redakteurl editor - african index medicusindexmedicus.afro.who.int/iah/fulltext/hsag/6.1/vol 6.1...
TRANSCRIPT
Geakkrediteerde Interdissiplinere Navorsingstydskrif Accredited Interdisciplinary Research Journal
lnhoud I Contents
Editorial comment1 Redaksionele kommentaar
Academic achievement and time concept of the learner
Ethical standards for the occupational health-nursing practitioner regarding the HIV positive person in the workplace
Diagnosis of vaginal infection in pregnancy
The experience of biological fathers of their partners' termination of pregnancy
Support for adult biological father during termination of their partners' pregnancy
A model for psychiatric nursing accompaniment of the patient with mental discomfort: Part Ill
Report: Visit to California State University: Los Angeles and Dominiquez Hills Campuses: 1-7 August 1999
tioll. 6 No. 1 2001
Redakteurl Editor Prof. Marie Poggenpoel, GV D.Phil
Departement Verpleegkunde, Randse Afrikaanse Universiteit
Assistent Redakteurl Assistant Editor Prof. Annatjie Botes, GV. D.Cur. Departement Verpleegkunde,
Randse Afrikaanse Universiteit
Tegniese Redakteurl Technical Editor Miss Liselle Keartland
Redaksionele Komiteel Editorial Committee Prof. PJJ Botha (Faculty of Theology, UNISA)
Dr T McD Kluyts (Department of Family Medicine, University of Pretoria)
Dr Malie Rheeders (Pharmacist, PU for CHE) Dr V Roos (Department of Psychology, University of Pretoria)
lnternasionale Adviesraadl International Advisory Board
Dr Judith M Parker (Australia) Dr Joyce Roberts (USA)
Dr Rowena Tessman (USA) Dr Yvonne Sliep (Netherlands)
Miss Maude Storey (UK) Dr JP Wessman (USA)
Administratiewe Assistenti Administrative Assistant
Mr Anthony Goslar
Drukkersl Printers 4 Colour Print
Adresl Address Die Redakteurl The Editor
Health SA Gesondheid Dept Verpleegkundel Nursing
Posbusl PO Box 524 Rand Afrikaans University
Auckland Park 2006
E-posl E-mail hsa@ raua.rau.ac.za
Interdissiplin6re paneel van referentel Inter- disciplinary panel of reviewers
MI NO Adejun~o (Nurse, University of Natal) Mr EJ Arries (Nurse, RAU) Dr ME Bester (Nurse, University of Stellenbosch) Dr MC Beruidenhout (Nurse, UNISA) Prof. SW Booyens (Nnne, UNISA) Dr ELD Boshoff (Nurse, University of the Western Cape) Dr ADH Botha (Nurse, UNISA) Mrs DE Botha (Nurse, UOFS)
\
Dr C Dorfling (Nurse, RAU) Prof. IC Dormehl (Nuclear Physicist, AEC Instihlte for Life Scie Prof. JM Dreyer (Nursz, M S A ) Dr D du Plessis (Nurse, RAU) Mev. E du Plessis (Nurse, PUCHE) Dr PP du Rand (Nurse, UOFS) Dr VJ Ehlers (Nurse, UNISA) Dr WJ Fourie (Nurse, University of Folt Hare) Mrs NM Geyer (Nurse, DENOSA) Dr AC Gmeiner (Nurse, RAU) Prof. M Greeff (Nurse, PU for CHE) Dr J Hugo (Gesondheidsopvoedkundige, University of Stellenbosct Dr K Jooste (Nurse, UNISA) Dr LB Khora (Nurse, University of the North) Mrs H Kirstein (ABSA, Health) Dr WP Kortenbout (Nurse, UWC) Mrs G Langley (Nurse, WITS) Prof. HPP Lotter (Philosopher, RAU) Dr B Louw (Speech-Language pathologist, UP) Dr SN Mahoko (Nurse, University of Vznda) Mrs RN Malema (Nurse, University of the North) Mrs P Mayers (Nurse, UCT) Dr PA Mc Inemey (Nurse, WITS) MIS NM Modungwa (Nurse, University of the North West) Prof. M Mulder (Nurse, UOFS) Prof. ME Muller (Nurse, M U ) Prof. CPH Myburgh (Educator, RAU) Dr M Naudi (Nurse, MEDUNSA) Dr WE Nel (Nurse, RAU) Prof. NJ Ngoloyi-Mekwa (Nurse, University of the North) Prof. A Nolte (Nurse, RAU) Dr D Nrimakwe (Nurse, University of Zululand) Prof. HJ Odendaal (Gynaecologist, University of Stellenbosch) Prof. LH Opie (Cardiologist, UCT) Mrs L Pottas (Speech therapist & Audiologist, UP) Dr E Potgieter (Nurse, UNISA) Dr S Potgieter (Nurse, UNISA) Dr SD Roos (Nurse, RAU) Dr HF Scheepers (Psychologist, RAU) Dr OC Schimange (Gynaecologist, Pretoria) Miss EL Stellenberg (Nurse, University of Stellenbosch) Prof. J Striimpher (Nurse, UPE) Prof. WJ Strydom (Medical Physicist, MEDUNSA) Prof. AD Stuat (Psychologist, RAU) Prof. RAE Thompson (Nurse, UCT) MIS JE Tjallinks (Nurse, UNISA) Dr FM Tladi (Nurse, University of the North) Prof. R Troskie (Nurse, UNISA) Ms Z Tshotsho (Nurse, Dept of National Health) Prof. T Uys (Sociologist, RAU) Dr RH van den Berg (Nurse, UOFS) Dr T van der Meme (Nurse, University of Stellenbosch) Mr DM van der Wal (Nurse. UNISA) Prof. A van Dyk (Nurse, University of Namibia) Prof. JGP van Niekerk (Nurse, UP) Ms SE van Niekerk (Nurse, UP) Dr WJC van Rhyn (Nurse, UOFS) Ms E van Vuuren (Educational Psychologist, UP) Prof. NC van Wyk (Nurse, UP) Dr S van Wyk (Nurse, M U ) Prof MJ Viljoen (Nurse, UOFS) Dr J von dcr Manvits (Nurse, UPE) Prof. I Wannenberg (Nurse, UPE) Prof. EB Wzlmann (Nurse, University of Stellenbosch) Mrs E Woodrow (Clinical Psychologist, UP) Dr TBS Zwane (Nurse, Technikon SA)
HEALTH St/Z GESONDNEID Geakrediteerde Interdissiplingre Navorsingstydskrif
Accredited Interdisciplinary Research Journal
ISSN: 1025-9848 Vol.61No.l - March 2001
2. Editorial comment1 Redaksionele kornmentaar
3 Academic achievement and time concept of the learner - RC Grobler & CPH Myburgh
12 Ethical standards for the occupational health-nursing practitioner regarding the HIV positive person in the workplace - M Otto & AC Botes
21 Diagnosis of vaginal infection in pregnancy - DE Botha & R van der Merwe
28 The experience of biological fathers of their partners' termination of pregnancy - Marie Myburgh, Antoinette Gmeiner & Sandra van Wyk
38 Support for adult biological father during termination of their partners' pregnancy - Marie Myburgh, Antoinette Gmeiner & Sandra van Wyk
49 A model for psychiatric nursing accompaniment of the patient with mental discomfort: Part 111 - M Greeff
60 Report: Visit to California State University: Los Angeles and Dominiquez Hills Campuses: 1-7 August 1999 - Valerie Ehlers
This work is copyrighted under the Berne Convention. In terms of the Copyright Act, No. 98 of 1978, no part of this work may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage or retrieval system, without permission in writing from the publisher.
Die outeursreg van hierdie werk word kragtens die Berne-konvensie voorbehou. Ingevolge die Wet op Kopiereg, No. 98 van 1978, mag geen gedeelte van hierdie werk in enige vorm of op enige manier, elektronies of meganies, insluitend fotokopiering, plaat-en bandopname, of deur enige inligtingsbewaring- en ontsluitingstelsel herproduseer word nie, sondes geskrewe toestemming van die uitgewer.
Health SA Gesondheid (ISSN 1025-9848) is published every three months. The physical or e-mail address of the Editor may be used for the purposes of commenting on the journal in general or published a~ticles in particular; to submit an article for evaluation and possible publication; or to subscribe to the magazine. We draw potential authors' attention to the guidelines for authors as they appear on the inside back cover.
THEEDITORHEALTHSA GESONDHEID,DEFT NURSING,PO BOX 524, RAND AFRIKtWNS UNIVERSITY, AUCKLAND PARK2006
E-mail: [email protected]
M F A I TH C A GFW7NnHFln Vnl 6 Nn 1 - 2001 1
All the articles in this edition address the issue of chal- lenges in a person's ability to actualise hislher own full potential in a quest for health. The health professional's possible contribution to assist a person to meet the chal- lenges is also highlighted in some of the articles. In the first article the conclusion reached by the authors is that secondary school learners can be assisted to be more future directed, manage time well, experience less anxi- ety about the future and be more content with the present in order to achieve well at school. The challenge of operationalising ethical standards for the occupational health-nursing practitioner regarding the HIV positive person in the workplace is highlighted in the following article. Emphasis is placed on the human dignity and human rights of the HIV positive person in the work- place. In another article the accuracy of methods to di- agnose vaginal infection in pregnancy is assessed. This is important for the correct treatment of the infection so that any negative effect on the unborn baby can be pre- vented. Two articles address the issue of biological fa- thers' experience of their partners' termination of preg- nancy. These fathers are challenged by: their powerless- ness related to the inability to have a choice in the deci- sion to terminate a pregnancy, their emotional turmoil related to the impact of the decision on inter-and intrapersonal relationships and the use of psychological defence mechanisms as a way of dealing with the stress- ful effect of the termination of a pregnancy. Guidelines
A1 die artikels in hierdie uitgawe spreek die aspek van uitdagings aan in 'n persoon se vermoe om syihaar eie volle potensiaal te aktualiseer in 'n strewe nagesondheid. Die gesondheidsheroepe se moontlike bydrae om 'n persoon te help om die uitdagings aan te spreek word in sornmige van die artikels aangespreek. In die eerste artikel kom die skrywers tot die gevolgtrekking dat sekondsre skoolleerders gehelp kan word om te presteer deur meer toekomsgerig te wees, tyd te bestuur, minder angs oor die toekoms te beleef en meer tevrede te wees met hul huidige situasie. Die uitdaging om etiese standaarde vir beroepsgesondheidsverplegings- praktisyns ten opsigte van die MIV persoon in die werksplek te operasionaliseer, word uitgelig in die volgende artikel. Menslike waardigheid en regte word benadruk ten opsigte van die MIV persoon in die werksplek. In 'n ander artikel word die akkuuraatheid van metodes om vaginale infeksie in swangerskap te diagnoseer, beraam. Dit IS belangrik vir die korrekte behandeling van die infeksie sodat enige negatiewe effek op die ongebore haba voorkom kan word. Twee artikels in hierdie uitgawe spreek die belewing van biologiese vaders van hnlle maats se besluit om hul swangerskap te termineer aan. Hierdie vaders word gekonfronteer met: hulle magteloosheid verwant aan hulle posisie om 'n keuse te h& in die besluit om 'n swangerskap te termineer, hulle emosionele ervarings wat 'n invloed het op hulle inter- en intrapersoonlike verhoudings en die gehruik
are described for the advanced psychiatric nurse practi- van psigologiese verdedigingsmeganismes om die tioner to support these biological fathers in mobilising spanningsvolle effek van die terminasie van swangerskap their resources and therefore promote their mental health te hanteer. Riglyne word beskryf vir die gevorderde as an integral part of health. This edition ends with an psigiatriese verpleegpraktisyn om biologiese vaders te article on a theoretical framework of reference for psy- ondersteun om hul hulpbronne te mobiliseer om hulle chiatric nurses on how to accompany a patient with geestesgesondheid te bevorder as 'n integrale deel van mental discomfort. This edition of Health SA gesondheid. Hierdie uitgawe eindig met 'n artikel oor Gesondheid thus provides information on several chal- 'n teoretiese raamwerk vir psigiatriese verpleegkundiges lenges facing us in the health sector and also possible oor hoe om 'n pasient met geestesongemak te begelei. ways of assisting persons to meet these challenges by Hierdie uitgawe van Health SA Gesondheid voorsien mobilising resources in the promotion of their health. dus inligting oor verskeie uitdagings wat ons in die
gesondheidsektor in die gesig staar asook moontlike optredes om persone te help om hierdie uitdagings te hanteer deur die mobilisering van hulpbronne in die hevordering van hulle gesondheid.
Marie Poggenpoel Editor
Annatjie Botes Assistant Editor
Marie Poggenpoel Redakteur
Annatjie Botes Assistent-redakteur
2 HEALTH SA GESONDHEID V01.6 No.1 - 2001
RESEARCH
ACADEMIC ACHEVEMENT AND TIME CONCEPT OF THE LEARNER
RC Grobler BSc.; DEd.; NSED
Lecturer: Dept Education Sciences
Rand Akikaans University
CPH Myburgh BSc. Hons.; MCom.; DEd.; HED
Professor, Dept Education Sciences
Rand Afrikaans University
ABSTRACT
The time concept and academic achievement of a group of high school learners were investigated and the
results are described in this article. The focus was on: the differences between the time concept of high
achievers and the time concept of low achievers; the dvferences in the time concept of high achievers and
low achievers according to their mother tongue; and the educational implications of the findings with
respect to the learners. These learners' time concept was measured by the application of a structured
questionnaire. A group of1 436 learners were involved in this research. Their academic achievements were
rated on a scale of 0 to 100. Two groups were identrj'ied: high achievers and low achievers. A difference was
found in the time concept of these two groups. Furthermore, the learners were divided into their various
mother tongne groups that would give an indication of their time concept with which they grew up. The
Afrikaans- and English speaking high achievers were more future directed, more conscientious in their time
management, experience less anxiety about the future, were less focussed on the present and were more
content with the present and the past than the low achievers. Among the learners with an African language
no statistical significant difference were found between the high and low achievers, only 15,3% of them
were high achievers. The learners with an African language need to be assisted to develop a linear and
integrated time concept. Only then these learners will be able to actualise their fill1 potential.
OPSOMMING
Die tydkonsep err akadeirriese prestasie van 'n groep hoerskool leerders is ondersoek en die resultate is
beskqf in hierdie artikel. Die fokzrs was op: die verskille tussen die tydkonsep van hoe presteerders en die
tydkonsep van lae presteerders; die verskille in die tydkonsep van hoe en lae presteerders verdeel volgens
hzille moedertaal; en die opvoedkundige implikasies van bevindings vir leerders. Hierdie leerders se tydkonsep
was gemeet deur die toepassing van 'n gestruktureerde vraelys. 'n Groep van 1 436 leerders is in hierdie
ondersoek betrek. Hulle akademiese presfasies is gegradeer van 0 tot 100. Twee groepe is ge?dentzj'iseer:
hoepresteerders en laepresteerders. 'n Verskil is gevind in die tydkonsep van hierdie twee groepe. Verder is
die leerders volgens hzllle onderskeie moedertaalgroepe verdeel wat 'n aanduiding sou gee van die ~dkonsep
bvaarmee hulle grootgeword het. Die Afrikaans- en Engelssprekende hoepresteerders is meer toekomsgerig,
meer konsensieus in hulle tydbestuui; ervaar minder toekomsangs, is minder op die hede gerig en is meer
- - - -
H F A l TH S A GFSONDHEID V01.6 N0.l - 2001
tevrede met die herie en verlede as die lae p~~esteerderc.. By die Afn'kataal1eerder.s is geen statisties beduidende
verskil gevind tussen die hoe en lae presteerders nie, slegs 15,3% van hrrlle is hoepresteerders. Die leerders
met 'n Afrikat~zal moet begelei word om 'n line& en gektegreercle fydkonsep te ontwikkel. Slegs dun sal
hierdie leerders by magte wees om hrllle volle potensicral te aktualiseei:
INTRODUCTION
It has become clear that not only do the learners in
our schools need to be given knowledge, they need
to be given cognitive skills (thinking skills) which
will enable them to cope with new, increasingly
more complex or difficult problems in a satisfac-
tory manner. According to Kaplan (in Marais,
1999:l) schools must therefore "educate for men-
tal health. One of these more complex problems
may be seen as the clamant need for higher aca-
demic achievements that make greater demands,
both on educators (parents and teachers) and learn-
ers (Grobler, Myburgh & Kok, 1998:l). It has be-
come vital for the educator to try and find answers
to how helshe can assist learners towards higher
academic achievement, as this seems to be of ut-
most importance for the development of a positive
self-concept of learners. If a learner does not
achieve well at school, hisker affective develop-
ment, which is emphasised by the mental health
movement (Marais, 1999:2), may be hampered.
There are various factors that could play a role in
academic achievement. Myburgh, Grobler and
Niehaus (1999: 165-178) found in their research that
some of the predictors of scholastic achievement
include IQ, self-concept, time concept and
background characteristics. In reference to time
concept one important fact may be that the timely
completion of assignments promotes the attainment
of scholastic and cognitive skills and capabilities.
The timely addressing of assignments that can be
related to effective time management (Gmeiner &
Poggenpoel, 1997:lO) is one of the aspects of the
ways that one can attend to in hisher everyday
management of life. According to Ben-Baruch,
Myburgh, Wiid and Anderssen (1 990:62) time and
the conceptions thereof are " ... inseparably
associated with achievement and success". This
statement encapsulates the relationship between
mental health, time management, the experience
of success and a healthy self-concept.
PROBLEM STATEMENT
Due to political and social changes and the
influence of these changes on education structures,
leamers in South Africa are placing new and even
higher demands on academic achievement. The
need for higher achievement is also demanded by
the modem technological society. These demands
make it more problematic for the learners to cope
with the expectations, and if they do not develop
some capacity to live with these stressful sihlations,
it might have an indirect effect on the individual
learner's mental health. The problem is that the
majority of South African learners are not
sufficiently equipped for academic achievements.
In the introductory paragraph it was quoted that
time concept is associated with achievement and
success. What then is an appropriate time concept
that may support academic achievement and mental
health and who are the learners that are not
sufficiently equipped for academic achievement?
Against this background the problems addressed
in this research project were demarcated as:
How does the time concept of leamers with
a high average in academic achievement
(high achievers) differ from the time
concept of learners with a low average in
academic achievement (low achievers)?
How does the time concept of high
achievers and low achievers differ
according to their mother tongue'?
What are the educational implications of
the above for the learners?
4 HEALTH SA GESONDHElD V01.6 No.1 - 2001
AIM OF THE ARTICLE
The time concept of a group of high school learners
was investigated. It is the aim of this article to
describe the:
differences between the time concept of
high achievers and the time concept of low
achievers;
differences in the time concept of high
achievers and low achievers according to
their mother tongue; and
educational implications of the findings
with respect to the learners.
THEORETICAL PERSPECTIVES
Time concept in mental health perspective
Jaques (1982: 15) has distinguished two dimensions
of time: chronological time and experiential time.
Chronological time refers to the sequential
characteristic of time that is measurable by
chronometers or watches, in other words "watch
time" or "calendar time" (Burgers, 1993:29). This
refers to the time of events with a definite
beginning, middle and end. This measurable
characteristic of chronological time is of utmost
impoflance to regulate society and relationships.
An inevitable implication of chronological time is
that time as such is divided into a past, a present
and a future. From the past the human being is
planning in the present for the future. Through this
planning, meaning is attached to the fuhlre and he/
she thus directs himherself towards the future. If a
person experiences that he or she cannot cope or
live up to offer self-set standards this might be an
obstacle to hisiher experience of mental health.
In contrast to chronological time, experiential time
relates to the human being's intentions, needs and
aims (Jaques, 1982:14-16). Concerning the
experiential dimension of time, Ben-Baruch
(1985:25-34) has distinguished three basic ways of
viewing time:
Time is cyclic - i.e. rhythmic and repetitive;
thus it is not a scarce resource and there is
no reason why there should be any haste
because it is plentiful. A productive
inclination in this case is absent to a large
degree and it is expected that scholastic
achievement and the importance thereof
will not enjoy a high priority.
Time is linear and infinite (unlimited or
endless) - i.e. time is experienced as
flowing constantly in one direction; the
human being must plan to obtain certain
results within an irreversible, though
prolonged and extensive period. In this case
it is expected that scholastic achievement
and striving towards it will enjoy higher
prominence, but as time is plentiful the
importance of, and aproductive inclination,
will still be largely absent.
Time is linear and limited - i.e. time is
measured and restricted, the human being
involved is placed under the pressure of
time limits to meet the demands set to
complete tasks and assignments. In this
case it is expected that academic
achievement and a productive inclination
will be highly emphasised.
These three views of time are not necessarily
mutually exclusive, although one of these modes
might he more prominent at a specific point in time.
In other situations one of the other two modes of
experiencing time might be more dominant. It
should be clear that the dominant way of viewing
time in a specific situation will definitely play a
role in the way in which the individual experiences
and treats the demands of time constraints.
A learner is "taught" in the home and especially in
school to orgauise time and utilise it purposefully,
in other words, to he bounded and restricted by time.
This can happen intentionally or unintentionally.
According to Ben-Baruch (1985:32), the school
purposefully acquaints the learner with the linear
and limited time mode. Achievement at school and
also later in life can be attributed to this time
concept as it is characteristic of the technological
society in that it sets the pace for the economy.
Fraisse (in Gormann & Wessman, 1977:32) states
that the complete development of the time concept
only occurs in the late adolescent years.
Time concept and culture
The differences in time concept between cultural
groups are prominent when the modem, Western,
technological oriented perspective is compared with
the time perspective of the more traditional oriented
people (Burgers, 1993:36). In the modern, Western,
technological community it is believed that 'time
is money' while traditional African cultures are not
concerned about time because 'he is not a slave of
time' (Mbiti, 1967:34).
Different communities have different group
interpretations of time, according to the cultural
heritage of a specific group (Grobler, 1998:50). The
average Westerner holds a linear view of time where
time is restricted while the traditional African sees
time as cyclic and a plentiful source. The inherent
conflict that might arise from the expectations that
arise from different perceptions and expectations
resulting different time conceptions can have
negative effects on the mental health of individuals.
In view of the above it was therefore, important to
investigate whether the time concepts of high and
low achievers differ. Does the mother tongue have
any relation to the time concept and the academic
achievement of the learners? If there are any
differences, what are they and what are the
implications of such findings for education and
mental health?
QUESTIONNAIRE AND RESEARCH GROUP
A structured questionnaire in Afrikaans and English
was developed according to the above-mentioned
time concept by adapting and refining existing
instruments. This questionnaire was used to
investigate the learners' time concept. Apart from
the hiographic information, the questionnaire
consisted of 39 items about the time concept of an
individual.
