient care team, training, reasons for employment and concerns about the PCW role. The findings indicated strong similarities with the health care asistant role as described in the literature study. The activities of PCWs are focused on direct patient care and they spend much time with patients. They are close observers of the patient’s condition and report to nurses. PCWs seem to be well integrated into the patient care team and are mostly seen as nurses. Yet, there are concerns about their evolving role despite their limited training programmes and the lack of direct supervision. The researcher recommends that the work of PCWs should be regulated, but that the nursing profession should critically evaluate the need for another nursing category in addition to that of the enrolled nurse auxiliary.
AFRIKAANSE OPSOMMING: Teenstrydigheid is waargeneem met betrekking tot die opinies van verpleegbestuurders oor die rol van pasiёntsorgwerkers (PSWs) in privaat hospitale. Hierdie opinies het variëer van waardering vir hul bydrae tot pasiёntsorg tot ernstige besorgdheid oor die impak van hulle rol op pasiënt veiligheid. Die doel van hierdie studie was dus om die rol van PSWs in privaat hospitale in die Kaapse Metropool in Suid Afrika te ondersoek. ‘n Kwalitatiewe benadering met ‘n beskrywende ontwerp is gevolg om die rol van PSWs, soos waargeneem deur eenheidsbestuurders, verpleegsters en PSWs self, te ondersoek. Doelgerigte steekproeftrekking is gebruik om deelnemers van mediese en chirurgiese sale uit drie verskillende privaat hospitale, een uit elk van die drie grootste privaat hospitaal organisasies in Suid Afrika, te kies (n=15). Toestemming om die studie te doen is verkry van die Etiek Komitee vir Gesondheidsorgnavorsing van die Universiteit van Stellenbosch sowel as van die privaat hospitaal organisasies. Vyftien semi-gestruktureerde onderhoude is gevoer, woordeliks getik en ge-analiseer. Ses temas het uit die data na vore gekom. Dit sluit die aktiwiteite van PSWs, die organisering van sorg, plek in die pasiёntsorg span, opleiding, redes vir indiensneming en besorgdheid oor die rol van PSWs. Die bevindinge toon ‘n sterk ooreenkoms met die rol van die gesondheidsorg assistent soos beskryf in die literatuur. PSWs fokus op direkte pasiёntsorg en spandeer baie tyd met pasiёnte. Weens hulle nabyheid aan die pasiёnt, kan hulle die pasiёnt se toestand waarneem en bevindings rapporteer aan verpleegsters. PSWs is oёnskynlik goed geїntegreer in die pasiёntsorgspan en word meesal as verpleegsters beskou. Tog is daar besorgdheid oor die uitbreiding van hulle rol ten spyte van beperkte opleidingsprogramme en ‘n gebrek aan toesighouding. Die navorser stel voor dat die werk van PSWs gereguleer behoort te word, maar ook dat die verpleegprofessie die nodigheid van ‘n addisionele kategorie tot die assistent verpleegster, krities moet evalueer.
25
Mlenzana, Nondwe Bongokazi. « The evaluation of processes of care at selected rehabilitation centres in the Western Cape ». University of the Western Cape, 2013. http://hdl.handle.net/11394/4078.
Texte intégralRésumé :
Doctor ScientiaeFollowing the introduction of the Health Act of 1995, the Primary Healthcare Package for South Africa, a set of norms and standards was developed in 2000, to ensure good quality of care and to act as a guide to provide good service at this level of care. Related to this, and bringing health services to the people, was the aspect of rehabilitation. It was highlighted that rehabilitation services should be restructured and strengthened in order to improve access to these services for those who did not have them before. This led to the development of the National Rehabilitation Policy in 2000, which focused on improving accessibility to all rehabilitation services, in order to facilitate the realisation of every citizen’s constitutional right to have access to healthcare services, but this policy was not implemented. During 2002, the Department of Health produced a strategic plan for the reshaping of public health services in the Western Cape. This initiative, Healthcare 2010, the Future for Health in the Western Cape 2020, mapped the way forward to improve substantially the quality of care provided by the health service. This plan was based on the primary healthcare approach and aimed to shift patients to more appropriate levels of care. It became evident that in order to move forward with the 2020 vision, there needed to be a greater understanding of the current situation. This study focused primarily on the aspect of rehabilitation, with a specific focus on systematic review and three dimensions of the process of care, namely patient information; service provider information; and realised access. These dimensions assisted in evaluating the rehabilitation service in order to understand what was happening in the delivery of rehabilitation services, focusing on the experiences of patients with physical disabilities, as well as service providers and caregivers, and realised access that included satisfaction of all participants in the rehabilitation centres. Hence the aim of this study was to evaluate the process of care at three selected rehabilitation centres in the Western Cape Province within the contextual framework of the National Rehabilitation Policy (NRP) and the United Nations Convention Rehabilitation Policy for People with Disabilities (UNCRPD). To assist in achieving this aim, objectives were developed as follows: to determine the reported barriers and facilitators to rehabilitation services through a systematic review; to determine the profile of patients with disabilities accessing rehabilitation services at three rehabilitation centres in the Western Cape Province; to determine the profile of service providers providing rehabilitation service to patients with disabilities attending rehabilitation centres in the Western Cape Province; to explore clients’ perceptions of and satisfaction with the rehabilitation services; to explore caregivers’ perceptions of and satisfaction with the rehabilitation services; to explore the experiences of service providers with the rehabilitation services; and to map the links between the experiences and perceptions of the key stakeholders. This was an evaluation study, which was primarily descriptive, with the focus on process evaluation. Process evaluation provides an indication of what happened, and why. The study was conducted at three rehabilitation centres in the Western Cape Province. Voluntary participation of patients, service providers and caregivers was gained by signing a consent form. Both qualitative and quantitative methods of data collection were used in this study. Questionnaires were used for quantitative data collection and SPSS version 17 and 21 was used to analyse the data. Focus group discussions and in-depth interviews, which were based on interview guides and tape recorded, were used to gather information on experiences and perceptions of all the participants. Quantitative data capturing was checked for errors by using excel spread sheets, where data was entered twice in two different spread sheets and checked for differences, as responses were coded by using numbers. Qualitative data was checked for errors by following the trustworthiness process where data was transcribed verbatim, and where necessary translated by two different translators to ensure accuracy. The researcher consulted with the supervisors during data analysis to enhance quality in the coding process and identification of themes and relevant quotations. Results showed that barriers to rehabilitation outnumbered facilitators of the rehabilitation process. There was a gap identified in the profile of the patients with regards to their rehabilitation needs. Records of the patients had missing information posing a challenge to data collection and possible presenting a distorted picture of service provision. However, records showed that not all rehabilitation professionals were not consulted during the rehabilitation process of care. Ninety-five percent (95%) of the clients consulted with physiotherapists, whereas only 4% consulted social workers. Rehabilitation service providers did not reflect a rehabilitation team. There was a shortage of rehabilitation service providers, in that some centres had full time staff while other centres only had sessional rehabilitation professionals. Service providers were negligent with some of the processes to be followed when consulting clients, such as getting consent to treat the patient and educating patients regarding their ailments, which then affected satisfaction of the patients. However, there were also positive aspects like treating patients with respect and allowing patients to ask questions during consultation. Caregivers on the other hand were satisfied with the rehabilitation process, as they found the centre easily accessible for their family members and were involved in the rehabilitation of the patients. In conclusion, the rehabilitation process was satisfying to the participants of this study. The main challenge that patients and caregivers experienced was financial constraints. Staffing remains a problem in rehabilitation centres in the Western Cape Province, as there were not enough staff for rehabilitation service delivery at these selected rehabilitation centres. Other staff members were not utilised during the rehabilitation process. These findings raise issues for the Western Cape Department of Health to consider regarding rehabilitation, as people with disabilities are not receiving optimal care. The study makes recommendations to the Department of Health in the Western Cape Province regarding the improvement of the rehabilitation process of care.
