The Managerial Duties of the Nurse in Charge of a Unit in Combating the Spreading of Hiv/aids

The charge sister has an essential role to play in com ­ bating the spreading of the HIV in the environment of the nursing unit. The HIV/AIDS dilemma is a reality in the health care environment. On a daily basis nurses is treating patients with the HIV. Through the basic con­ ceptual framework of the management process, the charge sister can play her part and contribute in keeping the disease under control in her work environment. An ex­ plorative, descriptive study was done through a struc­ tured questionnaire with four open questions. This study was aimed at developing and formulating guidelines to be included in a policy to be used in the combating of spreading of HIV in the health care unit by the charge sister and her staff. The results indicate the absence of policy regarding the prevention of the spreading of the HIV, necessary for orientation and in service training of staff. Abstrak Die suster in bevel speel 'n essensiële rol in die bekamping van die verspreiding van die MlVirus in die verpleegeenheidomgewing. Die MIV/Vigs dilemma is a re a lite it in die g eso n d h eid so rg o m g ew in g. O p 'n daaglikse basis word pasiënte met die MlVirus deur verpleegkundiges verpleeg. D eur die konsepsuele raamwerk van die bestuursproses, kan die bevelsuster 'n rol speel en bydra tot die beheer van die verspreiding van die siekte in haar werksomgewing. 'n Ontdekkende, beskryw ende studie is uitg ev o er by w yse van 'n g estru k tu reerd e vraelys m et vier oop ein digende vrae.Hierdie studie was gemik op die ontwikkeling en formulering van riglyne vir insluiting in 'n beleid wat gebruik kan word in die bekamping van die verspreiding van die MlVirus in die gesondheidsorgeenheid deur die bevelsuster en haar personeel. Die bevindinge dui op 'n afw esigheid van beleid ten opsigte van die voorkoming van die verspreiding van die MIV, wat nodig is vir die oriëntering en indiensopleiding van personeel.


Abstrak
Die suster in bevel speel 'n essensiële rol in die bekamping van die verspreiding van die MlVirus in die verpleegeenheidomgewing. Die MIV/Vigs dilemma is a re a lite it in die g eso n d h eid so rg o m g ew in g .O p 'n daaglikse basis word pasiënte met die MlVirus deur verpleegkundiges verpleeg.D eur die konsepsuele raamwerk van die bestuursproses, kan die bevelsuster 'n rol speel en bydra tot die beheer van die verspreiding van die siekte in haar werksomgewing.'n Ontdekkende, beskryw ende studie is uitg ev o er by w yse van 'n g estru k tu reerd e vraelys m et vier oop ein digende vrae.Hierdie studie was gemik op die ontwikkeling en formulering van riglyne vir insluiting in 'n beleid wat gebruik kan word in die bekamping van die verspreiding van die MlVirus in die gesondheidsorgeenheid deur die bevelsuster en haar personeel.Die bevindinge dui op 'n afw esigheid van beleid ten opsigte van die voorkoming van die verspreiding van die MIV, wat nodig is vir die oriëntering en indiensopleiding van personeel.

Introduction and rationale
The managerial duties of the charge sister in a nursing care unit involves the managerial functions of planning, organ izing, and directing and control in combating HIV/AIDS in the environment of the unit.The role o f the charge sister should focus on the prevention of the spreading of the HIV from one person (patient/nurse) to another in the unit.Most health care systems still lack clear guidelines and policies on various aspects of HIV/AIDS care (Nurses day 2(X)3:44).It is important that the charge sister ensures that the HIV/ AIDS patients in the unit are managed without any dis crimination towards them and that nursing care focus on the enhancement of the life span.Within a HIV/AIDS sce nario the charge sister should ascertain that HIV/AIDS patients are managed in totality, meaning that their physi cal, social, psychological, spiritual and emotional needs are attended to.Research by Kohl and M iller (1994:47) has indicated that nurse managers are not adequately trained to deal with AIDS in the workplace and that they have not developed policies and procedures to deal with this situa tion.Ten years later, one should assume this should be in place.
In South Africa there is a HIV/AIDS pandemic whereby most of the human deaths occurring are due to HIV/AIDS.HIV/AIDS is also spreading faster in South Africa than anywhere else in the world.According to South A frica's government, four million of its 43 million people have HIV and 1,700 more are infected daily.With a total of 4.2 million infected people, South Africa has the largest number of people living with HIV/AIDS in the world, as well as one of the world's fastest-growing epidemics.Already, 1 in 4 South African women between ages 20 and 29 are infected with the virus.The Johannesburg Hospital estim ates that 40 percent of men of the ages between 20-29 are HIV-positive.(http://iournalism .berkelev.edu/proiects/safrica/adapting/rape, html) The above highlights the important role o f the nurse man ager to combat the spreading of the HIV in the environment of the nursing unit.The researcher noted that in his work ing environment at a public training hospital in Gauteng, specific policies for addressing the prevention of spread ing of HI V in nursing units were absent or unknown to staff members.This study was aimed at developing and formu lating guidelines to be included in a policy to be used in the combating of spreading of HIV in the health care unit by the charge sister and her staff.

