'n Opleidingsraamwerk gerig op gehalte aborsiesorg vir verpleegkundiges aan hoëronderwysinstellings in die Wes-Kaap
morbidity and mortality rate of the women concerned, abortion legislation was implemented
with the aim of ending illegal abortions in South Africa by having abortions carried out legally
on request in designated health care facilities. The abortion legislation stipulates that
registered nurses who have undergone the proposed abortion care training may terminate a
pregnancy upon request of a woman during the first twelve weeks of the gestation period of
Although legislation authorises registered nurses to carry out first trimester abortions, an
inadequate number of nurses are being trained in the Western Cape to provide pregnant
women with guidance and counselling services, carry out the abortions and/or refer problem
cases. Since the implementation of the abortion legislation no real attempts have been made
by higher education institutions in the Western Cape to offer abortion care training for nurses.
A need has therefore been identified to develop a comprehensive training framework for
higher education institutions in the Western Cape for the training of nurses in abortion care.
The case study was used as research design and the specific unit of analysis on which the
researcher focused were the registered nurses who had received training in abortion care and
the context in which they provide abortion care at the various levels of service provision in the
different regions of the Western Cape.
A random, stratified sample (non-proportional) was taken of the designated state health care
facilities in the Western Cape, as well as a non-probability purposive sampling of registered
nurses who provide abortion care, a non-probability convenience sample of women who have
received abortion care and a non-probability purposive sampling of final-year pre-registration
Data was generated by means of questionnaires to the women who received abortions and/or
counselling, the registered nurses who carried out abortions as well as final-year preregistration
nursing students. A checklist was used to observe the abortions that were carried
out by registered nurses in an objective and non-participatory manner and semi-structured
interviews were conducted with various role-players in abortion care and training.
The main findings of this study indicate that the necessary infrastructure within which the
services could be provided according to the abortion legislation was adequate, but that the
ongoing shortage of trained health care practitioners hampers the abortion care services.
Only 10 (n=10) of the 15 certified nurses employed in state health care facilities actively
offered abortion care services in the various designated facilities in the Western Cape.
Deficiencies were identified in the existing provincial protocol and it was clear that some of the
guidelines are either not in use or have become obsolete in the light of new research findings.
It was found that midwives with appropriate and effective training are the ideal category of
health practitioner for the provision of abortion care. The certified nurses who have been
trained by the various regional offices of the Department of Health: Western Cape are skilled
in carrying out the abortion procedure, but the other aspects of abortion care, that are mainly
carried out by other categories of nurses, will probably require greater attention.
The recommendations, which are based on a thorough literature study as well as on the
findings and conclusions that arose from the empirical part of this study, have been included
in a training framework. The researcher recommends that the training framework provide the
basis for the development of a formal programme or programmes for the training of nurses in
abortion care at higher education institutions. The purpose of the proposed framework is
therefore to determine the context within which curriculation ought to take place, and to
provide a focus or format for those who develop the curriculum for prospective students. AFRIKAANSE OPSOMMING: Voor die implementering van aborsiewetgewing in Februarie 1997 was onwettige aborsies die
enigste uitweg vir vroue met ongewenste swangerskappe in Suid-Afrika. Weens die hoë
morbiditeit- en mortaliteitsyfer van die betrokke vroue is aborsiewetgewing geïmplementeer
met die doel om onwettige aborsies in Suid-Afrika te beëindig en aborsies op versoek
wettiglik in aangewysde gesondheidsorgfasiliteite uit te voer. Die aborsiewetgewing stipuleer
dat verpleegkundiges wat die voorgestelde aborsiesorgopleiding ondergaan het, ‘n
swangerskap kan beëindig op versoek van ‘n vrou gedurende die eerste 12 weke van die
draagtyd van haar swangerskap. Ten spyte van wetgewing wat verpleegkundiges magtig om eerste trimester aborsies uit te voer, word daar om verskeie redes onvoldoende aantal verpleegkundiges in die Wes-Kaap opgelei wat voorligting en berading aan swanger vroue gee, die aborsies uitvoer en/of
probleemgevalle moet verwys. Geen daadwerklike pogings is sedert die inwerkingstelling van
die aborsiewetgewing deur hoëronderwysinstellings in die Wes-Kaap aangewend om
aborsiesorgopleiding vir verpleegkundiges aan te bied nie. Derhalwe is ’n behoefte
geïdentifiseer om ’n omvattende opleidingsraamwerk vir hoëronderwysinstellings in die Wes-
Kaap te ontwikkel vir die opleiding van verpleegkundiges in aborsiesorg.