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Kali, Julia Mamosiuoa. « Understanding women’s involvement in primary health care : a case study of Khayelitsha (Cape Town) ». Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4095.
Texte intégralRésumé :
Magister Artium (Medical Anthropology) - MA(Med Ant)Women are the principle providers of their families when it comes to issues of health care, even though their health needs and efforts are neglected. The contributions that they make to health development seem to be undervalued, and their working conditions ignored. Societies depend heavily on women as role players in the welfare of their families and of national economics together with their physical well-being which determines the ability to be productive. The study has provided an overview of the experiences of women concerning primary health care and the quality of service in Nolungile PHC Khayelitsha, Cape Town. Primary health care (PHC) forms an integral part both of the country‘s health system and the overall social and economic development of the community. Central to the PHC approach is full community participation in the planning, provision, control and monitoring of services. Priority has to be given to the improvement of women‘s social and economic status.A much neglected perspective in health issues is that, a number of questions arise from the provision of PHC. Does PHC rely on the contribution of women and if so, why women? Women in their communities have joined their hands together as community health workers, educating community members on issues of health. The study has provided an insight of the work that women are doing in their communities, and how do they give meaning to their experiences in PHC. The study also answered questions that raise fundamental issues on gender stereotyping and disparities in PHC. The study gave me an opportunity to work closely with the women while observing the challenges that they are facing and how to they overcome them in the daily lives.Changes are called towards the attitudes of health care providers working in the formal and nonformal sectors. The provision of health education for women ultimately empowers them as health educators for the community.
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Krause, S. R. « An evaluation to asses [i.e. assess] the holistic care of tuberculosis patients with palliative care needs in the Western Cape, South Africa ». Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/13441.
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Engle, Eugene David. « Perceptions of patients and dietitians on the quality of nutrition care service delivery in primary health care facilities of the Western Cape Metro ». University of the Western Cape, 2020. http://hdl.handle.net/11394/8010.
Texte intégralRésumé :
Magister Scientiae (Nutrition Management) - MSc(NM)The provision of quality nutrition care services is needed to address the national burden of diseases, and to reduce under- and overnutrition in South Africa. Globally, there is a lack of information and data about the perceptions, experience of, and satisfaction with the quality of nutrition care services, both from patients and dietitians. Patients and dietitians are in the best position to provide useful information pertaining to their perception and experience of nutrition care service delivery. The aim of this study was to determine the perceptions of patients and dietitians on the quality of nutrition care service delivery in the Klipfontein/Mitchells Plain Sub-Structure (KMPSS).
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Somahela, Khanyisa Judith. « Professional nurses’ perceptions on quality patient care in one of the Eastern Cape state hospitals ». Thesis, University of Fort Hare, 2014. http://hdl.handle.net/10353/d1021141.
Texte intégralRésumé :
The focus of this study was to explore the perceptions of professional nurses in the quality of care rendered by nurses in the public hospitals. Nursing is a challenging, demanding, and yet fulfilling profession, whose goal is to provide quality care to individuals, families and communities. However, there are inconsistencies regarding the quality of care rendered by nurses in the public hospitals. The media and the public portray nurses as providing poor quality care in the health care facilities. Conversely, the nurses view that they are doing their best, considering the challenging circumstances under which they work in public institutions.The study followed a qualitative approach and an exploratory descriptive design. A purposive sample of 13 professional nurses participated in the study. The sample size was not pre-determined. Data were collected until data saturation, when the interviews yielded no new information. The study was conducted in a state hospital in the Eastern Cape, using an interview guide. Responses were recorded using a tape recorder. No incentives were given to participants. Data were collected and analysed following the Tesch’s method. Prior to conducting the study, the researcher obtained ethical clearance from the University of Fort Hare research ethics committee. The perceptions of the professional nurses who participated in this study were inconsistent. The majority pointed out that the quality of patient care was deteriorating which means the patient care is poor. whereas some participants indicated that the quality of patient care was still the same; it had not changed or deteriorated, The contributing factors to the poor quality patient care were indicated as; shortage of staff, shortage of resources such as equipment, inadequate empowerment of staff, insufficient training of students, staff arriving late for duties, lack of passion their work, skipping and missing of routines, support service that was not working hand in hand with the nursing staff, increased hospitalization of patients and the Eastern cape Department of Health failing to remunerate the nurses as promised.
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Sengwana, Manyeke Jeani. « Diarrhoea management in primary health care facilities in the Cape metropole region : the caregivers' perspective ». Thesis, University of the Western Cape, 2003. http://hdl.handle.net/11394/4594.
