Doctoral Degrees (Nursing)

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An analysis of health behaviour of children from child headed households in a selected health district in KwaZulu-Natal : an ethnographic study.
(2013) Gumede, Emelda Zandile.; Bhengu, Busisiwe Rosemary.
Introduction The loss of a parent predominantly as a result of HIV and AIDS disease has a negative effect on children, which can lead to increased number of orphans. Traditionally the extended family would take in orphaned children into their extended families and make one big family where culture of ‘’Ubuntu’’ still prevailed. The changes in the socio-economic systems and family structure leaves the children with very little choice but to make alternative living arrangements, where they find themselves in child headed household families. The eldest child becomes the head (caregiver) within a household. The aim of the study was to explore the health behavior, health seeking behavior and issues of access to health and social care services to children coming from child headed household families in a selected district in KwaZulu Natal. Methodology A qualitative approach using ethnographic method was conducted. Three households were purposefully chosen with a total of nine participants. Data collection processes included participant observation in their natural setting, individual interviews as well as focus group interviews in their own environment. Children participants were so heterogeneous that they could not be studied together in a focus group for three families, but the volunteers and professional group could be studied together in a focus group. The data analysis followed Spradley’s (1980) three levels of analysis called the domain, taxonomic and componential analysis as presented in chapter five. Findings The children’s health behavior is affected by the HIV and AIDS infection, poverty and lack of support from the extended family and communities. Their health seeking behavior is influenced by the previous history and attitudes towards the health professionals. The access to health and social care services is also surrounded with mistrust of the present health care system. Conclusions and study recommendations The discussions in the current study focuses mainly on the logistics of awarding the child headed status by the court of law as the lengthy and tedious process, but as the best practice because it eliminates the corruption and fraud in the system by expecting the children to be physically (identified) presented before the court of law before awarding of the status. The legislative ambiguity, shortage of volunteers, unaffordable transport and the attitude of the health care professionals impact negatively on the child headed household children’s health seeking behavior to an extent that children tend to avoid accessing health and social care services until they are very ill to be picked up by an ambulance which bypasses the administration section which subjects them to sad memories and embarrassing questions such as those related to HIV statuses of their late parents which could imply theirs too, within a limited space. The study recommended a longitudinal case study to be undertaken to follow up on the children who are 18 years and above as it appears that they tend to get lost in the thick vicious world and end up in the wrong side of the law. All participants echoed that the poor coordination of services made available for such children should be urgently attended to by government, the Faith Based Organizations (FBO) meaning the structures that represent the church and responsible Non-Governmental organizations (NGO’s). The greatest limitation of the study was that it was qualitative and used only nine participants in three families, hence cannot be generalized beyond the context of the study.
An analysis of nurse managers' human resources management related to HIV and tuberculosis affected/infected nurses in selected hospitals in KwaZulu-Natal, South Africa - an ethnographic study.
(2014) Kerr, Jane.; Brysiewicz, Petra.; Bhengu, Busisiwe Rosemary.
INTRODUCTION: Providing sufficient quality nurses in resource strapped countries is a human resource management challenge which nurse managers’ experience on a daily basis. THE PURPOSE of this study was to analyse and to determine the issues which affect the the human resources management of nurse managers in selected hospitals in the eThekwini District of the Province of KwaZulu-Natal, South Africa, and to formulate draft guidelines to assist nurse managers with human resource management. METHODOLOGY: A constructionist, reflexive ethnographic approach was used. The ethnographer spent two years in the field collecting data from informants, who were nurse managers, in four (4) selected district hospitals. Data was collected using unstructured informant interviews, non-participant observation and confirmatory document analysis. Data analysis led to eliciting codes from the data, searching for semantic relationships, performing componential analyses and discovering the themes for discussion within the final ethnographic report. A nominal group process was used to develop the draft guidelines. FINDINGS: The findings showed that the human resources management around sick nurses is a complex task. The themes of nurse managers’ experiences were a “burden” of maintaining confidentiality, as well as an emotional burden. Administratively, they experience the burden of absenteeism and the burden of policy compliance. The final theme is the burden of the deaths of HIV and Tuberculosis affected/infected nurses. CONCLUSION AND RECOMMENDATIONS: Organizations should create a non-judgmental work environment where non- disclosure by employees is respected in order to promote disclosure. They should have an awareness of the emotional effect on nurse managers and provide them with support. Emphasis needs to be placed on an HIV and AIDS policy and programme, incapacity leave workplace strategies and return to work policies. It is also recommended that contingency plans be provided when the death or prolonged absence of an employee impacts the staffing of the organization; consideration to be given to piloting and refining the draft guidelines; the management of employees on prolonged sick leave be included in the Nursing Administration Curricula taught to future nurse managers; and further research be conducted to assess employee reluctance to report needle stick injuries (sharps injuries) as well as the related phenomenon of stigmatization.
An appraisal of continuous quality improvement (CQI) mechanisms and development of quality care indicators amongst clinical nurses in selected teaching hospitals in South-West (SW) Nigeria.
