III. The Outcome component
3.4 Sampling and sample size
3.4.1 Sampling of the residential care facilities
The selection of the four RCFs was based on a multi-stage sampling technique, a complex form of cluster sampling. Czaja & Blair (2005) described multi-stage sampling as the process where the researcher divides the population into strata, samples the strata, and stratifies the samples, and then re-samples, repeating the process until the ultimate sampling units are selected at the end of the hierarchical levels. For this study, a list of state-sponsored and private RCFs for the elderly was downloaded from the Internet.
Another list of similar nature was obtained from a social worker at the Department of Social Welfare. The facilities were all accredited by the Departments of Social Welfare, and have been in operation for at least six months. The second list included some of the names of the facilities that were on the first list. The first list had 63 items while the second had 50. The researcher then compiled a complete list of all the facilities available in the various district of K.ZN, but she focused on those RCF in Durban Metro area and phoned 35 of the persons in charge. However only 7 expressed interest in taking part in the research. The 7 RCFs were then stratified into social-cultural groups, NGOs, private, government subsidy and geographic locations. From that stat a, the researcher purposefully selected four RCFs based on social-cultural and geographic locations.
Finally, the researcher selected the frail sections of each RCF purposefully because she was interested in frail residents. Purposive sampling technique is a form of non- probability sampling based on the judgment of the researcher regarding the characteristics of a representative sampling (Bless, Higson-Smith & Kagee, 2006).
Purposive sampling of each administrative staff was made through a set of criteria for selection. That is, all the RCFs had both administrators and nursing managers who were all included in the study. These key persons provided information on the structure, process and outcome of each facility because they were expected to be knowledgeable about the history, administrative, as well as every aspect of the respective facility they head.
3.4.2 Sampling of nursing staff: The nursing staff were purposively sampled since they are directly involved in the care of the elderly. They were included if they were registered with the South African Nursing Council (RN), enrolled nurses (EN) or enrolled nursing auxillaries (ENA); as they were deemed able to provide information on the types of care and services provided to the elderly in each facility, including challenges and successes in providing such care. However after the pilot study involving 3 RNs and three ENAs, it was found that the ENAs could not complete the questionnaire due to their low level of knowledge. They were therefore excluded from the entire study as they usually receive only four to six months training. Moreover in Case Three, one ENA completed the nursing staff questionnaire, but she was later excluded because she did not meet the inclusion criteria.
3.4.3 Sampling of elderly residents: Selection of the elderly residents was also based on the purposive sampling technique because they were the consumers of the care and services in each RCF. The elderly, both males and females, provided feedback or
"outcome" of the care and services that they receive in relation to their health status ,
quality of life and their level of satisfaction. They were selected on the basis of their age (60 yrs +); they were frail, but mentally competent to give informed consent to participate in the study. The residents who were too frail to withstand the stress of being interviewed or were mentally incapacitated were excluded from participating in the study because they could not fully understand the rationale for conducting the research.
3.4.4 Review of facility record: The record review focused on the facility's mission statement, vision, goals and objectives, protocols/guidelines for admission, care giving and physical infrastructure. These were selected as secondary data to give a clear picture of the phenomenon under study through the purposive sampling technique. Other relevant records and documents were revealed where applicable.
3.5 Sample size
3.5.1 Qualitative sample size was determined on the basis of data saturation (Polit and Hungler, 1999). That is the point where new information is no longer forthcoming.
3.5.2 Quantitative sample size: The researcher used a convenient sampling technique to select the most readily available nursing staff members as participants in the study.
The researcher invited all the nursing staff that were available on both day and night shifts at each ReF who met the selection criteria to participate in the study. She distributed questionnaires to those who agreed to participate in the study. The sample size was determined by the response rate of those who completed and returned the questionnaire.
3.6 Description of cases
The study was conducted in four RCFs in eThekwini, KwaZulu-Natal Province, South Africa, represented as "Case one to four" throughout the study.
3.6.1 "Case One" is located four kilometres away from eThekwini. It was established as an independent non-governmental organization (NGO) in 1949 for the care of frail elderly. However, in the past 10-12 years, its services have changed to accommodate people with physical and mental disabilities of all age groups. The total capacity of the facility is 500 beds, with about 200 elderly. It is partly subsidized by the South African government. The total number of staff is 340, including RNs, enrolled nurses, emolled nurse auxiliaries (ENAs) and general orderlies Uanitorial staff). It has a training college where care givers are taught, as well as a clinic that provides health care services to its residents. The facility also has self-catering flats for the elderly who are able to look after themselves, and shared houses for people with mental and physical disabilities. This research was conducted in one of the shared houses, where many of the residents who had mild to severe mental or physical impairment stayed. Some of these residents and were partially or totally dependent on their caregivers to meet their activities of daily living (ADLs) needs. Seventeen persons participated in Case One, including two administrative staff members, ten nursing staff and five elderly residents.
3.6.2 "Case Two", is located in one of the townships of eThekwini, 20 Km away from the city centre, it is a NGO partly subsidized by the national government. It was established in 1921 by a group of inspired men and women to alleviate suffering
medical, educational and spiritual needs. The total capacity of the facility is 550 beds, with a workforce of 250 staff. It also has a training institution where most of its nurses are trained, and a clinic that provides health care services to their residents. The organization is run by a board of managers. A chief executive officer (CEO) oversees the different projects of the facility, while the nursing service manager is responsible for the nursing aspects. This research was specifically conducted in the home for the elderly who have physical and mental challenges. Seventeen persons participated in Case Two, including two administrators, 10 nursing staff and five elderly residents.
3.6.3 "Case Three" is a private frail care centre that is attached to a private retirement
home in eThekwini. The business is run by six directors: three accountants, one attorney, one executive country club manager and one executive company director, on a share block basis. The owners of this RCF are the residents who live there, who are also the shareholders in the business. The centre has 16-bed capacity. It is run by a senior registered nurse. The purpose for establishing the centre was to provide emergency assistance, post operative and frail care to residents of the retirement home. Eleven (11) persons participated in Case Three including two administrative and four nursing staff and, five elderly residents.
3.6.3 "Case Four" "is an old age home also situated in one of townships in Ethekwini;
about 25 km away from the city centre. It was established in 1996 as a NGO, and it is run by a nine-member board of directors. The administrator of the home is an ex-police officer and a pastor. The institution has only one registered nurse and as the result, she
functions as a chief nursing officer and a unit manager/supervisor and the RN. Though busy, she is well organized and always works hard to promote the residents' comfort. The total capacity of the home is 50 beds. The purpose for establishing the home was to cater for the needs of the vulnerable aged. Twelve (12) persons participated in Case Four, comprising two administrative staff, five elderly residents and five nursing staffs.
o
KWAZULU-NATAL HEALTH DISTRICTS
Population - 9 070 457 Area -92 440 Sq. km Density -98 People per Sq. km
DC25
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DC23
,S91G'1'W;:
*
uThukela50 100
kilometres
*NOCK
DC26 , Zululand
Figure 3.1: Map of KwaZulu-Natal