Conceptual framework
The conceptual framework of the study is based on the four main steps of the management process.In discussion of the framework the key concepts of the study are also described.
The m anagem ent pro cess consists of planning, organiz ing, directing and control.It is the role of the charge sister/ professional nurse to manage the prevention of the spread ing of HIV/AIDS in the health care unit, that could occur among patients and/or nursing staff members.The term p a tien t refers to any person who is not healthy and re quired medical attention.For the purpose of the study the patient was viewed in a medical or surgical nursing care unit with nursing needs that had to be met by nursing care personnel.For the purpose of this study the term pro fes sion al nurse or charge sister referred to the charge and deputy charge sisters working in the medical and surgical wards of a public training hospital.
The term HIV refers to human immunodeficiency virus.The HIV affects the immune system.The immune system is the body's defence against infections by micro-organism (such as very small bacteria or viruses) that get past the skin and mucous membrane and cause disease.The immune system produces special cells called antibodies to fight or kill these micro organisms.A special weakness of the immune sys tem is called immunodeficiency.When the immune system becomes very affected, the illness progress to AIDS.AIDS stands for Acquired Immune Deficiency Syndrome.There is no cure for AIDS: Prevention is the only way to stem the spread of this deadly virus.( http://www.infoweb.org/library/misc/misc000040.html)Planning is the process of determining what should be done, why it should be done, where it should be done, by who it should be done, when it should be done, and how it should be done", (McConnell, 1997:51).Planning should be done with consideration to set policies and procedures.Policy making is essential in managing a unit effectively.Policy is written guidelines that regulate the execution of specific responsi bilities in the unit.
Policy should di rect the charge sis ter" s functions in the prevention of HIV/AIDS in the health care unit.
Presently there is no guideline to be used by the charge sister in the unit on m a n a g e m e n t o f HIV /A ID S in the hospital unit A c c o rd in g to Muller (1998:133), o r g a n iz a tio n in the nursing unit re fers to the orderly structuring of func tions or responsibilities in order to ensure the smooth run ning of activities.It requires job division by way of an organizational, the demarcation of authority in the form of line and staff functions, as well as the delegation of duties, tasks and responsibilities to the appropriate members.D i recting refers to the unit m anager's leadership responsibil ity, namely to give direction and ensure that goals are achieved in the unit (Jooste, 2001:146).Directing is also a facilitating function in which the unit manager practices applicable leadership in undertaking, motivation and em powerment of group members or subordinates in the nurs ing unit.Directing is, therefore an enabling management activity, which is aimed at the achievement of the objec tives of the nursing unit.The unit manager should also facilitate harmony in the nursing unit and focus on the principles of teamwork and how to deal with conflict in the health care unit (Muller, 1998:134).
Generally, the prevention of the spreading of HIV in the health care unit may be achieved by the use of the correct managerial skills and the quality of the resources available to be utilized in the unit.The charge sister should be able to organize the day-to-day activities effectively in the unit.Charge sister should also be knowledgeable with regards to the management of HIV/AIDS.(McConnell, 1997:52) C on trollin g means developing perform ance standards, Figurel.The management process in prevention of the spreading of the HIV 50 establishing report systems, monitoring em ployees' activi ties to determine whether the organization is on target to wards its goal and to make adjustments to encourage out comes to conform with expected results (Daft, 1999:35).It could be viewed as the empowerment of subordinates or group members to achieve set objectives successfully.The unit m anager's controlling function can be divided into proactive, continuous and reactive control.Proactive con trol refers to the measures, which are introduced to ensure that things run smoothly in the unit.Continuous control refers to supervising and directing in the unit supervising and directing which focus on the empowerment o f person nel in the unit to provide quality nursing care (McConnell, 1997:52)

Purpose of the research study
The main purpose of this study was to: Explore and describe the important managerial duties of the charge sister in the prevention of the spreading o f HIV in the nursing care unit; to formulate guidelines to lead to policy statements on combating the spreading o f the HIV within a nursing unit.This contribution could direct future nursing activities in the nursing care unit and could be addressed during in-service training sessions, in educat ing all the nursing staff members on the evidence of the findings.
The charge sister should use all her managerial functions to prevent the spreading of HIV among staff and patients in the health care unit.