A purposive sample of 1 436 learners from grade
eight, ten and twelve were involved. These learners
were selected on the basis of the fact that data
concerning IQ and other biographical aspects were
available. This information was crucial for this
research process and that is why random sampling
in the case of this study could not be considered.
The learners involved were enrolled at Afrikaans-
medium (656 students) and English-medium (780
students) secondary schools in the greater
Johannesburg area in South Africa.
VALIDITY AND RELIABILITY OF THE IN-
STRUMENTS
The validity and reliability of the measuring
instrument were firstly investigated. Item analyses
and various consecutive factor analyses consisting
of first- and second-order factor analyses were
conducted. Analyses concerning reliability were
conducted on the time concept scale. From the first
order analytical procedure (consisting of a principle
component and consecutive principal factor
analysis, both with orthogonal axes and varimax
rotation) and second order analytical procedure
(consisting of a principal factor analysis with
orthogonal axes and varimax rotation and a
consecutive principal factor analysis with the
Doblimin rotation procedure) it followed that single
factors for the time concept scale were derived at.
The Cronbach alpha score for the time concept scale
is 0,738.
DETERMINATION OF CUT-OFF POINTS FOR TWO GROWS
The academic achievements of the group of 1 436
learners were rated on a scale from 0 to 100. The
HEALTH SA GESONDHEID Vo1.6 No.1 - 2001
median of their scholastic achievement was 57 and
this was taken as the line of division between high
achievers and low achievers. Further, the group of
learners having indexes of 53, 54, 55, 56, 57, 58,
59,60 and 61 was omitted from the research group.
This group represents a middle group between high
achievers and low achievers
After eliminating the group between 53 and 61, the
original sample of 1 436 was reduced to a research
group comprising of l 105 pupils: 539 high
achievers and 566 low achievers. Thus 3 16 learners
were excluded from further analyses.
VARIABLES (FACTORS) OF TIME CON- CEPT
The variables (number of factors) of time concept
used in the further analysis of the data were
identified by means of a factor analysis, together
with a Doblimin rotation method. The following
variables of time concept were identified: future
orientation; conscientious time management; time
consciousness; anxiety about the future; present
orientation; unconcerned about time; independent
utilisation of time; and contentment with present
and past. The meaning of each variable is indicated
by the questions that were asked, for example:
Future orientation - to what extent: do
you work to fulfil your ideals in the future;
are you willing to work hard now, to benefit
at a later stage; do you like setting goals
for yourself; does your life have a clear
goal; are you prepared to work under
pressure to achieve success; is it important
to you to plan ahead?
Conscientious time management - to
what extent: do you organise your work
programme with success; do you know how
to utilise time; do you carry out your orders
strictly; do you work harder than what is
expected of you; are you doing things in
order of importance; do you postpone
tasks/assignments for today, to tomorrow?
Time consciousness - to what extent: do
you experience that time passes quickly;
do you regard time as something that passes
quickly; do you work fast; is it important
to you to know regularly what the time is?
Anxiety about the future - to what extent:
do you become afraid when you think about
the future; does your future look dark, even
if you work hard to achieve success; are
you being forced by time to do things that
you do not want to do; do you experience
the days as identical, the one day is only a
repetition of the other; do you regard it as
useless to remind yourself of things that
happened in the past; do you arrive late for
school and other gatherings?
Present orientation - to what extent: do
you prefer immediate pleasure to working
for future success; do you want immediate
reaction to your achievements; are you
doing only the amount of work which is
expected of you; do you ignore the
consequences of what you do?
Unconcerned about time - to what extent:
do you enjoy relaxing and forgetting about
time; do you find it easy to adapt to new
circumstances; do you like enjoying life
now irrespective of the consequences?
Independent utilisation of time - to what
extent: do you act independently; do you
do important things without being asked
or ordered by someone?
Contentment with present and past - to
what extent: do you wish that the present
will stay just as it is; do you find it pleasant
to think about the past; would you like to
change things that happened in the past?
ANALYSIS AND HYPOTHESES
Differences
The variables of time concept were used to conduct
multivariate and univariate analyses using the
biographical variables of the learners as
independent variables. These analyses were aimed
at establishing whether there were any differences
between the time concept of high achievers and the
time concept of low achievers. In the investigation
of these differences in the research group,
hypotheses on multivariate and univariate levels
were tested. Two sets of hypotheses were tested.
When two groups were compared, for example the
time concept of high achievers and the time concept
of low achievers, the average scale values of the
vectors formed were compared with Hotelling's T-
square test. If a significant difference on the
multivariate level was indicated, the differences on
the univariate level for each factor were investigated
with the Student t-test. The respective hypotheses
on multivariate and univariate levels were:
. Multivariate hypothesis (two groups)
H T The vectors of the averages of the two 0
groups do not differ.
H T The vectors of the averages of the two
groups differ.
Univariate hypothesis (two groups)
H t The averages of the two groups do not 0
differ.
H t The average of the first group is higher than d I
the average of the second group.
H t The average of the first group is lower than .+ 2
the average of the second group.
Significant differences are reported on the I % (:")
and 5% (*) levels of significance.
RESULTS
The results of the differences between the time
concept of the two groups of learners are presented
in Table 1. A statistically significant difference (p=0,000) was found between the time concept of
high and low achievers. High achievers are more
future-orientated, more conscientious in their time management, experience less anxiety about the future, are less focused on the present, utilise their time more independently, and are more
contented with the present and the past than low
achievers. On the whole, it would therefore appear
that two variables of the time concept, namely high
anxiety about the future and apresent orientation, could cause an inability to achieve academically.
Future orientation and conscientious time
management indicate goal-directedness, which is
one of the characteristics of mental health of a
person (Pender, 1987:27). On the other hand, if a
person has feelings of anxiety towards the future,
defensive reactions may arise (Donald, Lazarus and
Lolwana, 1999:293). As aresult of this, the person's
ability to adjust and to cope with reality is reduced,
causing further long-term anxiety that is a concern
for educational practitioners.
Tablel: Difference between the time concept of the two groups of learners (all learners toaether)
S Standaid deviation p-value Exceeding piobabiiibi
H High achiever5 L Lomi achiever5
VARIABLE
Futuie orientation
Conscientiou5time rnanagrment
T ime consoiousness
Anxiety aboutthe future
Piesent orientation
Unconceined about time
lndependentutiii5dtion oft ime
Contentment with present and past
Q UFAl TU CA G F S n N n H F l i l Vnl Fi Nn~l - 20n1
N Numbei of ieainers - Average
hi
H
539
539
539
539
538
539
539
539
-
H
34.43
28.11
20,61
21,24
18,38
15.14
g,92
10.80
L
588
586
588
588
588
588
568
568
L
32.70
28.89
20.46
23.11
18.30
14.87
9,87
10.08
S Hoteliing p.uai"e
0.000
H
4,95
5.92
4,03
6.03
3.99
3.07
2.17
3.43
p-vaiue
0.000
0.000
0.281
0.000
0.000
0.087
0.038
0.007
L
5.82
8.18
4.15
8.21
4.08
3,81
2.47
3,57
-
According to Tables 2a through c, there are more to take notice of the b ~ g difference in the number
high achievers (328) than low (188) achievers
among the Afrikaans-speaking learners. The
number of high (175) and low (186) achievers for
the English-speaking learners is more or less equal.
Among the learners with an African language there
are fewer high (28) achievers than low (155)
achievers. Afrikaans-speaking high achievers are
more time conscious, less unconcerned about time
and more independent in the utilisation of time than
the low achievers. The Afrikaans- and English-
speaking high achievers are more future directed,
more conscientious in their time management,
experience less anxiety about the future and are less
focussed on the present and are more content with
the present and the past than the low achievers.
Although no statistical significant difference were
found between the time concept of high and low
achievers with an African language, it is important
of high (28) achievers and low (155) achievers. This
should be of major concern for educators and
mental health practitioners.
The differences in the time concept of high and
low achievers, as well as the relatively low number
of high achievers among learners with an African
vernacular, hold some educational implications for
learners.
EDUCATIONAL IMPLICATIONS FOR LEARNERS
In view of the findings that are described above the
following recommendations with reference to
learners, parents, teachers, are made:
Learners must be assisted to set goals, plan
ahead, exchange the pleasure of the present
for future success, and to work hard to fulfil
Table 2a: Differences between the time concept of the two groups of learners with Afrikaans as their mother tongue.
1 Future orientation
VARIARLE
conscientiour t ime man+gement
T ime oonsciousness
Anxiety aboutthe future
piesent 0,ientation
Uncanoeined abovtt im.
independent utilisation n f f m e
contentmentwith present .nd p a s t
N Number O f 1earneis S Standaid deuiatjnn H High achieveis
N
328 188 34.01 32.13
328 188 28.80 26.87
328 188 20.82 20.15
328 188 21.88 23.61
328 183 18.10 17.89
328 183 15.72 18.31 1 328 1 0.75 1 0,38
328 188 10.87 0.07
- Average P-value E ~ c e e d i n g probabili* L LOW achievers
H
Table 2b: Differences between the time concept of the two groups of learners with English as their mother tongue.
L
-
I VARIABLE
H
Future o, ,ent l t ,an
Cansr lent loui t lme management
i , m e cons0,vusnes.
Anxiety aboutthe tuture
Piesent ailentat,*"
unsaneeinee Sboui i ime
independen, utiiiration 0, time
L
S
Contenimentwltb present 2nd pa*
N Number ot ie lrneis 5 Standarb deviaiian
~ o t e l l i n g p-"dlue
H
student p-value
L
Table 2c: Differences between the time concept of the two groups of learners with an African lan- guage as their mother tongue
- S Standdid deviation p-ualue Exceeding piobabili!q H High achievers L LOW achieveis
Fvtuie niientation
Conscient io~st ime management
Time oansciousness
Anxietg aboutthe fvtuie
Present oiientation
Unconcerned abouttime
Indayendent utiiisation oftime
Contentment with present and past
N Nvmbei of learners
their ideals in the future.
Learners should be assisted to help people
to organise their available time and guide
them to utilise their time purposefully: this
includes aspects such as organising their
work programme with success and carrying
out their orders strictly.
Educators should create a supportive
environment where learners can look
forward to the future with confidence and
to realise that hard work will be rewarded
with success.
Educators should provide specialised
attention and training for learners with an
African vernacular. These learners should
be sensitised towards development of a
linear and integrated time concept. In this
regard time should be viewed as scarce
resource and valued as such. This should
then be characterised by the ability to set
goals, to plan ahead, to exchange the
pleasure of the present for future success,
and to work hard to fulfil their ideals in
the future.
It should therefore be in the interest of learners if
educators make every effort to foster a future
oriented time concept in them. The emphasis should
H
28
28
28
28
28
28
28
28
be placed on planning and working towards future
goals. In addition, it should be stressed that the
enjoyment of the moment should be exchanged for
future success. Further research needs to be done
to find ways and means to change learner's time
concept in order to cope with expectations and
actualise their full potential.
REFERENCES
L
155
155
155
155
155
'155
'155
155
Averaoe
BEN-BARUCH, E 1985: Conception of time, theoretical
framework and some implications for education. (In:
Ben-Baruch, E & Netmann, Y eds. 1985: Studies in
education administration and policy making. Herzalia,
Israel: Ben Gurion University of the Negev).
BEN-BARUCH, E; MYBURGH, CPH; WID, AJB &
ANDERSSEN, EC 1990a: Differential time
perception of a group of American adolescents - a study
utilizing projective tests. [In: Myburgh, CPH 1990:
Instrument development for measuring time perception
(Ad hoc-investigation).] Pretoria: HSRC.
H
37.25
28.54
21.43
22.38
10.57
13,00
10.25
0.82
BURGERS, HH 1993: Tydpersepsie as faktor in
produktiwiteitsopvoeding. Johannesburg: Randse
Afrikaanse Universiteit. (DEd-proefskrif).
DONALD, D; LAZARUS, S & LOLWANA, P 1999:
L
35.88
29.98
21.31
23.93
10,53
13.45
0.08
10.77
H
3.60
8.20
4.46
7.50
3.88
3.25
2.4.3
3.50
L
4.81
5.06
4.01
8.42
4.00
3,72
2.45
3.71
0,088
0.025
0.091
0.944
0,124
0.470
0.288
0.299
0.104
Educat~onal Psychology in social context. New l'ork: practice. California: Appleton & Lange.
Oxford University Press.
GORMANN, BS & WESSMAN, AE 1977: The personal
experience of time. New York: Plenum
Press.
GROBLER, RC 1996: SeIfkonsep, tydkonsep en
skolastiese prestasie. Johannesburg: Randse
Afrikaanse Universiteit (DEd-proefskrif).
GROBLER, RC; MYBURGH, CPH & KOK, JC 1998:
Selfkonsep, Tydkonsep en skolastiese prestasie. Suid-
Afrikaanse tydskrifvir Opvoedkunde, 18(1), 1998:49-
57.
GMEINZR, AG & POGGENPOEL, M 1997: Riglyne
vir 'n omvattende venykingsprogram vir die bevordering
van die geestesgesondheid v'm onafhankiike sakemanne.
Health SA Gesondheid, 2(2), 1997:lO-15.
GROSS, E; NOLTE, A & SMITH, D 1996: Gesondheid:
'n realistiese perspektief. Health SA Gesondheid, 1(1),
1996:3-8.
JAQUES, E 1982: The form of time. New York: Crane
Russak.
MARAIS, JL (ed.) 1999: Practice of school guidance
Unpublished study guide. Potchefstroom: PU.
MBITI, 3 1967: The African concept of time. (In:
Rauchfuss A & Splett, 0 eds. 1967: Africa
German Teview of political economic and cultural affairs
in Africa and Madagascar. Ilmgaudrucherei:
Pfaffenhofgen.)
*MYBURGH, CPH, GROBLER, RC & NIEHAUS, L
1999: Predictors of scholastic achievement: IQ, self-
concept, time concept and background characteristics.
South African Journal of Education, 19(3), 1999: 165-
178.
PENDER, NJ 1987: Health promotion in nursing
RESEARCH
ETHICAL STANDARDS FOR THE OCCUPATIONAL HEALTH-NURSING PRACTITIONER REGARDING THE HIV POSITIVE PERSON IN THE WORKPLACE
M Otto Master sh~dent, Department of Nursing Science
Rand Afrikaans University
AC Botes Professor, Department of Nursing Science Rand Afrikaans University
ABSTRACT
The occc~pational health-nursing prncfitioner often becomes involved in ethical c1ilemma.s with regard to the
handling of HIV-positive people in the workplace in that the interests of the HIV-positive people conflict with
the interests of the employeyel: Therefore, the occr~patiunal health-nursing practitioner could find himself?
herselfacting as mediator between the hvoparties. Despite the existence of legal norms ancl ethicirl stanclarcls
to regulate the interests of the HN-positive person in the workpl~ce, no grridelines exist as to how these norms
and standards should be opercltionalised during interaction between the HN-positive person, the occc~potional
health-nursing practitioner crnd the employer: The occr~pputional health-nursing practitioner is therefore
rrncertain us to the manner in which to act professionally within the laid-ilown ethical standardsfor H N -
positive people in the cvorkplace.
The purpose of this shrdy is to provide gr~iclelines and criteria for the operationalisation of ethical stcmdcrrds
for the occc~parional health-nursing practitioner regarcling the HN-positive person in the workplace. This is
done through a literatrrre stcrdy with specijc reference to crrrrent ethical fri~meworks within the occrrpational
health context, after which the research is focrrsed on two target grocyx, namely the occr~pational henlth-
nursing practitioners and HIV-positive persons in the workplace. The de.~ign of the research is qrralitative,
explorative and descriptive. In order to assist the occr~pationnl health-narr.sing practitioner to handle the HIV-
positive person in the workplace in an ethical mannei; gr~idelines crnd criteria were compiled for the
operationuliration of the standards.
OPSOMMING
Die beroepsgesondheidsverpleegkr~ndige raak dihvels in etiese dilemmas betrokke ten opsigte van die
bantering van clie MWpositievve persoon by clie werkplek deurrlnt die belange van die MWpositiewe persoon
botsend is met die belnnge van die werkgecvez Die beroepsgesondheidsverpleegkr~ndige bevincl hornhoar as
tcrssenganger en advokaat trrssen die hvee partye, naamlik (lie ~verkgewer en die MIV-positiewe persoon. Ten
spyte van die voorsiening van wetlike norme en etiese standacrrde om die belange vein clie MN-positiewe
persoon by die werkplek te regrrleer; bestaan daar geen praktykriglyne oor hoe hierdie wetlike noime en etiese
stanclaarde geoperasionaliseer moet woril tydens die interaksie trrssen die MIV-positiewe per.soon, die
beroepsge.sonclheidsverpleegkr~r~~fige en die werkgewer nie. Dit skep onsekerheidoor hoe hy/sy as professjonele
persoon vanriit die gestelde efiese sfanclczarde teenoor die MWpositiewe penvoon by clie werkplek behoort op
te tree.
Hierdie st~rdie het ten doe1 om riglyne en kriteria vir die operc~sionali.~ering van etiese stcmdacrrde vir die
12 HEALTH SA GESONDHEID Vo1.6 No.? - 2001
beroepsgesondheidsverpleegk~indige oor die MN-positiewe persoon by die werkplek te beskiyf deur eerstens
die literatu~ir te verken en te beskryfmet spesifieke verwysing na die huidige wetlike en etiese raamwerke van
die beroepsgesondheidskoi~ teks, en tweedens die verkenning en beskrywing van probleme en oplossings van
die twee teikerrgroepe, rucarnlik die heroepsgesoizrlheidsverpleegk~indiges en die MIV-positie~ve persoon by die
werkplek. Die navorsingsontwerp is kwulitatieS, verkennend en beskrywend. Ten einde die
beroepsgesondheidsvelpleegk~indige te help om die MIV-positiewe persoon by die werkplek eties te hnntee~ is
riglyne en kriteria vir die operasinnalisering van die etiese stanclaarde opgestel.
BACKGROUND, RATIONALE AND PROBLEM STATEMENT
Since 1982 when the first person was diagnosed as
being HIV-positive in South Africa, major changes
in the relevant labour legislation, economy of
businesses and health services delivery in the
workplace have resulted. Employers set different
criteria for new employees, resulting in the
introduction of several discriminating practices, for
instance the rejection of H1V-positive applicants,
unfair dismissal of employees diagnosed as being
HN-positive as well as labelling and ill-treating of
HN-positive employees. It is to be recognised that
the prevalence of HIV in young employees can have
a serious impact on productivity of the individual
and the economy as a whole. Such people can
successfully contribute to the economy for many
years before they develop full-blown AIDS, which
will result in them becoming incapacitated.
Discriminatoiy practices were therefore prevented
by new concept legislation aimed at protecting the
HIV-positive employee against unfair testing for the
HI-virus, unfair dismissal and the segregation of
m-posi t ive prisoners (WHO, 2000:6-30; Arendse,
1988:218-219).
There are at present sufficient ethical standards and
legal norms available to regulate the handling of,
and interaction with, HN-positive persons in the
workplace. Examples of such legal norms are the
Labour Relations Act, No 66 of 1995 and The Bill
of Rights, as entrenched in The Constitution of the
Republic of South Africa, No 108 of 1996.
Medical and nursing ethics deal with issues regarding
professional behaviour that is of great importance
to nurses and other health care providers. It primarily
deals with morality, moral problems and moral
judgements. In its most basic form, ethics has to do
with the interpretation of words like "right",
"wrong", "good", "bad, "ought to" and "obligation"
(Deloughery, 1995:178-179). It implies that
occupational health-nursing practitioners have to
comply with ethical standards in every possible
action and interaction in the workplace. Ethical
standards are representative of the minimum
requirements for ethical behaviour that are setting
benchmarks for measuring compliance with ethical
behaviour in a particular profession. It refers to the
expected standard and behaviour as described in the
professional code of behaviour for a specific group
(Pera & Van Tonder, 1996:4). While ethics deal with
correct and expected behaviour amongst people of a
certain profession, the legislation of a country is
designed to regulate the behaviour of people on a
larger scale, ensuring that law and order is maintained
without anybody being placed above that law.
Occupational health-nursing practitioners are
confronted daily with ethical questions and the lack
of operational guidelines expose these practitioners
to medico-legal accountability. "Good" and "other"
as two central concepts in ethics mean that a person
acts ethically when heishe acts in hisher own
interest, whilst taking care of the interests of other
people. An ethical dilemma is created, however,
when there is conflict of interests between parties or
persons. An ethical dilemma involving the W-
positive person is created at the workplace in a
situation where the interests of the HIV-positive
person are in conflict with the interests of the
employer. The occupational health-nursing
practitioner fmds himselfherself acting as a mediator
HEALTH SA GESONDHEID V01.6 No.1 - 2001
between the two parties, namely the employer and
the HIV-positive person. Despite the existence of
legal norms and ethical standards to regulate the
interests of the HIV-positive person in the workplace,
no guidelines exist as to how these norms and
standards should be operationalised during
interaction between the HIV-positive person, the
occupational health-nursing practitioner and the
employer. The occupational health-nursing
practitioners can therefore ask themselves, as
professional people, how to handle the HIV-positive
person in the workplace according to a set of ethical
standards.
PURPOSE AND OBJECTIVES
The purpose of this study is to describe guidelines
and criteria for the operationalisation of ethical
standards for the occupational health nurse regarding
the HTV-positive person in the workplace. This
primary objective is achieved through the following
secondary objectives:
Exploring and describing literature with specific reference to current legal and ethical frameworks within the occupational health context regarding interaction with the HIV- positive person in the workplace in order to formulate the required ethical standards. Exploring and describing problems and solutions for the following target groups regarding tKe ethical aspects regarding the HIV-positive person in the workplace:
- Occupational health-nursing practitioners - The HIV-positive person in the workplace.
DEFINITION OF CONCEPTS
Ethical standards The minimum requirements against which ethical behaviour is measured to determine if there is compliance with the rules of a particular profession.
Occupational health-nursing practitioner A nurse registered with the South African Nursing
Council in General Nursing Science in terms of
Regulation 879, as amended. This nurse is also in
possession of a post-basic certificateldiploma in
Occupational Health, registered as an additional
qualification with the South African Nursing Council
(Act No. 50 of 1978).
Workplace The nurse renders primary healthcare and
occupational health service to the business sector.
The workplace refers to the place where people are
practising their occupations (Odendal & Schoonees,
1991:1358). For the purpose of this study
"workplace" refers to the factory where the
employees and occupational health-nursing
practitioner render a service for remuneration.
