Scielo RSS <![CDATA[Curationis]]> vol. 33 num. 2 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>An investigation into the level of empowerment of rural women in the Zululand district of KwaZulu-Natal province of South Africa</b>]]> The aim of the study was to evaluate the outcome of the empowerment of rural women in relation to gender issues, power, and communication within the Zululand District of KwaZulu-Natal in South Africa after implementation of a four-year Primary Health Care project in partnership with the Provincial Department of Health, and two Schools of Nursing at the University of KwaZulu-Natal and McMaster University in Canada. This project is based on substantial evidence which reveals that rural women are being neglected to the extent that these women have missed out on opportunities for development. The reasons for this disempowerment of women, particularly rural women, are thought to be due to the feminisation of p'overty, as well as femalesubmission, educational deprivation, privacy of domestic violence, exploitation, domination by men and cultural oppression (patriarchy). A qualitative research approach was used. Focus group discussion was utilised as the data collection technique, and this was also applied during the collection of baseline data. An interview guide covered issues of concern in the communities and households, including what the women would, or had done about these, how they engaged in decision-making in their families, how they handled situations when there was a difference of opinion, and their awareness of, and ability to claim their rights, including control of their lives. The data was collected from six clinics, from groups of six to ten women in the predominantly rural Zululand District of KwaZulu-Natal. The project has revealed improvement in the women’s realisation of their rights, albeit limited, in communication, self-confidence, and reliance, including partnerships between Primary Health Care Nurses and women’s groups. The formation of women’s groups facilitated community development and participation in their own health, socio-economic and emotional development. The project suggests that such groups be encouraged and allowed to network for support as they understand their own problems better, they merely require facilitation. <![CDATA[<b>Perceptions of clients regarding family planning service delivery in a clinic of the Greater Johannesburg Metropolitan Council</b>]]> Unwanted pregnancies with their negative impact on both women and children occur on an ongoing basis in Gauteng, South Africa. One way to prevent unwanted pregnancies is to use a reliable contraceptive method available free of charge from primary health care clinics providing family planning services throughout Gauteng Province. A literature review was completed on women and access to family planning services and an interview schedule (questionnaire) was developed. The purpose of this study was to describe guidelines to meet the expectations of clients accessing family planning services provided by a clinic in Region F, Area 28 of the Greater Johannesburg metropolitan council. This quantitative, exploratory, descriptive and comparative study measured the gaps between the expectations of participants on service delivery and the extent to which these expectations were met. A convenience sample was conducted and consisted of 50 women of reproductive age (ages 15 to 49) attending the family planning clinic. Pre-testing of the instrument was conducted. Structured interviews with a interview schedule were conducted before and after women attended a family planning service. Inferential statistics indicated that there was a significant gap between the client expectations of family planning service delivery and the extent to which these expectations were met. Of the sixty-four items where women indicated the extent of their expectations the findings on only three items were not statistically significant. These gaps were addressed by proposing managerial guidelines to be implemented by the nurse manager in charge of the facility, on which this article will focus. Validity and reliability principles were ensured in the study. Ethical principles were adhered to during the research process. <![CDATA[<b>Experiences of physical violence by women living with intimate partners</b>]]> Intimate partner violence directed towards females by male partners is a common significant global public health problem. Most victims of physical aggression such as women and children are subjected to multiple acts of violence over extended periods of time, suffering from more than one type of abuse, for example physical which is more symbolic and evidenced by scars. The purpose of this study is to increase understanding of the symbols of physical violence as experienced by women who live with intimate partners in the Vhembe district of the Limpopo Province. The research design of this study was qualitative, exploratory and descriptive in nature. The accessible population was those participants who used the trauma unit A in a particular hospital. Seven women comprised the sample of the study. In-depth individual interviews were conducted exploring the women's experiences in the context of physical violence. From the data collected all seven participants experienced some form of physical violence which resulted in permanent deformity. They experienced some form of battering such as kicking, stabbing, burning, fracturing, strangling and choking. Recommendations were made that health care providers are encouraged to implement screening for physical violence, to provide appropriate interventions if assault is identified and to provide appropriate education