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Research Articie

Nurses' views about tuberculosis patients'

discharge plan at Moses Kotane in the
North-West Province
SF Motsomane, Mcur
Department of Nursing Science, University of Pretoria

MD Peu, Mcur
Department of Nursing Science, university of Pretoria

Key words: Tuberculosis (TB), hospital

discharge plan, HIV/AIDS. DOTS, MDR.
Abstract: Curationis 31(1): 59-67
The purpose of this study was to explore and describe the opinions of nurses working
TB education. Traditional healers.
with tuberculosis (TB) patients regarding hospital discharge plans at Moses Kotane
in North-West. South Africa.
A qualitative, exploratory and descriptive study was conducted with these nurses.
The population involved registered nurses working with TB patients for more than
two years. The population was purposely selected. Focus group interviews were
conducted to collect data from this population. The research process was guided by
the research question: What are the opinions of nurses working with TB patients
regarding hospital discharge plans at Moses Kotane in the North-West Province?
The group moderator guided the participants throughout the interviews in which the
central research question was posed. Tesch's qualitative method of data analysis was
used to analyse the data obtained.
Subcategories and categories, and the following themes emerged during the data
analysis: the need for education and involvement, the co-existence of TB and HIV/
Aids infections and the knowledge of continuous laboratory investigations. The
participants discussed the suggestions and solutions for effective hospital discharge
plans. The research findings could assist in the improvement of existing hospital
discharge plans at Moses Kotane District.
The results revealed both positive and negative ophiions regardhig discharge plans.
The data were classified into themes, categories and subcategories. The participants'
suggestions regarding discharge plans were addressed and discussed. Finally,
recommendations were disseminated to concemed authorities.

