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Mortalities in the neonatal unit: after-hours compared with normal working hours at Pelonomi Tertiary Hospital over a 1-year period (January 2017 to December 2017)
No full textBackground: Neonatal mortality remains one of the leading causes of under-5-mortality in South Africa. South Africa has not reached the Millennium Development Goals targets for 2015 as set out by the WHO. The leading causes for neonatal mortality remains immaturity related (48.1%), complications of hypoxia (24.2%) and infections (11.2%). According to the PPIP and CHPIP program data, many of these deaths do have avoidable factors that are administrative and staff related. If there is a difference found in mortalities when comparing normal working hours with after-hours, then it is possible that administrative and staffing differences for these hours could be a reason for differences seen. This could assist relevant stakeholders to optimize allocation of resources (including staffing) as well as guide further research to investigate possible reasons for differences in mortalities for different time intervals. Objectives: This research set out to investigate whether or not there are differences in the number of neonatal mortalities at Pelonomi Tertiary Hospital, Bloemfontein, when comparing normal working hours with after-hours. If there are differences, then to determine if there are differences in the avoidable factors involved in these mortalities (according to the PPIP and CHPIP data). Method: This was a descriptive, cross-sectional study. The total number of mortalities (January 2017 – December 2017) for normal working hours and after-hours were investigated, and avoidable factors (according to PPIP and CHPIP codes) for these mortalities were compared. Results: A total number of 103 neonatal mortalities for this time period were included in this study. More deaths occurred after-hours (16:00 – 07:30 on weekday, whole weekends and whole public holidays) when compared to normal working hours (all other weekdays 07:30 – 16:00) (n=67, 65.05% vs n=36, 34.95%). When the time frames are divided into after-hours (any day 16:00 – 07:30) and normal working hours (any day 07:30 – 16:00), more deaths occurred after-hours (n=55, 53.4%). Most of these (any day) after-hour mortalities occurred between 16:00 and 00:00 (n=31, 56.4%). The most common causes of death for these neonates reflect the same causes as the national PPIP/CHPIP data, being 1. Infection related (n=26, 25.24%), 2. multi-organ immaturity (n=21, 20.39%) and 3.Complications of hypoxia (n=18, 17.48%). There were no major differences in administrative and staff-related avoidable factors when comparing these different time intervals. Conclusion: This study confirms that during this time period there were more neonatal deaths occurring after-hours when compared to normal working hours at Pelonomi Tertiary Hospital, Bloemfontein. Due to the design of this study we could not conclude whether or not these differences are statistically significant. To optimize allocation of limited resources and staffing, the researcher concludes that further research to determine the factors which may contribute to these differences in mortalities for different time intervals is warranted
Educational recommendations from the knowledge, attitudes and practice of Free State Province paramedics regarding vaccination policies
No full textThe Occupational Health and Safety Act, 1993 (Act no. 85 of 1993) promotes the health, safety and protection of employees against occupational hazards. Although managers are expected to implement the above policy, it remains the responsibility of every employee to ensure their health and safety at all times. However, Healthcare workers (HCWs), in particular paramedics, are at increased risk of contracting infectious diseases due to the hands-on nature of their work. A number of life-threatening infectious diseases have been identified and classified as occupational hazards, which puts paramedics at increased risk - some of which are vaccine-preventable. However, a low compliance with vaccination policies have been reported amongst HCWs, including paramedics. Possible reasons for this phenomenon are investigated and recommendations to enhance future compliance are made from reviewing of the results. The need for appropriate vaccination of paramedics has been identified. Research was therefore required to address this problem and so ensure the preparedness of paramedics when managing patients in the pre-hospital environment. This study developed educational recommendations that may enhance compliance of Free State Province paramedics with vaccination policies. The aim of the study was to explore the knowledge, attitudes and practice (KAP) of Free State Province paramedics regarding vaccination policies, and to develop educational recommendations that may enhance future compliance. This study was done in the field of Health Professions Education (HPE) and lies in the domain of pre-hospital Emergency Medical Care (EMC). In this study, the researcher explored the KAP of Free State Province paramedics with reference to their compliance with vaccination policies. The researcher made use of an explorative, non-experimental research design. Questionnaires were used to collect quantitative data which were statistically analysed and presented as percentages and frequencies, and reported on in tables and figures. Additionally, the literature study conducted in conjunction with the findings of this study provided reasons for paramedics’ low compliance with vaccination policies within the Free State Province. The findings of the study became the basis from where educational recommendations to enhance paramedics’ compliance with vaccination policies, was derived. This study contributes to Health Professionals, in particular paramedics, being more informed about the risks associated with exposure to occupational hazards. It is recommended that paramedics be vaccinated in order to be protected against vaccine preventable infection and diseases