Problem statement
Within the health care units o f a public training hospital it was observed that the different categories of nurses seemed not to pay serious attention to the prevention of the spread ing of HIV/AIDS amongst and between patients and nurses in the nursing care unit.For the researcher it seemed that nurses were not focusing on treating all their patients as potential candidates with HIV/AIDS.The absence of guide lines on the prevention of the spreading of HI V in the health care unit that should be utilized by nursing staff is a seri ous concern.The absence of guidelines could further com plicate the issue of spreading the HIV to nursing staff.When one focus on the prevention of spread of HIV/AIDS in the health care unit the charge sister should consider the con sequences o f the disease for the health care personnel, the patient as well as their family and their love ones in tlie community.HIV/AIDS is becoming a pandemic disease; therefore proper guidelines on the management o f HIV/ AIDS should be formulated.

Research questions
From the problem statement the following research ques tions were formulated for this study: a) How should the charge sister plan to combat the spreading of the HIV in the health care unit?b) How should the charge sister organize the daily nursing activities in the unit to prevent the spread ing o f the HIV in the health care unit?c) In which ways should the sister d irect the nursing staff to effectively prevent the spreading of the HIV in the unit environment?d) On which control measures should the charge sis ter focus to combat the spreading of the HIV in the health care unit?

Research design
An explorative and descriptive research design (Holloway and Wheeler, 1996: 3-9) was used to gain data regarding the managerial duties of charge sisters with regards to preven tion of spreading of HIV/AIDS in the health.

Explorative
This research study was an explorative in nature with the aim of gaining knowledge of the managerial duties of charge sister with regards to the prevention of HIV/AIDS in the health care unit.

Descriptive
Descriptive studies are used to collect accurate data on specific domain phenomenon, which in this study will fo cus on the dilemma of the spreading of HIV.The researcher will accurately and carefully describe guidelines after col lected data has been analysed (Brink, 2001:10-10)

Research method
A survey method was used.

Population and sampling
The nurse in charge and the nurse second in charge of all medical and surgical units at a public training hospital in Johannesburg were identified as the population for the study.The total population for the research was 20 profes sional nurses, who complied with the criteria of being allo cated in charge or second in charge in the five medical and surgical units o f the public hospital.Purposive, convenient sampling was used.According to Woods and Catanzano (1988:101) a convenient purposive sample is done to obtain the required data from the sample which possess the same characteristics to be studied and was the representative of the population of the interest.The population served as the sample.All the participants were registered with the SANC as professional nurses, al located in a similar job position and were females.

Data Collection Method
Four open-ended questions (see four research questions) were put to the participants in a questionnaire format.These questions address the planning, organizing, directing and controlling functions of the professional nurse as charge sister in preventing the spreading of the HIV among staff and patients in the health care units.

Data analysis
Coding was used to organize data collected in the open questions.Manual activities were used to develop catego ries of the themes and involved a thorough review of all recorded information that the researcher has obtained dur ing the course of data collection.The data of the partici pants was constantly compared in the determination of the final main guidelines for prevention o f spreading of the HIV (Brink, 2001:192-193).The data was analysed accord ing to the method and steps suggested by Tesch (1990in Creswell, 1994:154-155) and an independent coder coded the data as a measure to ensure reliability or dependability.
The following steps was used in analysing the data ob tained: coding for themes; categorizing; making notes about the context and variations in the phenomenon under the study; verifying the selected themes through reflection on the data and discussion with my supervisor in the field.

Trustworthiness
Accurate analysis of the collected data was performed us ing the steps outlined above under point 1.9.3.The super visor verified the selected themes and coding.The subject literature was utilized to confirm the trustworthiness of the of the data analysis.
Lincoln and Guba's model (in Babbie and Mouton 2001:276-278) was utilized to ensure trustworthiness in this research.
Trustworthiness was ensured according to the four princi ples related to credibility, transferability, dependability and confirmability.Credibility was ensured through the engage ment of professional nurses as charge sisters (with exper tise in the medical and surgical units) in the management situation in their own nursing practices.Consensus be tween the researcher and the supervisor (co-coder) was reached with regard to the categories derived from the data collected.Furthermore a literature review was conducted and the data analysis brought forward known concepts of management and combating the HIV.To ensure that the findings and interpretations of findings were credible and dependable the supervisor guided the research through out the process (Lincoln & Cuba, 1986:317-318,Talbot, 1995:488).