HN-positive persons
Human Immune Deficiency Virus refers to the
condition when antibodies against the HI-virus are
present in the blood of a human. This virus penetrates
the body and establishes itself in the human body
affecting as many organs and human tissue as
possible. The HIV-positive status is caused by a
retrovirus that changes the genetic information in
cells from RNA to DNA (Scoub, 1994:31-36).
research DESIGN and methods
A qualitative, explorative and descriptive design was
used (Polit and Hungler, 1997:21). The research
aimed at describing ethical guidelines and criteria
for the operationalisation of ethical standards for the
occupational health-nursing practitioner, insofar as
the HIV-positive person in the workplace is
concerned, was conducted in two phases.
During Phase 1 or the conceptual phase, the
Iiteratnre was researched with particular
reference to current legal and ethical frameworks
within the occupational health context, dealing
with the interaction with the EW-positive person
in the workplace for the formulation of ethical
standards.
Phase 2, or the fieldwork, was conducted in
HEALTH SA GESONDHEID Voi.6 No.1 - 2001
two stages: - During Stage 1 the problems and solutions
encountered by occupational health-nursing
practitioners in the treatment of an HIV-
positive person in an ethical manner, was
explored and debated during a workshop.
The ethical standards, as described as a
result of phase 1, were used as base line for
the debate. The problems and possible
solutions for each ethical standard were
debated. - During Stage 2 the problems and solutions
of the HIV-positive people in the workplace
were explored and described by means of
semi-structured personal interviews (Bums
& Grove, 1993:365). The central questions
to the respondents were formulated with
regard to each of the five ethical standards
from phase 1.
Population and sampling and ethical considerations
The occupational health-nursing practitioners as well
as the HIV-positive people were selected purposively
(Burns & Grove, 1993:246). In order for the
occupational health-nursing practitioners to be
selected, they had to comply with the following
sampling criteria:
They had to be fluent in English and had to
be employed as an occupational health-
nursing practitioner by the packaging
company for at least one year.
They had to be registered with the South
African Nursing Council in General Nursing
Science and Occupational Health-nursing.
They had to be in possession of a Certificate
in the counselling of HIV-positive people
and had to be involved with the handling of
W-positive people in the workplace.
Eighteen (n = 18) occupational health nurses that
met these criteria were included in the workshop.
The HIV-positive people had to comply with the
following sampling criteria:
They had to be fluent in English and
employed full time at one of the
factories of the packaging company.
They had to be between 18 and 60 years
old and be HIV-positive.
They had to be treated and counselled
by the occupational health-nursing
practitioner at that particular factory.
The occupational health nurses were used to contact
the W-positive person and to get informed consent
before the researcher interviewed the person.
Interviews were conducted with seven (n = 7) HIV-
positive employees.
The researcher adhered to the standards for nurse
researchers as described by Denosa (1997).
Data analysis
The data of phase 2 stage 2 was tape-recorded and
transcribed. For phase 2 stage 1 the data was
recorded as notes from the workshop. For both stages
the methods of reduction, display, conclusion and
verification as described by Miles and Huberman
(1994:21) were used in the analysis of the data. The
data of the two stages were analysed separately. Data
was reduced and condensed by organising the data
into two main categories, namely problems and
solutions. The following sub-categories were
employed to display the conclusions:
Problems/solutions influencing the
individual system.
Problems/solutions influencing the
organisational system.
Problems/solution influencing the health
system.
. Problems/solutions influencing the family
system.
Trustworthiness
The measures of Lincoln and Guba (1985:290-300)
were used to ensure the trustworthiness of the
HEALTH SA GESONDHEID V01.6 No.1 - 2001
research. The following measures were employed:
the concept of saturation was employed during
data analysis,
triangulation of data resources in stages one and
two;
peer group debriefing during data analysis; and
prolonged engagement.
CONCEPTUAL FRAMEWORK
During the conceptual phase or Phase I of the
research, the ethical-legal framework was described and the concepts defined, in order to formulate the standards for the ethical handling of the HIV-positive person in the workplace. The conceptual framework constitutes the legal norms and ethical standards required to be operationalised during the interaction between the HIV-positive person, the occupational health-nursing practitioner and the employer (Refer to Table 1).
Table 1: Legal-ethical framework for the formulation
of the ethical standards
LEGhL~ETHIC4L FRAMEWORK
1 ETHlCeiL FRAMEWORK 1 LEGAL FRAMEWORK I . The Conrfi tufon (No 108 of 1996)
The LabourRelaiionrAct(No66 of 1991) . The Ocrupatonal Health and Safety Pzt (No 151 of1993) . The Barlc dond8ilonr oiEmploymentAd (hlo 75 of 1597) . The compenrat,on for Occupaiimnil 1njur,es and Dtreares k t [No 130 of1993) The Employment Equi* P n ( N o 5 5 of19981 . The Nuii lng Act (No 50 af 1978)
The following ethical standards were formulated from the conceptual framework for implementation during the empirical phase or Phase 2 of the research: . The HN-positive person in the workplace is
entitled to fair and equal treatment. The autonomy of the HN-positive person in the workplace must he respected.
. The principles of confidentiality and privacy must be maintained in dealing with the H N - positive person in the workplace.
. The principles of honesty and truth must be maintained during the interaction with the HIV-positive person in the workplace.
. Maintaining the principles of beneficence
(no harm).
RESULTS AND conclusions
The data collected from the occupational health- nursing practitioners during Stage 1 of Phase 2 was triangulated with the data collected from the HIV- positive people during Stage 2 Phase 2. The solutions identified by the respondents were used as criteria for setting guidelines for the operationalisation of the ethical standards. The categorisation and interpretation of the two sets of data took place within the conceptual framework (Refer to Table 1).
Guidelines and criteria for the operationalisation of the ethical standards for the occupational health- nursing practitioner in the workplace were formulated. This was achieved by firstly exploring and describing the literature with specific reference to the legal-ethical framework for the occupational health context regarding the interaction with the W-
positive person at the workplace, in order to formulate ethical standards. Secondly the problems and solutions determined by the two target groups, namely the HIV-positive people and the occupational health-nursing practitioners, were explored and described. The guidelines formulated for each of the ethical standards was obtained from the problems and solutions identified by the two target groups.
The Ethical Standards were made operational by writing guidelines and criteria for every standard.
The guidelines and criteria can be used in practice
by the occupational health-nursing practitioner for
self-evaluation to determine whether or not helshe
treats the HIV-positive person in the workplace in
an ethical way (Refer to Table 2).
RECOMMENDATIONS
From the research it is evident that there are many
aspects regarding the practical application of ethical
standards that require further investigation. The
following are examples of such aspects:
. Recommendations for further research
Further research can be undertaken to
determine the way in which ethical decision-
HEALTH SA GESONDHEID V01.6 No.1 - 2001
Table 2: Operational Guidelines of the ethical standards
I Ethical standard 1: The HIV-positive person in theworkpiace isentitledto fair andequal treatment
'Use the self-evaluation scale to indicate your score O = do not meet the wlteria, / , = r . f iN,y meei fhe criteria. 2 = fuifyneei ihe criteria
Guidelines Criteriafor expected results
standard of education to be able to handie HiV- positive pelsons in ail facets
0
0
i I I
I ensure that my interpersonal communication skills are Satisfactow in rnv dealinas with HIV-wsitve oersons in the workpiece ' I ensure that my counselling skilk are adequate to accommcdate Lhe needs of the HiV-posiide person ! anend courses, workjhaps and seminais to expand my knowiedee of the Hi-vim3 and remain updated on
1 2 i o
develop&ents m this field 1 ensure that the eersons who work for me remain
I deal with hidhei diagnosis O I am sympatheticaiiy and show understanding and
empathy
2 undeistand 1 am not prejudiced towards my HIV-positive patients i 1 exhibiting the right anitude towards HIV-positive O I exhibit a positive attitude towards the HIV-positive ; persons at the warkpiace
I , I persons in the workplace 0 I am receptive and open towaras the HIV-positbe
i i persons who want to ~ I ~ C U S S specific problems and thoughts with me I
t I i understand that I must treat HIV-positive
i / persons just like peisons with any other disease
i
I i
updated an progress in this field, take the necessary ourses and anend woikshops and seminars
I do not label HIV-pasitue persons P t do not discriminate in what I say or do
I ensure that avaiiabie resouices in my budget are distributed equally to meet the needs of all my patients as far as possible
0 I ensure that the company's sick-have policy is applled ' without prejudice / D I suppM and heip the HIV-positwe person to accept and
0 I ensure that the persons who work far me apply the principles of equality and fairness
1 j other
I !
4
5
Ethical
- . - I 0 Yd'zot aive an" autocratic insVuction3 to the HiV- I
positive p e k n ' I ensure that I am sensitive in my conduct to accammcdate HtV-positive peisons from aii cutures
1 understand that I must be cultuiaiiy sensitive when dealing with HIV-positive persons in the workplace
1 undeistand that an expanded budget is necessary to meet the requirements of all
I patients in my care
1 1 1 medication against hisihei hi1 / / / I
respected. standard 2: Theautonomy of the HiV-positive person in the workplace must be
O I respect HIV-posiwe persons from other cuihires, racial groups and beiieis
O i am receptbe to the HiV-positive person who experiences problems in accepting Western Ueatment and a change in lifestyle owing to hidher ties to hisiher cunuie and traditions I guide HiV-positive persons from other cutures towards understanding and favouiabiy considering 'Western methods of treatment and a change in llfeslyie
I understand that I must allow the HIV-positive person to make hidher awn informed decisions and determine higher objectives
U I ensure that I am sufticiently educated and up to date to assist and suppon the HIV-positive pecson when important decisions have to be made
1
i intercede by ensuring that the HIV-positwe person is suficientiy educated to be able to make an informed decision to protect himseHheiseH against wrong decisions
I i 0 I do not enforce any decisions on the HIV-positve person P I empower the HIV-positwe person to make hidhei own
decisions P i do not Influence the HIV-positie person to make the i i
i i decisions i prefer
i I am not prejudiced towards the tiadilionai healer, but try lo invohie himiner in the treatment and handling of the I
I
HIV-positNe person
P i negotiate with my manageifor an expanded budget O I ensure that funds are available for health education of
ail employees in the factory P I ensure that my budget makes provision for the basic
needs of HIV-positwe persons in the workplace
I
u! paqp3sap saugap!n% uo!lr!np~a-~~as a u a ~ n ~ s o d - r n . . atp 30 uoddns 3!x]e!q3Lsd a q
q 3 q ~ LEM am aulurralap 01 pawnpuo3
'ql~eaq 30 1a~a1 aq p1no3 sasxnu 3u leqdsd Lq q x n a s a ~
urnw!mur am 8u~u!elu!aur puc 4u!~a!q3e . a x ? ~ d y ~ o ~ aql u! uos~ad a~!l!sod-~m aql
sr! IIam SF: 's!sou8e!p aql 30 a3u-eldame pue xauopg3e~d 8u!sxnu-qpaq puogednmo
xacsna aql 01 alnq!xluo3 pIno3 uosxad a q uaamlaq noq3examr axanau! 8u!yr!m
uosiad pas~loqjneun I j !
! I Aue oi uo!leiumju: ie!iuaDyuos hue Gu!lyddns
I / I iou hq uos~ad a@~!sod-,q!~ aq( oi ans we I wql alnsua ]
i ~uawaGeuew 1 ! Lioi3ej aqi o i pa6jnhlp IOU ads elel Aw 0% pajsnljua
I i ! / i 1 i S U O S ~ ~ an ! i ! sod -~ !~ aui lo saweu alil ieui a i n m 1 0 a>eldylo~ aqi u! uoslad aiul!sod-AIM aui
uosiad viw d!qsuo!iejai 4w iu! amapa3eid aye8 4 3 e ~ ~ d
i / 1 j a ~ ! s o d l ! ~ aui wwi nelaiu! ! uaw k e w d lmoi ainsua I 0 pue h!lenuap!1uo3 jo sajnj aul ieql putisiapun ! c
i i($en!id ui paljesuno"
! I I! oi SSa33F aneq 1 1 S U O S I ~ ~ pes~,~qjneun ou jeql pue heme pay- s! uosiad
a@i!sad-AIH aqi uo ua!ieiuawn3oP !!e ieqi alnsua 1 (7 iuawaGeueiu /doisel aqi a1 uosiad
hxe!juap!juo> pue A$e+d jo wadsal u! uosiad an!i!sod -A]H aql lo ~ i q f i ! ~ aqi i3adsal s n w ~auo!i!i3e~d
SnlelS-A!H laqF!u inoqt pawioju! aq 01 sjuem aqspu w o q ~ suosiad aql inoqe ua!s!oap s,uos~ad an!i!sad-A]+ aqi i3adsal I n
uo!ss!wiad uau!m hleqis!q in0qi.w uos~ad uosiad an!i!sod-A!H aul la siqfi!i 1 / an!i!sod-A!H aq! inoqe uo!iewloiu! hue Wdns iou op ! 0 aqi uodn aGu!>)u! IOU Aew ! 1eq1 pueis~apun !
i I I
z
1 / iaqio la a3uasaia aui u! &!e!1uap!1uo3 aui u~ea jq lanau ! 0 j i !
J 10 IRW-NH IY mow UO!I__I! 4~ 10" I 1 0
I / afli!sod-A]~ 58 uosJed aql 1 SU0!13'2iaIU! alqeljsapun iru!eGe uosiad I i l e g afiinn!~ hew ieui siuawnlop le!lue~uuiuo~ mi lou ap I 0 a ~ l ! s o d - A l ~ aul13aio~d isnw ! i e q pueis~apun !
~ Y ! S _ V U E ~ Y ! m s d n m aqi i s 1 awwn c
/ i
uos~ad afii!sod-~iH aq!isu!ebepa3!pn!eidiou we I 0 ! uos~ad a!l!sod-~!H a q i q ~ ~ fiu!!ea~ u! ; / I /
a3eldy~om aql splepums leiow q61q u!eiu!ew isnw ~auo!i!iae~d ie uoslao afli!sod-AIM aql s p l e ~ o l 4i3alla3 hiie3!uia ue I 0 Gu!sinu-4~eaq !euo!iedn33o aqi lsql puelsiapun ! z -
h!lenb q6!q e jo s! afipajmoux hill ieqi alnsua pue sn i !n- l~ aql jo p]e!l aui u! sluawdojanap ua palepdn ujewal s i ( ~ ~ j e ! n
waql do, oawe uaum uos~ad a@i!$od-AlH aql oi si3e1 4ddns I n
adoq asjejGu!qG I
lnOqw qCOo-AIH eqI qw I*yW UYI we I uoslad aiul!SOd-~H a3qdy io~ aqi spiemoi a ~ ! ! e w i n o q l ! ~ pe isnw ~auo!i!13eid
aqi u! uosiad an!i!sod-AIH aql la44 lo as!lewG!lslou op I 0 fiu!smu-qileaq leuo!iedn33o aql leq! puelsrapun ! I 1
1 '(aoua~!laueq lo sa!d!ou!ld) uoslad ou Gu!wleq l o sald!ou!ld aqi Gu]u!eiu!ew :g plepuels leS!413
aul inoqe uos~ad a ~ g s o d - ~ l ~ aqi splemoi "ado we I 0 passn~s!p s! s!souGojd uo!ie3!~niuiuoa jsauoq pue "ado uo
iauls!q u a q ~ uos~ad an!i!Sod-AIH all% 41!M isauoq we I u pasea s! uosiad a~ l ! sod - / i l ~ aul pue ~auo!i!i3eld fiu!slnu-queaq !euo!iedn330 aui uaahyaq
i
a l e l d y l o ~ aqi u! u o r ~ a d a n ! i ! s o d - ~ ~ ~ aql Su!ieali pue ~IIM Su!!ea~ u a q ~ pagdde aq xsnw K=en!ld l o $a~d!,u!>d a q l :C plepueis !e1!4ia
this document can, through further research,
be developed as a complete instrument of
which the construct validity, quality and
reliability can be tested.
Fur ther research can be conducted to
determine the way in which counselling can
address the needs of the HIV-posit ive
person.
Recommendations for the improvement of the occupational health practice and education
It is strongly recommended that counselling skills become the
central focus of the cumculum for occupational health-nursing
students. This should be a requirement for any nursing student
undertaking further study in any field requiring interaction with
patients. It is also aprerequisite that nurses develop and become
educatedin order to be culture-sensitive, pariicularly in a countly
like South Africa with its diverse cultures. This is especially
required if they want to demonstrate care and quality in nursing.
It is of utmost importance that nurses be
educated to be sensitive to and respect the
rights of other people. Guidance of nurses
in developing judgement skills in order to
facilitate ethical decision-making is strongly
recommended, as ethical practice is the
responsibility of all nurses.
REFERENCES
ARENDSE, N 1988: HIV and AIDS infected employees:
Some legal implications for the work place. Industrial
Law Journal, 6(1), Jan. 1989:218-227.
BURNS, N & GROVE, SK 1993: The practiseofNursing
Research - conduct, critique & utilisation; second edition.
Philadelphia: WB Saunders.
DELOUGHERY, GL 1995: Issues and trends in nursing.
St Louis: Mosby.
DENOSA, 1997: Ethical standards for nurse researchers.
Denosa: Pretoria.
LINCOLN, YS & GUBA, EG 1985: Nahlralistic inquity.
Sage: London.
MILES, & HLTBERMAN 1994: Qualitativedata analysis:
A sourcebook of new methods. Beverly Hills CA: Sage.
ODENDAL, FF & SCHOONEES, PC 1991: HAT:
Verklarende woordeboek van die Afrikaanse taal; tweede
uitgawe. Perskor: Johannesburg.
PERA SA & VAN TONDER, S 1996: Etiek in die
Vespleegpraktyk. Cape Town: Juta.
PILOT, DF & HUNGLER, BP 1997: Nursing research -
principle and methods; fourth edition. London: Oxford
University Press.
SCOUB, BD 1994: AIDS & HIV in perspective: A
guide to understanding the virt~s and its consequences.
Cambridge: University Press.
SUID-AFRIKAANSE INSTITUUT VIR RASSE-
AANGELEENTHEDE 1996: Verbod op die segregasie
van MIV-positiewe gevangenes. Pretoria.
SUID-AFRIKAANSE RAAD OP VERPLEGWG 1991:
Regulasie No R 2598 soos gewysig. Regulasies
betreffende die bestek van praktyk van persone wat
Icragtens die Wet op Verpleging, 1978 Pretoria.
SOUTH AFRICA (Republic) 1993: The Compensation
for Occupational Injurics and Diseases Act (No 130 of
1993). 6 October 1993. Government Gazette: Pretoria
SOUTH AFRICA (Republic) 1993: The Occupational
Health and Safety Act (No 181 of 1993). 29 December
1993. Government Gazette: Pretoria.
SOUTH AFRICA (Republic) 1995: The Labour Relations
Act (No 66 of 1995). 13 December 1995. Government
Gazette: Pretoria.
SOUTH AFRICA (Republic) 1996: The Constitution of
the Republic of South Africa (Act 108 of 1996). 18
December 1996. Govemment Gazette: Pretoria.
SOUTH AFRICA (Republic) 1997: The Basic Conditions
of Employment Act (No 75 of 1997). 5 December 1997.
Government Gazette: Pretoria.
SOUTH AFRICA (Republic) 1998: The Employment
Equity Act (No 55 of 1998). 19 October 1998.
Govemment Gazette: Pretoria
WORLD HEALTH ORGANISATION (WHO) 2000:
Facts sheets on HIVIAIDS: A desktop reference:
Department of Health: Pretoria.
9n HEALTH SA GESONDHEID Vo1.6 No.1 - 2001
RESEARCH
DIAGNOSIS OF VAGINAL INFECTION IN PREGNANCY
DE BOTHA Department of Nursing University of the Orange Free State
R VAN DER MERWE Lecturer, Department of Nursing University of the Orange Free State
OPSOMMING
Vaginale infeksies kom algemeen by swanger vroue voor: By die Primgre Gesondheidsorg klinieke word
geskiedenisvasstelling en beraming van kliniese beeld gebruik as metode orpl die ve7oorsakende organisme
van vaginale infeksie te diagnoseer. Die akk~traatheid van hierdie metode word in die studie ondersoek met
behulp van mikroskopiese natsmere om die veroorsakende organismes te identifiseer. Die resultaat soos
verkry, met behztlp van geskiedenisvasstelling m beraming van kliniese beeld, word vergelyk met die resultaat
verkry nadat 'n natsmeer van die vaginale afskeiding onder 'n mikroskoop ondersoek is.
Sewentig respondente het deelgneem aan die st~tdie. In 48,6% van die gevalle het die diagnoses van die
veroorsakende organisme, soos bepaal deur die twee verskillende metodes, ooreengestem. In 51,4% van die
gevalle het die diagnoses egter nie ooreengestem nie. So is Candida albicans infeksie by ondermeer 10
persone gediagnoseer, tervvyl3 Trichomonas vaginalis infeksie en sewe Gardnerella vaginalis infeksie gehad
het. By 26 persone is Trichomonas vaginalis irfeksie gediagnoseei; tenvyl 15 eintlik Candida albicans
infeksie en 11 Gardnerella vaginalis infeksie gehad her.
Vaginale infeksies, veroorsaak dew Gardnerella vaginalis is nie in enige van die gevalle met behulp van
geskiedenisvasstelling en beraming van kliniese beeld gediagnoseer nie, terwyl dit in 11 gevalle voorgekom
en met behulp van mikroskopiese ondersoek gediagnoseer is.
ABSTRACT
Pregnant women are prone to vaginal infection. At Primary Health Care Clinics diagnosis of causative
organism of vagincll infections is made by clsing historp-taking and assessment of clinicalpicture methods.
The accuracy of these methods is investigated in this stctdy by comparing the results obtained by history-
taking and assessment of clinical picture with that which is obtained by examining wet mount specimens
under a microscope.
Seventy respo~~dents participated in the study Irz 48,6% cases, the diagnosis c ~ t h e camtive organism, as
identified by the two different methods, were similar. In 51.4% of the cases the diagnosis differed Candida
albicans infection was diagnosed by 10 respondents, while 3 actlrally had Trichomonas vaginalis infection
and seven had Gardnerella vaginalis infection.
Trichomor~a.~ vaginalis iizfection was diagnosed in 26 cases, while 15 were actl~ally dne to Candida albicans
and 11 dele to Gardnerella vaginalis.
Vaginal infections, cncised by Gardnerella vaginalis was not diagnosed in any of the cases while the history-
taking and assessment of clinical picture methods were ~ u e d . It (lid occur in 11 cuses and was diagnosed by
the method of examining wet mount slides.
INTRODUCTION
Vaginal infection is extremely common amongst
women and accounts for a large number of consul-
tations at Primary Health Care Clinics. Pregnant
women are even more prone to develop vaginal
infections due to the physiological and hormonal
changes that occur in pregnancy. Persistent vagi-
nal infection in apregnant woman, can lead to geni-
tal and oral thrust of the neonate 'fter birth), neo-
natal respiratory @act infection, preterm labour,
urinary tract infection and chronic cervicitis and
postpartum endometritis.
