King‟s Conceptual System Concepts

King‟s interacting systems model was developed specifically for nursing in a hospital- based setting. Therefore, not all of King‟s concepts might be applicable in this study. Nonetheless, the researcher‟s belief is that majority of the concepts can be used to explore aspects related to health and wellbeing on the Transnet-Phelophepa HCT.

Based on this statement, only concepts identified to be applicable or relevant to a particular group will be explored and discussed. Noted in George (2011:234) is that the placement of King‟s concepts withineach system is subjective as all the concepts are interrelated in terms of human-environment interaction.

2.1.2.1 Personal system

The personal system that King refers to is the individual. The most current concepts within King‟s personal system, described as fundamental in understanding human beings, are perception, self, growth and development, and body image. Other concepts described in King‟s earlier publications (King, 1981/1990a, 1989, 1992& 1995a as indicated by George, 2011:237) are space, time, and learning. These concepts are essential in exploring health and wellbeing on the Transnet-Phelophepa HCT.

An individual‟s interaction with the Transnet-Phelophepa HCT is driven by that individual‟s perception of self. Included in the definition of self is an awareness of oneself as being

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separate from others as well as an awareness of who and what one is (King, 1981, in George, 2011:235). The definition and interpretation of self is influenced by one‟s attitudes, values and commitment. The process of reflection on self also includes reflection on one‟s body image. Body image is characterised by one‟s perception of the self, and is influenced by one‟s growth and development and genetic makeup, and by life experiences, especially those that have meaning and lead to satisfaction.

It follows that health-seeking behaviour among the service users is influenced by features of self, which are attitude and values regarding health commitment, as well as by time and space. The Transnet-Phelophepa HCT service users are mostly poor rural community members. The majority are unemployed, or employed in farming areas. For most, consulting a health service for a health problem is usually delayed due to health care services being financially or geographically inaccessible. However, many people from both near and far make an effort to come to the health train when they can, regardless of where it is stationed. For some it is a very expensive trip as there is no public transport system in their area. Some people even sleep on the platform. This is due to the perception of the value of the service. The Phelophepa train is regarded as a „miracle train‟ that contributes towards their health and wellbeing.

The focus of the discussion in the personal system is the individual‟s interaction with the Phelophepa train. When individuals interact with one another, they form interpersonal systems.

2.1.2.2 Interpersonal system

The interpersonal system is the second interacting system in King‟s model. The relevant concepts for the interpersonal system are interaction, communication, transactions, role and stress (George, 2011:243). These concepts are essential within a relationship of two or more people working towards a common goal.

On the Transnet-Phelophepa HCT, as in any other setting, the interpersonal systems concepts are important, as the common goal for all participants is health care. In addition, the interaction – whether verbal or non-verbal – is observable in all three participating groups. The health care service outcomes and people‟s coping mechanisms are dependent on how effectively and efficiently interaction and communication transactions are applied. The Phelophepa train participants‟ application of these concepts is dependent on the individuals‟ perceptions of their roles. In the process of interaction all the participants

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occupy a role, which in most cases is reciprocal. A person may be a giver at one time and a taker at another time. Therefore the role status in transacting takes precedence, as the concept role is also associated with a set of expected behaviour, procedures or rules that outline the responsibilities and privileges (King, 1981, in George, 2011:238). For example, the students on the Transnet-Phelophepa HCT receive updated information on an ongoing basis from the permanent service through on-the-spot teaching sessions and debriefing sessions at the end of each working day. This information in turn is used to update the service for the rural service users on the receiving end.

The permanent service providers consist of a hierarchical multidisciplinary team. The health care service transaction is dependent on the perception and understanding of the different professional‟s roles. In relation to authority and power, the team members are givers and takers. However, there should be clear communication on job expectations and decision-making authority to avoid problems related to role ambiguity and lack of autonomy, which could lead to stress.

How people communicate and interact is at the foundation of formulating relationships. Without a doubt, relationships defining how people relate to one another on the Transnet- Phelophepa HCT and to their families are important. Moreover, the permanent employees spend three quarters of the year working and living on the Transnet-Phelophepa HCT. Interpersonal friction at work could have a negative impact, causing stress. Stress in turn could impact on an individual‟s quality of life. Another factor that could affect quality of life among the permanent employees is the work/home clash; if there is a something that needs to be attended to at home, it could be neglected due to work commitments.