Ethical measures
Strict ethical measures were adhered to during this research study.These will include the right to privacy, confidential ity and anonymity.The participants will in no way be linked to the research findings.The research will not harm the participants in for example jeopardizing their positions.Par ticipants were asked to participate in the study (informed consent) and will have the right to express their viewpoints regarding the open questions they have to complete.Ac cess to information was ensured and the participants will have access to the results of the research at the end o f the research study (Ethical standards RAU, 2002).The ethical committee of the university as well as the training hospital where the researcher was registered as a student approved the proposal for the research and provided ethical clear ance for proceeding with this ethical sensitive issue.

Description of the findings
For each o f the main components/questions of planning, organising, directing and control, the following similar ca tegories emerged, each with their related themes: Taking effective precautions.4 Counselling 5 Management of equipment and supplies 6

Delegation and supervision 7
Recording

Category 1: Planning
The first research question was: "How should the charge sister plan to combat the spread ing of the HIV in the health care unit?" According to Me Connell, (1997:51) planning is the pro cess of determining what should be done, why it should be done, where it should be done and how it should be done.
From the data analysis the planning activities o f the unit involve situational analysis, education, taking effective precautions, counselling, management of equipment and supplies, delegation and supervision and recording in the health care unit.Table 1 sets out the subcategories and related themes identified for the category of planning.
The subcategory situational analysis is the analysis of the situation as it occurs in the unit.A nurse must be able to make all relevant observations of the patient in order to plan effectively in the prevention of HIV in the health care unit.From table 1 it is clear that the situation analysis in planning of the daily routine in the unit on prevention of HIV/AIDS does include the staff and patient population.
E ducation of the patient should be done continuously in the health care unit.According to Muller (1998:340) patient education forms part of the professional responsibilities that are set out in the scope of practice.In order to obtain a maximum effectiveness, educational programmes should take into account the characteristics of the different pa tients, their knowledge and attitudes, their capacity of un derstanding, and the forms of communication most likely to be acted upon by the patient.Education can help to alleviate fear dispel ignorance and expose myths about the HIV/AIDS disease.
P lanning precautions refers to the charge sister that should Table 1 Subcategories and related themes with regard to planning in the nursing unit

S u b categories R elated themes Exam ples o f quotes to su pport themes
Situation analysis 1. Assess potential treats "The routine daily duties of the ward to be assessed for their potential in spreading" plan how to prevent the spread of HIV in the health care unit.All the safety measures to be followed in the unit should be put in place, e.g.not to re-cap the needles after used.Taking effective precautions in planning to prevent HIV from spreading in the health care unit is supported by the related themes with the quotes from the respondents as indicated in table 1.
According to M ellish (2001:320), cou n sellin g is a personto-person form of communication.Counselling is a service to individuals in need of assistance which will help them to clarify a problem in their own minds, identify the cause of the problem and arrive at a decision as to the best way in which to sole the problem or cope with the situation.For the charge sister to plan effectively in order to offer the service of counselling to the their patients, the charge sis ter should have a knowledge of counselling.An example of a quote is given in

M a n a g e m e n t o f e q u ip m e n t a n d s u p p lie s in p la n
n ing to combat the spreading of HIV in the health care unit sh o u ld be done with the use of cor rect unit policy on h an d lin g o f c o n tam inated articles in the u n it.D is p o sal sh o u ld be p ro p erly done in the correct manner on a daily basis.From the data it be came apparent that the charge sister should plan to manage and handled con taminated items such as sharps, syringes, linen and waste correctly in the health care unit in a daily basis to prevent the spread of HIV.It is important that health care providers have sufficient supplies and equipment, especially when invasive procedures are involved or when risk of signifi cant exposure to blood and other body fluids is likely (Nurses day, 2003:44).
The sixth sub category identified was related to delegation a n d su pervision .According to M uller (1998:174), delegation refers to the devolution of duties, task and responsibilities by a super visor to a subordinate in the nursing unit.The principles and process of delegation requires the assessment o f the work, assessment of the subordinate's abilities, delegation of the work as well as professional liability.The charge sister should plan accordingly to ensure that staff in the unit executes their delegated task without being at risk of contracting and spreading the HIV in the unit.The two themes of p revio u s kn ow ledge and involvem ent o f sta ff were identified as important.The involvement of the staff  From the above d is c u s sio n it w as cle a r that the com ponent of planning is executed in prevention of the spreading of HIV/AIDS in the health unit.The conclusions drawn from the data analysis of the category planning were that; the daily routine o f the health care unit should be assessed for its potential in spreading HIV.(Theme: Situational analysis) it is necessary to educate staff on the HIV/AIDS condition and the various possible modes of spread ing of the virus and with the use of appropriate edu cational methods.(Theme: Education) applicable and warning signs and verbal warning should be utilised to both staff and patient to take effective precautionary measures to prevent unnec essary spreading of HIV in the health care unit.