Texte intégralRésumé :
Master of Public Health - MPHThis mini-thesis, assessed the use of ORT as a treatment for childhood diarrhoea in primary health care facilities in the Cape Metropole from the caregivers' perspective. Awareness and knowledge of oral rehydration therapy (ORT) and the preparation abilities of sugar salt solution (SSS) by caregivers of children younger than 5 years attending the health facilities were assessed. The availability of resources and utensils for the use of ORS packets and SSS and the accessibility to health facilities by caregivers were also determined. Using a cross sectional descriptive study design, a baseline situation review was carried out. Primary health care facilities in three heath districts namely; Khayelitsha, Nyanga and Oostenberg were purposely selected. Ninety-two caregivers in 12 facilities participated in the study. Basic analyses of quantitative data were done using Epi-Info 2002 software. Qualitative data were analysed manually. The study found that according to caregivers, all facilities used ORS packets as their immediate treatment for uncomplicated diarrhoea, and recommended sugar salt Diarrhoea Management in PHC Facilities solution as home treatment. Ninety-one percent of caregivers used ORT at home before they presented to the health facility.Of the caregivers who were advised by the health worker to use SSS at home, 60.7%, 55.8% and 60.2% in Oostenberg, Khayelitsha and Nyanga districts respectively remembered the correct ingredients and quantities to make the solution at home. Of those given ORS packets, 94.5%, 99.0% and 98.5% respectively, remembered the quantity of water to be mixed with each packet. Packets were found to be convenient and were preferred by many caregivers as compared to SSS. The advice or health education messages given to caregivers were often unclear, and there were language barriers in Brighton and Bloekombos clinics in the Oostenberg district. A litre bottle was available in 47% of caregivers' homes, 82 % had a teaspoon and all of them had access to running water. Twelve percent and 11 % admitted to not having sugar and salt respectively when they wanted to make SSS. Eighty-eight percent walked to the health facility and 12% used taxis or buses. The study concludes that ORT is widely used in primary health care facilities for diarrhoeal disease treatment, however caregiver's knowledge and preparation abilities of SSS is still limited. The resources and utensils to prepare ORT at home were fairly available in many homes, which makes SSS preparation at home feasible and acceptable.
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Beukes, Daniel Wilhelm. « How to improve diabetic care in the Wesbank/ Ilingu Lethu suburb of Malmesbury, Western Cape ». Thesis, Stellenbosch : Stellenbosch University, 2010. http://hdl.handle.net/10019.1/20439.
Texte intégralRésumé :
Thesis (MMed) -- Stellenbosch University, 2010.Bibliography
Introduction: Diabetes in Africa has been described as a pandemic, with the prevalence in South Africa estimated at 4.5% of the population. Despite clear national guidelines from the Society of Endocrinology, Metabolism and Diabetes of South Africa, an unpublished quality improvement cycle in 2007 has shown poor patient knowledge with associated uncontrolled glycaemic and hypertensive control in diabetic patients in a district health system. The purpose of the study was to identify possible reasons for this and to find solutions for improving diabetic care within the Wesbank/ Ilingu Lethu suburb of Malmesbury, Western Cape. Methods: A cooperative inquiry group was established, consisting of primary health care providers at a district hospital and a primary health care clinic. The inquiry completed several cycles of action-reflection over a period of eight months, and included training in diabetic related topics and critical reflection techniques. At the end of the inquiry consensus was reached on key findings by group and learning within the group. Findings: Consensus was expressed in two key findings. The group identified and prioritized continuity of care and diabetic education key areas where diabetic care could be improved in the research population. The first was addressed by initiating diabetic registries, establishment of a regular diabetic clinic, implementation of a diabetic schedule within the medical records and the forming of a diabetic team that could support continuity of relationships, clinical management and organisation of care between both facilities. The diabetic team involved non-governmental organizations, private health providers and the community to increase awareness and develop capacity to improve diabetic care. The other finding confirmed diabetic education as a critical area in diabetic self management. The diabetic team initiated a diabetic community forum for educational and informative group activities. There was also continued professional development with education sessions within the cooperative inquiry group themselves. Conclusions: Improving diabetic care through continuity of care and education is well supported in known evidence based literature. The challenge is to translate/ transfer the available knowledge and render it operational and clinical in any health setting. The co-operative inquiry process was a valuable tool to identify, prioritized and addresses unique challenges for improving diabetic care in our specific context.
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Beukes, Daniel Wilhelm. « How to improve diabetic care in the Wesbank/ Ilingu Lethu suburb of Malmesbury, Western Cape ». Thesis, Stellenbosch : University of Stellenbosch, 2015. http://hdl.handle.net/10019.1/97216.
Texte intégralRésumé :
Introduction: Diabetes in Africa has been described as a pandemic, with the prevalence in South Africa estimated at 4.5% of the population. Despite clear national guidelines from the Society of Endocrinology, Metabolism and Diabetes of South Africa, an unpublished quality improvement cycle in 2007 has shown poor patient knowledge with associated uncontrolled glycaemic and hypertensive control in diabetic patients in a district health system. The purpose of the study was to identify possible reasons for this and to find solutions for improving diabetic care within the Wesbank/ Ilingu Lethu suburb of Malmesbury, Western Cape.
Methods: A cooperative inquiry group was established, consisting of primary health care providers at a district hospital and a primary health care clinic. The inquiry completed several cycles of action-reflection over a period of eight months, and included training in diabetic related topics and critical reflection techniques. At the end of the inquiry consensus was reached on key findings by group and learning within the group.
Findings: Consensus was expressed in two key findings. The group identified and prioritized continuity of care and diabetic education key areas where diabetic care could be improved in the research population. The first was addressed by initiating diabetic registries, establishment of a regular diabetic clinic, implementation of a diabetic schedule within the medical records and the forming of a diabetic team that could support continuity of relationships, clinical management and organisation of care between both facilities. The diabetic team involved non-governmental organizations, private health providers and the community to increase awareness and develop capacity to improve diabetic care. The other finding confirmed diabetic education as a critical area in diabetic self management. The diabetic team initiated a diabetic community forum for educational and informative group activities. There was also continued professional development with education sessions within the cooperative inquiry group themselves.
Conclusions: Improving diabetic care through continuity of care and education is well supported in known evidence based literature. The challenge is to translate/ transfer the available knowledge and render it operational and clinical in any health setting. The co-operative inquiry process was a valuable tool to identify, prioritized and addresses unique challenges for improving diabetic care in our specific context.
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Hepburn, Mary Patricia. « An exploration of environmental understanding among primary health care providers in an Eastern Cape community ». Thesis, Rhodes University, 1999. http://hdl.handle.net/10962/d1003415.
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This study explores environmental understanding among the health care practitioners serving a rural community in the Eastern Cape Province in South Africa. During the preliminary phases of the research, the decision was made to adopt a participatory approach to the inquiry as far as was possible. Semi-structured interviews, participant observation and focus group discussions were the techniques chosen to focus the participants' thinking about: the meaning of environment, environmental issues and problems which impact on health, and, environmental education in practice. Comparisons between the recently transformed health education idea proposed by the World Health Organization (WHO), known as "health promotion", and a popular environmental education model are made. It is argued that many of the obstacles to effective health education described by the participants in the study can be overcome by using environmental educationlhealth promotion approaches. The findings show that the health practitioners studied relate to a wide range of environmental issues with varying levels of engagement. They are influenced by changing values, their feelings about indigenous knowledge, and their notions about how people should respond to the environment. An urgent need for more and better communication among the different levels of health practitioners is identified. Finally, it is recommended that health care practitioners be supported with opportunities for professional development which can lead to a confident, seIfreflective approach to health education.