Die gevallestudie is as navorsingsontwerp gebruik en die spesifieke eenheid van analise
waarop gefokus is was die verpleegkundiges wat opleiding in aborsiesorg ontvang het en die
konteks waarbinne hulle aborsiesorg lewer by die onderskeie vlakke van dienslewering in die
onderskeie streke van die Wes-Kaap. ’n Ewekansige, gestratifiseerde steekproef (nie-proporsioneel) is geneem van die aangewysde staatsgesondheidsorgfasiliteite in die Wes-Kaap, sowel as ’n nie-waarskynlike, doelbewuste steekproefneming van verpleegkundiges wat aborsiesorg verskaf, ’n nie-waarskynlike gerieflikheidsteekproefneming van vroue wat aborsiesorg ontvang het en ’n nie-waarskynlike,
doelbewuste steekproefneming van finalejaar voorregistrasie verpleegstudente.
Data is gegenereer met behulp van vraelyste aan onderskeidelik die vroue wat aborsies en/of
berading ontvang het, die verpleegkundiges wat aborsies uitgevoer het, asook finalejaar
voorregistrasie verpleegstudente. ’n Kontrolelys is gebruik om die aborsies wat deur
verpleegkundiges uitgevoer is objektief en nie-deelnemend te observeer en semigestruktureerde
onderhoude is met verskeie rolspelers in aborsiesorgdienste en -opleiding
gevoer. Die hoofbevindings van hierdie studie dui daarop dat die nodige infrastruktuur waarbinne die
dienste ingevolge die aborsiewetgewing gelewer kon word voldoende was, maar dat die
voortslepende tekort aan opgeleide gesondheidsorgpraktisyns die aborsiesorgdienste
kortwiek. Slegs 10 (n=10) van die 15 gesertifiseerde verpleegkundiges in diens van
staatsgesondheidsorgfasiliteite het aktief aborsiesorgdienste aangebied in die onderskeie
aangewysde fasiliteite in die Wes-Kaap. Leemtes is in die bestaande provinsiale protokol
geïdentifiseer en dit het in die lig van nuwe navorsingsbevindings geblyk dat sommige van die
riglyne óf nie in gebruik was nie, óf dat hulle intussen verouderd geraak het.
Daar is bevind dat vroedvroue met toepaslike en doeltreffende opleiding die ideale kategorie
gesondheidsorgpraktisyn is vir die verskaffing van aborsiesorg. Die gesertifiseerde
verpleegkundiges wat deur die Departement van Gesondheid: Wes-Kaap se onderskeie
streekskantore opgelei is, is vaardig in die uitvoer van die aborsieprosedure as sulks, maar
die ander aspekte van aborsiesorg, wat meestal ook deur ander kategorieë verpleegkundiges
uitgevoer word, sal waarskynlik groter aandag moet kry.
Die aanbevelings is gegrond op ’n deeglike literatuurstudie sowel as op die bevindings en
gevolgtrekkings wat uit die empiriese gedeelte van hierdie studie spruit en is vervat in ’n
opleidingsraamwerk. Die navorser beveel aan dat die opleidingsraamwerk die grondslag sal
bied vir die ontwikkeling van ’n formele program of programme vir die opleiding van
verpleegkundiges in aborsiesorg aan hoëronderwysinstellings. Die doel van die voorgestelde
raamwerk is dus om die konteks te bepaal waarbinne kurrikulering moet plaasvind, asook om
’n fokus of formaat te verskaf vir diegene wat die kurrikulum vir voornemende studente
Thesis (PhD (Education)--Stellenbosch University, 2008.
Doctoral Degrees (Curriculum Studies)