Different micro-organisms that cause vaginal
infection are sensitive to different drugs and if an
incorrect drug is given, the organism may develop
resistance to the drug. In the case of Candida
albicans, the condition will be aggravated if the
patient is treated with antibiotics instead of a
fungicide (Neuherg, 1995:6 1).
The researcher observed, in Primary Health Care
Clinics, that the causative organisms of vaginal
infections are mainly diagnosed as being Candida
albicans or Trichomonas vuginalis. The organism
Gnrdnerella vaginalis is seldom diagnosed as the
causative organism. The method used to make these
diagnosis is history-taking together with clinical
assessment.
Several methods can be used to diagnose the
causative organisms of vaginal infections. The
following are the most popular:
Diagnosis by means of laboratory tests
A sample of the discharge is taken and sent to a
laboratory for incubation and isolation of cultures.
This is an accurate method of diagnosing the
organism, but is time consuming and expensive.
History-taking and clinical assessment
A thorough history concerning the discharge is
obtained from the client, after which a clinical
examination, usually a speculum examination is
carried out. The genitals are inspected, as well as
the colour, consistency and odour of the discharge.
The diagnosis of the causative orgaiiism is made
according to the specific characteristics associated
with the different organisms. These are the
following:
Cundida albicans infection: in females it
usually causes vulva irritation with a
scanty, watery discharge, or in severe cases,
a profuse, thick, white and curdy discharge.
On examination, the vulva may be red and
edematous. A speculum examination will
reveal thick, white, cheese-like patches
adhering to the vaginal mucus (Nel, 1995;
Olds et al. 1996).
Trichomonas vaginalis is associated with
complaints of a copious, thin, yellow or
yellow-green discharge, which may be
frothy in appearance. The discharge usu-
ally smells offensive. On examination,
acute inflammation and excoriation of the
vulva, perineum and even the inner thighs
may be seen. The vaginal walls and the
cervix may be covered with a thin discharge
which, when removed, reveals severe red-
dening of the mucosal surfaces, thus the
term "stra>vberry cervix" (Freeman, 1995;
Ament & Whalen, 1996).
Gardnerella vaginalis infection is
characterised by a grey, homogeneous, ad-
herent vaginal discharge that is usually
malodorous. Unlike other causes of vagi-
nal discharge, this infection is not associ
HEALTH SA GESONDHEID V01.6 No.1 - 2001
ated with pruritis, dysuria or dyspareunia. The
main complaints are the presence of the
vaginal discharge which may be profuse,
and the odor that is often described as
"fishy" (Nel, 1995; Freeman, 1995; Olds
et al. 1996).
Using the history-taking and clinical assessment
method to identify the causative organisms seems
quite easy, but ~mfortunately, it is complicated by
the following:
The typical picture, as described above,
does not always appear as clearly as de-
scribed. Weinberger & Harger (1993) sup-
ported by Pastorek, Cotch, Martin &
Eschenbach (1996) indicate that the typi-
cal clinical picture associated with Tri-
chomonas vnginalis infection is only seen
in 10% of wornen with vaginal infection.
The well-known "white, curdy" discharge
associated with Cnndida nlbicnns infection
is only seen in a small number of patients
(Deutchman, Leaman and Thomason,
1994). . In some patients the vaginal discharge may
not cause symptoms. Govender, Hoosen,
Moodley, Moodley & Strum (1996)
indicate that Bncterinl vnginosis (caused
by Gnrdnerellrr vnginnlis) may be
asymptomatic. . Occurrence of more than one type of or-
ganism simultaneously, the so-called
"mixed picture". O'Dowd (1991) points out that Gardnerelln vaginrrlis may be
found simultaneously with either Crzndirln
nlbicans andlor Trichomonns vnginnlis.
Microscopic examination of wet mount prepa-
ration
With this method, a preparation of the discharge
and certain solutions is made, and this is examined
under a microscope, the causative organism is
identified by its characteristics. The following
criteria are used to identify organisms:
KOH-prepared slides . If a "fishy" odor occurs after adding a drop
of 10% KOH, Gardnerelln vaginnlis is di-
agnosed. . When the KOH-prepared slide is examined
under the microscope, and hives and spores
(Figure 1) are identified, the organism is
Candida nlbicans. The KOH devolves the
vaginal epithelial cells to expose the fun-
gus.
Sodium chloride-prepared slides . When the slide is examined under the mi-
croscope and movement is seen, the or-
ganism is Trichomonas vnginalis. It should
he noted that this characteristic of the Tri-
Figure 1: Hives and spores of Candida albicans (Nel, 1995:335)
chomonns vaginnlis is soon lost and there-
fore the examination of a smear must take
place immediately after it has been pre-
pared. . If "clue cells" or speckled cells are identi-
fied (Figure 2), the vaginal discharge is due
to Gnrdnerella vnginnlis since the cocco-
bacilli adheres to the epithelial cells and
this causes the speckled appearance
(Eschenbach, 1992: 139).
This method of diagnosis of micro-organisms is a
reliable method since the distinctive characteristics
of the micro-organisms can clearly be identified.
The examiner though has to be skilled in the use of
a microscope and has to be knowledgeable on the
identification of the distinctive characteristics.
Figure 2: Clue cells covered with Gardnerella RESEARCH DESIGN vaginalis (Net, 1995335)
PROBLEM STATEMENT
As indicated, diagnosing the causative organism of
vaginal infections by using the method of history-
taking and clinical assessment, which is used in
most Primary Health Care Clinics, can be
complicated if the clinical picture deviates from
the described picture. The accuracy of diagnosis
of the causative organism of vaginal discharge when
using the history-taking and clinical assessment
method was investigated in this study.
It was assumed that professional personnel are
competent in diagnosing the causative organism
with the history-taking and clinical assessment
method. The study was undertaken as part of a post-
graduate programme.
PURPOSE OF THE STUDY
The purpose of the study was to compare the re-
sults of diagnosis made by using history-taking and
clinical assessment method with that made by us-
ing a microscope and examinins wet mount speci-
mens.
This examination gave information on how accu-
rate diagnosis were when using a specific method.
A non-experimental, descriptive approach was ap-
plied while a survey method was used.
RESEARCH TECHNIQUE
Biophysical measurement was used since micro-
scopic examination of prepared specimens was
done.
Validity of biophysical measurement was ensured
by using a calibrated, electric microscope and by
identifying the organisms by means of described,
well-known, distinctive, microscopic characteris-
tics. The researcher is proficient in the use of a
microscope.
The reliability of identifying the organisms on wet
mount preparations was enhanced by the researcher
who had previously been evaluated on identifying
organisms on wet mount specimens by an experi-
enced medical officer. This was done before the
onset of this study. During these evaluations, the
researcher correctly identified all the organisms of
the given specimens on different occasions.
Reliability of measurement was further enhanced
by the fact that the researcher examined all the
specimens. The wet mount preparations were ex-
amined immediately after they were obtained in
order not to miss characteristics such as mobility,
which disappears shortly after exposure to unfa-
vorable surroundings.
SAMPLING METHOD AND SAMPLE
Respondents were identified by means of conve-
nience sampling. Pregnant women who visited two
different antenatal clinics during May 1998 and
who met the inclusion criteria were selected and
asked for voluntary participation.
24 HEALTH SA GESONDHEID V01.6 No.1 - 2001
Inclusion criteria amine the wet mount specimens.
The respondent: DATA COLLECTION . had to be more than 12 weeks pregnant.
By this time most of the physiological Patients who visited two different Primary Health
changes in her body had already taken Care Clinics for antenatal care and who met the
place; inclusion criteria were approached for invitation . had to have a complaint about a vaginal to participate in the study. After consent was ob-
infection. tained, the respondents were seen by midwives for
routine check-ups as well as management of the
Respondents were informed that participation was vaginal discharge.
voluntary and they were informed about the pur-
pose and implications (such as obtaining a sample After each respondent was interviewed by the mid-
of vaginal discharge during the PAP-smear proce- wife, the researcher performed the PAP-smear pro-
dure) of the study. cedure, during which a specimen of the discharge
was simultaneously obtained. At the time of the
Seventy participants took part in the study. study, taking of PAP-smears was a routine proce-
dure.
VALIDITY AND RELIABILITY The researcher then immediately prepared the wet
Validity of the study was ensured by using a scien- mount smears and examined it under the micro-
tific method, microscopic examination, to identify scope. Thereafter the midwife and researcher com-
causative micro-organisms of vaginal infections. pared the results and reached agreement on which
organism was present in the specific case so that
Reliability of the study was further enhanced by the appropriate treatment could be described.
having one person, the researcher, prepare and ex-
Table 1: Comparison of diagnosis of causative organisms (n=70)
/ DIAGNOSIS BY HISTORY AND CLINICAL PICTURE Candida alhicans 31 respondents (44,334) 21 respondents (67,7%)
contirmed
DIAGNOSIS BY MICROSCOPE
. 13 respondents (33.33%) contirtned
COMMENTS
No diagnnsis made 18 respondents (257%) contirriied
I Candida albtcans 1 From the 3 1 respondents in column one: 3 respondents @,65%) h a d 7.m , ,r)c,?o,v?onas va.ginahs instead of Candida albicans 7 respondents (22,58%) had Zardnereiia vagihaits instead of Candtda albtcans From the 39 respnndents in colutnn one: 15 respondents (38,5%) had Candtda aibtcans instead o f Trtchomonas vagina1i.s 11 respondents (28,2%) had Gardnereiia vaainaits instead of Trtchornings vagt~~aits 18 respondents (25,7%) havi n y ~ard t~ere j la hait~)alt,s were rnissed >,viti> history- taking and clinical assessment
RESULTS practical procedures.
A comparison of the diagnosis of causative organ-
isms obtained by the two different methods is in
Table 1.
With reference to Table 1, it is clear that the diag-
nosis of Candida albicans as causative organism
were incorrect in 10 (ten) cases. In three of the
cases, Trichomonas vaginalis was the causative
organism and in seven cases, it was Garnerella
vnginalis.
Concerning the 39 respondent who were diagnosed
as having Trichomonas vaginalis infection, 13 were
confirmed as having Tn'chomonas infection. In 15
cases the wet mount method identified Candida
albicans and in 11 cases Gar(lnerel1a vaginalis as
causative organism.
It should be noted that through the wet mount
method, Gardnerella vaginalis infection was diag-
nosed in 18 cases, while there was no diagnosis of
this organism when using the history-taking and
clinical assessment method.
In total, 48,6% of the diagnoses made by history-
taking and clinical picture correspond with that of
the researcher, but more than half (51.4%) of the
diagnoses did not correspond.
In no case, more than one organism simultaneous
(mixed picture) occurred in this study.
RECOMMENDATIONS
The competence of midwives and professional
nurses in diagnosing causative organisms by
means of histoly-taking and clinical assessment
method, should be evaluated.
The competence of midwives regarding the
history-taking and clinical assessment method
was not evaluated in detail in this study, since
it is expected that a professional midwife will
be updated and clinical competent regarding
Microscopes should be considered standard
equipment in Primary Health Care Clinics and
professional nurses and midwives should be
trained to use it in the appropriate situations.
It can be used to diagnose the causative organ-
ism in vaginal infections, but also, amongst
others, in identifying the ferning capacity of
the cervical mucus with ovulation (Olds et al.
1996:138), or to cany out the ferning test in
order to diagnose rupture of membranes (Olds
et al. 1996:484).
CONCLUSION
Chronic vaginal infection in pregnant women may
lead to several complications as indicated in the
introduction.
In this study, more than half of the causative or-
ganisms of vaginal infections in the sample, diag-
nosed by history-taking and clinical assessment
method, differed from the diagnosis made by using
wet mount preparations.
These differences can be either due to the fact that
the method itself is not as reliable as thought, or it
might be due to lack of competence in using the
method.
To improve maternal and child health, this situa-
tion should be challenged. Challenged by the pro-
fessional nurses and midwives as well as by man-
agers of health care.
REFERENCES
AMENT, LA & WHALEN, E 1996: Sexually transmit-
ted diseases in pregnancy: Diagnosis, impact and inter-
vention. JOGNN, 25(8).
BURNS, N & GROVE, SK 1993: The practice of nurs
HEALTH SA GESONDHEID Vo1.6 No.1 - 2001
ing research conduct, critique and utilization; 2"' ed.
Philadelphia: WB Sannders Co.
DEUTCKVAN, ME; LEAMAN, DJ & THOMASON,
JL 1994: Vaginitis: Diagnosis is the key. Patient Care,
September 1994.
FREEMAN, SB 1995: Comlnon genitourinary infec-
tions. JOGNN, 24(8).
GOVENDER, L; HOOSEN, AA; MOODLEY, J;
MOODLEY, P & STRUM, AW 1996: Bacterial
vaginosis and associated infections in pregnancy. Inter-
national Journal of Gynecology and Obstetrics, 55.
NEL, JT 1995: Kernvcrloskunde en ginekologie met
eksamenwenke vir 1M.B.Ch.B. Isando: Heinemann
Vooltgesettc Ondenvys.
NEWTON, ER; PIPER, J & PEARIS, W 1997: Bacte-
rial vaginosis and intra-amniotic infection. American
Joi~rnal of Obstetrics.
O'DOWD, TC 1991: New light on vaginitis. Update,
June 1991.
OLDS, SB; LONDON, ML & LADEWIG, PW 1996:
Maternal newborn nursing. Menlopark: Addison-Wesley
Publishing Co.
PASTOREK, JG; MARTIN, DH; COTCH, M F &
ESCHENBACH, DA 1996: Clinical and microbiologi-
cal correiatcs of vaginal trichomonas during pregnancy.
Clinical Infections Diseases, 23, 1996.
HEALTH §A GESONDHEID V01.6 No.1 - 2001 27
RESEARCH
THE EXPERIENCE OF BIOLOGICAL FATHERS OF THEIR PARTNERS' TERMINATION OF PREGNANCY
Marie Myburgh MCur (Psychiatric Nursing) student M U
Sandra van Wyk DCur (Psychiatric Nursing)
RAU
ABSTRACT
The purpose ofthis article was to explore and describe how single ad~rlt biological fathers experience the
termination ofpregnancy their partners had. The research design entclilerl cz qualitative, descriptive, ex-
plorative and contextlral design.
Cuba's model of ensuring trusnvorthiness in qrmlitative research was applied The phenomenological strategy
was used to collect data from [I purpo~ive sample of respondents, consi.sting ( fn ine acllrlt biological fathers
who met the sampling criteria.
Three themes emerged from the rrnalysis of respondents which were: po~verlessness related to the inability
to have a choice in the decision of the termination ofpregnancy; emotionc~l tzirmoil related to the impact of
the decision on inter-per.sonal and intra-personal relcitionships; ancl lastly psychologicnl defence mecha-
nisms as a way of dealing with the stressfir1 efect of the terminatioit ofpregnancy. A literat~rre control >vas
done to v e r i ' the reszrlts nncl recontextlralise it within the field of psychiatric nnrsing. Conclusions cine1
recommenrlations were made.
OPSOMMING
Die doe1 van die artikel was om eerstens ondersoek in te stel en te beskqf hoe enkellopende, vol~vasse
biologiese vaclers die beginrliging van hlrl mants se swangerskap belee5 Die nnvorsingsontcverp was
hvalitatiej; verkennend, beskiyvencl en kontekst~ieel van nard. Gzrba se model vir vertrolrens~vaardigheid in
bvalitatie~ve nnvorsing is clezirgaans toegepas om vertrozrenswaardighein te verseker: Data is ingesarnel
dezir die gebruikinaking van 'n fenomenologiese strategic vvaar 'n cloelgerigte steekproef van nege vohvasse
biologies vcrclers, cvat aan die steekproejkriteria volcloen het, geneem was.
28 HEALTH §A GESONDHEID V01.6 No.1 - 2001
Die volgende femas i.r uit die data geiilentijjiseer: hzilpeloosheid te bv,vte nnn die onvermoe om 'n kerise te
kan uitoefen in die heslllitneming oor die terminasie van s~vangersknp; emosionele t~irb~ilensie rondom die
impuk van die besluit op interpersoonlike en intrnpersoonlike verhondinge; en laastens psigologiese
verdedigingsmeganismes om die stresvolle effek van terminnsie van svvangersknp te hnnteer. ' n
Literntuzlrkontrole is dnarnn gedoen om die resultate te verifieer en hinne die veld van psigiatriese
verpleegkunde te rekontekstunliseer: Gevolgtrekkings en aanhevelings i r gemmk.
BACKGROUND AND RATIONALE
Termination of pregnancy! Whilst other people are
still debating whether termination of pregnancy is
right or wrong it has been legalised in South Af-
rica and implemented since February 1997. The
Act (Choice on Termination of Pregnancy Act No.
92 of 1996) enables women from the age of 12 years
old to decide to terminate a pregnancy before 12
weeks gestation. This was done to enhance the
health and quality of life of women in South Af-
rica. The Act (Choice on Termination of Pregnancy
Act No. 92 of 1996) makes provision for non-com-
pulsory counselling before, during and after the
termination of pregnancy.
Although the Act (Choice on Termination of Preg-
nancy Act No. 92 of 1996) makes provision for
women, it does not embrace the right of the adult
biological father. Men's standing in the termina-
tion of pregnancy debate has remained essentially
unchanged during the past two decades (Shifman,
1990279-296). Throughout the world termination
of pregnancy is a woman's choice; even in the most
egalitarian relationships, the male must realise it is
his partner who makes the final decision to termi-
nate or to continue with a pregnancy, and the most
he can do is offer suggestions.
The Act (Choice on Termination of Pregnancy Act
No. 92 of 1996) states that non-compulsory coun-
selling must be provided before and after the preg-
nancy, however the counselling is only intended
for women. Counselling according to Thompson
& Rudolph (1992: 18) is a process where a trained
professional forms a trusting relationship with a
person who needs assistance. This relationship
focuses on personal meaning of experiences, feel-
ings, behaviours, alternatives, consequences and
goals. This implies that by being able to describe
and explore the experience will help to put the ter-
mination of pregnancy into perspective. This high-
lights the fact that where proper counselling facili-
ties are not available to adult biological fathers, it
is going to prolong the biological father's process-
ing of the termination of the pregnancy by his part-
ner.
No previous research has been done within this
context to explore and describe biological fathers'
experiences of the termination of pregnancy their
partners had.
PROBLEM STATEMENT, RESEARCH QUESTION AND OBJECTIVES
The problem statement will be described using the
following narrative:
It was one of the only times in his life where he
realised that he was involved, but did not have the
ultimate say. He was really in favour of it at the
time, but he realised it was . . . a woman's decision.
He was against termination of pregnancy and still
is; he believed that a man's position was second-
zuy. It had to be in such a decision. It involved
someone else's body. It made him feel helpless,
having a certain conviction and realising that it did
not matter in reality. It did not bother him that
people have a choice, but it bothered him, because
he did not like the termination of pregnancy.
The most difficult part for him was three days prior
to the termination of the pregnancy. In a small way
H F A l TH S A GFSnNDHElD Vo1.6 No.1 - 2001 29
he felt relieved the minute they stepped out of the
clinic, although he felt guilty. He thought to hinl-
self "Someone who should have been born is gone".
It is someone who did not get a chance.
From the above narrative it is clear that the bio-
logical fathers seem helpless and despondent in
their inability to have a say in their partner's ulti-
mate decision and tkat they display a desperate need
for their voices to be heard.
Little information in this regard is available in the
South African context. It is because of this story
and those of other fathers that the authors asked
the following research question:
How do czd~llr biological fathers experience the ter-
rr~ir~atioiz of pregnancy their partners had?
The objective for this article is as follows:
To explore and describe hovv adlilt biological fa-
thers' experience the termination ofpregnancy their
partners had.
RESEARCH DESIGN AND METHOD
A qualitative descriptive, explorative and contex-
tual research design (Ma~iglio & Marais, 1994:43-
44) was utilised to conduct thrs research. The fo-
cus was to obtain data that would facilitate the un-
derstanding of the experience of the adult biologi-
cal fathers whose partner had a termination of preg-
nancy.
between the ages of 18-35 years who accompanied
their partners to the various identified private clin-
ics in Gauteng for a termination of pregnancy. The
sample was also culturally represented by the larger
South African population. They ail spoke and un-
derstood both English and Afrikaans. The last cri-
teria involved voluntary participation. Participants
were prepared to participate in the research and it
was elicited by their written consent, ensuring an
ethical code of conduct.
The respondents interviewed displayed the follow-
ing characteristics:
All the respondents accompanied their
partners voluntarily to the various identi-
fied private clintcs in Gauteng for a temi-
nation of pregnancy.
All the respondents paid R800 for the ter-
mination of the pregnancy.
Socio-economically one could categorise
them in the so-called middle class of soci-
ety.
All the respondents were single and com-
mitted to their relationship with their part-
ner. . Two of the interviews were conducted in
Afrikaans and the remaining six in English.
Four of the respondents were White, one
Coloured, one Asian and three Blacks.
Thus the sample was multi-cultural.
Data collection Sampling
In this phase the respondents who met the sampling
criteria were identified purposively (Mouton,
1996: 134) to participate in this study.
The sample of this study comprised a total of nine
adult biological fathers, as data was saturated by
means of repeating themes. There were various
sampling criteria for the participants to be included
in the study. The first being that the target popula-
tion for the study was single biological fathers,
Semi-structured, in-depth phenomenological inter-
views (Kvale, 1983:184) were conducted as a
method of data gathering. Interviews were recorded
using a dictaphone and were transcribed verbatim
(Bums & Grove, 1993578-581).
One central question was asked, namely:
"How was it for you when your partner had an abor-
tion?'
The interviewer created a context where the respon
HEALTH SA GESONDHEID V01.6 No.1 - 2001
dents could speak freely and openly by utilising
non-directive communication techniques such as
probing, paraphrasing, summarising, silence, clari-
fying, reflecting of content and minimal verbal re-
sponses. During the interviews the interviewer used
bracketing (putting preconceived ideas aside) and
intuiting (focusing on the lived experience of the
respondents during the termination of pregnancy
by their partners). Interviews were conducted un-
til the data was saturated as demonstrated by re-
peating themes and not by the amount of interviews
done.
The interviewer took field notes based on observa-
tions made during the interviews. These field notes
addressed the interviewer's observation, personal
experience, methodological issues and theoretical
notes. More importantly the field notes are for re-
membering the observations, retrieving and
analysing them (Wilson, 1989:434).