Knowledge, attitude and practices of health care providers on smoking cessation intervention – a case of Sol Plaajtie Subdistrict, Northern Cape
No full textBackground: Clinicians are crucial in influencing smokers to quit through provision of behavioural (counselling) or pharmacological smoking cessation interventions. Numerous studies conducted across different parts of the world indicate an increase in smokers who quit with assistance compared to those without. However in-order for healthcare providers to efficiently offer this advice; they need to be equipped with the right knowledge on smoke intervention and possess the right attitude and willingness to counsel their patients on smoking cessation. Objective: To determine the knowledge, attitude and practises of healthcare providers on smoking cessation intervention strategies in Sol Plaatjies Sub-district in the Northern Cape. Methodology: The researcher made use of a descriptive cross-sectional design with a selfadministered questionnaire aimed at determining the knowledge, attitude and practises of health care providers on smoking cessation intervention. One hundred and sixty five participants were selected to participate in the study from four groups namely; medical officers, professional nurses, enrolled nurses and assistant enrolled nurses. Results: Responses were received from 156 participants constituting 95% of the targeted population. The results revealed that 52% had no knowledge of South African tobacco smoking cessation guidelines highlighting a lack of training on smoking cessation intervention whilst 87% knew the importance of counselling patients on smoking and its impact on quitting. Majority of them did not know the medicines recommended for tobacco treatment in South Africa. Three-quarters (75%) expressed that smoking cessation counselling is an important part of their jobs, but only half of them indicated that they made follow-up arrangements on those attempting to quit. They also cited a number of barriers to smoking cessation interventions mainly due to lack of community-based tobacco cessation treatment centres for referrals as well as unavailability of educational materials among others. Conclusions: The study revealed that most of healthcare workers in the Sol Plaatje District are not aware of the existence of smoking cessation guideline. It was also observed that respondents agree that smoking cessation knowledge is an important element of their jobs and it’s necessary to provide smoking cessation counselling. However, these healthcare providers do not consistently record patient smoke history and quit attempt. They also faced other challenges such as lack of time and unwillingness of patients to quit smoking. Recommendations: It is to improve training and development among healthcare providers in-order to adequately equip them with the right knowledge on smoking cessation as well making available material on smoking cessation; there is also need to open more communitybased tobacco cessation treatment and referral centres for patients to avoid relapse
Feasibility of using the Residential Environment Impact Scale (REIS) and the Assessment for Occupation and Social Engagement (ATOSE) as assessment tools within Engo Residential Aged Care Facilities in the Free State province, South Africa
No full textIntroduction: The occupational wellbeing of elders is influenced by the physical and social long-term care environments in which they live. Elders living in Residential Aged Care Facilities are often exposed to occupational injustices and become institutionalised as a result of an environment that does not provide adequate occupational opportunities, support and stimulation. Purpose: The main purpose of this study was to investigate the feasibility of two occupation-based assessment tools, the REIS and ATOSE within Residential Aged Care Facilities affiliated with the Engo organisation. The REIS and ATOSE have not previously been used within the South African aged care sector or the Engo organisation. Methods: An embedded mixed methods approach with a qualitative focus was employed. The research was conducted in two phases. The first phase saw the researcher administering the two assessment tools within three participating facilities and providing each participating facility with their report containing the REIS and ATOSE findings. The reports contained quantitative statistics as yielded by each assessment, supported with descriptive information yielded by qualitative notes made by the researcher during the assessment period of phase one. During the second phase a discussion group employing the nominal group technique, was held with leadership staff of the participating facilities. Leadership staff considered and deliberated on the findings presented in the reports in order to identify possible enablers and obstacles of using the REIS and ATOSE assessment tools. A thematic analysis was employed during data analysis. Findings: The findings were categorised into two main themes, i.e. organisational culture and occupational justice issues. The findings of the REIS and ATOSE assessments (phase 1) and the nominal discussion group (phase 2) indicated an organisational culture which is dominated by a top-down management approach and distinguished by a medicallydominated care approach. Leadership staff struggled to directly conclude what enablers and barriers exist for using the REIS and ATOSE assessments. The findings of the research process, however, indicate that the assessments yield practical and usable information but the current Engo organisational culture is not receptive to implement the findings. Conclusions: The main contribution of this study is the exploration of two previously unused occupation-specific tools in the South African aged care sector, which presented information about elder communities that occupational therapists should consider when practicing in these environments to effect person-centred culture change