the patient is moving and the needs

Correspondence address: Introduction and related to the patient's condition, imposed
Mrs MD Peu
Department of Nursing Science
background of the study by this situation (Phipps and Sands
P.O.BOX 667 District hospitals in the Norih-West 2003:155). Although discharge plans are
Faculty of Health Care Sciences Province of South Africa, cater for rural used, TB patients continue to relapse on
University of Pretoria communities with illnesses and diseases, their treatment.
Pretoria such as psychiatric illnesses, minor
0001 ailments and tuberculosis (TB). In these Discharge planning is a process that
hospitals, discharge planning begins the involves the patient, family members and
Tel: (012) 354-2133 day the patient is admitted. It involves members of the multidisciplinary
an assessment of the situation into which healthcare team. In the case of TB
E-mail : mpeu@postilIion.up.ac.Ea
Curationis March 2008
patients, this includes the nurses health problem, of a hospital discharge knowledge of and insight into their
working with the patients (Stanhope & plan for TB patients. illness. A discharge plan for a TB patient
Lancaster, 2000:382). Furthermore, should focus on the total well-being of
discharge planning is needed to ensure The South African National Tuberculosis the patient. Nurses should be given the
the continuity of care as patients move Association (SANTA, 2001:6) stated that opportunity to sit down and discuss the
from one segment of the healthcare TB, as a social and health problem, is situation with the patient, to plan ways
system to another. The multidisciplinary curable, even with the additional effect and methods of coping with the problems
healthcare team has to plan in order to of HTV/AIDS. However, socioeconomic that may arise, and to make reahstic futtire
prevent (further) complications in the factors such as poverty and plans (Phipps and Sands, 2003:156).
patient's condition. It is therefore unemployment adversely affect the
important to investigate the opinions of prognosis of TB being curable. The needs of the patient should be
nurses working with TB patients Unemployed TB patients, especially assessed before discharge occurs
regarding a discharge plan that affects those living far from clinics, might be ensuring that continuity of care is
not only the health of the individual TB unable to pay for transport to health maintained during and after transfer from
patient, but also the prevalence of the services (SANTA, 2001:6). People in the healthcare facility to another setting
disease. poorer communities tend to be ignorant (Phipps and Sands, 2003:156).
of their health status, the
Stanhope and Lancaster (2000:382) state communicability of TB, curative aspects The care providers need information
that discharge planning prepares the and compliance with treatment. Nurses, about the patient, treatment and follow-
patient for the next phase of care by as members ofthe multidisciplinary team up visits to assist in implementing the
means of organised planning and working with TB patients, assess clients TB patients' treatment and follow up visit
coordination of resources. Patients for referral. Integrating the ideas or (Clemen-Stone, McGuire and Eigsti
suffering from TB are informed of relevant suggestions of nurses working with TB 2002:313-314). Stanhope and Lancaster
resources available for the continuity of patients into a hospital discharge plan at (2000:843) regard discharge planning as
their care after being discharged from the district hospitals could contribute toward continuity of care in which the
hospital (Vlok, 2006: 534-535). However, a reduction in TB statistics in South multidisciplinary team prevent further
some patients discontinue their Africa. complications ofthe patient's condition
treatment. As a result, patients have to and promote his/her health. A discharge
be readmitted after two to three months, Patients, who suffered relapses as a plan ultimately promotes self-
a frequent occurrence at district hospitals result of discontinuation of treatment or observation, self-determination and self-
in the North-West. There are an other reasons, are continuously respect in a TB patient.
estimated 9557 cases of TB in the North- readmitted to district hospitals.
West Province including George Individuals with diverse beliefs and
Stegmann Hospital in the Moses Kotane
Problem statement
traditions consult indigenous healthcare
The George Stegmann Hospital statistics
District and 25% of TB patients are HIV services within the communities about
(Department of Healtii, 2006:1-10 and
positive (South Africa, Department of their ill health. Their cultural values and
2006:1-10) indicate frequent readmissions
Health, 2002:1). The incidence of TB per beliefs affect their compliance with
of TB patients to district hospitals. There
100 000 people is 271 in the respective conventional medical treatment. In these
were 1300 patients who were admitted in
province. In South Africa, City of Cape communities, TB is known as sejeso,
a hospital, 83 cases of relapses were
Town alone, 22 999 people were infected resembling signs and symptoms of TB
diagnosed and 6 patients were diagnosed
with TB in 2003 (Jouberi & Ehriich (Bamhart, 1996:179). Patients usually
as MDR in 2006 (Ibid 2006:6). Patients
2007:180). visit traditional healers for further
are often unable to continue with their
management of their ill health. In her
prescribed TB treatment. Treatment is
In addition to this, nurses working with study of the attitudes of traditional
prescribed by healthcare personnel and
healers toward TB patients at Ga-
TB patients are faced with the following collected by patients, but not continued
Rankuwa Hospital, Moloantoa in Vlok
challenges: or completed. Therefore, a discharge plan
(2006:524) provides useful information on
• Patients relapse; for TB patients needs to be designed and
the disease. She indicates that traditional
• Discontinuation of treatment by evaluated for progress. The research
beliefs and attitudes persist in these
patient; question for this research was: What are
communities. Moloantoa suggests that
the views of nurses working with TB
• Diverse attitudes and effective communication could promote
patients regarding a hospital discharge
viewpoints regarding the improvement in nurse-patient
plan for these patients in the George
relationship between TB and relationships. By incorporating the
Stegmann Hospital in the Moses Kotane
the human immunodeficiency suggestions of nurses working with TB
Local Municipality in the North-West
vims/acquired patients into an effective discharge plan
Province, South Africa?
immunodeficiency syndrome for TB patients, the number of defaulters