Data analysis
Data was analysed using Tech's descriptive method
(in Creswell, 1994:154-156) of qualitative data
analysis. This method entails reading through the
transcripts to form an idea of the story line. The
next step is to think about the underlying meaning
and writing notes in the margin. All the similar top-
ics are clustered together under major topics, unique
topics, and leftover topics. The most descriptive
wordings for topics will then be turned into cat-
egories. These categories will then be revised until
final categories and sub-categories arise. An inde-
pendent coder analysed the data separately from
the researcher (Creswell, 1994:158; Krefting,
1991216). After consensus discussion between the
independent coder and the researcher, the identi-
fied themes were presented and tabulated.
A literature control was done to verify the research
study and results, according to Morse & Field
(1996:106). Recontextualisation is the develop-
ment of the emerging theory so that the theory is
applicable to other settings and other populations
and a literature control was used as a basis for de-
scribing guidelines. The guidelines were then dis-
cussed with other advanced psychiatric nurse prac-
titioners for the purpose of validating them.
Measures to ensure trustworthiness
Measures to ensure trustworthiness were applied.
Guba's model as summarised in Krefting
(1991:215-222) suggests strategies of credibility,
transferability, dependability and confirmability.
The activities in achieving credibility were pro-
longed engagement in the field, keeping reflexive
field notes, member checking by a literature con-
trol using findings of similar studies done in and
about men and abortion, the researcher's authority
and structural coherence.
Dependability was achieved by dense description
of the data, audit trail, peer examination and a code-
recode procedure. Transferability was achieved by
purposive sampling; dense description of method-
ology and literature control to maintain transpar-
ency, confirmability was by audit trail and reflex-
ivity (Krefting, 1991 :215-222).
Ethical measures
Due to the sensitive nature of the research, strict
ethical measures were adhered to during this re- search. These include informed consent of the re- spondents' privacy, ensuring confidentiality and anonymity and providing the adult biological fa- thers with results (Denosa, 1998:l-7).
RESULTS AND DISCUSSION OF RESULTS
Table 1 is an overview of the major themes and
sub-themes of the adult biological father's experi- ence of the termination of pregnancy his partner
had.
HEALTH SA GESONDHEID V01.6 No.1 - 2001
Tablel: An overview of major themes and sub-themes of the adult biological father's experience of the termination of pregnancy his partner underwent
2. Experiencing emotional turmoil related to the impact o i the decision on inter-personal and
intra-personal relationships.
M M O R THEMES
1. Powerlessness related to the ~nabil ity to have a choice in the terinination o f pregnancy
Internal struggles with own values and morals.
'1. Sadness related to: the loss of a potential child; . change in their relationships.
2. Feelings of guilt related to: destroying the foetus, being an accompl~ce; . not attending to their contraceptiue responsibilities.
3. Anger related to: . iiot having done more to prevent the pregnancy;
their own helplessness and inability to iully share the burden o f the
unwanted child;
their pattners who became irritable and i~ i thdrawn. 4. Concern related to:
the experience their partner has to go through because of the termination of pregnancy;
changes occurring in their relationship with their partner;
SUB-THEMES s Po>fi/erlessness related to having little control over the decision beiiig
made. . Feelings of being excluded and isolated from the decision-making. . Silent about their own concerns.
disguising their own ieeiings.
3. Psychological defence 1 e Rational isat~or~ to make the d e c ~ s ~ o n about terminating the mechanisms as way of dealing ,,with the stressful effects of the
terrnination of preqnanc?
pregnancy more acceptable. Avoiding feelings of being ashamed by being silent and secretive
about the sub~ect oftermination o i ~ r e u r t a n c ?
~h~ discussion of findings wi]] be based on major related to the little control they have over the ter-
themes and sub-themes as set out in table 1. This mination of pregnancy, their own needs, choices
table will be discussed in detail as well as and feelings. This was reflected in one the inter-
recontextualised and verified with a literature con- views where an adult biological father verbalised
trol. the following "when sheJellpregnunt you know it
The findings are discussed below. is my baby as much as it is hers. It might be her
body, and that is what she says to me.. . 'You know
Theme 1: Powerlessness related to the in- it is different beca~~se it is in my body'. But one
ability to have a choice in the decision of the minute she is keeping the baby and the next minute
termination of pregnancy she is not keeping the baby, and it is like I don't
haven say. She makes the decision and that is that. "
Powerlessness related to having little control over
the decision being made Support for this observation can be found in Shostak
The powerlessness expressed by the adult biologi- andMcLouth's (1984:51) survey of l000men who
cal fathers related to the unequal power distribu- accompanied their partners to an abortion clinic in
tion regarding the decision of a termination of preg- the early 1980's. In this study 5 11 of the respon-
nancy. The respondents who participated in the dents did not object to women's unilateral right to
shidy believed that a termination of pregnancy was a termination of pregnancy, but in fact objected to
the only option they had because their pamers had being held accountable for a decision in which they
already made the decision to have a termination of had no legal right to participate.
pregnancy. The powerlessness they experienced
HEALTH SA GESONDHEID V01.6 No.1 - 2001
Feelings of exclzdsion and isolatior~ from the de- cision
The powerlessness for another respondent was re-
lated to his own feelings of exclusion and isolation
from the decision about the termination of preg-
nancy, he was quoted as saying, "Ja, I have to put
her needs in front of mine at this stage mainly for
the reason that I don't want to put her through this.
I can l expect her to have the baby, I can't tell her I
>vrmt the baby, becartse she has to decide, and that
hurtc. inside".
Peter Zelles (in Shostak & McLouth 1984:145), a
termination of pregnancy counsellor, supports this
by saying, "Abortion is a woman's choice, and
while I agree with the logic sense and necessity of
this I realise there is an inherent feeling of unfair-
ness in it. Even in the most egalitarian relationship
the male must realise it is his partner who makes
the final decision, to abort or continue a pregnancy
and the most he can do is offer his suggestion".
Silence about their own concerns
Another respondent respected the fact that it was
his partners right to have termination of pregnancy
but struggled with his own values and morals of
his choice. The following statement reflects this
"It's her choice, but for me it is like a debate
whether it is right or wrong. You know because
morally I know it is the wrong decision".
This experience of the internal struggle with their
own values and morals is supported by research
done by Marsiglio and Diekow (1998:276) who
state that men differ widely in their perception of
abortion whereas many recognise women's rights
to choose to have a termination of pregnancy. Some
are confronted with moral issues due to their own
individual experiences and belief systems. They
continue by saying that the abortion itself is the
culmination of a decision-making process from
which men are often excluded. This is not to say
that men must make the decision regarding the ter-
mination of the pregnancy. It is only to observe
that the emotional products of leaving men out of
the termination of pregnancy decision-making pro-
cess and counselling are often mixtures of power-
lessness and isolation. Various emotions that the
adult biological fathers experienced will now he
discussed.
Theme 2: Experiencing emotional turmoil related to the impact of the decision on in- ter-personal and intra-personal relation- ships
The adult biological fathers, who participated in
this study, experienced a wide range of emotions
related to the impact of the decision on their inter-
personal and intra-personal relationships. These
feelings will now be discussed.
Sadness related to the loss of apotential child
and other changes in their love relationship
Sadness around the sense of different losses expe-
rienced will now be highlighted by the following
direct quotations:
"I feel sad becaltse it is a life, it has not been born
yet, but it is a life that has been created. A lot of
the time it is all I think about, that I always try my
best and block it out tofind some way of accepting
it, you know. It is going to be d i f l c ~ ~ l t " . To sup-
port this Shostak & McLouth (1984: 11 1) found in
their research that men were set back by the entire
experience and many dwelled on their multiple
losses (the affair, the unborn child, the sense of
being unable to manage their lives).
Unfortnnately, the adult biological fathers who par-
ticipated in this research study seemed not only to
experience sadness and a sense of loss over their
child but also spoke about sadness over the changes
in their relationship with their partner. "Ja, it is
from now on our relationship ~vill never be the same.
I am not sure about anything. I don't know how
she is going to be like. Ifshe came orit I don't know
if1 have to be quiet. I don't know because there is
going to be so many feelings going through her
HEALTH SA GESONDHEID Vo1.6 No.1 - 2001
head".
The Pro-Life Activists Encyclopaedia (httpll
www.prolife.com, 1997:6) says that women re-ex-
perience a termination of pregnancy in many ways
and consequently behave in ways to avoid stimuli
associated with a termination of pregnancy, namely:
Feelings of detachment or of estrangement
from others.
Withdrawal in relationships andlor reduced
communication.
Restricted range of affection, e.g. unable
to have loving feelings.
This is further confirmed by studies (httpll
www.prolife.com, 1997:14) that have shown that
more than eighty percent of the relationships break
up within two months of the termination of preg-
nancy. In the literature Shostak & McLouth
(1984:212) are of the opinion that when a preg-
nancy occurs most men find themselves with deep
and unexpected feelings. These feelings such as
anger and sorrow are not comfortable for most men,
and they eventually develop into feelings of guilt.
Other emotions experienced by the adult biologi-
cal fathers include guilt and anger, which will now
be discussed.
Guilt related to the idea of destroying the foe- tus, and not attending more carefully to their contraception responsibilities Feelings of guilt are expressed in the following
quotation. "I went through a heavy guilt period,
even before the termination ofpregnancy had taken
place. I think Ifelt grtilty just because of the things
I ignored, we were 1azy.for a while and then it hap-
pens and you end LIP killing a potential life, killing
something".
Whitfield (1989:43) states that guilt is an uncom-
fortable or painful feeling that results from doing
something that violates or breaks a personal stan-
dard or value. A respondent from research done
by Shostak & McLouth (1984:17) puts what
Whitfield says in words. "In a small way I felt re-
lief the minute we stepped o~rt the clinic, altho~igh
the gliilt and regret was there. Have yo11 rendAnre
Sextens poem abo~rt abortion? There is a line some-
thing like 'Someone who shocrld have been bonz is
gone' I read it and that is how 1,felt about it and
still do".
Anger related to their own feelings of help- lessness, anger towards their partners who become irritable and withdrawn and some- how not doing more toprevent fhepregnancy The adult biological fathers are angry with them-
selves for not (somehow) having done more to pre-
vent a pregnancy. They are angry with their part-
ners who upon learning of the pregnancy may be-
come withdrawn, initable or seem to shut them out.
They are angry at their own helplessness and in-
ability to fully share the burden of an unwanted
pregnancy. One respondent felt angry with him-
self for not somehow having done more to prevent
the pregnancy and felt solely respoilsible for what
was happening to his girlfriend. "This was not szrp-
posed to happen, she ivas not sirpposed to fallpreg-
nant. I feel angry with myselJ I made a mess lip,
and it is hard yoii know, Ifeel bad doing this to her.
lreally feel like scum, really baddoing this to her".
Counsellor Rodger Wade (in Shostak and McLouth,
1984:41) an abortion counsellor, traces an inordi-
nate amount of the problem to the exaggerated
macho expectations males place on them. The man
who believes that he should protect his partner from
all harms may feel like a total failure because "his
woman" is pregnant and will have to mn the risk
of abortion.
Anotherrespondent was angry with his partner who
becomes tearful, withdrawn and irritable. "Oh ivell,
she is going throrrgh a lot right now. She can not
he the same a5 what she normally is, you can not
have the same conversations, can't watch the same
movies, beca~rse she is emotionally rrnstrible and
the strain on the relufionship, you can jeel that there
is a clolld hanging over us, yo11 can see on herfiice
HEALTH SA GESONDHEID Vo1.6 No.1 - 2001
she is not her chirpy old seg and I can't get through
to her". Finally the adult biological father experi-
ences feelings of concem, which will be discussed
under the following heading.
Concern related to their partners' experience of the termination ofpregnancy and by being silent about their own pain and confusion Some respondent's concern was about their
partner's experience and they believed that if their
partners coped, it would make it easier for them to
cope. "Becanse ifl cnn sclppor? her and I think she
is doing okay it is going to have an a~rtomatic ef-
fect on me as well, vvhen she isfine, I will befine".
This type of reaction is relevant to Major, Cozarelli
andTestas' (1992: 114) study of 73 couples in which
they examined the impact of men's coping expec-
tations on women's post abortion adjustment. They
found men's coping expectations were not impor-
tant in situations where women had high coping
expectations but men's coping mechanisms and
support were important for women with 110 coping
expectations.
It appears that men respond to a termination of preg-
nancy experience by being silent about their own
pain and confusion because they believe that dis-
cussing these issues would only heighten their part-
ners' concem. The following direct quotation high-
lights this. "I feel I have to do the right things, I
can Y say how Ifeel. You have to thiizk befire you
say anything".
Lronically the silence of such men can be misinter-
preted by certain women as indicating the man has
no such feelings and such suspicions are likely to
estrange the partners in hard to heal ways. This
experience is supported by Peter Zelles (in Shostak
& McLouth, 1984: 142) a termination of pregnancy
counsellor, who is of the opinion that men feel they
need to be strong for their partners, to be fxm, logi-
cal and emotionless to avoid upsetting them.
The next category explores the defence mechanisms
used to maintain emotional equilibrium.
Theme 3: Psychological defence mechanisms as way of dealing with the stressful effects of the termination of pregnancy
Rationalisation to make the decision about terminating the pregnancy more acceptable The adult biological fathers used rationalisation to
make the decision about terminating a pregnancy
more acceptable to them. The following quote is
an example of arationalisation process. "lfwe want
to have a child coming into this rvorld, we vvnnt
this child coming into a gooil rvorld. I don't want
the child to struggle, the timing was bad, and we
are doing the terminafion of prepnancy before 3
months, then it is not a life yet ... the baby has not
even started breathing, that helped ns make fhe
decision". Kaplan, Sadock and Grebb (1994:251)
state that a person offers rational explanations in
an attempt that may otherwise be unacceptable.
Such underlying motives are usually instinctually
determined.
Avoiding feelings of being ashamed because they were in this predicament, by being silent and secretive about the subject of termination of pregnancy The majority respondents offered isolating state-
ments. "It was a mad issue, I hird to resolve it my-
seg and ~vell basically I don 't think anybody could
do anything. Basically it's behveen two people to
sort out fheirproblems".
Others explained that no one seemed appropriate
for this unique sort of intimate conversation. A
respondent (in Shostak and Mclouth, 1984:13)
sums this up: "I really needed someborly to talk to
at the time bnt there was not anybody and I was
tired dealing with this issue. I went to my father's
empty house and sat there for hvo days and tried
not lo feel".
RECOMMENDATIONS
It is recommended that guidelines for srrpport for
these fathers should be deducted and described for
operationalisation in the context where termination
of pregnancies are carried out. A biological father
should receive support in the form of counselling,
where he can be empowered to let his voice of pain,
frustration, sadness, powerlessness, hurt, and an-
ger be heard. In this way, he can also define the
situation in some way to promote his own healing.
CONCLUSION
The interviews that were conducted indicated that
the adult biological fathers were deeply affected
by the termination of pregnancy their partners had.
Their story seemed to be one of experiencing pow-
erlessness regarding their decisions of termination
of pregnancy. Because of the decision and act they
experienced feelings of sadness and loss that in-
cluded feelings of anger and guilt. They believed
that by hiding their own feelings and needs their
partners would be able to handle the termination
of pregnancy and they expressed their concern by
hiding their own feelings. To cope with the stress-
ful situation, they used coping mechanisms, like
rationalisation and secretiveness. Not knowing
exactly how he is expected to feel and behave, and
lacking a customarily rigid and unforgiving male
role model, the typical man rushes to protect his
partner, repress his emotions and takes his cues from
his environment that others structure for him (for
example the public, with its moral censure of a ter-
mination of pregnancy, the clinic staff with their
meagre range of services for waiting room males).
From beginning to end this research tried to make
clear a male struggle to restore self-confidence in
their ability to manage unexpected events. They
try to keep a suddenly strained love relationship
from ending sooner than either partner envisaged
and they do what they can do, to make the best of it
all; to define the situation in some fashion that pro-
motes healing for both partners.
This research indicated that the legislation of ter-
mination of pregnancy in South Africa not only
affects the woman involved but also her partner.
This emphasises the importance of assisting all
parties involved in the termination of pregnancy.
REFERENCES
Act no. 92 of 1996: Act on the Freedom of choice in
terminating pregnancy
BURNS, N & GROVE, SK 1993: The practice of nurs-
ing in research. Philadelphia: WB Saunders
CRESWELL, JW 1994: Research design: qualitative and
quantitative approaches. California, London, New Delhi:
Sage Publications.
DEMOCRATIC NURSING ORGANISATION OF
SOUTH AFRICA 1998: Ethical standards for nurse re-
searchers. Pretoria: DENOSA.
INTERNET 1997: The pro-life activists encyclopaedia:
The American Life League. 1997:l-31.
KAPLAN, HI; SADOCK, BJ & GREBB, JA 1994:
Synopsis of psychiatry: Behavioural sciences: clinical
psychiatry; 7th edition. Baltimore: Williams and
Wilkens.
KREFTING, L 1991: Rigor in qualitative research: the
assessment of trustworthmess. The American Journal
of Occupational Therapy, 43(3), March 1991:214-222.
KVALE, S 1983: The qualitative research interview: A
phenomenological and a hermenentic model of under-
standing. Journal of Phenomenological Psychology,
(14), 1983:171-196.
LINCOLN, YS & GUBA, EG 1985: Naturalistic inquiry.
Beverly Hills: Sage Publications.
MAJOR, B; COZZARELLI, C &TESTA, M 1992: Male
partners appraisals of undesired pregnancy and abortion:
Implications for women's adjustment to abortion. Jour
HEALTH SA GESONDHEID V01.6 No.1 - 2001
nalof Applied Social Psychology, (4)March, 1989:214-
237.
MARSIGLIO, J & MARAIS, HC 1994: Basic concepts
in the methodology of the social sciences. Pretoria:
HSRC Publishers.
MORSE, JM & FIELD, PA 1996: Nursing research: The
application of qualitative approaches. London: Chapman
& Hall.
MOUTON, J 1996: Understanding Social Research
Pretoria: Van Schaik.
SHIFMAN, P 1990: Involuntary parenthood: misrepre-
sentation as to the use of contraceptives. International
Journal of Law and the Family, (4), 1990:279-296.
SHOSTAK, AB & MCLOUTH, G 1984: Men and ahor-
tion: Lessons, losses and love. New York: Preager Pub-
lishers.
THOMPSON, CL & RUDOLPH, LB 1992: Counsel-
ling children; Yd edition. California: BrooksiCole.
WHITFIELD, CL 1989: Healing the child within. United
States of America: Health Communications.
WILSON, HS 1989: Research in nursing; 2"d edition.
Redwood City, California: Addison-Wedey.
HEALTH SA GESONDHEID V01.6 No.1 - 2001 37
RESEARCH
SUPPORT FOR ADULT BIOLOGICAL FATHERS DURING TERMINATION OF THEIR PARTNERS' PREGNANCTES
Marie Myburgh MCur (Psychiatric Nursing) student
RAU
Antoinette Gmeiner DCur (Psychiatric Nursing)
RAW
Sandra van Wyk DCur (Psychiatric Nursing)
RAU
ABSTRACT
Nobody denies the fact that termination of pregnancy has an effect on women, but very few people realise
that termination of pregnancy also has a major impact on men.
Men experience a sense of po+verlessness related to an inability to have a choice in the process of the
termination of pregnancy. They also experience emotional turmoil related to tfie inzpact of the decision OIZ
interpersonal and intra-personal relationships. A way for the adult biological ,father to deal with these
stressfrl effects is to ~ctilise psychological defence mechanisms (Myburgh, 1999:39-57).
The goal of this article is to describe guidelinesfor the advancedpsychiatric nurse practitioner to scrpport
adult biological fathers in mobilising their resources and therefore promoting their mental health. A quali-
tative, descriptive and context~cal research design was ~rtilised, where resztlts from phenomenological inter-
views and a literat~rre control, served us a basis for dedzccting and describing guidelines for sc~pportive
counselling. The counselling process will allow the adult biological father to ventilate his feelings, thoz~ghts
and behavio~cr and put the termination of pregnancy into perspective as a starting point for constructive
change, therefore facilitating his mental health.
OPSOMMING
~Viemand ontken dat die beeindiging van swangerskap 'n uitwerking op die vrou het nie, maar baie min
mense besef dat die beeindiging van swangerskap ook 'n bedicidende invloed op mans het.
Mans ervaar 'n gevoel van magteloosheid ten opsigte van die feit rlat hnlle geen s t het in die prosed~cre wat
gevolg word o?n die swangerskap te beeindig nie. Mans ervaar ook emosionele verwarring ten opsigtr van
die impak van die beslirit op interpersoonlike en intra-persoonlike verhondings. Volwasse biologiese vaders
gehririk verskeie psigologiese verdedigingsmeganismes om die stresvolle irihverking van die beeindiging
van die svvanger.skap te probeer hanteer (Myburgh, 1999:39-57).
Die doe1 vnn hierdie artikel is oin riglyne vir die gevorclerde psigintriese verpleegpraktisyn te beskrjf om
38 HEALTH SA GESONDHEID V01.6 No.1 - 2001
adult biological fathers experience powerlessness related to the inability to have a choice in the
termination of pregnancy, as they believed that the
termination of pregnancy was the only option they
had.The powerlessness was about having little con- trol over the situation and their own needs. In ad-
dition, the adult biological fathers experienced
emotional turmoil related to the impact of the decision on interpersonal and intra-personal relationships. Finally, the adult biological fathers
who participated in this study experienced various
emotions and it was found that they use psycho- logical defence mechanisms, in an effort to cope
with their feelings and to maintain emotional equi-
librium.
All of the above is a clear indication that these adult
biological fathers need support to provide the op-
portunity for them to ventilate their thoughts, feel-
ings, and behaviour in order to put the termination
of pregnancy into perspective as a starting point
for constructive change and facilitation of mental
health.
In lieu of the above, the following research ques-
tion was posed:
What guidelines can be described for the ad- vanced psychiatric nurse practitioner to support adult biological fathers whose partners had a termination of pregnancy?
The objective of this article is to describe guide-
lines for the advanced psychiatric nurse practitio-
ner to provide support to adult biological fathers
who accompany their partners to the various iden-
tified private clinics in Gauteng for a termination
of pregnancy, and to assist them in mobilising their
resources to facilitate the promotion of their men-
tal health as an integral part of health. A literature
control will also be completed to recontextualise
guidelines and verify it.
RESEARCH DESIGN AND METHOD
A qualitative, descriptive, and contextual research
design was utilised (Mouton & Marais, 1994:43-
44) where the results of the in-depth, semi-struc-
tnred, phenomenological interviews and the litera-
ture control served as a basis for the description of
guidelines for the advanced psychiatric nurse prac-
titioner to provide support to adult biological fa-
thers whose partners had a termination of preg-
nancy, and assist them in mobilising their resources
to facilitate their pro~notion of mental health
(Creswell, 1994:15; Mouton, 1996: 134; Morse &
Field, 1996:106-107; Lincoln & Guba, 1985:290-
327; DENOSA, 1998:7).