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Mandizvidza, Vimbai. « Quality of current ischaemic stroke care practices in the Cape Metro Health District, South Africa ». Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27457.
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The aim of this study was to assess the acute and post-acute services for ischaemic stroke patients in the Cape Metro Health District in relation to the South African ischaemic stroke guideline. Part A: Protocol - The protocol outlines the purpose of the study and highlights the importance of conducting this study by analysing the literature on stroke care in both high and low and middle-income countries. The literature also highlights the gaps in stroke care in South Africa which justify the need for this study. The protocol also outlines the methods of data collection and analysis as well as the ethical considerations. Part B: Literature Review - This expands on the literature on the different components of both acute and post-acute stroke care in both high and low and middle-income countries. It also elaborates on stroke in South Africa and why it is important to conduct this study. Part C: South African Medical Journal manuscript - The manuscript summarises the whole study and includes the literature on stroke care, justification of the study and how the data was collected and analysed. The manuscript also includes the results obtained and sections on the discussion and conclusions.
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Kruger, Irma. « Paediatric and neonatal admissions to an intensive care unit at a regional hospital in the Western Cape ». Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86757.
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Thesis (MMed)--Stellenbosch University, 2014.ENGLISH ABSTRACT: Objective: The aim of the study was to determine the outcome of critically ill neonates and children admitted to a general intensive care unit in a large regional hospital (Worcester) in the Western Cape. A secondary aim of the study was to determine the risk factors for death in these neonates and children. Methodology: This was a retrospective descriptive survey of all paediatric admissions (under 13 years of age; July 2008 till June 2009) to an intensive care unit at a large regional hospital in Worcester, South Africa. Data collected included: demography, admission time, length of stay, diagnoses, interventions and outcome. Outcome was defined as successful discharge, death or transfer to a central hospital. Results: There were 194 admissions including children and neonates. The files of 185 children and neonates were analysed, while 8 children were excluded due to incomplete data set and one patient was a surgical admission. The male: female ratio was 1.3: 1 and the majority of patients (83%) admitted, were younger than 12 months of age at admission with a mean age of 8.5 months (median age 3.7 months; range 0 to 151 months). The majority (70%) of admissions were successfully discharged, nearly a quarter (24%) transferred to central hospitals in Cape Town and only 6% died (all younger than 5 years of age). Causes of death included acute lower respiratory tract infections (33%), acute gastroenteritis (25%), birth asphyxia complicated by pulmonary hypertension (16%) and prematurity (16%). Patients requiring airway assistance, were more likely to experience an adverse event (p=0.0001) and invasive ventilation was associated with an increased risk for a poor outcome (p=0.00). Conclusion: The majority of children requiring access to a paediatric ICU are younger than one year of age. The common causes of death are acute lower respiratory tract infections, acute gastroenteritis, prematurity and neonatal asphyxia. A regional hospital in South Africa should offer intensive care to children as the majority of their admissions can be successfully cared for without transfer to tertiary hospitals. To our knowledge, this is the first study reporting admissions and outcome of neonates and children cared for in a mixed intensive care unit in a large regional hospital in South Africa. This study suggests that large regional hospitals in South Africa should have mixed intensive care units to improve child survival.
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Cakata, Zethu. « Epidemiology of sexually transmitted infections in selected primary health care centres in the Eastern Cape Province ». Thesis, University of the Western Cape, 2004. http://hdl.handle.net/11394/4599.
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Magister Psychologiae - MPsychAn epidemiological study was conducted with the main goal of describing the occurrences of the various STIs in the Eastern Cape province as well as biographical factors such as age, gender, and geographical location influencing them. Ten primary health care (PHC) centres located throughout the province served as sentinel sites for surveillance data collection for a period of 3 months using Daily and Monthly Report Forms. The surveillance data was analysed using relative frequencies to determine STIs prevalence. The main findings from the present study suggest that the most frequently encountered female syndromes were vaginal discharge and lower abdominal pains and most frequent male syndrome was Urethral discharge. Other syndromes accounted for less than 10% of the STI cases observed at the PHC centres during the study. The study also indicate that more STI patients were seen at urban PHC centres compared to rural ones and that most of the STI patients seen at PHC centres were women. These findings are helpful for the Health Department in the Eastern Cape Province to effectively plan for the control and prevention of all STIs including HIV I AIDS.
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Magana, Grace Wanjeri. « Contextual factors influencing the turnover of nurses in specified intensive care units in the Cape Metropole ». Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/80149.
Texte intégralRésumé :
Thesis (MCurr)--Stellenbosch University, 2013.ENGLISH ABSTRACT: The shortage of nurses in the intensive care units (ICU) affects both the nurse and the patient with regard to quality care and the quality of work life. Job satisfaction as well as factors within the organisation and work environment predisposes dissatisfaction. Identifying these factors may improve the quality of life at work and reduce staff shortages. The aim of this study is to evaluate the contextual factors influencing the turnover of intensive care nurses in specified hospitals in the Cape Metropole. The objectives were: • To determine the factors influencing the turnover of intensive care nurses in specified hospitals in the Cape Metropole. • To compare the findings of the data in the specified hospitals. An explorative, descriptive design with a quantitative approach has been applied. The research sample consists of all nurses working in the intensive care units in the specified hospitals at the time of the study. A convenience sampling was applied. A structured questionnaire containing predominantly closed-ended questions was used and data collection was conducted by the researcher herself. A pilot study consisting of 10% (N=21) of the sample was done in one of the hospitals to validate the reliability of the questionnaire. The 21 participants who completed the pilot test did not participate in the actual study. The reliability and validity of the findings was assured by the utilization of the statistician and experts in the nursing department. The data is presented in tables and histograms. A Chi -square test is used to test the statistical significance association between variables. Spearman’s ranks (rho) order correlation is used to show the strength of the relationship between two continuous variables. The findings of the study show that discontent with salaries, inferior working environments, organisational factors, physical as well as emotional stress and the lack of career development opportunities, were major determinants in the poor quality of life at work with regard to the two set objectives. Recommendations include those for better remuneration, improved career opportunities and the creation of a safe as well as a friendly work environment. The aim is to create a positive work environment and improve the quality of life at work.