(HIV/AIDS); and the number of patients who
• Insufficient medication; poor discontinue freatment could be reduced. Significance of the Study
coordination and lack of Research findings on the views of nurses
cooperation between members Proper discharge platming regarding TB working with TB patients regarding a
ofthe healthcare team. patients should include the provision of hospital discharge plan for these patients
These challenges could influence the sufficient information by healthcare at George Stegmann Hospital in the
positive effect, in reducing TB as a workers to ensure that patients have Moses Kotane Local MunicipaUty in the
Curationis March 2008
North-West could enhance TB patients' and relevant information in working with of the study and the freedom to choose
hospital discharge plans. The findings TB patients in the province. One focus whether to participate or not. Subjects
might also assist with the reduction of group consisting of six participants was had the right to withdraw fiom the study
relapses and multidrug resistant TB utitised. They had the confidenee to give without any penalty.
patients. information on TB patients, friends,
families and other eommunity members.
Data collection and
Aim of the study
The aim of the study was to explore and The participants of this study were instrument
describe the views of nurses working purposely sampled and consciously Data were obtained from nurses working
selected to include those nurses with with TB patients by means of focus group
with TB patients regarding the hospital
relevant information on TB. Sampling interviews. Six participants were involved
discharge plan for TB patients at George
refers to the process of selecting a in a focus group interviews. A foeus
Stegmann Hospital in the Moses Kotane
portion of the population to represent the group interview is described as a
entire population (Poht et al., 2001:234). purposive discussion of a specific topic
A seleetion criteria for this study was or related topics, which takes place
Definition of concepts nurses who had at least 2 years between eight to ten individuals with
• Defaulter experience working with TB patients. similar baekgrounds and common
Burns and Grove (2003:374) define interests (De Vos, 2001:314 and Bless and
A TB defaulter is a person who has not
selection criteria as the selection of Smith 2000:110).Thegroup'sinteraction
attended therapy for two consecutive
typical individuals in relation to the during this study consisted of verbal and
months or who has had less than 75% of
phenomenon under study. Babbie and non-verbal commutiication and interplay
doses during tbe six-month therapy
Mouton (2007:166) add that purposive of perceptions and opinions, which
period CVlok, 2006:535).
sampling is a strategy in which the stimulated the diseussion without
researcher's knowledge of the population necessarily modifying or changing the
• Discharge plan is used to select the cases to be ineluded ideas and opinions of participating
A discharge plan involves identifying the in the sample. The partieipants were individuals (De Vos, 2001:314).
patient's needs and making plans purposively selected because they
regarding continued care following possessed tbe relevant information
In this study, six partieipants were
diseharge fi-om a healthcare institution required for the study.
involved in a focus group discussion. A
(Lundy and Janes, 2001:902-903).
focus group interview was conducted
with the aid of a tape recorder. The
• Relapse Ethical considerations language of choice for interviews was
TB relapse denotes recurrence following Permission to conduct the research was English because the participants were
successful treatment of TB (Karim and obtained from the district hospital fiuent with Engtish language. The use of
Karim,2(X)5:437). authorities and the informed consent and a single source of data collection was not
nurse working with TB patients as sufficient in qualitative research;
participants were given explanations on therefore, a tape recorder added value to
• Ibherculosis
the purpose and nature of the research. the study. Two focus group sessions
The bacillus Mycobacterium Ethical principles were adhered to, and
Tuberculosis causes this chronic, were conducted because the researcher
participants were ensured of protection had to reach data saturation.
infectious disease (AUender and from harm. The researeher considered
Spradley, 2005:206). the sensitivity of partieipants when
After the interview, the researcher
setting questions (Polit et al, 2001:78).
thanked the participants and gave them
Research design Participants were respected for human
a chance to give feedback about their
An exploratory and descriptive dignity. This included the right to self-
experiences during the interview. The
qualitative research design was adopted determination and the right to full
participants were given refreshment to
to conduct research into the views of partieipation. The researcher proteeted
allay any anxiety.
the rights of pariicipants throughout the
nurses, working with TB patients,
research process. The participants were
regarding discharge planning for TB
patients at George Stegmann Hospital in
protected from discomfori and harm. Data analysis
Their rights to anonymity and Qualitative methods were used to analyse
the Moses Kotane Local Municipality confidentiality were ensured. The the data. Qualitative data analysis is an
district. participants' privacy was ensured. The active and interactive process, especially
numbers were used as names to address at the interpretive end of the analysing
Population and sampling the participants during the research style continuum (Pout eifl/., 2001:383).
The population in this stiidy consisted process. In this research, the Tesch method of
of all nurses working directly with TB data analysis was followed (Tesch 1990
patients at the George Stegmann Hospital The right to self-determination was in Creswell 2003:192). This method
in the Moses Kotane Local Municipality respected during the research process. involves following a series of steps in
district, North-West Province. The study Self-determination was based on the order to analyse the data. In order to do
population for this research involved ethical principle of respect for persons, this, qualitative coding methods were
nurses who had two or more years of which stated that humans are capable of employed. The data were analysed in the
experience working with TB patients. self-determination (Polit et al, 2001:78). language (English) in which the
These nurses had tremendous experience Subjects were informed about tiie natiire interviews were conducted. All