Category 2: Organising
The second research question stated: "How should the charge sister organize the daily nursing activities in the unit to prevent the spreading o f the HIV in the health care unit?"Therefore, organising relates to the second main category.
According to Roos (2001:118), organization in the nursing unit refers to the orderly structuring o f functions or re sponsibilities in order to realize a common objective.It re quires job division by way of an organizational, the demar cation of authority in the form of line and staff functions, as well as the delegation of duties, tasks and responsibilities to the appropriate members.
The following sub categories and themes were identified for the category of organizing (Table 2): The subcategory situational analysis revealed the theme related to ensure availability o f resources.The related quote in table 1 states that the charge sister must make sure that he/she organise resources such as gloves, sharps container and etc available to comply with the universal precaution ary measures in the health care unit to prevent the spread ing of HIV in the health care unit.
The sub category education support the theme uses vari ous education methods.The utilisation of the self-explanatory methods in the educating the patients, public and the staff in the health care unit should be the ultimate respon sibility of the charge sister to organise it, as it helps to offer a continuous education to everyone in the unit.Informal staff gatherings/discussions to share experiences in living and working with HIV/AIDS should be facilitated (Nurses day, 2(X)3:44).Effective AIDS educational programmes make information eadily available to employees.A variety of edu cational approaches (newsletters, brochures, videos etc.) should be used to reach every employee, and to change behaviour (Kohl & Miller, 1994:48).
Taking effective precautions is another sub category and various quotes from the respondents supported the theme of use o f universal precaution.The charge sister has the duty to ensure that the universal precautionary measures are used in the unit by planning its use to prevent the spread of HIV in the health care unit as supported by the above quotes.
The sub category counselling has the theme on assessing in dividual needs.
The patient's needs should be assessed in order to offer the patient with the required services such proper referrals and to inform the counsellor.It is the duty o f the charge sister to make sure that the patient's needs are met.
One theme was identified for the sub category manage ment of equipment and supplies, namely using and dispos ing contam inated items.A quote from a respondent is pro vided in table 2. The charge sister has the responsibility to ensure that the unit activities is organise to prevent the spread o f HIV in the unit during the execution of the daily routine such as separating contaminated linen from dirty clean linen, cleaning of patient beds on discharge of the patient, correct disposal and handling o f contam inated items as indicated in the quotes above.
In the sub category o f delegation and supervision it was identified that the theme on acknow ledging the skills and k n ow ledge was im portant.O ne respondent stated the "tasks should be delegated to staff according to level of competence; putting o f intravenous lines.A person who knows or has be exposed to the procedure.Knowing how to put up a drip without any risk of pricking him self or causing unnecessary spillage of blood all over the show".
The charge sister has the professional obligation to ensure that the delegated task is according to the staff level of knowledge and skills as lay down on the scope of practice as set by the SANC to prevent the spreading of HIV in the health care unit during the execution of the delegated task.
In the sub category recording, the following quote sup ported the theme, of keeping statistics: "To have daily sta tistics for the HIV patient" .The quote indicates that the charge sister should ensure that there daily statistic of the HIV positive patient in order to organise the activities of the unit effectively on the preventative measures to be uti lised in the health care unit to prevent the spreading of the virus.According to Mellish (2001:171), accurate record keep ing form the basis for reassessment, re-planning, re-implementation and re-evaluation for the present and the future.
From the above discussion it is apparent that the com po nent of organising the prevention of spreading of HIV is a crucial step.The conclusions drawn from the data analysis of the category organization were that; the effective ordering and availability of supplies and equipment according to the situation in the unit can influence the effective management of the spreading of the virus.(Situation analysis) various educational methods should be in place so that staff members and patients can visualise the spreading of the disease.(Education) universal guidelines should be available for all staff members to follow the same steps and procedures, in establishing an effective routine, in combating the spreading of the virus.(Taking effective precau tions) an effective counselling process should be in place to refer staff members and patients when needed.
(Counselling) the daily routine of the unit should include the us ing and effective disposing of contaminated linen.
(Management of equipment and supplies) the charge sister should delegate responsibilities and tasks to nurses, according to their knowledge, skills and scope of practice.(Delegation and super vision) the charge sister should encourage staff members to keep record of all tasks performed to the patient, according to which she can hand in complete statis tics of the patients in her unit.(Recording)