Sampling, data gathering and data-analysis
A purposive sample of nine single, adult, biologi-
cal fathers, who met the sampling criteria, was
utilised. Phenomenological interviews were done
to elicit their experience of the termination of preg-
nancy their partners had. Interviews were done until
saturation of data occurred with repetition of themes
(Kvale, 1983:Xl-107). Data was analysed by means
of the descriptive method of open coding of Tesch
(in Creswell, 1994: 154-156). Data gathered for the
purpose of this article included results from inter-
views and a literature control that served as a basis
for deduction of guidelines. A literature control was
also done to verify guidelines and recontextualise
it within the context of psychiatric nursing.
DESCRIPTION OF GUIDELINES AND LITERATURE CONTROL
From the results of the interviews it was clear that
the adult biological fathers experienced the termi-
nation of pregnancy as a stumbling block in their
lives, and they expressed a need for counselling.
Consequently for the reason mentioned above it is
important to encourage the adult biological father
to tell his story. Guidelines for the study propose
the development of counselling guidelines for in-
tegrating men into termination of pregnancy coun-
selling services.
HEALTH SA GESONDHEID Vo1.6 No.1 - 2001
Therefore the objective (Egan, 1986:34) when do-
ing this is to allow him to ventilate his feelings,
thoughts and behaviours. By giving him the op-
portunity to do this it will help the adult biological
father to put the termination of pregnancy into per-
spective and to use this as a starting point for con-
structive change, and therefore facilitate the pro-
motion of his mental health.
The advanced psychiatric nurse practitioner as il-
Instrated in figure l functions in the capacity of
facilitator supporting the adult biological fathers
in improving their well-being and alleviate their
distress, by helping them to use their existing re-
sources and skills, and guiding them in developing
new ways to help themselves.
The following counselling guidelines could be
made for the advanced psychiatric nurse practitio-
ner based on the findings of this shidy. Counsel-
ling is understood by helping professionals as a
relatively short process, often occurring in one ses-
sion and rarely comprising more than five sessions
(Corsini, 1995:79). Therefore it is hoped that the
following counselling guidelines within the con-
text of the termination of pregnancy clinics will
contribute in a unique manner to the adult biologi-
cal fathers healing and facilitation of their mental
health.
The framework of the counselling guidelines will
be discussed as aprocess under the following head-
ings:
Relationship phase
The goal of this phase is to form a strong therapeu-
tic alliance with the adult biological father, to fully
examine the male experience. The heart of the
counselling process is the relationship. The rela-
tionship is important in coiinselling because it
Figure 1: Guidelines for counselling for adult biological fathers facilitated by the advanced psychi- atric nurse
Context - Private Clinic E
HEALTH SA GESONDHEID V01.6 No.1 - 2001 41
handels significant feelings and ideas. In special
ways the counsellor models how to establish and
maintain a relationship (Brammer, Shostrom &
Abrego 1983:83). Disclosing these feelings and
emotions that the adult biological father experience
on an intimate level with a counsellor help work
against the sea of isolation and personal withdrawal,
that the adult biological father often experience
following this benchmark, emotional event. Since
many adult biological fathers haven't tnlked with
anyone about their situation, this contact breaks
down isolation and allows for initial expres~ion of
emotion.
Skills that the advanced psychiatric nurse practi-
tioner would need to help the adult biological fa-
ther tell his story, would be empathy, which is the
ability to enter into and understand the world of
another person, and to communicate this under-
standing to him (Egan, 1986:85); active and reflec-
tive listening where the advanced psychiatric nurse
practitioner listens to feelings and deeper mean-
ings behind what is being said, and lastly
summarising so that all the issues that need to be
worked on can he identified
Joining with the adult biological father lets him
know that the advanced psychiatric nurse practi-
tioner is working with him and for him in a com-
mon search for alternate ways of dealing with what
has likely become an impasse. In the process the
advanced psychiatric nurse practitioner is encour-
aging the adult biological father to feel secure
enough to explore other more effective ways of
interacting and solving problems together
(Goldenberg & Goldenberg, 1996:203).
Tools and techniques to invite this conversation
could be used, by using a narrative perspective.
Narrative therapy is based upon the belief that there
is always "lived experience" or stories that chal-
lenge the dominant stories of disempowerment, and
that therapy is about bringing forth there alterna-
tive stories (White & E p ~ t o n , 1996:155). An
individual's stories have been influenced by the
social, cultural, political and economic environ-
ments in which the individual has lived (White,
1991:llO). According to White and Epston
(1996:112) aclient brings the dominant story about
the problem to counselling. The dominant story is
usually problem-saturated and ignores the trouble
free experiences of the individual. Dominant sto-
ries therefore work against the positive experiences
by filtering them out. As experiences that do not
fit within the dominant story are filtered out, so
too are positive attributes, such as strength and cour-
age (Chasin & Roth, 1995:lll). A narrative ap-
proach to therapy seeks to collaboratively re-au-
thor the person's self-narrative into a more liberat-
ing and positive life story.
Here the advanced psychiatric nurse practitioner
can invite the adult biological father into a conver-
sation about his account of the experience of the
termination of pregnancy, and introducing a pai-
ticular conversation called an extemalising conver-
sation. Extemalising conversations encourage adult
biological fathers to separate themselves from the
effect the problem is having on their lives and rela-
tionships (White, 1991:lO). The influence of the
problem is explored while also investigating how
the individual has been recruited into this self-iden-
tity by social, cultural and political practices.
People then gain a reflexive perspective of their
lives (White & Epston, 1996:llO-112) and are able
to experience a separation from the story and are
then free to explore alternative and preferred sto-
ries (White, 1991:llO).
Externalisation occurs primarily through wording
of questions that separate people from internalising
language. This also encourages the adult biologi-
cal father to provide an account of how the termi-
nation of pregnancy has been affecting his life and
relationships.
Working phase
Most of the co~~nselling work is carried out durinz
HEALTH SA GESONDHEID V01.6 No.1 - 2001
the working phase (Stuart & Sundeen, 1991:lOl).
The adult biological father and the advanced psy-
chiatric nurse practitioner explore relevant stres-
sors and promote the development of insight, by
linking his perceptions, thoughts, feelings and ac-
tions. It is therefore important for the adult bio-
logical father to share his feelings and experiences
with the advanced nurse practitioner as this helps
him to gain insight into a better understanding of
the termination of pregnancy.
Working in the "here and now" will allow the ad-
vanced psychiatric nurse practitioner to explore
some of the categories and themes highlighted in
the research. The here-and-now focus, to be effec-
tive, consists of two symbiotic tiers, neither of
which have therapeutic power without the. other.
The first tier is an experiencing one, the adult bio-
logical father lives in the here-and-now. The thmst
is ahistoric, the immediate events in the meeting
take precedence over events both in the current
outside life and in the distant past of the adult bio-
logical father. This focus greatly facilitates feed-
back, catharsis, meaningful self-disclosure, and
acquisition of socialising techniques. The second
tier which is the elimination of process (Yalom,
1998:45-48) where the advanced psychiatric nurse
practitioner together with the adult biological fa-
ther examines the here-and-now behaviour that has
just occurred in the counselling session. The ad-
vanced psychiatric nurse practitioner could reflect
on some of the feelings the adult biological father
experiences, encouraging him to verbalise them,
as well as his use of psychological defence mecha-
nisms, and what meaning and functions these might
serve.
The adult biological father could be encouraged to
confront and become curious about "inherent" be-
liefs of being a male, such as not having permis-
sion to talk about feelings for fear of being viewed
as a failure, thereby reconstructing a new way of
viewing his world. Working in the "here and now"
the advanced psychiatric nurse practitioner could
explore issues of trust, openness, decision-making,
power, separation, control, equality and feelings of
anger, sadness andloss. The psychiatric nurse prac-
titioner may urge the adult biological father to sig-
nal the very moment such feelings occur during the
session so that the advancedpsychiatric nurse prac-
titioner together with the adult biological father can
track down and relate these experiences to events
in the session (Yalom, 1995:58).
Corsini (1995: 10) identified that negative feelings
must not be avoided hut rather expressed. If these
feelings are allowed to surface and be experienced
they can be put into a useful perspective. The ad-
vanced psychiatric nurse practitioner can suggest
that the adult biological father write a "feeling let-
ter" adopted from the feeling letter technique (Gray,
1993:223-225). The best way to learn how to com-
municate upset feelings is to write them out. The
feeling letter helps to give yourself the support you
need when your partner can't. In brief the feeling
letter technique has two parts, the first consists of
writing out the complete truth about how you feel,
while imagining you are being heard and under-
stood and the second part is then to write a loving
response to your letter, responding with an open
heart. Write a response expressing the feelings and
acknowledgements that you need to hear. The pur-
pose of writing a feeling letter is to expand your
awareness to incorporate positive loving feelings
without having to repress your negative emotions.
Shostak & McLouth (1 984:79) support this by say-
ing, "If the man is given encouragement to ac-
knowledge his negative feelings about the tenni-
nation of pregnancy, a lot of pressure can be taken
of the woman, and the relationship".
In the research conducted, themes of loss and iso-
lation arose repeatedly. Unfortunately because they
are so rarely discussed their impact tends to be de-
structive rather than constructive carrying many
men to a point of emotional detachment and de-
spair rather to a sense of emotional maturity and
enhanced intimacy (Shostak & McLouth,
1984:155).
Therefore the advanced psychiatric nurse practi-
tioner can propose the following evocative tech-
niques that facilitates communication with self, by
evoking feelings, thoughts and emotions that when
worked through may deepen the individuals insights
and enhance his self-concepts (Okun, 1992:lll).
The following exercise adopted from Hendrix
(1992:278) could be used:
Take two chairs, place one in front of you and sit
on the other. Place the "loss" on the chair and pre-
tend it to be there. Begin speaking to the loss and
put into words all your feelings about it. Include
all the positive things it meant to you, how your
life has been affected by its absence, how you hurt
because it is gone. Express any anger you may
have that was not expressed when you had it or
that you have about it being gone. When you have
finished, imagine that you are at a burial site and
you are now going to say a final goodbye. In the
way that you may choose, bury the person or ob-
ject. Imagine the entire process, for instance, see
the person you are grieving for in the casket, see it
lowered into the ground and covered with dirt,
visualise the flowers and the weather. Then leave
the scene in your imagination. The purpose of this
exercise is that all past angers and ungrieved losses
will follow you into any relationship. The more a
person completes any past experiences the less
unconscious and archaic emotions will erupt
(Hendrix, 1992:279).
In addition the advanced psychiatric nurse practi-
tioner should emphasise the importance of com-
munication, as lack of communication shows dis-
interest and lack of concern for their partners.
Hendrix (1992:lll) supports the above. An inabil-
ity or unwillingness to communicate may be harm-
ful, establishing emotional and behavioural patterns
that not only hurt men and women individually but
also preclude their ability to engage in loving rela-
tionships. Skills for building relationships and com-
munication skills could be taught to the adult bio-
logical fathers. Dinkmeyer (1990:99, 121) provides
the following techniques to improve communica-
tion. Effective listening by "hearing" both non-
verbal and verbal messages, including the skills of
reflection of feelings, paraphrasing, clarification
and the use of open responses to encourage further
communication. Egan (1986:83-85) is of the opin-
ion that achievement of the ability to be intimate is
indispensable if the maturing male is to mitigate
excessive isolation. Intimacy he contends is "The
critical experience that brings the self back into
connection with others, making it possible to see
both sides to discover the effects of actions on oth-
ers as well as the cost to the self'. For this reason
intimacy is the transformative experience for men
through whom adolescent identity turns into the
generativity of adult love and work, and for this
reason termination of pregnancy clinic counselling
for males should be dramatically revised and ex-
panded to include intimacy-gaining skills.
Another area of need, once options and feelings
have been discussed, is how the adult biological
father can support his partner's decision. If there
is a mutually agreeable decision for the adult fa-
ther and his partner then the adult biological father
can be a valuable source of support. For example,
the adult biological father may help his partner
through the termination of pregnancy with emo-
tional support, financial contribution and with the
logistics of getting to and from the clinic. Further-
more he can be an important encouragement to
comply with termination of pregnancy after care,
instmctions and in making sure that she remem-
bers to follow through on a post-termination check-
up appointment.
Lastly, the adult biological fathers encountered
contlicts with familial values and morals. The task
of the advanced psychiatric nurse practitioner then
is to facilitate clarifying values and start the adult
HEALTH §A GESONDHEID V01.6 N0.l - 2001
biological father onto what may be a re-examina-
tion of long held values. Shostak and McLouth
(1984: 146) believes that the age of the average cli-
ent - between 18 and 25 years old - makes him an
appropriate candidate for this potentially uncom-
fortable process.
Termination phase
Here the advanced psychiatric nurse specialist can
evaluate with the adult biological father his progress
and goal attainment.
The advanced psychiatric nluse practitioner should
make herself available after the temlination of the
last session, should the adult biological father re-
quire further discussion andlor therapy.
Listed below are some suggestions for facing the
pre- and post-termination of pregnancy periods.
This can be printed on a pamphlet, which could be
available at clinics. This could satisfy a need many
males have for something more substantial than the
single sheet of post-termination of pregnancy medi-
cal tips routinely offered.
The following guidelines are adapted from Leslie
Buttedieid (in Shostak and McLouth, 1984:295-
297):
Allow yourself to take termination of preg-
nancy seriously.
Termination of pregnancy is not an abstrac-
tion; it is an event with great physical and
emotional significance to a couple.
Be patient with yourself and with your part-
ner.
Feelings and perceptions change rapidly in
stressful situations. You may find your-
self alternating from acceptance to uncer-
tainty with astonishing rapidity. Don't give
into the temptation to tidy your emotions
into a neatly organised package. Feelings
take time to settle into a state of finished
completeness; rushing the process will only
delay true integration and rob you of the
change for further understanding.
Allow each other to grieve.
Grieving any loss whether tangible or not,
is normal. It does not mean you blame one
another. It does not mean you are aware of
your loss. Grieving this loss for an ex-
tended period of time may set you up for a
repeat termination of pregnancy experi-
ence, or a series of poor relationships.
Actively share your feelings with each
other.
When a couple communicates their emo-
tional experience of a termination of preg-
nancy to each other, both have a better
chance of gaining increased understanding
about themselves as individuals and as a
couple. This is extremely valuable knowl-
edge whether you plan to continue in the
relationship or not.
. Remember that sharing pain, decreases it.
Many couples feel that if they express
emotional pain to their partners, the expe-
rience will be too overwhelming for them
to cope with. Actually, when we share any
feelings at all, we are creating a kind of
human connection that lessens pain.
Don't be afraid of "negative" emotions.
Feelings of sadness, anger or regret are a
valid part of the termination of pregnancy
experience - and need to be attended to. If
these feelings are allowed to surface and
are experienced, they lose some of their
frightening power and can be put into use-
ful perspective.
Understanding that by not communicating
HFAI TH SA GESONDHEID V01.6 N0.l - 2001
biological father onto what may be a re-examina-
tion of long held values. Shostak and McLouth
(1984:146) believes that the age of the average cli-
ent - between 18 and 25 years old - makes him an
appropriate candidate for this potentially uncom-
fortable process.
Termination phase
Here the advanced psychiatric nurse specialist can
evaluate with the adult biological father his progress
and goal attainment.
The advanced psychiatric nurse practitioner should
make herself available after the termination of the
last session, should the adult biological father re-
quire further discussion andlor therapy.
Listed below are some suggestions for facing the
pre- and post-termination of pregnancy periods.
This can be printed on a pamphlet, which could be
available at clinics. This could satisfy a need many
males have for something more substantial than the
single sheet of post-termination of pregnancy medi-
cal tips routinely offered.
The following guidelines are adapted from Leslie
Butterfield (in Shostak and McLouth, 1984:295-
297):
Allow yourself to take ternlination of preg-
nancy seriously.
Termination of pregnancy is not an abstrac-
tion; it is an event with great physical and
emotional significance to a couple.
Be patient with yourself and with your part-
ner.
Feelings and perceptions change rapidly in
stressful situations. You may find your-
self alternating from acceptance to uncer-
tainty with astonishing rapidity. Don't give
into the temptation to tidy your emotions
into a neatly organised package. Feelings
take time to settle into a state of finished
completeness; rushing the process will only
delay true integration and rob you of the
change for further understanding.
Allow each other to grieve.
Grieving any loss whether tangible or not,
is normal. It does not mean you blame one
another. It does not mean you are aware of
your loss. Grieving this loss for an ex-
tended period of time may set you up for a
repeat termination of pregnancy experi-
ence, or a series of poor relationships.
Actively share your feelings with each
other.
When a couple communicates their emo-
tional experience of a termination of preg-
nancy to each other, both have a better
chance of gaining increased understanding
about themselves as individuals and as a
couple. This is extremely valuable knowl-
edge whether you plan to continue in the
relationship or not.
Remember that sharing pain, decreases it.
Many couples feel that if they express
emotional pain to their partners, the expe-
rience will be too overwhelming for them
to cope with. Actually, when we share any
feelings at all, we are creating a kind of
human connection that lessens pain.
Don't be afraid of "negative" emotions.
Feelings of sadness, anger or regret are a
valid part of the termination of pregnancy
experience - and need to be attended to. If
these feelings are allowed to surface and
are experienced, they lose some of their
frightening power and can be put into use-
ful perspective.
Understanding that by not communicating
HEALTH SA GESONDHEID V01.6 No.1 - 2001
you are communicating:
1. disinterest
2. lack of concern for your partner.
Seek help.
If you can not do these things on your own,
seek help. Mental health professionals are
trained to facilitate emotional understand-
ing and clear communication.
The historically advanced view that men and
women can not really understand each other has
produced much sorrow and isolation as we struggle
through the termination of pregnancy experience.
Our society's avoidance of grieving in general, and
of termination of pregnancy in particular, has also
contributed to the fact that the termination of preg-
nancy experience becomes one that is faced and
grieved alone.
RECOMMENDATIONS
It is clear that from the research results that the
adult biological fathers require professional help
and support in dealing with their experience of the
termination of pregnancy and the impact it has on
their lives and relationships. Psychiatric nurse prac-
titioners should he involved at their local termina-
tion of pregnancy clinic as consultants by applying
guidelines proposed for this article to facilitate the
promotion of the adult biological fathers' mental
health.
CONCLUSION
There is very little known about the male's experi-
ence of a termination of pregnancy. This opens
one's eyes to the stark and regrettable features of
the scene -the absence of any helpful preparation
for the experience: the embarrassment and sense
of uselessness men feel during the termination of
pregnancy and the wish to talk about it versus the
social pressure to tell no one and the need to ap-
pear supportive regardless of their own ambivalence
and heartache. This leads one to ask if there isn't a
better way formales to help their partners and them-
selves to meet the termination of pregnancy chal-
lenge.
The authors would like to conclude with these
words from Arden Rothstein (1974:837):
" . . . all that we know of psychological functioning
suggests that active involvement of a person in his
own life planning fosters mastery, while we cannot
say that every man who is thus engaged will be
more active in subsequent family planning, that he
will become more supportive of his partner at the
time of abortion, or that he will be a better father in
years to come, it is possible that some small move-
ment in these directions could take place. The abor-
tion experience considered as a whole might well
serve to perpetuate or suggest alternatives to aman's
proclivity for active or passive modes of dealing
with stress, thus potentially influencing further
development".
BRAMMER, LM; SHOSTRAM, EL & ABREGO, PJ
1983: Therapeutic Psychology: Fundamentals of coun-
selling and psychotherapy; 6'h edition. New Jersey:
Prentice Hall Incorporated.
CHASIN, R & ROTH, S 1995: Externalization - Lin-
guistic key to a new approach in family therapy. Psychi-
atric Times, (22) , 1995: 110-1 15.
CORSINI, RJ & WEDDDVG, D 1989: Current psycho-
therapies; 4'h edition. United States of America: Pea-
cock Publishers.
CRESWELL, JW 1994: Research design: qualitative and
quantitative approaches. California, London, New Delhi:
Sage. Publications.
DEMOCRATIC NURSING ORGANISATION OF
SOUTH AFRICA 1998: Ethical standards for nurse re-
searchers. Pretoria: DENOSA.
DINKMEYER, D 1990: Step: The parents' handbook.
United States of America's American Guidance Service.
EGAN, G 1986: The skilled helper: A systematic ap-
proach of effective helping. Pacific Grove: BrookslCole
Publishing Company.
GOLDENBERG, I & GOLDENBERG, M 1996: Fam-
ily therapy: An overview; 4" edition. United States of
America: BrooksICole Publishing Company.
GRAY, J 1993: Mars and Venus. Glasgow: Newleaf
HENDRIX, M 1992: Keeping the love you find. New
York, London, Toronto, Sydney, Tokyo, Singapore:
Pocket Books.
KVALE, S 1983: The qualitative research interview: A
phenomenological and a hermeneutic model of under-
standing. Journal of Phenomenological Psychology,
(14), 1983:171-196.
LINCOLN, YS & GUBA, EG 1985: Naturalistic inquiry
Beverly Hills: Sage Publications.
MARSIGLIO, W & DIEKOW, J 1998: Procreative man.
New York: New York University Press.
MOUTON, J & MARAIS, HC 1994: Basic concepts in
the methodology of the social sciences. Pretoria: HSRC
Publishers.
MOUTON, J 1996: Understanding social research.
Pretoria: Van Schaik.
MORSE, .lM & FIELD, PA 1996: Nursing research: The
application of qualitative approaches. London: Chapman
& Hall
MYBURGH, MM 1999: The experience of biological
fathers of their partner's termination of pregnancy. RAU:
Aucklandpark (Unpublished MCur dissertation).
OKUN, BF 1992: Effective helping: Interviewing and
counselling techniques; 4* edition. California: Brooks1
Cole Publishing Company.
ROTHSTEIN, A 1974: The would-have-been father.
(Unpublished Doctoral Dissertation).
SHOSTAK, AB & MCLOUTH, G 1984: Men and abor-
tion: Lessons, losses and love. New York: Preager Pub-
lishers.
STUART, GW & SUNDEEN, SJ 1991: Principles and
Practice of Psychiatric Nursing; 4* edition. United States
of America: Mosby.
WHITE, M 1991: Re-authoring lives: Interviews and
Essays. Adelaide, South Australia: Dulwich Centre Pub-
lications.
WHITE, M & EPSTON, D 1996: Experience contra-
diction. Nmative and Imagination - selected papers.
South Australia: Bulwich Centre Publications.
YALOM, ID 1995: The theory and practice of group
psychotherapy. New York: Hooper - Collins Publishers
YALOM, ID 1998: The Yalom Reader. United States of
America: Basic Books.