Curationis March 2008
transcripts of two focus group sessions In Polit er a/. (2001:313) and Babbie and
were carefully read in order to get a Mouton (2007:275) states that
Theme 1 : Need for
hohstic overview. Thoughts were written triangulation is a method used to improve education
down as they occurred. The topics were the likelihood of qualitative findings The first theme that emerged was the
abbreviated as codes, and the codes were being credible. Triangulation refers to the need for education about TB. Various
written on the appropriate side of the text. use of multiple referents to draw categories, namely TB patients, families
A final decision was made for each conclusions about what constitutes the of TB patients, teachers of children
category, tmth (Pohteia/,, 2001:313). hi this study, suffering from TB and hospital nurses.
the researcher used observations, a tape
iVIeasures to ensure recorder and field notes to ensure Category 1 : TB patients
credibility of data. The researcher Three subeategories, namely side effects
trustworthiness replayed the tape recordings after each of drugs, MDR and drug interaction,
The tmstworthiness of this research was discussion so that the participants could emerged from the category of TB
ensured through confirmability, listen to what they had discussed or how patients, which emerged from the theme
credibility, transferability and they had contributed to the study. The of the need for education.
dependability (Lincoln & Guba ( 1985:301 ) participants were followed up to verify
in Poht er a/, 2001:312). the findings of the study to increases the
• Side effects
confidence of the participants. The
The participants in the focus group all
member check also increased the
Confirmabiiity confidence of the participants. Persistent
agreed that patient education must be
Confrrmabihty refers to the objectivity or incorporated into the discharge plan of
observation, as described by Lincoln and
neutrahty of the data such that two or TB patients. Several issues were
Guba, in Polit et al (2001:313), was
more independent people could agree emphasised as being important in this
ensured when the researcher focused on
about the data's meaning (Polit et al. education, such as the side effects of TB
the aspects of a situation that are relevant
2001:315). In this study, confirmability dmgs.
to the phenomena being studied.
was ensured through researcher
objectivity and audit tiail. The researcher The following quotations are relevant:
remained objective throughout. The Transferability "You should teach the patient about the
records made during data collection, In Lincoln and Guba's framework, side effects like vomiting and allergic
including observations were kept and transferability refers essentially to the reactions." "They might experience
made available for future reference, generahsabitity of the data (Potit et al. things like yellow eyes and the urine
scrutiny and confirmation. 2001:316). In this study, because turning yellow ... but these should not
generalisability to other situation will make them stop taking the treatment. "
Credibility pose an obstacle, therefore the researcher
provided the reader with the description • Multi-drug resistance (MDR)
Credibility addresses the question as to
of the background of the study, Participants mentioned the need to inform
whether the research has established
methodology as well as the information patients about the phenomenon of MDR
confidence in the findings. The credibility
of participants involved. Other and advise them about the benefits of
of qualitative data and the resulting
researchers will then utiUse the relevant compliance to medication. This was
findings is the aspect of data quality on
parts of this study. expressed as following:
which most methodological attention has
"With MDR it is very rare that the patient
focused (Polit et al. 2001:313), Polit et
al (2001:313) cite Lincoln and Guba Dependability gets well: most die from TB. " "Once a
patient has been diagnosed with MDR.
(1985:301) who suggest a variety of The dependability of qualitative data
the relatives should come for tests as
techniques, such as prolonged refers to the stability of data over time
they are now contacts. "
engagement, persistent observation, and conditions (Pohtei a/., 2001:315), In
triangulation and member checking, for this study, the participants were selected
improving the credibility of quahtative and described. The data gathering • Drug interaction
research. methods, analysis and the findings of the Partieipants agreed that the discharge
study were described to ensure plan must include the education of the
The researcher was engaged for a dependabihty of the study. TB patient with regard to drug
prolonged period with the participants. interactions.
The researcher studied the culture of the Discussion of resuits and
participants and spent time with them. They mentioned that:
Trust and rapport was established during literature controi "The patients, especially women, must
the collection of data. The participants Four themes, namely the need for know that TB treatment weakens the
were fi-ee to answer the researeh question education, the need for involvement, the effectiyeness of family planning drugs,
without fear. The moderator conducted co-existence of TB and HIV infections, thus they might need to use an intra-
the interview so that the researcher was and the knowledge of continuous uterine device (IUD) instead "The TB
able to make note of observations during laboratory investigations, emerged patient must report to all practitioners
the interview. The moderator clarified the during the data analysis (see table 1 during consultation that they are on TB
research question for the participants by below). Literature relevant to the themes, treatment. "
simphfying or putting it in a different categories and subcategories was used
manner. to control or verify the fmdings, Pearson (2002:1090) supports the need