A business generator for online undergraduate programme offering at a Dual-Mode University
No full textDissertation (MBA (Business Administration))--University of the Free State, 2020In the current economic climate, public higher education institutions cannot afford to carry on doing business as usual. This is not only due to increased costs and decreased government funding, but also because the world is increasingly digitalised. Digitisation in the higher education arena has been intensified during the Covid-19 pandemic where staff and students very quickly had to adapt to the so-called “new normal” of working and studying from home, and this trend is likely to continue. Online learning indeed offers a unique opportunity for public higher education institutions to expand their programme offerings, and thus also increase their income. Online programme delivery comes with its own cost, and these must be considered when decisions are taken about this mode of delivery. The main purpose of this study is thus to compare the current financial model used at the distance education campus of one institution with models used by other online universities around the world to improve its ability to inform decision-making with regard to future fully online structured programmes accurately. In addition, the researcher aimed to review knowledge on current financial models available in the literature and described the importance of current financial model variables incorporating the view of other higher education institutions worldwide. A mixed-method approach was used in the study: the qualitative data was collected through interviews and the quantitative data by means of an online survey. Findings suggest that the model used by the institution compares well with other models. All financial model variables included were also included by the other institutions from which respondents hailed. Some important insights were the suggestion to include a market analysis, to ensure higher accuracy with the estimation of student numbers along with the finding regarding the importance of the experience and knowledge of the person capturing the data in the financial model. In conclusion, the study highlighted that the current South Campus business Generator financial model used by the University of the Free State are useful in providing information with regard to future online structured qualifications, especially in the absence of any replacement model. Future developments should include making it more user friendly
and establishing an accountability culture where section heads will take responsibility for the information submitted
Exploring addiction experiences through a sociological lens
No full textThis study aimed to explore the lived addiction experiences of people recovering from addiction challenges through a sociological lens. As a theoretical and heuristic device, the sociological imagination functions primarily as the research study’s ontological framework to adequately illuminate the mentioned sociological lens. While mainstream studies of addiction tend to predominantly focus on psychological and/or medical perspectives, this research endeavour aimed to capture the significance of sociology in the context of addiction experiences. Mainstream disciplines in addiction research tend to locate addiction as a phenomenon that mainly occurs at the level of the individual, often creating a platform for stigmatisation and labelling. Contextual and situational aspects of people struggling with or recovering from addiction challenges tend to merely suffice as additional factors that might be considered as optional when conceptualising addiction. The sociology of addiction aims to conceptualise addiction as a complex social event that should be understood within its contextual significance. The current research study was conducted within the qualitative methodological framework. The primary aim was to construct narratives from the subjective experiences of people recovering from addiction challenges, ultimately capturing the sociological significance in their personal account of addiction experiences. Six research participants involving people recovering from addiction challenges were the primary sources of data for this research endeavour. The participants’ subjective account of addiction experiences was captured by using in-depth interviews, which mainly comprised of unstructured or open-ended questions to encourage an uninterrupted form of storytelling from the participants. The data was analysed using the narrative-thematic analysis technique, which ultimately allowed for the construction of themes to capture the participants’ lived addiction experiences and how they made meaning of these experiences. This analysis technique or method gave rise to three main themes and nine sub-themes. Through exploring addictive interpellation, the reality of addiction encounters, and addiction as a fabrication mechanism, sociocultural influences associated with addiction experiences illuminated the importance of socio-cultural change as a driving force of understanding addiction. To capture the significance of socio-environmental influences associated with addiction experiences, addiction as a remissive companion, sociologically imagining addiction onset and recovery, and the nature of relationships and identities within lived addiction experiences were themes that were explored and developed. To sociologically explore the gap of addiction ideology, the double bind of community and various body problems and illness narratives were used to make sense of the data. Finally, because of the addiction career's fluctuating nature, the suggestive “narrative of phronesis” was developed to attempt to capture the lived experiences of people who find themselves in the clutches of the addiction career