Category: Directing
The third research question stated: "How should the sister direct the nursing staff to effec tively prevent the spreading of the HIV in the unit environ ment?"Therefore, directing is the third main category.
Directing refers to the unit m anager's leadership responsi bility, namely to give direction and ensure that goals are achieved in the unit.The unit manager should also facili tate harmony in the nursing unit and focus on the princi ples o f team work in the health care unit (D ienem ann, 1998:163).Generally, the prevention of the spreading of HIV in the health care unit may be achieved by the use of the The following subcategory and themes were identified for the category o f directing.
In the sub category related to situational analysis the theme encouragem ent o f the sta ff participation , emerged.In di recting the staff, the charge sister has to analyze he ward situation, and encourage the staff to participate in preven tion o f HIV-virus from spreading in the health care unit during their execution of their duties.(Lim & Loo, 2000:132).
The charge sister should direct the educational programme as planned to ensure that the staff and the patient are edu cated on different topics such as the universal precaution, mode of spread of HIV to empower them to able to prevent the spreading of the HIV in the health care unit.Continu ous education to the learner should the responsibility of the charge sister to organise and direct the running of the programmes.The above quotes indicate that there is a need for education on the precautionary measures to the learn ers.This will empower the learners with the knowledge in order to prevent the spreading o f HIV in the health care unit.All staff should be trained in patient's rights and the right to equal care and confidentiality (Nurses day, 2003:45).

Only one theme was identified relating to taking effective precaution, nam ely c o r re c t h andling an d d isp o s a l o f
sharps.Several quotes were made of which an important one is "Adherence to the golden rule of one needle per patient and syringe usage."The role o f charge sister dur ing directing the activities of the unit during the execution of the task to prevent the spread of the HIV involve the taking of effective precautionary measures by the staff as evidence by the quotes above.
Counselling is playing a more prominent role in current health services.The theme of follow p ro to c o l" was identi fied through a quote; "Ensure that everyone k n o w s,... the p ro to co l to follow in case of a needle prick" .The charge sister should ensure that the protocol for nee dle stick injury is followed at all times.The injured person should e.g. to be referred to a counsellor to debrief the situation.
Management of equipment and supplies as a sub category, included the theme of using an d disposal o f contam inated items.The charge sister should direct the staff to dispose sharps, waste products correctly as evidence by the above quotes.Charge sister should direct the staff in the unit to use sharp container, red bags, disinfectant agent and the gloves to manage the contaminated items.The staff should be directed on proper management of contaminated item and the use of preventative measures during the rendering of the service.

The theme, effective utilisation o f infection control policy,
was highlighted in the sub category of delegation and su pervision.The charge sister should supervise and organ ise the staff in the unit to follow the infection control policy to prevent the spread of HIV in the unit.Supervision should be don by the charge sister at regular interval to ensure that the policy is followed at all times.Another theme was identified, namely retaining know ledge an d taking respon sibility.The charge sister should make sure that the staff in the health care unit retain the knowledge of the precaution ary measures and should take responsibility to ensure that the HIV is prevented from spreading in the unit as sup ported by the quotes.
In the sub category, recording, the quote emphasised the importance of recording important information in the theme, placing notices.The use of notices will help the charge sister in directing the activities of the unit as it was in a written form to make the public, patient and the staff aware of the correct methods of dealing with e.g.used needles in the health care unit.
From the above discussion it became clear how important the role of the directing component is in combating the spreading of HIV in the health care unit.The conclusions drawn from the data analysis of the category directing were that; staff should be encouraged to participate in the pre vention of HIV from spreading in the unit.(Situational analysis) the running of the different educational programme should be directed to make sure that the appropri ate educational methods are utilised to educate both staff and patient about the mode of spreading of HIV and the precautionary measures in the unit.
(Education) activities of the unit should be directed towards pre vention of spreading the HIV during execution of the task using the correct handling and disposal of sharps.(Taking effective precautions) it should be ensured that the needle stick injury protocol is in place in the unit and to be followed at all times.(Counselling) staff members are guided on proper management of contaminated items such as correct handling of was product and correct disposal of sharps to prevent spread of HIV in the health care unit.(Management of equipment and supplies) staff should be supervised and organised in the unit to follow the infection control policy to prevent the spread of HIV in the unit.(Delegation and supervi sion) staff and patient should be aware of the importance of the notices placed in the unit for the prevention of HIV.(Recording)