Curationis March 2008
Table 1 : Summary of themes, categories and subcategories

Theme Categories Subcategories

1. Need for education about TB 1.1 TB patients a. Side effects of dmgs

b. Multi-dmg resistance (MDR)
c. Dmg interaction

1.2 Families of the TB patient a. DOTS (Direct Observation Therapy)

b. Dehydration effects of enema

1.3 Teachers of children suffering from a. DOTS


1.4 Hospital nurses a. DOTS

b. Discharge plan commences

2. Need for involvement 2.1 Family of patient a. Provision of good diet

2.2 Social worker a. Assessment for discharge grant

2.3 School a. Emotional support

2.4 Traditional healers a. Encourage compliance

3. Co-existence of TB and HIV infecdons 3.1 TB patients a. Emotional support by nurses

3.2 Breast-feeding a. Knowledge about treatment


4. Knowledge of continuous laboratory 4.1 Nurses a. Inform patient and their significant
investigations other

4.2 TB patients and families a. Blood, sputum and x-ray tests

for patient education in aspects of TB (2003:389) further support the educating the families of TB patients
medication, such as, if a patient participants' emphasis on the need for about DOTS. The following quotes are
experiences trouble with swallowing the patient education with regard to adverse relevant:
dmgs, they can be mixed with soft foods. side effects and the reporting of these "The family must know about the green
The patient must be urged to comply with effects. card. " "The patient should always carry
the prescribed regime, and not miss doses his/her green card like an identity
or discontinue drug intake without According to Schilling and Cann document. " "'The teachers can supervise
medical approval. (2003:389), people who have been treatment of the scholars and even
exposed to a patient with MDR TB need record in the green card. " "It must be
Patients with nausea, vomiting or other to be tested and prophylactic measures started in the hospital by nurses, and be
gastro-intestinal upsets should be taken. Therefore, before any medication continued afier discharge. "
advised to take dmgs with food. Pearson regime is initiated, the patient must be
(2002:1090) further states that urine and tested for HIV/AIDS for purposes of • Dehydration effects of enema
other body fluids may become exclusion, as these patients can often end According to the participants, the
discoloured, and patients should be up with MDR (Kozier, Erb, German & families of TB patients should be wamed
cautioned that their clothes and soft Snyder, 2004:88). against the dehydration effects of
contact lenses may become permanently Category 2: Families of the TB patients enemas that are sometimes prescribed by
discoloured. Famihes of the TB patient emerged as the traditional healers:
Shannon, Wüson and Stang (2004:1083) second category in the theme of the need "And now, when we pick up ... the
add that pafients should be educated that for education. The internationally patient from the hospital, who is feeling
food may be useful in preventing gastro- recognised TB control strategy, DOTS, better, we should also advise them not
intestinal upsets. Schilling and Cann emerged from this category. to consult traditional healer. "
(2003:389) suggest that patients should
be told of the benefits of plenty of rest. It
is also important to eat balanced meals DOTS The participants of this study
to promote recovery. Schilling and Cann Participants expressed the importance of emphasised the need to educate patients