Sustainable farmer livelihoods and enhancement of food security in Mbhashe Municipality, Eastern Cape Province, South Africa
No full textThe present study aimed to investigate how smallholder farmers use sustainable farming practices and how this contributes to their household and food security. Data were collected from 130 smallholder farmers residing in Mbhashe Municipality in the Eastern Cape, South Africa. The approach used in this study combined household survey on sustainable agricultural practices and food security in five villages in Mbhashe Municipality. A total of 62 percent of the respondents stated that they do not use artificial mineral fertilisers. Their reasons were not connected to using sustainable farming practices; however, it ranged from lack of subsidies from the government and expensive inputs. Meanwhile, 49 percent of the respondents used animal manure because it is readily available and cheaper compared to artificial fertilisers. On the other hand, 39 percent of respondents used pesticides and the remainder did not use it because of lack of finance. The results of the regression model show that five variables namely; age, education, farm size, membership in association, household size, extension visits and farmers’ perceptions were statistically significant in influencing the utilisation of Sustainable Agricultural Practices (SAPs). This implies that perceptions of farmers, education, gender, membership in an association and credit access were important factors in SAPs adoption. In terms of food security, 81 percent households were food secure in the study area. Rarely has there been situations where there is no food to eat. However, 35 percent of respondents of those who faced food shortages stated that they do so in June/July. This is the winter period were fields are usual dry, especially in the rural areas. The main cause of food shortages was mainly due to unemployment, lack of finance and weather conditions. In order to improve SAPs utilisation in South Africa, it is necessary for the government to provide incentives and provide a legal framework that will allow more organisations to provide extension services to their communities. The creation of such a framework will increase autonomy for agricultural associations to provide specialised knowledge to their areas of jurisdiction. The study proposes a model that will bring sustainability if well implemented
Factors affecting time and cost overruns in road construction projects in a Metropolitan Municipality of the Free State Province
No full textDissertation (MBA (Business Administration))--University of the Free State, 2020Time and cost overruns in construction projects remain a significant challenge facing
the construction industry worldwide. The purpose of this study was, therefore, to
assess the most significant factors affecting time and cost overruns in road
construction projects in a metropolitan municipality of the Free State Province to
facilitate the formulation of comprehensive mechanisms to enhance project
performance. The study employed a quantitative research approach and cross-sectional research
design. A structured questionnaire was developed from 61 factors identified in existing
literature as the leading causes of time and cost overruns in construction projects. The
questionnaire was reviewed by the study supervisor and industry experts to guarantee
the face validity of the study and thereafter piloted with five industry practitioners before
distribution. The final questionnaire was disseminated to 66 purposively nominated
participants classified into three groups, namely, client (12), consultant (21), and
contractor (33). The respondents were nominated based on their direct participation in
47 selected road projects completed between July 2014 and March 2020. The
response rate for the valid questionnaires was 56% (37 out of 66). The empirical data
were analysed using the Relative Importance Index (RII), Importance Index (IMPI), and
weighted RII and IMPI methods to identify the hierarchical order of importance of the
61 variables on the performance of the road construction projects in the municipality.
The Spearman's rank correlation coefficient was employed to assess the degree of
correlations of perceptions between the respondent groups on the subject. Cronbach's
alpha was used to evaluate the reliability of the survey instrument.
The study found that 83% (39 out of 47) of the selected projects experienced time
overruns, with an average overrun percentage of 107.33%. Out of the sample projects,
44.68% (21 out of 47) experienced cost overruns with an average overrun percentage
of 24.48%. Using the weighted RII and IMPI methods, the study identified the top ten
variables contributing to the poor performance of projects from the collective responses
of all the participants to be: appointment of contractors with political clout; contractor's
cash flow; community disruptions; labour unrest; corruption; delays in progress
payments; subcontracting challenges (dispute and performance); under-pricing of the work due to strategic misrepresentation; under-pricing of the work due to overconfidence in own ability; and appointment of consultants with political clout. The
Spearman's rank correlation results indicated an overall high agreement between the
client and consultant groups (0.79), consultant and contractor groups (0.75), and client
and contractor groups (0.68) for the weighted RII and IMPI indexes. The questionnaire
was found to be reliable with a Cronbach's alpha value of 0.97.