The permanent service providers spend most of their work and leisure time on the Transnet-Phelophepa HCT, sharing the limited space with the students. This kind of setting could alter the process of interpersonal communication and relations. The lack of boundaries leads to more and closer interaction with the students and potential loss of privacy for the permanent service providers. This may lead to students regarding themselves as equals with the permanent service providers, which may in turn impact negatively on professional interaction levels.

34 2.1.2.3 Social system

The social system is the third and final interacting system in King‟s model. The concepts that King identified as relating to social systems are organisation, authority, power, and decision-making, in addition to the concepts from the personal and interpersonal systems.

Social systems are composed of groups with common interests or goals in a common setting, for example, at a medical practice. Social systems provide a framework to maintain the values of a medical practice as well as strategies to regulate the practice and its rules (King, 1981 in Alligood and Tomey, 2006:185). The examples cited of social systems include peer groups, families, community groups, health care settings, workplaces, educational institutions and religious organisations.

The Transnet-Phelophepa HCT fulfils the criteria of a social system, as groups of student from different universities and colleges participate in the capacity of learning in the workplace. Permanent employees are there in a capacity of facilitating a health care service and they are like family to one another as they live and work on the Transnet- Phelophepa HCT.

Alligood and Tomey (2006:185) state that throughout the life span of human beings, they are influenced by their interactions with social systems. It is within these systems that individuals learn their expected roles, attitudes and behaviours. Furthermore, individuals‟ beliefs, values and customs are developed or moulded.

Organisation: King (1981) as stated in George (2011:239) describes an organisation as a structure made up of individuals who have prescribed roles and positions and who make use of resources to meet both personal and organisational goals. On the Transnet- Phelophepa HCT, as in most health institutions, there is a vision, policies and guidelines for service delivery. It is the responsibility of management to make sure that the organisational goals are communicated to all employees and students. This is to make sure that all the participants are aware of the service provision expectations. Management has the authority to give direction and to monitor processes. According to King, authority can be held by a professional with special management skills, and it can be delegated and exercised through group leadership. On the Transnet-Phelophepa HCT, authority is delegated to all, including the students. Each student group is required to nominate a person to be in charge of the group and to communicate with the respective manager of that department. The people in authority have power to reward others, sanction activities,

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maintain order and facilitate team work. King (1981) states that power has a direct association with authority and it is also associated with decision-making.

Decision-making in organisations is defined as „a process through which choices related to goals are made among identified possible activities‟. The criterion for student- participation on the Transnet-Phelophepa HCT is that students must be final-year students. The assumption is that they would by then have gained the necessary professional skills and competence to function with minimal supervision, and to be able to take make choices as far as their learning is concerned on the Transnet-Phelophepa HCT. Learning is a concept that King mentioned in other publications (1981/1990a, 1989, 1992, 1995a) along with space and time. These concepts are essential for exploring students‟ health and wellbeing on the Transnet-Phelophepa HCT.

Space occupied on the Transnet-Phelophepa HCT is time-bound. It is based on the individual or group‟s expectations or responsibilities and is goal-driven. Health science students occupy the Transnet-Phelophepa HCT allocated space for a specific period of one or two weeks for learning purposes. During this period the students have to meet certain learning outcomes. Because the Transnet-Phelophepa HCT is stationed in an area for a specific limited period of time, students are expected to work at a faster pace than usual to attend to all the people who have come to the health train for a health service. Since these are senior students, they are expected to take responsibility for their learning. This expectation comes with the power and freedom to decide how they are going to do the job on the Transnet-Phelophepa HCT. The researchers‟ concern is: are students given the latitude to decide on how to do the work? Do they have authority and power to make decisions? What are the students‟ perceptions of skills used on the Transnet-Phelophepa HCT? Do they have an opportunity to perform a variety of tasks and to develop their own special abilities?

The other concern is related to the students‟ perception of safety on the health train; this in an environment that requires one to work at a faster pace. Do the students have control over what happens to their safety? Are safety issues on the Transnet-Phelophepa HCT communicated to the students?