It is important for nurses to have positive attitudes towards patient care if good quality care is to be provided. This study explored nurses’ attitudes towards providing care to patients in one rural district hospital in KwaZulu-Natal from the perspective of the nurses themselves, and from the patients’ perspective. We conducted an explorative qualitative study. Thirteen focus group discussions were conducted with professional/enrolled nurses, enrolled nurse assistants and patients. Discussions were audio-recorded, transcribed and analysed using a thematic approach. While some nurses were passionate about nursing for altruistic reasons, many nurses said they actively disliked nursing. Reasons were staff shortages, high patient loads, absenteeism, and poor interpersonal communication. Both nurses and patients reported incidences of poor patient care and even willful neglect of patients’ basic care. Nurses blamed sub-standard nursing care on the attitudes of patients or patients’ relatives, as well as on lack of management support. Patients described both positive and negative experiences of nursing care received. Poor attitudes of nurses, resulting in poor patient care, could severely undermine the ability of the health system to provide quality care and improve outcomes for patients. It is recommended that all hospitals assess nurses’ attitudes regularly to ensure that patient care is not compromised.

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Background: Integration of services in primary health care settings can provide mother/baby pairs with all required services at one visit. This study aimed to evaluate a proof of concept, quality improvement (QI) intervention to strengthen well-child service provision and integration with maternal health services in five rural clinics in KwaZulu-Natal, South Africa. Methods: Quantitative cross-sectional surveys were conducted among mothers bringing their child for well-child services, before and after implementation of the intervention. Exit interviews and reviews of the child's Road to Health Booklet (RTHB) were conducted to determine services provided at the visit, and the time spent in the clinic was observed and recorded. Results: A total of 413 exit interviews and record reviews were conducted (123 at baseline and 290 at follow-up). At follow-up, significantly more mothers were tested for HIV during the well-child visit (9.2% vs. 22.6%; p = 0.045) and significantly more mothers received ART (3.7% vs. 35.5%; p = 0.010). However, coverage of growth-monitoring services remained low and there was no difference in infant feeding advice provided to mothers at baseline and follow-up (49.5% vs. 49.7%; p = 0.996). More mothers interacted with a registered nurse at follow-up than at baseline (35.8% vs. 80.7%; p = 0.032). Conclusions: Over the implementation period of the QI intervention, improvement was shown in coverage and quality of some maternal health and HIV services, but there was no improvement in growth monitoring. This suggests that QI has the potential to improve integration of service delivery, but this was a small study and further research is recommended.

Introduction: In South Africa fewer health professionals (HPs) work in rural areas compared to urban areas, despite rural communities having greater health needs. This study explores factors influencing recruitment and retention of three categories of HPs in KwaZulu-Natal and has implications about how to retain them in rural areas.Methods: A cross-sectional, descriptive survey was conducted in 8 hospitals, 5 rural and 3 urban, in one district in KZN in 2011. Data were collected on single day in each hospital and all HPs on duty were requested to participate. We compared responses from rural and urban based HP as well as professional nurses (PNs), doctors, and allied HPs.Results: 417 questionnaires were completed: 150 from HPs in rural and 267 from HPs in urban hospitals. Perceptions of living/working in rural areas is negative and the quality of health care provided in rural areas is perceived as poor by all categories of HP. Rural-basedHPs were more likely to report living apart from spouse/partner (72.1% vs 37.0%, p < 0.001)and children (76.7% vs 36.9%, p < 0.001), and living in hospital accommodation (50.8% vs 28.9%; p < 0.001).Conclusions: Decisions made by HP about where to work are complex, multifactorial and should be tailored to each category of health professional.

Background: Integration of services in primary health care settings can provide mother/baby pairs with all required services at one visit. This study aimed to evaluate a proof of concept, quality improvement (QI) intervention to strengthen well-child service provision and integration with maternal health services in five rural clinics in KwaZulu-Natal, South Africa.Methods: Quantitative cross-sectional surveys were conducted among mothers bringing their child for well-child services, before and after implementation of the intervention. Exit interviews and reviews of the child’s Road to Health Booklet (RTHB) were conducted to determine services provided at the visit, and the time spent in the clinic was observed and recorded.Results: A total of 413 exit interviews and record reviews were conducted (123 at baseline and 290 at follow-up). At follow-up, significantly more mothers were tested for HIV during the well-child visit (9.2% vs. 22.6%; p = 0.045) and significantly more mothers received ART (3.7% vs. 35.5%; p = 0.010). However, coverage of growth-monitoring services remained low and there was no difference in infant feeding advice provided to mothers at baseline and follow-up (49.5% vs. 49.7%; p = 0.996). More mothers interacted with a registered nurse at follow-up than at baseline (35.8% vs. 80.7%; p = 0.032).Conclusions: Over the implementation period of the QI intervention, improvement was shown in coverage and quality of some maternal health and HIV services, but there was no improvement in growth monitoring. This suggests that QI has the potentialto improve integration of service delivery, but this was a small study and further research is recommended.