AFRIKAANSE OPSOMMING: ’n Tekort aan verpleegsters in die intensiewesorgeenheid beïnvloed beide die verpleegster en die pasient sovêr dit die gehalte van sorg lewering en die kwaliteit van arbeidservarings in die werkplek betref. Werkstevredenheid, sowel as faktore binne die organisasie en omgewingsfaktore in die werkplek, is aanleidend tot ontevredenheid binne die organisasie. Deur hierdie faktore te identifiseer, mag die kwaliteit van werkslewe verbeter word en die verlies aan personeel verminder word. Die doel van hierdie studie is om die kontekstuele faktore wat die personeel omset van intensiewesorgverpleegsters in spesifieke hospitale in die Kaapse Metropool beïnvloed, te evalueer. Die doelwitte was: • Om die faktore wat die omset van intensiewesorgverpleegsters in spesifieke hospitale in die Kaapse metropool beinvloed, te bepaal • Om die bevindinge van die studie binne verskeiehospitale te vergelyk Om hierdie navorsingsvrae te beantwoord, is ’n verkennende en beskrywende ontwerp met ’n kwantitatiewe benadering aangewend. Die steekproef het bestaan uit alle verpleegspersoneel werksaam in die intensiewesorg-eenhede in die gespesifiseerde hospitale binne die studie vermeld . ’n Gerieflikheids-steekproef is uitgevoer. ‘n Goedgestruktueerde vraelys met hoofsaaklik geslote vrae is gebruik vir datainsameling en vraelyste was persoonlik deur die navorser ingeneem. ’n Loodsstudie wat 10% van die steekproef beslaan, (N= 21), is in een van die hospitale onderneem om sodoende die betroubaarheid van die vraelys te bevestig. Die 21 deelnemers was nie deel van die werklike studie nie. Die betroubaarheid en geldigheid van die betrokke studie is bevestig deur die statistikus en kenners in die verplegingsdepartement van sodanige inrigting. Data is voorgelê in die vorm van tabelle en histogramme. ’n Chi-vierkanttoets is gebruik om die statistiese-beduidends verwantskap tussen veranderlikes te toets. Spearman se rangorde (rho) korrelasie is gebruik om die sterkte van die verhouding tussen twee aaneenlopende veranderlikes aan te dui. Die bevindinge dui aan dat ontevredenheid oor salarisse, ‘n swak werksomgewing en organisatoriese faktore, sowel as fisiese en emosionele stres, asook ’n gebrek aan loopbaanontwikkeling, groot bepalers was van swak werkskwaliteit in terme van die twee voorgestelde doelwitte. Aanbevelings bestaan uit voorstelle vir beter salarisse, die skepping van loopbaangeleenthede en die daarstelling van ’n veilige, vriendelike, werksomgewing. Die doel is om ’n positiewe werksomgewing te skep en om die kwaliteit van werkslewe te verbeter.
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Skiti, Vuyi. « Barriers in implementing total quality management in Kraaifontein public health care facility in the Western Cape ». Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/964.
Texte intégralRésumé :
Thesis (MBA (Business Management))--University of Stellenbosch, 2009.ENGLISH ABSTRACT: Purpose – The health care industry is faced with numerous challenges ranging from rising medical costs, poor state of hospitals, deteriorating health care services and an increasing number of hospital deaths. All these disparities present tremendous challenges for the health care managers in charge of the health care services. As a result, they are forced to try new management methods that will assist their organizations to remain cost effective and efficient. Total Quality Management (TQM) constitutes an appropriate response to these challenges and it has become the strategy of choice to improve organization’s performance and patient satisfaction. However, in practice the implementation of TQM is often unsuccessful. Certain barriers have been identified which prevent the successful implementation of TQM in other industries as well as in the health care industry. The main aim of this research is to investigate the barriers to the successful implementation of Total Quality Management in Kraaifontein health care service organization in the Western Cape Province, 2008. Design/methodology/approach – The study employed a quasi-qualitative and quantitative case study. For the quantitative section a questionnaire with a 5–point Likert style scale was used to quantify the response (strongly disagree=1; strongly agree=5). For the qualitative section a focus group discussion was conducted to verify the results obtained from the questionnaire which addressed the challenges of TQM implementation. The statistical population of this research consisted of all health care workers working the pharmacy department who were involved in the implementation of TQM in their organization. Data was analyzed using appropriate statistical procedures. The mean score of each of the dimensions was used as a representative performance indicator and the coefficient of variation (CV) was used as a general measure of standardized skewness on the performance of each dimension. A high means score indicated desired outcomes while low scores indicated poor outcomes. Findings – Major barriers that were encountered during the implementation of TQM in this case study included the lack of top management active involvement and full commitment in the initiative, rigid organizational structure, culture towards quality changes that inhibited communication between management and employees which in turn hindered employee empowerment. Other obstacles that were encountered were lack of continuous improvement processes and initiative, improper evaluation, the lack of a recognition and reward system for team work, poor collection and analysis of data that resulted in difficulty to convert this data into meaningful information to improve quality. The absence of an integrated performance measurement system also exhibited a problem as employees were not aware what was being assessed during performance appraisals. Lack of evidence based decision making, poor communication and inflexible organizational structure and culture were also viewed as barriers. Research limitations/implications – Although conducted in Kraaifontein health care facility, it is expected that the results of the study may be relevant on a broader scale to other health care departments and facilities. The results could assist the health care managers to develop a plan that addresses the barriers and challenges faced during the implementation of TQM, yielding fruitful results which allow TQM to be implemented easily, effectively, efficiently and successfully in health care facilities.