HEALTH SA GESONDHEID V01.6 No.1 - 2001
RESEARCH
A MODEL FOR PSYCHIATRIC NURSING ACCOMPANIMENT OF THE PATIENT WITH MENTAL DISCOMFORT: PART I11
ABSTRACT
The research process did not proceed in the traditional step-by-step manner. A theory generating approach
was followed by way of exploration and description. The first three levels: factor isolating, factor relating
and situation relating theories, were generated. A conceptual framework fnr psychiatric nursing accompa-
niment of the patient with mental discomfort was formulated on the basis of concept ident8cation and
classfication. The concepts mental discomfort, lifestyle finctioning and psychiatric nursing accompani-
ment were identified and subjected to concept analysis. A systematic, logical and consistent approach led
to the conceptc~alisation of the model for psychiatric nursing accompaniment of the patient with mental
discomfort.
This addressed the initial question according to which the psychiatric nursing specialist could direct her
interaction, and also cleared up the conMion sctrrounding the concept of accompaniment. m e quest for
wholeness was set as the final goal of the accompaniment events, and lifestyle functioning was established
as a unit for assessment and diagnosis.
Hypotheses for validation of the model were formulated forfollowup research. The conceptualised model
,for psychiatric nursing accompaniment of the patient with mental discomfort was followed by a literature
survey of models and theories for nursing and related disciplines and critically judged according to their
main themes, application possibilities and limitations. The model for psychiatric nursing accompaniment
of the patient with mental discomfort was evaluated on the basis ofpredetermined criteria. The shortcom-
ings and coizclusio~zs vvere indicated and recommendations were made according to the operational possi-
bilities of the research.
OPSOMMING
Die navorsingsproses het nie volgens die tradisionele, stapsgewyse metode plaasgevind nie. 'n Teorie-
genererende uitgangspunt is gebruik dew die toepassing van ondersoek en beskrywing. Die eerste drie
vlakke: faktor-isolering, faktor-verbvantskap en sitctasionele venvcmte teoriee is gegenereer: 'n Konseptuele
raamwerk vir psigiatriese verpleegkelndige begeleiding van die pasient met geestesongemak is geformuleer
op grond van konsep-identfikasie en -kluss@kasie. Die konsepte geestesongemak, lewensty&(nksionering
en psigiatriese begeleiding is geydentifiseer en onderwerp aan konsep-analise. 'n Sistematiese, logiese en
konsekwente aanslag het gelei tot die konseptualisering van die model virpsigiatriese verpleegkundige
begeleiding van die pasient met geestesongemak.
Dither die oorspronklike vraag aangespreek na aanleiding waarvan die psigiatriese verpleegspesialis haar
interaksie kan rig en het ook die verwarring rondom die konsep "begeleiding" opgeklaur: Die strewe nn
heelheid was die hoofdoel van die begeleiding en lewensty@tnksionering is daargestel as eenheid vir bernming
en diagnosering.
Hipoteses vir validasie van die model is geformnleer vir verdere navorsing. Die konsep-model virpsigiatriese
verpleegkundige begeleiding van die pasient met geestesongemak is gevolg deur 'n literat~~~lrstudie van
modelle en teoriee vir verpleegkunde en aanvenvante dissiplines en is krities beoordeel volgens die hooftemas,
toepassingsrr~aontIikIzede en Deperkinge. Die ?node1 vir psigiatriese verpleqkundige begeleiding san die
pasient met geestesongemak is geevalueer op grond van die vooraJbepaalde kriteria. Die tekortkominge en
gevolgtrekkings is anngedui en voorstelle is gemnak nu aanleiding van die toepassing.smoontlikhede van
die navorsing.
INTRODUCTION
The preceding articles on the research, namely: "A
model for psychiatric nursing accompaniment of
the patient with mental discomfort": PART I,
Curationis, Vol. 16, No. 1 (April 1993), gave a
complete explanation of the research design and
methods of this theory generating approach. The
second article: "'n Model vir psigiatriese
verpleegkundige begeleiding van die pasient met
geestesongemak": DEEL 11, Curationis, Vol. 16,
No. 3 (October 1993). explained the analysis of the
concept mental discomfort. For the purpose of this
article the final visual model for psychiatric nurs-
ing accompaniment of the patient with mental dis-
comfort (see figure 1) as well as an overview of
the already formulated aspects applicable to the
model will be portrayed. A full description of the
conceptualised model for psychiatric nursing ac-
companiment of the patient with mental discom-
fort will then follow as depicted in Greeff (1991).
THE FINAL VISUAL MODEL FOR PSY- CHIATRIC NURSING ACCOMPANI- MENT OF THE PATIENT WITH MEN- TAL DISCOMFORT
The final visual model was constructed after dia
A MODEL FOR PSYCHIATRIC NURSING ACCOMPANIMENT OF THE PATIENT WITH MENTAL DISCOMFORT
MENTAL DISCOMFORT
INTERPERSONAL LIFE SPACE
EVENTS OF ACCOMPANIMENT
MENTAL HEALTH Pnase 1 Realisation of the expeience of menial Phase 4 Patient accepts iesponslbilih/ for the
dlscomfoii changng and testing of aiternatlve Phase 2 Cognitive and emotional c!ailiicatlon of the methods of coping
pattents experience Phase 5 lnternalislng the chosen alternative Phase 3 investigating alternative methods of coping Phase 6 The patlent distances h m from the
pychatilc nurse spesiallst
F A HEALTH SA GESONDHEID V01.6 No.1 - 2001
logue with experts, by ensuring the incorporation
of changes in the reasoning processes of both the
conceptual framework as well as the visual model.
Figure 1 reflects the final constructed visual model
on the basis of which the rest of the model
conceptualisation will be explained and discussed.
This final visual model serves as context for the
description of the model for psychiatric nursing ac-
companiment of the patient with mental discom-
fort.
AN OVERVIEW OF ALREADY FORMU- LATED ASPECTS APPLICABLE TO THE MODEL FOR PSYCHIATRIC NURSING ACCOMPANIMENT OF THE PATIENT WITH MENTAL DISCOMFORT
Before continuing with the detailed description of
the model for psychiatric nursing accompaniment
of the patient with mental discomfort, it is neces-
sary to briefly mention the aspects applicable to
the model for psychiatric nursing accompaniment
of the patient with mental discomfort, in order to
be consistent and systematic.
Main concepts applicable to the model fo r
psychiatric nursing accompaniment of the patient with mental discomfort
a Research parameters: Individuals with men-
tal discomfort e Purpose of psychiatric nursing accompani-
ment (frame of reference): Promotion of
mental health as integral part of health e Desired patient outcome (end result): Health
(wholeness in body, mind and spirit) e Unit of assessment and diagnosis: Lifestyle
functioning s Nature of the environment: Internal and ex-
ternal environment in continuous interaction
e Supporter: Psychiatric nursing specialist
e Methodology: Psychiatric nursing accompa-
niment
Conceptual definitions of the three analysed
concepts of the model fo r psychiatric nurs- ing accompaniment of the patient with men-
tal discomfort
Three concepts were identified for concept analy-
sis namely: naenml dbscomfoq lifestyle function-
ing and psychiatric nursing accompaniment. Af-
ter the investigation of dictionary and subject spe-
cific definitions, construction of model and mar-
ginal cases, and formulation of criteria for each
concept, the three concepts were reformulated and
conceptually defined.
Menial discomfort Mental discomfort is the subjective, reality-orien-
tated experience of an individual feeling internal
discomfort (psychologica1 and/or spiritual). The
individual's own unique perception and cognisance
of the pressure and demands that developed over a
long period, for no specific reason, from his per-
sonal and/or work life, contribute to hisher dis-
comfort. This internal discomfort is not necessar-
ily observable by others. The experience leads to a
gradual feeling of losing control (cognitive and
emotional) in his life because of a temporary fad-
ing of coping mechanisms and problem-solving
methods which would otherwise be effective. The
individual's level of lifestyle functioning at work
and on a social and personal level is maintained
with difficulty and heishe experiences it as a change
in hisher ability to handle situations.
Lifestyle finctioning Lifestyle functioning is the observable, unique
manifestation of an individual's behaviour, emo-
tions and thoughts because of the complex, inter-
dependent, dynamic process of interaction between
his internal environment (body, mind and spirit) and
the external environment in his continued quest for
wholeness. The manifestation occurs in the spe-
cific individual's daily functioning in a consequent
and identifiable manner. The subjective process
of formation already stms at birth and is sanctioned
U E A I TU C A CFCnNnHFln Vnl 6 N n ~ l - 2001
within a specific community's values and norms.
The individual could periodically experience an
enriching or problematic lifestyle functioning dur-
ing the process of hisher daily functioning, but
could go to the extreme and present a disorganised
lifestyle.
Psychiatric nursing accompaniment Psychiatric nursing accompaniment is a psychia-
tric nursing method aimed at the management of
the patient with mental discomfort. It is a mental
health promotive (preventative and enriching) and
problem-solving, cognitive and emotional way of
interaction, that develops between a patient becom-
ing aware of his experience of mental discomfort
and a psychiatric nursing specialist. It is aimed at
facilitating the upliftment of aproblematic lifestyle
because of the experience of mental discomfort.
The patient willingly enters into a temporary, short-
term interaction and maintains full control, free-
dom of choice and responsibility for his own
behaviour. The psychiatric nursing specialist at no
stage violates the patient's personal boundaries.
The aim is to guide the patient to a cognitive and
emotional clarification of his mental discomfort,
investigate altemative coping mechanisms, take
responsibility for change and choices, as well as
intemalise the chosen altemative. The patient then
distances himself from the psychiatric nursing spe-
cialist, and the process of psychiatric nursing ac-
companiment comes to an end.
SUMMARY
Before the rest of the model for psychiatric nurs-
ing accompaniment is conceptualised and de-
scribed, it is necessary to once again bring the fol-
lowing to the reader's attention. Psychiatric nurs-
ing accompaniment only applies to interaction with
the patient experiencing mental discomfort. It does
not apply to the patient with mental illness or who
presents a disorganised lifestyle. With the men-
tally ill patient, long term support and therapy
would more likely manifest as possible ways of in-
teraction.
DESCRIPTION OF THE CONCEP- TUALISED MODEL FOR PSYCHIATFUC NURSING ACCOMPANIMENT OF THE PATIENT WITH MENTAL DISCOM- FORT
The description of the conceptualised model for
psychiatric nursing accompaniment of the patient
with mental discomfort implies a description of the
structure as well as the process of the model. An
explanation of these aspects follows.
THE STRUCTURE OF THE MODEL FOR PSYCHIATRIC NURSING ACCOMPANI- MENT OF THE PATIENT WITH MEN- TAL DISCOMFORT
The structure of the model for psychiatric nursing
accompaniment of the patient with mental discom-
fort is determined by looking at the most central
relation of the model. The investigation of the struc-
ture of the model for psychiatric nursing accompa-
niment reveals the following:
The model for psychiatric nursing accompaniment
does not contain a clear, single structure, but rep-
resents a combination of possibilities.
The most central relationship derived from the
model is:
Psychiatric nursing accompaniment facilitates the
upliftment of the experience of mental discomfort
in the patient and therefore improves his niental
health.
Structures identifiable are: mental discomfort,
lfestylefi~nctioning andpsychiatric nursing accom-
paniment.
Mental discomfort The concept mental discomfort forms an integral
HEALTH SA GESONDHEID Vo1.6 No.1 - 2001
part of mental health, which in turn is an integral
part of health. Health implies wholeness of body,
mind and spirit. There are therefore various over-
lapping interactive dimensions and aspects, which
can not be hierarchically arranged.
Health contains the dimensions: body, mind and
spirit, where each dimension has its own charac-
teristics, is in constant interaction with each other
and does not stand separately, hut forms a whole.
Lifestyle functioning Lifestyle functioning as unit of assessment and di-
agnosis is presented as a continuum concept which
can move from enriching to disorganised. Mental
discomfort is found on this continuum as one of
the levels of lifestyle functioning. Lifestyle func-
tioning can therefore imply various levels.
Psychiatric nursing accompaniment Aithough psychiatric nursing accompaniment has
a beginning and ending phase, with health as goal,
the concept health is a relatively abstract and theo-
retical concept that can not be measured empiri-
cally. The process of psychiatric nursing accom-
paniment is more circular, since psychiatric nurs-
ing accompaniment is aimed at uplifting the expe-
rience of mental discomfort in the patient and to
facilitate mental health. An individual could how-
ever experience a need for psychiatric nursing ac-
companiment because of pressure and demands
from his environment.
Since the last mentioned substructure reflects the
central process of the model for psychiatric nurs-
ing accompaniment of the patient with mental dis-
comfort, it seems as if the structure of the model is
circular in ilnhlre.
THE PROCESS OF THE MODEL FOR PSYCHIATRIC NURSENG ACCOMPANI- MENT OF THE PATIENT WITH MEN- TAL DISCOMFORT
The description of the process of the model for psy-
chiatric nursing accompaniment of the patient with
mental discomfort follows:
Goal content specified as the goal for activ- ity by the psychiatric nursing specialist dnr- ing psychiatric nursing accompaniment
Psychiatric nursing accompaniment by the psychi-
atric nursing specialist is aimed at facilitating the
patient's quest for health (wholeness in body, mind
and spirit), by changing the problematic lifestyle
functioning of the patient experiencing mental dis-
comfort (psychological and/or spiritual) to an im-
proved mental health (psychological and/or spiri-
tual) functioning.
Prerequisites for psychiatric nursing accom- paniment
Before accompaniment can meaningfully com-
mence, certain prerequisites for the activation and
course of the process are necessary.
Regarding the patient qualifiing for accom- paniment and who therefore activates it: The experience of a feeling of internal mental dis-
comfort (psychological andlor spiritual); cognitive
and emotional cloudedness in the patient; no
disorganisation present in the patient's lifestyle
functioning; an indication of a problematic lifestyle
functioning; a cognitive ability to converse intel-
lectually with the accompanist, irrespective of the
experience of mental discomfort by the patient;
voluntary entry into the process of accompaniment
by the patient; permission to activate accompani-
ment granted by the patient to the accompanist;
belief in the psychiatric nursing specialist's pro-
fessional capabilities and personal characteristics.
Regarding the accompanist:
Love and respect for fellow human beings as un-
derlying to the process of accompaniment; the need
for mental health promotive action by the psychi
atric nursing specialist; &e willingness of the psy-
chiatric nursing specialist to invest time and en-
ergy in the process of accompaniment; the ability
of the psychiatric nursing specialist to allow the
patient to maintain control, allowing him freedom
of choice, responsibility, as well as maintaining
independence during accompaniment; a positive
outlook on life, as well as a sense of futurity in the
psychiatric nursing specialist; acceptance of the
patient as a responsible and dignified individual.
Regarding the process of accompaniment: An atmosphere of equality and respect for each
other; the availability of a psychiatric nursing spe-
cialist as accompanist, with more cognitive and
emotional clarity than the patient with mental dis-
comfort; an interpersonal process with the possi-
bility of mutual interaction; the goal of facilitating
the upliftment of the experience of mental discom-
fort; a trusting basis with the possibility of a deep-
ened trusting relationship; mutual maintenance of
control, freedom of choice, responsibility and in-
dependence from both parties involved in accom-
paniment.
The course of accompaniment
The process of psychiatric nursing accompaniment
of the patient with mental discomfort is a dynamic,
temporary and short-term facilitating interaction
between the psychiatric nursing specialist as ac-
companist and the patient with mental discomfort
as the accompanee. It is a mental health promotive
interaction and supports the patient to extend his
ability for daily activity and experience, to lead a
fuller, more satisfying life. It is therefore aimed at
self-development, growth and a high level of health.
The psychiatric nursing specialist maintains her
own, as well as a professional, human and life per-
spective, as well as ethical and moral values at all
times, but never at the cost of the patient. She never
forces her own set of values on the patient.
The process moves through various phases, each
with its own occurrences during that specific phase,
and it moves from an experience of mental discom-
fort (problematic lifestyle functioning) to mental
health (enriching lifestyle functioning).
Subsequently a layout of the accompaniment
phases:
Awareness of the experience of mental dis- comfort: The patient gradually becomes aware of an experi-
ence of internal discomfort, namely mental discom-
fort, which develops from the pressure and demands
of his personal andlor working life, but with no
identifiable origin. He starts feeling that there is a
change in his ability to cope with situations and
that coping mechanisms and problem-solving meth-
ods normally applied, temporarily fade. It becomes
increasingly difficult to maintain his level of
lifestyle functioning. The inner experience and
feeling of loss of control is not necessarily observ-
able, and the patient feels more and more isolated.
This experience activates the patient to willingly
enter into interaction with the psychiatric nursing
specialist. The psychiatric nursing specialist moves
from a position of "availability" to a position of
"presence" for the patient by making herself avail-
able for the facilitation of upliftrnent of mental dis-
comfort. The psychiatric nursing specialist - with
her delicate attunement towards her fellow human
being - enters into the interaction with openness to
get a sense of the experienced emotions and to break
down the barriers between her and her fellow hu-
man being, but at all times respects the body bound-
aries of the patient and never oversteps these bound-
aries. An extent of control of the boundaries de-
velops, but not of respect and love. Respect and
love towards fellow hzrman beings is therefore an
important core element of the process from the com
HEALTH SA GESONDHEID Vo1.6 No.1 - 2001
-
mencement of interaction. The accompaniment interaction where the psychi-
Cognitive and emotional clan$cation of the patient's experience: Should the patient become aware of his mental dis-
comfort during the awareness phase, he must de-
cide if he wants to permit the continuation of ac-
companiment. The psychiatric nursing specialist
only moves towards the patient's body boundary
but never violates the patient's privacy. Since the
psychiatric nursing specialist utilises her profes-
sional life space, the privacy of the psychiatric nurs-
ing specialist is protected. Although the psychia-
tric nursing specialist is the expert in this process,
it is the patient that indicates the direction of inter-
action from his personal needs and who maintains
control, freedom of choice and responsibility for
his own action.
Expectations regarding the process of psychiatric
nursing accompaniment are clarified to ensure that
both the patient and the psychiatric nursing spe-
cialist strive towards the same goals. From the
beginning of the process the psychiatric nursing
specialist activates control, freedom of choice and
responsibility in the patient, since it forms the foun-
dation of interaction. The patient can experience a
partial loss regarding one of the three aspects, but
the psychiatric nursing specialist supports him in
realising that it occurred because of his mental dis-
comfort.
In this phase the patient experiences a cognitive
and emotional clorrdedness because of the experi-
ence of mental discomfort. It becomes increasingly
difficult for the patient to maintain his current level
of lifestyle functioning. Entering into accompani-
atric nursing specialist pays attention and listens,
provides the patient with the opportunity to venti-
late re the pressure and demands of his personal
andlor working life. The psychiatric nursing spe-
cialist follows in a cognitive-emotional interpret-
ing fashion and enables the patient to identify his
problem through cognitive and emotional clarifi-
cation of his experience. The cloudedness is cleared
and the patient acquires perspective of his situa-
tion. The patient starts feeling in control of his
situation.
Investigation of alternative methods: The fact that the psychiatric nursing specialist is
the more knowledgeable and experienced person
during accompaniment and possesses cognitive and
emotional clarity, enables her to provide the pa-
tient with a variety of coping mechanisms and prob-
lem-solving methods. It is important for the pa-
tient to identify and reconfirm the coping mecha-
nisms and problem-solving methods that has
worked so far. In the investigation of alternatives
the psychiatric nursing specialist initially lets the
patient search for alternative coping mechanisms
in his present situation. She is there for him while
he investigates. At this stage she can introduce a few alternatives to the patient, but should not lapse
into the process of giving advise.
The challenge to the psychiatric nursing specialist
is to provide just enough support required by the
patient to continue, and in doing so provides the
patient with an opportunity for self-activity. There
is therefore an interchange in direct and indirect
guidance from the psychiatric nursing specialist.
ment could result in a temporary increase in the Patient accepts responsibilily for change and patient's interdependency of the psychiatric nurs- tests mechanisms: ing specialist. The psychiatric nursing specialist The patient is made aware of his own contribution must reformulate this as quickly as possible, to a to his experience of mental discomfort, and the more balanced interdependence. psychiatric nursing specialist tries to get the pa-
tient to accept responsibility for changing coping
UCAI TU C A cFcnNnuFln Vnl G Nn 1 - 3nn1 55
mechanisms. The sense of responsibility of the
patient is increased by his feeling of control. The
patient is therefore called ~ p o n tufindpurposr and
accept responsibility for self-action. The patient
acquires freedom in his search for coherence. He
tries to identify the relationship between situations
and make the right decision regarding the alterna-
tive he is willing to test. During this phase the psy-
chiatric nursing specialist provides the patient with
the opportunity to exercise these choices in a safe
atmosphere of trust and respect. The patient peri-
odically discards the process of accompaniment to
discover and to endeavour to make the psychiatric
nursing specialist redundant. Should the patient
feel unsure during this exercise he can always re-
turn to the process of accompaniment since the psy-
chiatric nursing specialist is there and he knows
from the trusting relationship that he is allowed to
return. The patient is lead to the mobilisation of
personal and environmental sources for effective
coping with mental discomfort. The psychiatric
nursing specialist can lead by example, act as role
model or provide an exercising opportunity through
role-play.
The patient is on his way, but the psychiatric nurs-
ing specialist accompanies him, observes how he
goes and tells him what she sees. The patient is
therefore active in exercising alternative coping
mechanisms. The psychiatric nursing specialist
actively participates, but does not accept responsi-
bility for the patient.
Internalisation of the chosen alternative: Since the psychiatric nursing specialist provides the
patient with the opportunity to work through the
various alternative coping mechanisms, to investi-
gate and to exercise, it becomes possible for the
patient to decide what he can make his own and
what is alieiz to him. The recurring application of
the chosen alternatives enables the patient to
intemalise the action and make it his own. During
the application of alternatives the psychiatric nurs-
ing specialist is a mirror image or reality resonator
for the patient because of the existing position of
trust. During the internalisation phase the psychi-
atric nursing specialist gradually moves from a
position of 'presence" to a position of "availabil-
ity". The patient gradually takes control and re-
sponsibility and makes choices with more conji-
dence.
The patient distances himself from the psy- chiatric nursing specialist: Although the psychiatric nursing specialist moves
from a position of "presence" to a position of "avail-
ability" and increasingly tries to make herself re-
d~mdant, it is the patient whofinally decides to es-
tablish the distance. This distancing is made pos-
sible by a strengthening in the patient's previous
level of lifestyle functioning or even an increase in
this level because of an enriching process that oc-
curred during accompaniment. The patient has
therefore developed a perspective of his situation.