Category: Control
The fourth research question was: "On which control measures should the charge sister fo cus to combat the spreading of the HIV in the health care unit?" Controlling was thus the fourth main category.
Controlling is the follow up and correction of activities, supervision looking at actions and making adjustments to encourage outcomes to conform with expected or required results (McConnell, 1997:52).
Table 4 outlines the subcategories and themes of the cat egory control: T hree them es w ere id en tified for the sub c ateg o ry situational analysis.
The theme on previou s knowledge had one quote that sug gested that the charge sister should assess the previous knowledge of the staff in order to plan the control meas ures to prevent HIV from spreading in the health care unit.
The second theme was, con trol m aterial resources and the relevant quote highlighted that to control the spread of HIV in the health care unit, the charge sister should ensure that there are sufficient supplies of material as evidenced by the quote.The third theme addressed the regular a p plication o f p recau tion ary m easures to control the spread of HI V in the unit that should be done regularly in the unit.
Education of the patient should be done continuously in the health care unit.Several quotes supported the theme of professional developm en t and highlighted the importance of continuous staff development including various speak ers, attending outside conference and focusing on the cur rent behaviour of patients.Kohl and M iller (1994:47) point out that organisations must provide their employees with comprehensive training programmes in order to reduce risky behaviours which spread HIV and to change biased atti tudes which may lead to moral and legal problems.
The subcategory of taking precautions outlined the themes  Counselling as a subcategory focused on the role of the charge sister to exercise control in maintaining counselling sessions where needed, to em power patients to live with the disease.The theme of, em pow erm ent o f patients came to the fore in one quotation (Table 4).The education of patients is the responsibility of the charge sister during the patient's period o f hospitalisation to em power them with the knowledge and to make them to come into terms with th e ir p re se n t s itu a tio n and this required the charge sister to plan the educa tio n a l p ro gramm e to fol low .R e le v a n t h um an r e so u rces issues that should be addressed in the o rg a n isa tio n a l policy include h e a lth in s u r ance, healthcare c o sts, jo b a c com m odations, w ork d is ru p tions, discrim i nation and har assment of HIVinfected w ork ers, declin e in p r o d u c t i v i t y and w orkplace morale (Lim & Loo, 2000:132).
In the category of management o f e q u ip m e n t and s u p p lie s, th e th e m e , p ro p e r m anage ment o f body flu id s w as c o n firm e d by a q u o te sta tin g , " ...bloo d spills be treated with bleach before wiped up" .In order to control the spread of HIV in the health care unit, the charge sister should ensure that the correct handling of body fluids is carried out as evidenced by the above quotes.
The sub category titled delegation and supervision, firstly enlightened the theme on regular observation.One quote stated: "Have regular checks to the see if all sharps con tainers are properly closed and are not overflowing."An other respondent stated: " Have direct supervision of staff."Supervision should be done regularly and unstructured in the health care unit to promote the use o f preventative measures by the staff.The charge sister has the responsi bility to delegate the task to the staff and to make sure that the regular checking is done to ensure that the delegated task is carried out without any risk of spreading the HIV.An achievement checklist could also be used s a self-assess ment tool for managers in assessing how well their ward/ unit reaches, serves and treats HIV-positive patients (Nurses day, 2003:45).
The manager should check that adequate record keeping (category in table 4) in the form of e.g.notices, make staff and patients aware of how to prevent spreading of the HIV.The theme "Install notices " highlight the above.The quote "Notices reminding (teaching) measures to be taken in pre vention of spread" was made.The charge sister should write notices and utilise it to remind the staff, patient and the public on the preventative m easures in the form of records in the health care unit.On the other hand, policies should clearly outline how the organisation intends to deal with employee and patient confidentiality and privacy (Lim & Loo, 2(XX): 132).
From the above it is clear how important the managerial component of control is in managing the prevention of the spreading of HI V in the health care unit.According to Muller (1998:134-135), control is not a bureaucratic action, but rather the empowerment of subordinates or group members to achieve the set objectives successfully.Continuous con trol refers to supervising and directing in the unit -super vising and directing which focus on the empowerment of personnel in the unit to provide quality nursing care (McConnell, 1997:52) The charge sister should use all her managerial functions to prevent the spreading of HIV among staff and patients in the health care unit.The conclusions drawn from the data analysis of the category control were that; continuous assessment of staff knowledge is needed on the preventative measures to prevent the spread o f HIV and reinforcement of the previous knowl edge on the importance of regular application of precautionary measures to prevent the spreading o f HIV in the health care unit.Plan to use a staff rotational system to encourage staff members to attend the HIV course provided by the nursing service.Encourage staff to plan to use precautionary meas ures all the times when performing any procedure that involve body fluid of patients.
Involve relevant available stakeholders in provid ing counselling both to patients and the staff mem bers.
Have an adequate plan to properly dispose con taminated supplies and equipment.The charge sister should pay attention to the following guidelines on the com ponent of organizing that address her/his role in the combating of spreading of the HIV: Organise in-service training sessions for nursing staff and other health care workers e.g.ward help ers on the prevention of spreading of HIV /AIDS.Encourage nursing staff to arrange their trolleys in such a way that all items needed to prevent the spreading of infection of any kind, is in the trolley such as gloves and sharp container to discard used needles.Remind them on a daily basis of the measures to be taken to prevent oneself of obtaining the virus, be cause anything can happen to the nursing staff e.g.needle pricks.Encourage hand washing as a must, that is part of the daily routine, done thoroughly and encourage staff to do it as often as possible, e.g. between pa tients.Ensure effective organisation of ward activities, by ensuring that there are adequate equipment e.g.gloves and sharps containers.They should be uti lised during the execution o f the health care unit activities to comply with the universal precaution ary measures.Organise self-explanatory visual AIDS.For example posters should be displayed in the health care unit to warn the patient, staff and the public on the pos sible mode of spreading e.g.needle pricks and hu man fluids.Formulate a protocol to be followed in the event of needles stick injury in the care unit and make it avail able in the unit.Organise the staff to follow the universal precau tionary measures e.g.wash hands after handling each patient, handling of specimen as high risk for spreading of the HIV in the unit, wear gloves all the times when working with contaminated articles and body fluids, do not re-cap the needle after usage and etc. Organise counselling for the patient or staff mem ber who needs counselling.The charge sister for immediate referrals should know the times and coun selling hours.
The charge sister should pay attention to the following guidelines on the component of directing that address her/ his role in the combating of spreading of the HIV: Guide staff in the use of facilities or equipment, to prevent spread of HIV/AIDS at all times.Ensure that all the blood com ponents i.e. blood platelets are thoroughly checked and HIV free.
Act as a role model in taking precautionary meas ures like discarding sharps i.e. needles, into proper sharps containers and to always use gloves as stipu lation by the infection control policy of the service.
The charge sister should pay attention to the following guidelines on the com ponent of control that address her/ his role in the combating of spreading of the HIV: Observe that nursing staff doesn't have cuts on their skin, for in case they come into contact with infected blood products.Staff should be notified to close all cuts using Elastoplasts and to wear gloves.Ensure that the staff member properly follow the procedure of disposal of needles into the sharps container.The charge sister should check this dur ing her daily ward rounds.
Have ward discussions and ask staff m ember's ques tions on the prevention of spreading of HIV/AIDS.She should be certain that each staff members are aware of the patient conditions so as to take special precautions.