regarding, employment opportunities, legal literacy, and rights to inheritance. Human rights education and information regarding domestic violence should be provided to them because this is their absolute right (UNICEF, 2000:14). <![CDATA[<b>Knowledge related to nutrition and hypertension management practices of adults in Ga-Rankuwa day clinics</b>]]> Hypertension is a global, non-communicable chronic disease being asymptomatic and known as the silent killer with signs and symptoms only occurring when a target organ is damaged. Being a condition common in South Africa, hypertension is also a risk factor for cerebro-vascular incidents, myocardial infarction, left ventricular hypertrophy, renal disease and retinopathy. Black adults in an urban environment appear to be especially vulnerable to excessive increases in blood pressure. The research question explored was what was the knowledge of hypertensive adults attending day clinics in Ga-Rankuwa regarding nutrition and hypertension management practices. An exploratory strategy was used as no similar research had previously been conducted in Ga-Rankuwa. A cross sectional survey design was used to investigate hypertensive adults attending the three primary health clinics in Ga-Rankuwa. The sampling method was convenient and the sample size 101 participants. Two data gathering methods were used, these being physical measurements and self-report. For the self-report, a structured interview was conducted. The data were analysed using descriptive statistics. The results indicated a lack of knowledge regarding nutrition and management of hypertension. The proportion of participants with uncontrolled hypertension was high (58.6%) and non-compliance with medication occurred frequently (58.1%). A third (28.7%) of the sample lacked knowledge of the complications of hypertension (28.7%). A community-based intervention, based on the results of the study, is recommended. <![CDATA[<b>Perceptions of registered nurses in four state health insititutions on continuing formal education</b>]]> This study investigated registered nurses in four selected state health institutions' perceptions with regard to continuing formal education. The relevance of continuing formal education is being emphasised globally by the increasing quest for quality assurance and quality management systems within an ethos of continuous improvement. According to Tlholoe (2006:5), it is important to be committed to continual learning, as people's knowledge become less relevant because skills gained early in a career are insufficient to avoid costly mistakes made through ignorance. Continuing formal education in nursing is a key element to the maintenance of quality in health care delivery. The study described: • registered nurses’ views on continuing formal education • registered nurses’ perceived barriers to continuing formal education A quantitative descriptive survey design was chosen using a questionnaire for data collection. The sample consisted of 40 registered nurses working at four state health institutions in the Western Cape Province, South Africa. Convenience sampling was selected to include registered nurses who were on duty on the days during which the researcher visited the health institutions to distribute the questionnaires. The questionnaire contained mainly closed-ended and a few open-ended questions. Content validity of the instrument was ensured by doing a thorough literature review before construction of items and a pretest. Reliability was established by the pretest and providing the same information to all respondents before completion of the questionnaires. The ethical considerations of informed consent, anonymity and confidentiality were adhered to and consent to conduct the study was obtained from relevant authorities. Descriptive statistics, based on calculations using the Microsoft (MS) Excel (for Windows 2000) programme, were used to summarise and describe the research results. The research results indicated that most registered nurses perceive continuing formal education as beneficial to their personal and professional growth and that it could lead towards improving the quality of patient/client care, but barriers exist which prevent or deter them from undertaking continuing formal education programmes. The main structural barriers included lack of funding and lack of coherent staff development planning and physical barriers including job and family responsibilities. <![CDATA[<b>Revitalization of clinical skills training at the University of the Western Cape</b>]]> Most educational institutions that offer health related qualifications make use of clinical skills laboratories. These spaces are generally used for the demonstration and assessment of clinical skills. The purpose of this paper is to share our experiences related to the revitalization of skills training by introducing the skills lab method at the School of Nursing (SoN), University of the Western Cape (UWC). To accommodate the contextual changes as a result of the restructuring of the higher education landscape in 2003, the clinical skills training programme at UWC had to be reviewed. With a dramatic increase in the student numbers and a reduction in hospital beds, the skills lab method provided students with an opportunity to develop clinical skills prior to their placement in real service settings. The design phase centred on adopting a skills training methodology that articulates with the case-based approach used by the SoN. Kolb's, experiential learning cycle provided the theoretical underpinning for the methodology. The planning phase was spent on the development of resources. Eight staff members were trained by our international higher education collaborators