The study recommends the following key measures to improve the performance of
projects at the municipality: vetting bidders and supply chain management
practitioners; appointing qualified and competent staff with integrity; developing a
comprehensive financial plan by contractors; introducing payment guarantee clauses
in contracts for advance payments and delayed progress payments; conducting a
comprehensive risk assessment during the bidding process; blacklisting service
providers caught practising bribery; conducting adequate public participation;
introducing capacity development programmes; paying wages in line with BCCEI and
standardising wages among all the contractors working in a site; ring-fencing the
project budget; limiting subcontracting to projects equal to or above R30 million;
appointing experienced subcontractors that are registered with the CIDB;
implementing cession payments for subcontractors; and appointing competent cost
estimators by the contractors
Exploring the experiences in mainstream schools with the implementation of the Policy on Screening, Identification, Assessment and Support (2014)
No full textThe aim of this qualitative study was to explore the experiences in mainstream schools with the implementation of the Policy on Screening, Identification, Assessment and Support (SIAS policy) of 2014. As I was interested in discovering reality through the experiences of members of the School-Based Support Team (SBST), my study was informed by interpretivism. Premised on interpretivism as my paradigmatic orientation, I focused on the participants’ multiple experiences with interpretations of the SIAS policy. In order to realise the research aim, my study evolved through logically sequenced chapters. Although the chapters are interrelated, each chapter responded to a specific research question and objective, and involved a particular research method. A literature review enabled a conceptual understanding of a global perspective on disability, the international treaties on inclusion and various theories on inclusion. Against my understanding of the medical model of disability, the social model of disability, the theory of full-inclusion and the theory of inclusive special education, I considered how inclusive education is implemented in four countries. I concentrated on two developing countries in the global south, namely Zimbabwe and Lesotho, and two developed countries, namely Finland and Italy. To contextualise the study, I give a brief overview of the trajectory of inclusive education in South Africa. After South Africa became a democracy in 1994, its position on inclusive education shifted from the medical model of disability to the social model of disability. As such, attempts were prompted to reduce the barriers found in society for those with disabilities. This attempt resulted in the enactment of various education policies aimed at the inclusion of all learners in education. A document analysis was undertaken to foreground a policy framework for inclusive education. The framework consists of the Constitution of the Republic of South Africa (1996), the South African Schools Act (1996), the National Education Policy Act (1996), and Education White Paper 6: Building an Inclusive Education and Training System (2001). The commonality in all of these documents is the advancement of inclusion. In drawing on this legislative framework, I was able to position the SIAS policy in relation to the fundamental principles that drive inclusive education in South Africa. In order to explore the experiences in mainstream schools with the implementation of the SIAS policy, I conducted focus group interviews with members of the SBST’s and semi-structured interviews with vice-principals of three primary schools. These schools varied in terms of their quintile categorisation, ranging from quintile level 3 to 5. The findings centred on themes relating to the SIAS process, challenges experienced by the schools and recommendations for a more sufficient implementation of the SIAS process. The findings revealed challenges such as insufficient school readiness, a lack of parental involvement, elongated processes, teacher’s attitudes and inadequate resources. The need to simplify the forms of the SIAS process, and the need for in-service training were brought to the fore. Based on the findings of this study, I made suggestions for improved resources provisioning, skills development for teaching staff who are required to support learners who experience barriers to learning, and the strengthening of relationships between the school and the DBE, and also with parents. In addition to proving some insight in the experiences in mainstream schools with the implementation of the SIAS policy, the study also implicates an existing gap between policy expectations and school realities
Social capital as a resource for in-service teacher development and support
No full textAccording to literature, teachers can improve their learners‘ academic results by applying social capital in their teaching. However, through my experiences as a mentor, my participation in mentoring courses, and my study of appropriate literature, I identified a gap between practice and literature. Although theory regarding social capital and its application to education is well developed, as is theory about mentoring, explicit application of social capital in education, in the context of in-service professional development and support of teachers through mentoring, appeared to be absent. In an attempt to address this identified gap in practice, I modified my approach to mentoring mathematics teachers in previously disadvantaged, low quintile South African schools to focus on the promotion of social capital. I implemented this mentoring model, derived from a review of the literature and my four years‘ experience as part of the University of the Free State‘s School Partnership Project (UFS SPP). I adopted an informal, individual approach in which I primarily modelled using the domains of social capital implicitly, with some explicit discussion sessions as opportunity allowed. During the fourth year, I conducted the empirical part of this research in an attempt to address the identified gap in the literature. In order to investigate how I, in my role as a mentor, and the teachers whom I mentored, understood and applied social capital in the classroom, I employed a qualitative case study design. Data were collected by participant observation during my interactions with eight teachers from four low quintile schools involved in the UFS SPP mentoring programme. Data were collected using field notes made during classroom observations, reflective journaling, and semi-structured interviews. Data collection was continued until a point of data saturation was achieved. Thereafter, I used qualitative data analysis with a combination of inductive and deductive analyses. Bourdieu‘s theory on social capital was deductively used as analytical hook to construct consistent indicators for my research. While organising the data, I used inductive data analysis to form general sub-themes. The findings revealed that, by the fourth year of the programme, the teachers were still only using social capital to a minimal extent. I suggest that this is due to constraints of habitus and/or field, and that this underutilisation of social capital perpetuates these constraints. It appeared that some variations observed in both habitus and field were associated with some variation in using social capital, suggesting possible conditions under which such a mentorship programme is more likely to be successful. The significance of this research is the explicit explanation of the importance of social capital in teaching and learning; how it can be applied as a resource for optimal school education; and the value of social capital through mentoring teachers in in-service teacher development and support programmes. Furthermore, it accentuates the difficulty of the implementation of social capital in teaching and learning, pointing to the need for further research