CuratioDis March 2008
about the dehydrating effects of should be implemented for all patients, first category in the theme of the need
traditional medicines, particularly making use of community-based health for involvement. The provision of a good
enemas. Mulder (2004:334) confums that workers who meet with patients in their diet emerged from the category of family
enemas cause imbalances between fiuid homes, at their jobs or at other local of the patient.
intake and output, and therefore venues.
precautionary measures should be taken • Provision of good diet
when prescribing medicines for TB. The Category 4: Hospital nurses All pariicipants recognised the need for
author further mentions that fluid Hospital nurses emerged as the fourih family involvement when planning for a
imbalances occur when the category in the theme of the need for TB patient's discharge. They mentioned
compensation mechanisms of the body education. This category was further that the family, as well as other role
are incapable of maintaining a subdivided into DOTS and discharge plan players, should be involved. The family
homeostatic balance. Abnormal loss of commences. must provide a well balanced diet for the
body fiuid in the case of administration patient. This was expressed as follows:
of enemas causes diarrhoea and. later, "They must be encouraged to grow a
body weakness. DOTS
Pariicipants once again emphasised the vegetable garden because food is very
imporiance of the DOTS strategy. expensive to buy. "
Category 3: Teachers of children The following quote is relevant:
suffering from TB "Direct Observation Therapy Short Family members, as well as friends, play
The third category that emerged from the course is started in the hospital by the an important role with regard to the
theme of the need for education is nurses and immediately when the patient treatment of the patient. Lewis et al.
teachers of children suffering from TB. is discharged. The relatives will be (2004:604) indicate that family members
This category also emerged in the invited and taught about DOTS and they or friends may help the client to eat
subcategory of DOTS. must supervise the patient at home. " correctly and maintain the required
lifestyle changes. Family members
DOTS • Discharge plan commences should motivate the patient to adhere to
the prescribed treatment in order to
The participants involved in the study According to the participants, the
prevent the emergence of resistant strains
emphasised that: discharge plan commences as soon as
of TB. Pearson (2002:1091) adds that
"DOTS can be taught by the clinic sister. the patient is admitted to hospital.
family members should encourage the
They should record on the green chart "Discharge plan starts immediately afier
patient to promptly repori any sign of
on daily basis until the patient goes for the admission of the patient. The
flu. rash or itching of the skin when they
review or check up. " relatives are to be invited and to be
are on TB treatment. Kozier et al.
taught about DOTS. They will be
(2004:454) urge family members to be
The participants of this study indicated informed about the DOTS supporters
involved in the care of the patient,
that the DOTS programme provides a who are volunteers. "
especially during the course of TB
solution to TB control. The South African
treatment and during preparations of
Department of Health in its Tuberculosis PiUitteri (2003:1037) argues that discharge
food. These, in turn, ensure capacity
Control Programme Practical planning is an important link in the
building for the patients. Fanüly members
Guidelines (South Africa, Depariment of patient's move from hospital to home. If
should suppori patients in not allowing
Health. 2000b:9), supporis the DOTS a discharge plan were to be well
their personal hves to become affected
shori course as a break-through that is developed. TB patients would not relapse
by the disease (Van Wyk 2005:46). Family
increasingly providing solutions to the but rather comply with their treatment.
members also need to inform TB patients
control of the TB epidemic in South Stanhope and Lancaster (2000:382) add
of any health awareness days regarding
Africa. that a discharge plan is part of the
TB. On the TB awareness day, the family
continuous healthcare process and
should attend the function with the
This document further mentions that prepares the patient for the next phase of
individuals from different sectors have a care. However, it is imporiant that all
major role to play in the effective health institutions have a comprehensive
treatment of TB. All healthcare providers discharge plan in order to enhance the Category 2: Social worker
should use this programme in the patients' prognosis. To achieve this plan, The social worker emerged as the second
management of TB. According to SANTA DOTS strategy should always be category in the theme of the need for
(2001:7). DOTS is the most effective observed. involvement specifically for organising
strategy available for controUing the TB a discharge grant for the TB patient. The
epidemic. It is thus the Govemment's pariicipants expressed this as following:
commitment to sustain TB control Theme 2: Need for "The social worker must be involved
activities (South Africa. Department of involvement from the word go ..." "The poor and
Health, 2005:22). needy patients must be assisted by means
The second theme that emerged was the
According to AUender and Spradley of social grants. "
need for involvement. The categories are:
(2005:211), DOTS needs sustained
family of patients, social worker, school
political commitment, with the A social worker is a professional
and traditional healers.
government of nations recognising the individual who provides the needy
long-term benefits of providing the community with social relief SANTA
resources and staff necessary to ensure Category 1 : Family of patient (2001:19) states that a social worker
its proper implementation. DOTS therapy The family of the patient emerged as the assists with grants and establishes
Curationis March 2008