who also facilitated the training of clinical supervisors and simulated patients. The physical space had to be redesigned to accommodate audio visual and information technology to support the phases of the skills lab method. The implementation of the skills lab method was phased in from the first-year level. An interactive seminar held after the first year of implementation provided feedback from all the role players and was mostly positive. The results of introducing the skills lab method include: a move by students towards self-directed clinical skills development, clinical supervisors adopting the role of facilitators of learning and experiential clinical learning being based on, amongst others, the students' engagement with simulated patients. Finally, the recommendations relate to tailor-making clinical skills training by using various aspects of teaching and learning principles, i.e. case-based teaching, experiential learning and the skills lab method. <![CDATA[<b>An information system to manage the rollout of the antiretroviral treatment programme in the Free State</b>]]> The Acquired Immune Deficiency Syndrome epidemic, caused by the Human Immunodeficiency Virus, is a global crisis which threatens development gains, economies, and societies. Within sub-Saharan Africa, where the epidemic began the earliest and the HIV prevalence is the highest, African countries have death rates not seen before. In South Africa the epidemic has a devastating impact which creates profound suffering on individuals and their families, and the impact on the socio-economic level is of great concern. The eradication of HIV/AIDS represents one of humanity's greatest challenges, which requires co-operation and comprehensive collaboration between many different role players. In this endeavour clinical information plays a major role. To combat the effect of the disease, the Free State Department of Health started with the provisioning of antiretroviral therapy in the public health sector. The objective of this paper was to address the challenges they faced in order to develop and implement an information system to manage the rollout of antiretroviral treatment effectively. They started with a paper-based system to collect vital information. It was followed by a palm computer project that was initiated to electronically capture the data collected by the paper-based system. This system was then replaced by a comprehensive Hospital and Clinic Information System which was acquired and customised for the antiretroviral data collection process. Research partners developed a standalone antiretroviral data warehouse for collecting information associated with the monitoring and evaluation of the Free State antiretroviral and HIV/ AIDS treatment programme. The data warehouse successfully produced several management information reports to the antiretroviral management team. A need was identified to design a comprehensive antiretroviral data warehouse that will integrate data from several operational sources which are all associated with HIV/AIDS. <![CDATA[<b>Exploring the challenges of implementing participatory action research in the context of HIV and poverty</b>]]> HIV/AIDS is having a devastating impact on South Africa and particularly on poor communities. Empowerment of communities has been identified as an important step towards mitigating the consequences and helping communities to overcome the challenges presented. Participatory Action Research (PAR) has been identified as a useful methodology for the purpose of facilitating empowerment. This study explores the challenges involved in implementing PAR in the context of HIV/AIDS and poverty. In this article, the author describes a PAR project that took place in 2003/ 2004 with a group of five Xhosa speaking people living with HIV/AIDS in Masiphumelele, Cape Town. The aims of the study were to: 1. Create an opportunity for the participants to engage in a participatory process aimed at self-awareness and empowerment. 2. To record and analyse this process with the intention of producing insight into the use of PAR in the context of poverty and HIV/AIDS and to identify the challenges involved. The findings of this study highlight some important insights into the process of engaging people in the PAR process and the experiences of HIV positive people living in the context of poverty. The study explores the challenges involved in the process of empowerment and examines the process of "transferring" power and control from the researcher to the participants. Challenges were uncovered both from the point of view of the researcher who had to "let go of control" and participants who had to take on control. Participants struggled with issues of low self-efficacy and learned helplessness. Fluctuations in health also contributed towards alternating periods of hope and despair and these problems had an impact on their motivation to participate in the study. Lack of motivation to participate is a challenge highlighted in the literature and explored in this study. Participation is necessary for a study of this nature to be of benefit to the community, but unfortunately those most in need were found to be least likely to participate. The study also critically examines the research process that was conducted and highlights the positive and negative contribution of the process towards empowerment. Certain aspects of the research process, including the contracting process, were identified as being problematic as they emphasize the power and control of the researcher rather than the participants. Recommendations for future research include: Promoting participation among the disempowered; the Contracting process and Power relations in PAR.