AFRIKAANSE OPSOMMING: Doel – Die gesondheidsorg sektor het vele uitdagings wat wissel van stygende mediese kostes, lae standaarde in hospitale, die agteruitgang van gesondheidsorg dienste, en die toename in sterftes in hospitale. Hierdie en ander probleme stel groot uitdagings aan diegene verantwoordelik vir die lewering van gesondheidsorg, met die gevolg dat diesulkes nuwe bestuursmetodes moet vind om te verseker dat hulle organisasies steeds koste-effektief en doeltreffend funksioneer. Totale Gehalte Bestuur (TGB) is ‘n geskikte en toepaslike alternatief om genoemde probleme aan te spreek, en word toenemend as oplossing gesien om organisasies se dienslewering te verbeter, en pasiënt-tevredenheid te verseker. Die implementering van TGB blyk egter nie altyd suksesvol te wees nie. Daar is spesifieke struikelblokke geidentifiseer wat as redes aangevoer word vir die onsuksesvolle implementering van TGB in verskeie sektore, insluitend die van gesondheidsorg. Die hoof doel van hierdie navorsing was om die struikelblokke te ondersoek wat verhoed dat TGB suskesvol toegepas word in Kraaifontein gesondheidsdienste in die Weskaap, 2008. Ontwerp/Metode/Benadering – Die studie was ‘n kwasi kwalitatiewe en kwantitatiewe gevallestudie; vir die kwantitatiewe komponent is ‘n 5 punt Likert tipe skaal gebruik om die response (verskil beslis = 1; stem beslis saam = 5) te kwantifiseer. Die kwalitatiewe komponent het ‘n fokusgroep bespreking behels, waartydends die resultate van die vraelys geverifiëer is, wat die uitdagings van die implementering van TGB uitgewys het. Die statistiese populasie vir hierdie navorsing was al die gesondheidsorg werknemers in diens van die aptekers-departement, wat betrokke was in die implemetering van TGB in hulle organisasie. Die data is geanaliseer met toepaslike statistiese metodes. Die gemiddelde telling van elkeen van die dimensies was gebruik as ‘n verteenwoordigende aanduiding van prestasie, en die koëfisiënt van veranderlikheid was gebruik as ‘n algemene maatstaf van die gestandardiseerde skeefheid soos gemeet op elkeen van die dimensies. ‘n Hoë gemiddelde telling was ‘n aanduiding van die beoogde uitkomste, en lae tellings aanduidend van swak uitkomste. Bevindinge – Belangrike uitdagings wat ondervind is tydens die implementering van die TGB in hierdie gevallestudie sluit in, die gebrek aan aktiewe betrokkenheid en toewyding van die topbestuur vir hierdie inisiatief, rigiede organisatoriese strukture, die kultuur teenoor gehalte veranderinge wat kommunikasie tussen bestuur en werknemers belemmer, wat op sy beurt werknemer-bemagtiging verhoed. Ander struikelblokke wat geidentifiseer is, was ‘n afwesigheid van voortdurende verbeteringsprosesse en inisiatief, swak evaluering, ‘n gebrek aan ‘n sisteem vir erkenning en vergoeding vir spanwerk, swak data insameling en ontleding, wat tot probleme gelei het om die data in betekenisvolle inligting te verwerk wat kon lei tot ‘n verbetering in gehalte. Die afwesigheid van ‘n geintegreerde prestasie-beoordeling sisteem is ook as probleem geidentifiseer omdat werknemers nie ingelig was oor wat die prestasie-beoordelings behels nie. Die gebrek aan navorsingsgesteunde besluitneming, swak kommunikasie, en onbuigsame organisatoriese strukture en kultuur, was ook gesien as struikelblokke. Navorsing-beperkinge/implikasies – Alhoewel die studie in Kraaifontein gesondheidsorgfasiliteit gedoen is, word dit aanvaar dat die bevindinge van hierdie studie ook van toepassing is op ander gesondheidsorg departmente en fasiliteite. Die resultate kan gesondheidsorgbestuurders help om die uitdagings en struikelblokke te identifiseer in die implementering van TGB. Hierdie identifikasie kan lei tot ’n meer effektiewe en suksesvolle implementering van TGB in gesondheidsorgfasiliteite.
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Tsoabisi, Sello. « Investigating the extent and efficiency of community participation in primary health care in Khayelitsha, Cape Town ». Thesis, Cape Technikon, 2004. http://hdl.handle.net/20.500.11838/1669.
Texte intégralRésumé :
Thesis (MTech (Public management))--Cape Technikon, Cape Town, 2004The evolution of the South African health system has been characterised by inequities, imbalances as well as fragmentation. The unification of South Africa in 1910 did not consolidate public health administration, which was characterised by increasing institutionalisation, professionalism and organisation. This was the status-quo up until after 1990, whereby there were marked efforts and endeavours to effect defragmentation. In the context of the dramatic political changes that the country has seen over recent years, many aspects of local health care have been upgraded. Issues such as policy making and planning, the development of human resources and training for health care and the establishment of health systems and structures requires a different approach from the previous. Effective human resources development and management in consultation with communities, can contribute towards improvement of service delivery around health issues. Personnel matters and skills development should be considered in the exercise to boost employee morale and job satisfaction. The challenge facing South Africa has been to design a comprehensive programme to redress social and economic injustices, to eradicate poverty, increase efficiency and reduce waste. In the health sector this has been ongoing to involve the complete transformation of the national health care delivery system and the relevant institutions. Health care workers jointly, require the right skills, knowledge and expertise with attitude in their duties and obligation to serve the community.
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Röhrs, Stefanie. « Nurses decision-making in termination of pregnancy services at health care facilities in the Western Cape ». Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/9427.
Texte intégralRésumé :
Includes bibliographical references.Using the theory of "street-level bureaucrats" , this thesis examines the implementation of the South African Choice on Termination of Pregnancy Act by exploring nurses' decision-making in termination of pregnancy services. As front-line providers, nurses play a critical role in the implementation of termination of pregnancy services. Nurses may be required to assist in informing, preparing or counselling women who request a termination of pregnancy and, if appropriately trained, nurses can perform terminations of pregnancy. Research suggests, however, that 15 years after the promulgation of the law, nurses continue to be reluctant to participate in termination of pregnancy services thereby undermining the successful implementation of the Choice on Termination of Pregnancy Act.
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Leon, Natalie H. « District health systems development : functional integration at joint primary health care facilities in the Western Cape ». Master's thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/10769.
Texte intégralRésumé :
Bibliography: leaves 65-68.South Africa has embarked on a range of health sector reforms since the start of the democratic government in 1994. The Primary Health Care approach has been accepted as a way of delivering cost effective, efficient and accessible comprehensive health care at the primary care level. The district health system has been promoted as the best model for the delivery of primary health care because it decentralizes power to the local, district level and it is able to integrate fragmented primary care services under one management and governance structure. In the absence of a formal, legal district health system, provincial and local government authorities have made efforts towards functional integration in primary health care. The establishment of shared health facilities with the aim of providing integrated, comprehensive health care is part of the effort towards functional integration. This study investigates the level of functional integration in joint health facilities between Local Authority (LA) and the Provincial Administration of the Western Cape (PAWC).
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Jimoh, Azeezat M. « Evaluation of Burnout, Coping Strategies and Resilience in Paediatric Oncology Health Care Workers in Cape Town ». Master's thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/30100.