Community development with self-help Both traditional healers and nurses its young; therefore, it stands to reason
projects, such as gardening, sewing, should be educated on both Westem and that breast milk is the perfect food for the
candle-making and brick-making. Kibel traditional methods of deahng with the human baby and contains all the
and Wagstaff (2003:540) mention tiiat TB epidemic. Consensus can be reached nutrients which it requires, in the correct
there exists a lobby that all children with about TB patients' compliance to TB proportion.
disabihties and chronic illnesses, as well treatment. Another area in which
as their families, should be eligible for traditional healers, who are supportive In support of the above discussion.
grants, as families incur extra expenses, of patients suffering from TB, can play a Young, Van Niekerk and Mogotlane
such as visits to health centres, special role is the DOTS course (SANTA, (2003:549) argue that diarrhoea and
clothing, loss of income, food and as a 2001:23). vomiting in infants and young children
result of not being able to work because are often as a result of the inadequate
of caring for such children. hygiene of feeding bottles. When infants
Theme 3: Co-existence of are breast-fed, the question of the
Category 3: School TB and HIV infections hygiene of feeding bottles does not arise.
School emerged as the third category in The third theme that emerged was the The promotion of breast-feeding is an
the theme of the need for involvement. co-existence of TB and HIV infections. important priority for health workers,
Two categories, namely TB patients and particularly in poor mral communities.
The participants identified the need for
breast-feeding, emerged from this theme. Because these communities are poor,
schools to be involved in discharge plans
they may not have access to a clean water
in order for them to emotionally support
supply or mothers may not afford formula
young TB patients. Category 1 : TB patients milk. In reference to the breastfeeding,
The subcategory emotional support by babies who are infected by HIV/AIDS
The school is an institution that can nurses emerged from the category of TB through mother-to-child transmission
contribute to the progress of TB patients. The respondents mentioned the via breastfeeding, may be at risk to be
programmes. Teachers should problems of these patients in connection given breast milk (van Dyk 2005: 32-33).
emotionally support those who are sick, with comphance. If the child is at risk, other options such
and young children who are taking and as exclusive breastfeeding and
complying with treatment. Wong • Emotional support expression and pasteurisation of breast
(2003:12) agrees that these patients The following quotations are relevant: milk are considered (van Dyk 2005: 32-
require support and sometimes "No, I wouldn 't take it because I am HIV 33).
counselling. Teachers can act as positive, 1 do not have to take treatment
counsellors by offering emotional because I am dying. " "Patients must
support to TB children through listening, know that they can take anti-retroviral Theme 4: Knowledge of
touching and through their physical treatment together with TB treatment. " continuous laboratory
presence. "Patients need to know that TB investigations
treatment is effective even when they are The last theme that emerged was
Category 4: Traditional healers HIV positive. " knowledge of continuous laboratory
Traditional healers emerged as the fourth investigations. This was further
category, and encourage compliance Lewis et al. (2004:605) mention that categorised into knowledge for nurses,
emerged as a subcategory ofthe category. patients on anti-retroviral drugs for HIV TB patients and famihes.
should not take Rifampicin, as it can
* Encourage compliance
impair the effectiveness of the drugs. Category 1: Nurses
They are given another Tuberculostatic, The participants identified the need to
The participants expressed the need to
which will not bring any alteration in dmg educate clinic nurses about informing
involve traditional healers in the
interaction. Schilling and Cann (2(X)3:389) patients of laboratory investigations
discharge plan of patients who consult
note that patients should eat balanced conducted during the treatment regime.
them. They mentioned that: meals to promote recovery. They They said that:
"Culturally patients prefer traditional emphasise that nurses must teach "Patients need to know that afier two
healers,,," patients about the adverse effects of months of taking TB treatment they
medication and wam patients to report should have their sputum investigated, "
Traditional healers play an important role fatigue, weakness and other signs and "Liverfunction test is done every month
in the South African context. Because symptoms with which they might to investigate overloading done to the
South Africa is a diverse nation, nurses experience. liver by TB treatment"
must be sensitive and accommodative to
all chents irrespective of their culture,
education and creed (Peu, 2000:1 ). Their Category 2: Breast-feeding Wong (2003:1375) states that nurses
nursing care should focus on the In South Africa, baby-friendly hospital assume several roles in the management
provision of congruent healthcare. initiatives encourage breast-feeding. of TB, including that of helping the family
Patients have rights and choices with Breast-feeding is also promoted at to understand the rationale for diagnostic
regard to their health. They have the right antenatal clinics. This is because breast- procedures, assisting with radiographie
to consult Westem or traditional healers. feeding reduces mortality and morbidity examinations, performing skin tests and
The only way to ensure that congment rates among infants. De Haan (2003:194) obtaining specimens for laboratory
healthcare is provided is through states that tiie milk of every mammal is examination. In case ofa child, the ntirses
collaborative efforts with these healers. designed to meet tiie particular needs of must calm parental anxieties by dealing