The patient chooses to contin~le alone, and the psy-
chiatric nursing specialist makes herself available
forfuture "presence". The process of psychiatric
nursing accompaniment is terminated. The patient
has thus changed his experience from mental dis-
comfort to a lifestyle functioning testimonial of
mental preparedness.
In conclusion it can be said that psychiatric nurs-
ing accompaniment uplifts the patient's experience
of mental discomfort. He is lead to change his
behaviour and can therefore experience an optimal
level ofhealth (whoIeness in body, mind and spirit).
The dynamics of the process of accompani- ment
The dynamics of accompaniment takes place within
the total framework of psychiatric nursing as inter-
actional approach and is aimed at the improvement
of the patient's mental health. The activating ele-
ments of dynamics in the accompanying process
are amongst others the patient's level of lifestyle
56 HEALTH SA GESONDHEID V01.6 No.1 - 2001
functioning, the psychiatric nursing specialist's
quest for wholeness in herself and others, as well
as the patient's environment,
The psychiatric nursing specialist is activated be-
cause of her love and respect for her fellow human
beings, as well as the quest for wholeness in her-
self and others and to be available during times of
problematic lifestyle functioning. Love and respect
form the basis, as well as the climate for accompa-
niment. To date her availability was mainly be-
cause of her genuine personal frame of reference,
and the person opposite her is her fellow human
being in need of support. Should the other person
become aware of his mental discomfort the pro-
cess changes and he reaches out to her as a profes-
sional. The definition of the relationship now
changes from a social relationship to a professional
relationship and the person opposite her's status
changes to that of patient.
The psychiatric nursing specialist now leaves her
own frame of reference of personal and self knowl-
edge, social attitudes and communication and in-
terpersonal skills as social fellow human being,
behind.
She enters as a professional into the interaction and
her professional frame of reference forms the basis
of her interaction with the patient experiencing
mental discomfort. By utilising her professional
frame of reference she applies her extensive theo-
retical knowledge, her professional self knowledge,
her extensive life and human philosophy, therapeu-
tical attitudes and communication, as well as her
psychiatric nursing skills and methods. She is flex-
ible and versatile, but consequent in stating her
values and assumptions. Her personal value sys-
tem gained from education and experience provides
stability in her own demeanour, but is placed on
the background regarding the patient. As profes-
sional guide she never forces her personal values
on the patient. During this interaction it is the pa-
tient who must confirm his own value system, and
the exposure to the value system of the psychiatric
nursing specialist could only complicate the expe-
rience of mental discomfort, should the value sys-
tems be contradictory. The patient's value system
is treated with respect, irrespective the discrepancy
with that of the psychiatric nursing specialist.
The following subsequently comes under discus-
sion in accompaniment, namely the interpersonal
life space between the patient and the psychiatric
nursing specialist. This interpersonal life space
exists because of the personal boundaries of the
patient as well as that of the psychiatric nursing
specialist. To create a parallel in professional ac-
companiment, the psychiatric nursing specialist
enters into this interaction with her professional
boundaries and shifts her personal boundaries to
the background. The boundaries between the
patient's personal life space and the psychiatric
nursing specialist's professional life space serve a
specific goal during accompaniment. During a so-
cial or even therapeutic relationship this interper-
sonal life space boundary is overstepped with per-
mission. It is this overstepping that distinguishes
accompaniment from social or therapeutic interac-
tions since the interpersoEd life space boundary is
never overstepped during psychiatric nursing ac-
companiment. It is this aspect that makes it pos-
sible for the patient to maintain control, freedom
of choice and responsibility during the interaction
with the psychiatric nursing specialist. The patient
could grant the psychiatric nursing specialist per-
mission to invade his privacy, but she must refrain
from doing so. She concentrates on accentuating a
feeling of control within the patient, as well as the
contribution he made to his own existing mental
discomfort.
The patient enters into accompaniment with a feel-
ing of mental discomfort arising from the pressures
and demands of his own personal andlor work life.
He enters into accompaniment with specific expec-
tations. The psychiatric nursing specialist also has
specific expectations from her "presence" and a
need to facilitate a quest for wholeness in herself
and her patient. Both must place their expectations
in perspective and let it run in parallel. The inter-
nal and external environment of the patient is of
relevance. The psychiatric nursing specialists
makes the patient aware of how much and to what
extent he could have contributed to his own expe-
rience of mental discomfort and his ability to be
free to determine his own behaviour. The experi-
ence of mental discomfort can create a temporary
period of cognitive and emotional cloudedness in
the patient since he cannot distinguish between the
problem areas in his life. His coping mechanisms
and problem-solving methods, which are normally
effective, temporarily fade.
The psychiatric nursing specialist pays attention,
listens and uses her internalised therapeutic atti-
tudes and communication, as well as her psychiat-
ric nursing skills to convince the patient to venti-
late his experience of mental discomfort, to find
meaning and to accept responsibility. The psychi-
atric nursing specialist never takes responsibility
for the patient, but reflects genuine honesty, warmth
and unconditional acceptance. She is at all times
empathetic, concrete and congruent.
The patient feels safe due to the fact that the psy-
chiatric nurse does not enter his personal life space
and the trusting relationship increases. The psy-
chiatric nursing specialist channels her supporting
interactions during accompaniment to the patient's
internal frame of reference (personal experiences
regarding volition, emotion, thoughts and spirit
from his internal environment) and not the exter-
nal frame of reference (aspects involved with the
patient from his external environment) as such. By
ventilating aspects relating to the internal frame of
reference, the patient is lead to cognitive and emo-
tional clarifying, and subsequent clarity.
The fact that the psychiatric nursing specialist does
not control or take over the freedom of choice and
responsibility, enables the patient to maintain these
aspects in himself, and even strengthen and extend
them. It is because of her extended life and human
philosophy and her professional frame of reference
(formed by the exposure to the nursing profession
with its specific values, norms and ethical prin-
ciples), and not her personal frame of reference,
that she can accompany the patient in his search
for alternative coping mechanisms and prohlem-
solving methods. The patient increasingly gains a
feeling of control in his situation which up to now
has been vague, and he declares himself willing to
accept responsibility for investigating alternative
coping mechanisms. The psychiatric nursing spe-
cialist provides the patient with the freedom of self-
activity and detaches herself in order not to mea-
sure her own effectiveness during these interactions
by means of goal achievement.
The patient's experience of control, freedom of
choice and acceptance of responsibility, to choose
that alternative best suitable to him, provides him
with the opportunity to internalise it as his own.
The change brought forth in the patient is not in
essence, but in his "essence of being". The patient's
experience of mental discomfort is uplifted.
This experience of success and achievement makes
it possible for the patient to part, without assistance,
from the psychiatric nursing specialist after a short
temporary period, since his mental discomfort is
uplifted and he experiences a strength in himself
that enables him to control his own lifestyle func-
tioning, freedom of choice and take responsibility.
The psychiatric nursing specialist accepts this dis-
tance and changes her position of "presence" to one
of "availability". This availability of the psychiat-
ric nursing specialist and the assurance that he can
return to the process of accompaniment due to the
existing trusting relationship, should he deem it nec-
essary, strengthens the patient's experience of con-
trol, and it becomes increasingly possible for him
to enrich and extend his lifestyle functioning. The
process terminates and both return to a position of
merely being fellow human beings.
HEALTH SA GESONDHEID Vo1.6 No.1 - 2001
CONCLUSION
Should the psychiatric nursing specialist deem it
necessary from her broader professional frame of
reference, to redefine the relationship of accompa-
nist to therapist, the prerequisites, the process as
well as dynamics, undergo a total change. Permis-
sion to transgress into the patient's personal life
space is now granted by him specifically and will-
ingly and the psychiatric nursing specialist is al-
lowed to transgress into this area. The personal
life space of the patient could in the case of
disorganised lifestyle functioning, be entered into
on a non-willing basis. This transgression should
at all times be professional and conducted with love
and respect. The relationship is redefined and no
longer falls within the context of psychiatric nurs-
ing accompaniment.
BIBLIOGRAPHY
GREEFF, M 1991: 'n Model vir psigiatriese
verpleegknndige bcgeleiding van die pasient met
geestesongemak. Auckiand Park: Rand Afrikaans Uni-
versity, (Unpublished DCur (Psychiatric Nursing) the-
sis).
HEALTH SA GESONDHEID V01.6 No.1 - 2001 59
REPORT: VISIT TO CALIFORNIA STATE UNIVERSITY: LOS ANGELES AND DOMINQUEZ HILLS CAMPUSES: 1-7 AUGUST 1999
Dr Valerie Ehlers Department of Advanced Nursing Science
Unisa
OVERVIEW OF THE CALIFORNIA to US$ 1 506, if registered for six or more units,
STATE UNIVERSITY (CSU) and to US$ 1 584 per postgraduate student.
According to the California State University's
(CSU's) Chancellor, Professor CB Reed, the CSU
is America's largest senior system of higher edu-
cation with 350 000 students on 22 campuses, situ-
ated throughout California. The University of Cali-
fornia was founded in 1947 and celebrated its fifti-
eth anniversary during 1997. However, the oldest
campus, the San Jose State University, was founded
in 1857 and the most recently opened campus at
Monterey Bay, started admitting students only dur-
ing 1995. The Academic Senate of the California
State University, is composed of elected represen-
tatives of the faculty from each campus, and rec-
ommends academic policy to the Board of Trust-
ees through the Chancellor.
Admission standards are strict, complying with or
exceeding the minimum specifications of the Cali-
fornia State. Besides specific school subjects and
school grades, prospective students also need to be
tested in English and in Mathematics prior to en-
rolment to determine their eligibility for specific
courses. All foreign students need to obtain satis-
factory pass marks in the Test of English as a For-
eign Language (TOEFL) - different campuses have
different minimum acceptable grades. Further-
more, students are required to present proof of
immunisations against measles and rubella at the
beginning of their second term of enrolment.
The 1999-2000 annual enrolment costs per under-
graduate student at this State University amounted
Most classes are offered on site but an ever-increas-
ing number of courses become available for stu-
dents wishing to pursue distance education courses,
comprising video conferencing and Internet
courses. Many students combine some distance
education courses with full time andlor part time
courses. The different campuses specialise in spe-
cific courses to some extent, necessitating some
students to relocate in order to obtain specific quali-
fications. Each campus is entitled to limit the num-
ber of students who can register annually, and to
accept only limited numbers of students majoring
in specific courses at specific campuses in any year.
Once the maximum number of students for a spe-
cific major has been admitted, the course becomes
"impacted" at that campus and further students will
be redirected to other campuses or to other major
subjects. Some campuses also offer so-called
"Open University Classes" permitting members of
the general community to follow regular univer-
sity courses without going through the formal ad-
mission processes provided space is available in
the specific course during a specific tern or se-
mester. Students following Open University
Classes can update their professional knowledge,
earn continuing education credit units subject to
specifications, and earn a limited number of cred-
its toward obtaining a degree.
In addition to the normal courses offered through-
out the academic ye- selected courses are also
offered at specific campuses during the summer
fin HEALTH SA GESONDHEID Vo1.6 No.1 - 2001
holidays (May-August) to assist students to enhance
their skills in specific courses, especially languages,
or to accelerate their progress by completing one
or more courses during the summer holidays.
The campuses visited included the Los Angeles
(UCLA) campus with 19 160 students and the
Dominguez Hills campus (UCDH) with 10 704 stu-
dents. The CSU's World Wide Web home page,
providing detailed information about courses,
programmes and registration procedures, can be
accessed at: http://www.calstate.edu (California
State University, 1999-2000:3-11).
VISIT: THE UNIVERSITY OF CALIFOR- NIA, LOS ANGELES (UCLA) CAMPUS
Department of Nursing
Visits were co-ordinated by Professor Marlene
Farrell, from the Nursing Faculty, UCLA. The
Faculty of Nursing falls within the School of Health
and Human Services at the UCLA campus.
Discussions were held with the Chairperson, Pro-
fessor Judith Papenhausen, and staff of the Depart-
ment of Nursing, UCLA. Identified challenges in-
cluded coping with the increasing number of un-
der- and postgraduate students whilst the number
of academic staff members continues to decline.
During 1999 the Department of Nursing coped by
offering contract appointments to retired staffmem-
hers, and by offering practising nurses part-time
teaching positions. Specific programmes were of-
fered on-site, such as in a hospital in Santa Bar-
bara, but then the services requesting specific
programmes, financed the Faculty's expenditures
for these specific courses.
This Department of Nursing offers a Bachelor of
Science Degree in Nursing (BSN) and a Master of
Science Degree in Nursing (MSN).
The purpose of UCLA's BSN nursing programme
is stated as:
"The Bachelor of Science Degree in Nursing is an
upper division program especially designed for reg-
istered nurses who have completed the lower divi-
sion nursing courses at community colleges or hos-
pital schools of nursing. Full time students can
complete the program in six quarters" (California
State University, Los Angeles, 1999a). Only can-
didates with California Registered Nurse licenses,
valid California drivers' licenses, with no grade
lower than a "C" for any nursing course can be
admitted to the BSN (Bachelor of Science Degree
in Nursing). The BSN is accredited by the Cali-
fornia Board of Registered Nursing and by the
National League of Nursing (NLN).
Students registering for the MSN degree should be
in possession of a BSN degree and meet the mini-
mum academic achievements (minimum B or 3.0
grade point average in upper division nursing
courses), and have completed courses in both sta-
tistics and nursing research within the past seven
years. The MSN is accredited by the NLN. The
MSN provides advanced study and specialisation
in administration, education, nurse case manage-
ment, clinical nurse specialisation in psychiatric
mental health, and nurse practitioner (with options
for specialising in adult care, paediatrics, acute
cardio-pulmonary care for adults, critical care for
children).
Associate degree nurses wishing to pursue the MSN
courses can follow one of two accelerated tracks: . those with non-nursing bachelor's degrees . those without any bachelor's degrees.
Basically the accelerated tracks imply that the stn-
dents need to complete the courses missing for the
BSN whilst they pursue their MSN courses. Credits
can be granted subject to specifications. However,
to remain in the accelerated courses, the MSN stu-
dents need to maintain a minimum average B grade
point in upper division nursing courses.
HFAl TH SA GESONDHEID V01.6 N0.l - 2001
At this Faculty of Nursing, MSN students complete
their Nursing Research courses during the last part
of their programmes, because the lecturers consider
them to derive maximum benefit from these re-
search courses at the end of their MSN programmes.
Students are not compelled to generate research,
but to criticise and utilise research, by focusing on
mid-range theories. MSN students are required to
evaluate research reports, criticise the research
methodology used, including qualitative research
approaches.
Although all the lecturers at the Faculty of Nursing
held doctorates, this Faculty did not offer doctoral
programmes for nurses, because the demands of
such a programme would exceed the capabilities
of the available staff members. Prospective doc-
toral candidates were referred to the University of
California, San Francisco (UCSF) or to the Texas
Women's University offering a summers-only doc-
toral programme enabling students to maintain their
full time teaching or other jobs in Los Angeles,
whilst pursuing part-time doctoral studies in an-
other state.
Center for Effective Teaching and Learning
One day was spent with Professor George Taylor
in the Center for Effective Teaching and Learning.
Professor Taylor and his colleagues specialise in
teaching staff and shtdents computer skills, includ-
ing how to design home pages on the Internet.
The Center for Distance Learning was visited. A
course in Fire Protection Administration and Tech-
nology, was being videotaped whilst the lecturer
presented the contents to a class of students at the
UCLA campus. Simultaneously a class of students
in San Francisco participated by means of video
conference facilities. Students who could not at-
tend class, could watch the video tapes at specific
times, and this would be recorded on their student
activity files.
Further information about Distance Learning
courses offered by UCLA can he obtained from the
following website: http:Ilwww.calstatela.edu/
cont-ed. More information about continuing edu-
cation courses can he located at: http.//
bestla.calstatela.edu/www/lifeloug/leaming.html
Two courses offered entirely on-line which attracted
much attention and numerous debates from many
countries were: . The Math Prep Course preparing candi-
dates for the Entry Level Mathematics
Examination, comprising algebra, data in-
terpretation and geometry. is completely
on-line requiring no campus visits and no
prescribed hooks (more information avail-
able from: www.elmprep.com/la.html).
Music librarianship presented entirely via
the World Wide Web and e-mail which
familiarises librarians with the special
needs for music librarianship, including
cataloging of sheet music, multi-media,
audio- and video recordings (more infor-
mation available from www.calstatela.edu/
stafflnweckwelmflyer.htm or by e-mailing:
VISIT: THE UNIVERSITY OF CALIFOR- NIA, DOMINGUEZ HILLS (UCDH)
Visits to clinics offering clinical experiences to students
Clinics operated by nurses, with the telephonic as-
sistance of medical practitioners, were visited in
Pasadena North and in Cudahy. These clinics pro-
vide practical experience to nursing students from
the University of California, Dominguez Hills
(UCDH) campus. Many of these clinics' nurse
practitioners also lectured part time at the UCDH.
The large numbers of volunteers, including students
and school children, who worked at these clinics
as cleaners, clerks, typists, and even nurse auxilia-
ries created lasting impressions of community in-
volvement in clinical activities. During discussions
H F A l TH S A GESONDHEID V01.6 N0.l - 2001
with two schoolgirls, sacrificing their final sum-
mer school holiday to work at a clinic, it became
apparent that their chances of obtaining scholar-
ships for nursing courses could be considerably
enlarged by their hours of voluntary community
service accumulated over a number of years.
Another interesting observation at the clinics was
the obvious lack of contraception education. This
appeared to be contradictory to the communities'
needs, where large numbers of school girls were
observed pushing babies into school areas where
their babies attended day care facilities whilst the
adolescent mothers continued with their school les-
sons. When questioned, the students explained that
the majority of people living in the areas surround-
ing the clinics belonged to the Roman Catholic faith
and that contraceptives were not freely discussed,
but advice would be given should any person re-
quest it.
The Division of Nursing, School of Health, Dominguez Hills (UCDH)
At the Dominguez Hills Campus, the Division of
Nursing falls within the School of Health. The BSN
and MSN programmes offered are similar to those
offered at the Los Angeles campus except that MSN
students can specialise in the following options:
. Nurse Education
. Nurse Administration
Parent-Child Clinical Nurse Specialist
Gerontology Clinical Nurse Specialist
Family Nurse Practitioner.
Both the BSN and the MSN are accredited by the
National League of Nursing. During 1999 more
than 3 000 students were enrolled in these nursing
programmes.
This Division of Nursing commenced offering state-
wide BSN and MSN programmes during 198 1 with
the mission to: . make quality higher education in nursing
more accessible to employed registered
nurses
ultimately improve health care in Califor-
nia.
Initially the BSN and MSN programmes were
funded by the WK Kellogg Foundation, health care
organisations and individuals. In order to reach
nurses who cannot pursue advanced nursing stud-
ies because of geographical constraints, the Divi-
sion of Nursing co-operates with a private agency
to offer courses and degree programmes through
electronic media - satellite delivery, cable vision,
computer conferencingle-mail, voice mail, and
video tapes. This Division of Nursing has divided
the entire State of California into specific regions,
with a student advisor for each region. This stu-
dent advisor visits selected health care services at
predetermined times to inform prospective students
about the available courses, regulations and dis-
tance education possibilities. Prospective as well
as registered students are encouraged to maintain
regular contact with their specific student advisors.
The Center for International Nursing Edu- cation (CINE)
Based on the successes of the Dominguez Hills'
Campus Statewide Nursing Program, requests ac-
cumulated to establish a Centre for International
Nursing Education (CINE). With the assistance of
WK Kellogg grants, this center was established in
1990, with the aim of assisting the international
community in improving and expanding educa-
tional opportunities for health care professionals.
It has provided services to governments, national
organisations, public and private health care agen-
cies and universities in Europe, Africa, Asia and
Latin America.
Prof. Judith Lewis, the Head of CINE, explained
that the major functions of CINE include: . US Preparation Programme for foreign
nurses, providing a background in US nurs
ing and health care in strengthening language
and academic skills prior to commencing
studies at US universities; . visiting Scholars' Programme designed for
individual students and based on their spe-
cific needs varying in duration from one
month to one year;
. continuing Education Programmes en-
abling professionals to update and expand
their knowledge without enrolling in for-
mal degree programmes;
workshops and seminars tailored to clients'
needs; and
programmes for Departments of Nursing
at universities in Mexico, Brazil, Chile, Co-
lumbia and other Latin American countries.
The activities in these countries do not
imply transplanting Californian
programmes to other countries, but strive
to build in-country capacities with regard
to specific aspects, such as curriculum de-
sign. These programmes are offered at in-
vitation from the country and the univer-
sity concerned and can be offered in En-
glish, Spanish or Portuguese by CINE staff
members.
More information about CINE'S activities and
programmes can be obtained from the following e-
mail address: [email protected].
ACKNOWLEDGEMENTS
I wish to express my sincere gratitude to Unisa's
Research and Bursaries Committee for awarding
me a travel grant and for granting me leave to make
the above visit possible. All the persons who helped
to make this visit a reality, and especially the staff
at UCLA and at UCDH, whether mentioned in the
report or not, who sacrificed some of their pre-
cious time to accommodate my requests, and to
engage in discussions and visits, need to he ac-
knowledged specifically, with special reference to
Proff. Marlene Farrell, Judith Lewis, Judith
Papenhausen and George Taylor.
California State University, Los Angeles 1999a: Bach-
elor of Science Degree in Nursing (Information Bro-
chure).
California State University, Los Angeles 1999b: Master
of Science Degree in Nursing (Information Brochure).
California State University 1999-2000: Summer 1999-
Spring 2000 Undergraduate Admission (Information
Brochure).
California State University, Dominguez Hills 1999-2000:
University Catalog.
G A HEALTH SA GESONDHEID Vo1.6 No.1 - 2001
HEALTH SA GESONDHEID V01.6 No.1 - 2001 65
66 HEALTH SA GESONDHEID V01.6 No.1 - 2001
SUBSCRIPTION TO WEALTH SA GESONDHEID
SUBSCRIPTION FEES 2000 R80 per annum (individual) R180 per annum (organisation)
SUBSCRIPTION FORM
Title: .......................................................... Initials: .......................................................... Surname: ................................... .... ................... Organisation (if subscribing as an organisation):
Address: ..................................................................................
Postal code: ............................................... Tel. number: (........... ) ....... : .......................... Fax number: (........... ) .................................. E-mail: ...................................................
Enclosed please find a cheque/postal order for the amount of R .................... Cheque made out to: Health SA Gesondheid, RAU
Please send subscription form and chequelpostal order to:
HEALTH SA GESONDHEID The Editor Department of Nursing Science Rand Afrikaans University PO BOX 524 AUCKLAND PARK 2006
For further information contact: Liselle Keartland (Technical Editor) Tel. (01 1 ) 489-3325 Fax. (011) 489-2257 E-mail: [email protected]