Texte intégralRésumé :
Background: Burnout is a work-related condition with a significant footprint in the medical profession. It is characterised by emotional exhaustion (EE), depersonalisation (DP), and a low sense of personal accomplishment (PA) at one’s job. Depending on situational and individual factors, the prevalence of burnout among healthcare workers (HCWs) has shown an upward trajectory with peaks in certain medical specialities. Paediatric oncology unit (POU) HCWs are at a high risk of developing burnout because of the immense physical and emotional involvement that can be associated with caring for children with cancer. The burnout process can, however, be influenced by adopted coping strategies and resilience. Research into the phenomenon of burnout and associated factors in POU HCWs is low in South Africa in spite of the global attention it has commanded. Because of the need to institute appropriate and acceptable intervention strategies and to avoid erroneous conclusions often associated with burnout, it is imperative to understand the local prevalence and the possible associated factors. This study, therefore, seeks to establish the prevalence of burnout in POU HCWs and to understand how the adopted coping strategies and level of resilience influence the burnout process in a defined setting. Acknowledging and understanding how these psychosocial factors affect HCWs is fundamental to designing interventions to reduce work-related stress conditions.
Objectives: This study seeks to determine the following: prevalence of burnout among POU HCWs in Red Cross War Memorial Children’s Hospital, Cape Town; identify adopted coping strategies by the HCWs; evaluate the level of resilience in the HCWs; and make recommendations that may help reduce burnout in paediatric oncology care and, probably, other fields of health care in South Africa.
Methodology: This research used a mixed method approach (quantitative and qualitative) to explore burnout, coping and resilience amongst POU HCWs. A questionnaire consisting of validated instruments (Maslach Burnout Inventory-Human Services Survey [MBI- HSS], Brief Resilience Scale [BRS], the Brief COPE and researcher-designed questions) was used to conduct a survey after obtaining ethical clearance (HREC REF: 051/2017). Depending on preference, electronic or paper-based questionnaires were distributed to POU staff. Data analysis was performed using Microsoft EXCEL (2010 version).
Results: The response rate was 50% (n= 25). Five out of the total respondents were dropped due to gross omissions in responses to the survey questions. The majority of the respondents were females (95%), and by profession, nurses had the highest representation (80%). Eightyfive per cent (85%) of the respondents have worked in the POU for more than a year. The burnout prevalence was 15% – 45% across the three dimensions of burnout - high EE (20%), high DP (15%) and reduced PA (45%). The majority (70%) of the respondents were moderately resilient. The coping styles predominantly used by the respondents in this study were positive reframing, religion, acceptance, planning, self-distraction and active coping. The least used coping styles were substance use, denial and behavioural disengagement, which are all maladaptive coping strategies. There was no statistically significant association between burnout and demographic characteristics. However, with a high prevalence of 45%, reduced personal accomplishment (rPA) was also associated with most demographic characteristics. rPA was high in females; age groups 25-25 and 46-60; single and married; respondents with number of children >1; respondents with a graduate level of education; POU professionals that are nurses and administrators; respondents with work experience in medicine and work experience in oncology for less than 10 years. Respondents with low levels of resilience experienced average levels of burnout as evidenced by average EE and DP scores, while those with moderate levels of resilience experienced low burnout as evidenced by low EE and DP scores (P< 0.05) Furthermore, EE and DP correlated negatively with the BRS while PA correlated positively with the BRS. Concerning coping strategies, EE and DP correlated positively with denial, substance use, behavioural disengagement, venting and self-blame. PA correlated positively with emotional support, positive reframing and religion but negatively correlated with active coping. Generally, the respondents expressed the desire for better goal-focused teamwork in the POU as well as the implementation of effective intervention strategies.
Conclusion: The prevalence of burnout in this study is between 15% - 45%. The particularly high prevalence of reduced personal accomplishment (45%) is of interest because it cuts across most demographic features. This is suggestive of a stronger influence of situation specific factors, common to all respondents, contributing to burnout. The predominant use of emotion and problem-focused coping methods, and the moderate level of resilience in the majority of the staff appear to be protective against burnout. There is, however, the need and desire for implementation of effective group and institutional intervention programmes for burnout in the POU staff in terms of availability, awareness and accessibility.
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Roelofse, Maryke. « Investigating factors contributing to late initiation of antenatal care in a health facility in Cape Town ». University of the Western Cape, 2018. http://hdl.handle.net/11394/6849.
Texte intégralRésumé :
Magister Curationis - MCurDespite the awareness of the importance of initiating antenatal care in the first trimester of a pregnancy (before 12 weeks gestation), late initiation of antenatal care (on or after 24 weeks of gestation) remains a common trend amongst pregnant women. The late initiation of antenatal care poses such a risk, to both the pregnant women and their unborn babies that it can contribute to maternal and foetal mortality and morbidity. The late initiation of antenatal care, an entirely avoidable occurrence, has an impact on targets set by the United Nations Millennium Development Goals (MDGs), now focusing on the Sustainable Development Goals (SDG‟s) set out by the United Nations. This study aim to investigate the factors which contribute to and cause the late initiation of antenatal care in pregnant women in a region in the Western Cape. Aim: The aim of this study was to investigate the factors that influence pregnant woman and contribute to late initiation of antenatal care (after 24 weeks gestational age) in one health facility/district in Cape Town. The findings of the study identified possible factors that may cause pregnant women to initiate antenatal care late in pregnancy and these findings could facilitate planning and possible interventions targeting the importance of early initiation in the community.
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Gubitzer, Luise, et Katharina Mader. « Care-Ökonomie. Ihre theoretische Verortung und Weiterentwicklung ». Beirat für gesellschafts-, wirtschafts- und umweltpolitische Alternativen (BEIGEWUM), 2011. http://epub.wu.ac.at/5296/1/Care%2D%C3%96konomie.pdf.
Texte intégral
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Van, Driel Adrian Edgar. « An exploratory study into the benefits of the new health care system in South Africa, with specific reference to health care providers in the Western Cape ». Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
Texte intégralRésumé :
The research explored the new health care service vehicle of South African with special reference to health service providers in Western Cape Department of health for the period 1995-2001. A study was made of the District Health System and the shift of emphasis from tertiary and secondary level of health care to the more cost effective Primary Health Care Service rendered at District level.
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Turton, Mervyn Sydney. « Barriers to Oral Health Care among People Living with HIV in Kwazulu Natal and the Western Cape ». Thesis, University of the Western Cape, 2008. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_1170_1274314831.