Conclusion
A policy could be used by nursing staff in combating the spreading of the HIV in a health care service.This should direct the future nursing activities of the health care unit and was used during in-service training sessions in edu cating all the nursing staff of the guidelines.All charge sisters should through to planning, organising, directing and control, prevent the spreading of HIV in the health care unit.

T
he sub c a t e g o ry o f r e c o r d in g w as a n aly sed .The use o f n o tic e s in th e h e a lth care unit has to be planned by the charge sister in order to offer a c o n tin u o u s e d u c a tio n .It was an indica tion o f the fact that the method o f education is utilised in the form of record as e v id e n c e d by the q u o te s above.
(Theme: Taking effective precautions) relevant stake holders should be involve in render ing the service of counselling to the patient.(Theme: Counselling) the nursing unit should have an adequate plan to properly dispose contaminated supplies and equip ment.(Theme: M anagement of equipment and sup plies) the supervisor should plan effectively on how and when to delegate and supervise staff members and taking into account their previous knowledge to ensure that the preventative measures to prevent spreading of HIV during the execution o f the daily unit activities.(Theme: Delegation and supervision) the use of notices should be installed in the unit to offer continuous education.(Theme: Recording) notices "Notices reminding (teaching) measures to be taken in prevention o f spread" o f usage o f aseptic technique and usage an d disposal o f sharps.The charge sister should ensure that the staff does use the aseptic technique to prevent unnecessary spread ing of HIV in the unit in order to control the spread.Fur thermore the charge sister should ensure that all the staff carries out the effective precautionary measures during their execution of their duties as supported by the quotes.The organisational AIDS policy should state explicitly how the organisation and units should treat existing and potential employees who become or are already infected with HIV (Lim & Loo, 2(XX): 132).

Table 4 Subcategories and related themes with regard to control in the nursing unit Main Category Control S u bcategories R elated themes Exam ples o f quotes to support themes
Accept the responsibility of planning the correct handling of equipments used for the HIV positive patients e.g. a bone marrow procedure.Assess the daily routine o f the health care unit for its potential in spreading the HIV.Schedule a regular in-service training for the staff in the health care unit.Plan to use appropriate educational methods and AIDS in educating the staff and the patients in the health care unit.Educate the staff on the HIV/AIDS condition and the various modes of spreading of the virus, and precautionary measures.