(2009) Onianwa, Patricia Obiajulu.; Bhengu, Busisiwe Rosemary.
Aim: This study appraised the CQI mechanisms and processes in the clinical nursing divisions of five selected teaching hospitals located in South-West Nigeria and developed quality care indicators to measure and monitor quality of care amongst clinical based nurses in these teaching hospitals. Background: Studies have been done on evaluation of quality care to determine what good care is; whether the care nurses give is proper and effective, and whether the care provided is good quality. Several authors have asserted that evaluating the quality of nursing care is an essential part of professional accountability. Literature also suggests that in providing high quality care, it is important that nurses develop appropriate evaluative measurement tools to ensure professional aspect of nursing. Conversely, it is a concern that in the clinical nursing division of some teaching hospitals in SW Nigeria, CQI mechanisms/processes (such as a structured auditing, monitoring and measuring quality of nursing care, established systems of continuing professional learning/ In-service Education Unit) were not more evident, particularly when these teaching hospitals were supposed to be seen as models for providing quality care services. It was not certain what CQI activities were present in similar hospitals, and if such activities were present, there was uncertainty as to how these activities were performed. In addition, the type of instrument/tools available for nursing care measurement was uncertain. There is a paucity of published evidence relating to the quality of nursing care measurement in the teaching hospitals in SW Nigeria. Gaps identified in the study would form the basis for future training and education of nurses involved in care-giving to promote quality care. Findings from the study provided evidenced-based scientific rationale for practice in relation to quality nursing care measurement in the health care institutions, thus adding to the body of knowledge of quality improvement. The methodology employed in the study is an action research; with a mixed method-Sequential explanatory incorporated. Quantitative data was collected and analysed, followed by the collection and analyses of qualitative data. The study was done in five cycles which included a survey that elicited responses from the participants on general knowledge and perceptions about CQI. Cycle two included generating promising solutions and an action plan. In cycle three, established quality-care indicators were analysed, developed and thereafter, the newly adapted instrument for nursing care measurement was tested for applicability to settings. Participants reflected on the testing of the new tool in the fourth cycle and lastly, implementation/testing outcomes were evaluated in the fifth cycle. Conclusion: Established quality-care indicators were adapted in each of the five hospital settings for quality nursing care measurement. The newly adapted quality care indicators were tested for applicability on two acute-care wards in three of the five participating hospitals. The results of the study could be used in Nigeria and elsewhere as a means to protect the rights of the patient; by measuring and monitoring the quality of nursing care.
An exploratory study towards disclosure of status and reduction of stigma for people living with HIV/AIDS in a low income community : the development of a community-based framework.
(2010) Razak, Ayisha.; Bhengu, Busisiwe Rosemary.; Brysiewicz, Petra.
Introduction: Stigma associated with HIV/AIDS creates a barrier to prevention, care and treatment of HIV/AIDS. It further restricts PLWHA from learning about their status, disclosing their status, adopting safe behaviour and accessing services such as antiretroviral treatment. Disclosure of HIV status and a reduction in stigma may contribute to the decrease in new HIV cases. Purpose: The purpose of the study was to develop a community-based framework that would encourage people living with HIV/AIDS to disclose their HIV status and reduce the stigma associated with the disease. Method: This study used the action research method to explore the experiences of stigma and disclosure of HIV status and to develop a community based framework with PLWHA who encouraged disclosure and promoted the reduction of stigma in a community-based setting. The research setting was Bhambayi, an informal settlement in the district of Inanda. Non-probability purposive sampling was used. In-depth interviews with PLWHA that had disclosed their HIV status and focus group discussions with family members, adult children and community members were conducted. Findings: The data was analyzed manually and the following categories and subcategories emerged. The categories were experience of disclosure, stigmatizing reactions, lifestyle changes after disclosure and supports to reduce stigma. Some of the sub-categories were ‘opens out the illness’, gossiping and pointing fingers, discrimination against PLWHA by family and community, changes in relationships, community awareness and formation of support groups. The findings revealed that PLWHA that had disclosed their HIV status had changed their lifestyles. Recommendations were made on the need for nurses to develop community engagement projects and establish partnerships in order to reach out to communities regarding HIV/AIDS. Incorporate HIV/AIDS stigma and discrimination into the current nurses’ curriculum. The need for research is expressed on the evaluation of the framework and conducting similar research in larger communities. Conclusion: PLWHA who had disclosed their HIV-status shared their experience of being HIV-positive and encouraged other people to get tested. The community-based framework to facilitate disclosure and reduce stigma among PLWHA can be operationalised in other informal community-settings.
Facilitation of behaviour change communication process for maternal, newborn, and child health at primary health care level of midwifey practice in Kaduna State, Nigeria.
(2012) Akin-Otiko, Bridget Omowumi.; Bhengu, Busisiwe Rosemary.