Texte intégralRésumé :
HIV/AIDS is a major problem in South Africa with more than 25 percent of the adult population infected with HIV. Oral lesions and various opportunistic infections characterize the progression of HIV making it imperative for people living with HIV to have access to good quality oral care. There is a need to examine accessibility and use of dental services in South Africans living with HIV as very little research in this regard, has been undertaken. Aim: To investigate the barriers to oral health care for people living with HIV in the KZN and the WC. Research Design and Methodology: A cross-sectional study utilising a self-administered questionnaire and semi-structured interviews has been employed. Participants were people living with HIV older than 18 years attending HIV clinics located throughout Kwa-Zulu Natal and WC. Binary logistic regression was performed to determine the variables associated with not obtaining care.
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Borrageiro, Filomena. « Clinical learning environment and supervision : student Nurses experiences within private health care settings in the Western Cape ». Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86616.
Texte intégralRésumé :
Thesis (MPhil)--Stellenbosch University, 2014.ENGLISH ABSTRACT: Background - Student nurses indicated that the clinical environment was not conducive to learning because they were part of the ward staff ratio and clinical supervision was inadequate. Upon observations by the researcher and feedback from student nurses’ a study was planned to identify the clinical experiences and supervision. The study itself was conducted within private health care settings in the Western Cape Province of South Africa. Objectives - The objective of this study was to determine the experiences of student nurses of the clinical learning environment. To also identify the support and clinical supervision that the student nurses received from ward staff, clinical facilitators and lecturers. Methods and analysis - The CLES+T is a reliable and valid evaluation scale for the gathering of information on the clinical learning environment and supervision of student nurses. The CLES+T evaluation scale was completed by 234 student nurses within the selected sites. A quantitative, descriptive cross-sectional survey was conducted by making use of the CLES+T evaluation scale. The CLES+T evaluation scale is subdivided into three main sections with additional sub-sections: (1) the Learning environment, (2) the Supervisory relationship and (3) the Role of the nurse teacher (lecturer). Results - The clinical learning environment was experienced as mostly positive by the student nurses; however the format and type of clinical accompaniment and supervision students received varied. Conclusion - This study gave valuable insights into the status of the clinical learning environment, the clinical accompaniment and supervision of student nurses which can be useful to the nursing school in order to enhance existing nursing programmes.
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Cornoc, N. S. « Quality improvement cycle for cardiac failure in primary health care : Elsies River community health centre, Cape Town ». Thesis, Stellenbosch : University of Stellenbosch, 2015. http://hdl.handle.net/10019.1/97226.
Texte intégralRésumé :
Abstract
Introduction
The study aimed to assess and improve the quality of care for congestive cardiac failure in a public sector, primary health care setting, in Cape Town. There is currently no literature available on the quality of care for the management of congestive cardiac failure in primary health care in South Africa.
Methods
A disease register was constructed by identifying patients prescribed Furosemide and checking the medical records. Altogether 95 patients with CCF were identified. The study followed the usual steps for a quality improvement cycle: Formation of an audit team; agreeing on criteria based on current CCF guidelines; collection of data from medical records to measure the criteria; analysis and feedback of results to the staff; critical reflection, planning and implementing change; re-audit of the medical records.
Results
There was a mean age of 63.4 years, 21% were male and 75% were females. The results of the initial audit revealed suboptimal management of patients diagnosed with CCF: 53% had an aetiological diagnosis recorded in the clinical notes, 24% had a documented functional capacity, 12% of patients had documented precipitating/exacerbating factors, 58% had fluid status documented, and 37% had documentation of their cardiac rate and rhythm.
The intervention consisted of feedback on the audit results and critical reflection with the relevant staff members. The doctors were provided with a printed protocol to refer to for the management of CCF. Clinicians were resistant to change and to taking on new tasks in relation to the management of patients with CCF and decided to only focus on improving the clinical assessment of patients.
The results of the re-audit after 5-months in 40 patients demonstrated improvement in the clinical assessment criteria: 95% of the patients had an aetiological diagnosis recorded in the notes, 50% had a documented functional capacity, 42% had documented precipitating/exacerbating factors documented, 72% had their fluid status documented, and 85% of patients had their cardiac rate and rhythm documented.
None of the five assessment criteria were met at baseline but post-intervention three of the five met the target set and all showed substantial improvement. There was no improvement noted in any of the other criteria, which were not specifically focused on in the plan to improve clinical practice.
Conclusion
The current quality of care for CCF in primary health care is poor and needs to be improved. The quality improvement cycle led to substantial improvement in the clinical assessment of patients with CCF. Recommendations are made regarding future criteria, which could be included in local audit tools.
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Hsiao, Nei-Yuan. « Analysis of HIV early infant diagnosis and linkage to care in the Western Cape : a laboratory perspective ». Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/12274.
Texte intégralRésumé :
Includes abstract.Includes bibliographical references.
Prevention of mother-to-child transmission (PMTCT) of HIV is the cornerstones of HIV prevention programs. The principle of using antiretrovirals (ARV) to reduce the risk of transmission from mother to child is well established as a range of PMTCT regimens with varying efficacies have been widely studied and reviewed1. In South Africa and other Sub-Saharan countries, single dose Nevirapine, amongst other cost- effective regimens, have been adopted as part of the national HIV prevention program2 since 2003.
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Ndango, Immaculate Nyonka. « Parents’ perception of nursing support in neonatal intensive care units in private hospitals in the Western Cape ». University of the Western Cape, 2018. http://hdl.handle.net/11394/6867.
Texte intégralRésumé :
Magister Curationis - MCurParents undergo negative experiences that include parental anxiety, depression, and posttraumatic stress when their new-born babies are hospitalised in neonatal intensive care unit. During this stressful period, parents need assistance from staff in order to cope. A quantitative, descriptive survey design was used to describe parents’ perception of nursing support during their baby’s admission in neonatal intensive care units (NICU) at three selected private hospitals in the city of Cape Town in the Western Cape Province. A structured existing 21- item Likert type questionnaire, the Nurse-Parent Support Tool (NPST) was used to collect data from an all-inclusive sample of 85 parents with a response rate of 78.8% (n=67). The purpose of the questionnaire was to determine their perception of information giving and communication by nurses; emotionally supportive behaviours by nurses; care given support or instrumental support and to identify parents’ perception of esteem or appraisal support while in the NICU environment. The data was analysed using Statistical Package for Social Sciences (SPSS) version 24. The findings of this study suggested that the overall mean score for parents’ perception of nursing support was high 4.6 (±0.5) out of a possible of 5. There was no significant difference in the overall mean perceived support score between the different facilities. No significant differences were found in terms of all the demographics characteristics with regard to perceptions of the support that was received, thus indicating that there was no relationship between the demographic variables and perception of support. The findings suggested that though high parental support was reported, the area of involving parents in the care of their babies i.e. letting them decide whether to stay or leave during procedures need improvement.