Curatiouis Mareh 2008
with the illness constructively and in • The DOTS stiategy should be practice of social research. Cape Town:
eollaborating in planning the child's adopted in order to provide Oxford University Press.
continued care (Wong 2003:1375). comprehensive treatment to TB
Nurses should emphasise compliancy patients. The DOTS strategy BARNHART, RK1996: The worid book
regarding medicine (Wong 2003:1105). should also be explained in rural dictionary (vol. 1 ). Chicago: Scott Fetzer.
Nurses should encourage adherence to homes.
prescribed medication regimen for TB in BLESS, C & SMITH, CH 2004:
• Prevention of MDR TB should
order to decrease tbe opportunities for Fundamental of social research methods.
be emphasised to all patients on
transmission of the disease (Allender & 3"* Edition. Cape Town: Juta.
Spradley, 2005:211) and to the treatment for TB.
progression to MDR TB. • The Government should
BURNS, N & GROVE, SK 2003: The
support the district hospitals in
practice of nursing research: conduct,
discharge planning by
Category 2: TB patients critique and utilization. Philadelphia: WB
providing the necessary Saunders.
The category TB patients emerged from
the theme of knowledge of continuous
laboratory investigations. From the • Nurses who work with TB CLEMEN-STONE, S; MCGUIRE, SL &
category TB patients, the subcategory patients should receive regular EIGSTI, DG 2002: Comprehensive
blood, sputum and x-ray tests emerged. in-service training. Community Health Nursing: Family,
• Community members should be Aggregate & Community Practice. St.
• Blood, sputum and x-ray tests empowered through the Louis:Mosby.
acquisition of knowledge about
The participants emphasised that:
TB and HIV/Aids, so that they CRES'WELL, JW 2003: Research
"V^e do investigations when the patient
ean serve as the extended arms design: qualitative, quantitative, mixed
is on TB treatment. We usually take
of cUnics and hospitals. methods approaches. Thousand Oaks:
sputum; after two months being on
treatment we take patient's sputum; after Sage Publications.
six months we take the sputum again to Conclusion
see whether the patient has been cured DE HAAN, M 2001: The health of
The objective of the study was to explore
or what. " Southem Africa. 2™ Edition. Cape Town:
and describe the views of nurses working
with TB patients at a district hospital in
The family has the constitutional right to the North-West Province, The researeh
access information (South Africa, 1996). DE VOS, AS 2001: Research at grass
process followed a qualitative research
Their understanding of TB as a disease roots: a primer for the caring professions.
design and looked at the question "What
will enhance their coping skills. The Pretoria: Van Sehaik.
are the opinions of nurses working with
family also needs to know about x-rays TB patients regarding a hospital
and sputum tests, whieh they, as DENNILL,K;KING,L&SWANEPOEL,
discharge plan at George Stegmann
contacts, must undergo. Shannon et al. T 2005: Aspects of primary health care.
Hospital in the Moses Kotane Local
Johannesburg: Thompson.
(2004:1382) state that periodic tiver Municipality district. North-West
function tests are done for patients with Province?". In the focus group
hepatic diseases. Patients' Prothrombin HARMENING, DM 2002: Clinical
interviews, the participants revealed both
indices are checked, as tbis is necessary haematology and fundamentals of
positive and negative opinions regarding
to establish and maintain the required hemostasis. 4* Edition. Philadelphia: F.A.
discharge plans. The data were classified
anti-coagulant blood levels to prevent Davis Company.
into themes, categories and
severe episodes of haemorrhage. subcategories. The participants'
Harmening (2002:663-664) confirmed that JOUBERT, G & EHRLICH, R
suggestions regarding discharge plans
Prothrombin indices are checked once a were addressed and discussed. The main Epidemiology: a research manual for
month or if there are some indicative discussions focused on the need for Soutb Africa. 2" Edition. Cape Town:
signs. The acceptable range of PI is 11.1 patient education on eompliance and Oxford University Press.
to 14.1 (Harmening, 2002:663-664). patient involvement. Finally,
recommendations were disseminated to KARIM, SS & KARIM, Q 2005: HIV/
AIDS in South Africa. Cape Town:
Recommendations concemed authorities.
Cambridge University Press.
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