Background: Nigeria’s unacceptably high maternal and child mortality rates are related, among other things, to the people’s lack of access to appropriate information to assist them in making decisions about their health, and to promote their utilization of available services. Midwives’ skills for result-oriented client education and friendly services are fundamental to women’s behaviour change for favourable maternal and child outcomes. Aim: The purpose of the study was to appraise and facilitate behaviour change communication (BCC) by midwives at primary health care level of maternal, newborn, and child care. Methods: Action research, with concurrent transformative mixed method data collection strategy, was adopted for the study, and the maximum variation sampling technique was employed to recruit participants. Fifteen, representing sixty-eight percent of the twenty-two recruited midwives continued through the three phases of the study. The diagnostic, intervention, and monitoring phases of the study were arranged in line with the objectives of the study, and each succeeding phase built on the findings of the previous one. At the diagnostic phase, the strengths and weaknesses in behaviour change communication by midwives in the facilities, and the appropriate solution to bridge the gaps were identified at a three-day search conference. At the intervention phase, a training manual was developed. A capacity building programme, made up of a training component for the midwives, and an interactive session between the government and the midwives, was designed and implemented at a three-day workshop. The monitoring phase comprised the midwives’ hands-on practice, using the developed training manual, core messages, and interpersonal communication (IPC) observation checklist for three months. The implementation of the midwives’ action plans in their respective work places was also monitored. Both qualitative and quantitative data collection and analysis methods were utilized at each phase of the study. Results: The diagnostic phase revealed that midwives lacked the essential knowledge, skills and attitudes for effective behaviour change communication activities in the facilities. Health talks were seen as midwives’ responsibility, however, they were unplanned, difficult, and given routinely, providing inadequate information, and without focus on behaviour change. Socio-cultural and environmental factors such as inadequate staff, material and time were barriers. The midwives’ knowledge, attitudes, and skills responded positively and significantly to the training, to hands-on practice, and to the use of reminders at their workplaces. In addition, midwives were able to network for support from the community and other workers in the facilities, to implement their action plans. Through exhibition of innovative behaviour in the implementation of their action plans, the midwives in most of the facilities were able to effect changes to facilitate utilization of maternal and child health (MCH) services. The gross shortage of staff, staff transfers, lack of drugs and supplies, heavy workload, and midwives’ lack of trust in their employers, however, hindered optimum implementation of some of the plans. Conclusion: The women living in the communities where the midwives worked, desired to know more about the role of midwives and to have competent ones; while the midwives were willing to assist their clients to adopt desired health and health-seeking behaviours, because they were duly recognized and empowered during the project. The study showed that the grave disconnection between the midwives and the government policies / programmes to facilitate behaviour change, and promote maternal and child health, can be corrected. The findings and recommendations have implications for practice, education, research and policymaking in Kaduna State and similar settings.
Participation of nurse leaders in health policy development: an action research approach.
(2016) Dlamini, Zanele Faith.; Bhengu, Busisiwe Rosemary.; Bhengu, Busisiwe Rosemary.
Introduction All aspects of nursing education, practice and research are influenced by health policy. Proactive participation in the policy arena is key to excellence in clinical practice and education for nursing. Nurses constitute the majority of healthcare personnel in most countries, playing a major role in providing quality care. South Africa has a nurse-based healthcare system with nurses comprising 80 per cent of health professionals. The nursing leadership is instrumental in influencing both policy and nursing practice. Therefore it is important that nurses understand and influence the public policy process. However, their participation in health policy development is limited, even though they play a critical role in providing care for individuals. This study contributes to the body of knowledge on the participation of nurse leaders in health policy development. It is hoped that the knowledge gained from this study may, at some point, be put into practice. Purpose To determine and analyse the extent of nurse leaders’ participation in the health policy development process in selected regional and tertiary hospitals in the province of KwaZulu-Natal in South Africa. Methodology This study adopted an action research design using convergent mixed methods. Statistical data was also required to measure the effectiveness of research interventions. Both qualitative and quantitative data sources were given equal emphasis and equal weight. Eight face-to-face in-depth interviews of a minimum length of 20 minutes were conducted. Quantitative data was collected through self-administered questionnaires to 81 participants to allow for generalisation. Data were collected during 2015 to inform the diagnostic phase of the action research process. The second phase of the study consisted of a knowledge translation policy workshop and the development of a policy brief document. Results Findings from all data sources in the current study showed that the participation of nurse leaders in health policy development was limited, especially at provincial and national levels. Those who had participated did so at an institutional level. Nurse leaders participated only at the implementation stage. Their level of knowledge and confidence in health policy development was low, which has implications for the interpretation and implementation of the policies. Conclusion The findings of the study suggest that there is an increasing disconnection between policy and delivery. This serves as a barrier to involving the people who are in the frontline and responsible for delivering results, in policy development. Since nurse leaders are implementers of policy, their involvement in policy development would encourage greater ownership and result in better assessment of policy feasibility. The findings and recommendations of this study have implications for practice, education and policy-making in South Africa.

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