Browsing by Author "Brysiewicz, Petra."

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Access to higher education in the health sciences : a policy implementation analysis.
(2014) Orton, Penelope M.; Brysiewicz, Petra.; Essack, Sabiha Yusuf.
Access to health sciences education in South Africa is a challenging and contested area of higher education seeped in politics and history within a context of transformation. There are a large number of students wanting to study health science courses but there are limited places. The first democratically elected government in South Africa issued White Paper 3: A Programme for the Transformation of Higher Education with a vision of transforming the higher education system to one that was more representative of the country`s demographic profile. However in the absence of any guidelines for the implementation of this White Paper 3, higher education in many instances has not been transformed as the government envisaged. The aim of this study was to identify the factors affecting access to health sciences education at universities in South Africa and to develop guidelines to broaden access for social redress. This study was conducted within a pragmatic paradigm using a mixed methods sequential exploratory design in the complementarity genre. Universities offering traditional health science courses` including medicine were included in the study. The research consisted of 3 Phases – Phase 1 reviewed existing policies and practices through the review of relevant documents; Phase 2 assessed existing practices through one-on-one interviews and Policy Delphi and Phase 3 developed policy implementation guidelines and two policy briefs to broaden access using the information gathered from the literature reviewed and data collected from stakeholders. The Policy Delphi questionnaire was developed following the analysis of qualitative data collected in Phase 2 and the instrument was subjected to 2 cycles of item content validity index (I-CVI). The results indicated that achieving equity of access is multi-factorial and has diverse and complex challenges. Some of these challenges are ingrained in South Africa`s apartheid history, some are rooted in the process of access and some in the mind-set of the actors involved in access. The research identified eight categories, promotion of health science disciplines; challenges to transformation; competitiveness; health sciences sets the “bar”; alternative access; reason for choosing a health sciences profession; innovation in teaching and learning and retention and throughput rates which were related to access to health sciences education in universities. The data indicated that the student demographic has changed substantially in Health Science programmes but more could be done. Faculties of Health Sciences need to implement some strategies to reach out to the eligible students in rural and remote areas. Student success in Health science courses is relatively good as would be expected as the selection and admission criteria, is generally higher. Health Sciences at many of the universities are committed to the imperative of transformation for social redress but there are others who are caught between facilitating transformation and overwhelming demand for their programmes. Guidelines for the Implementation of the Access Policy in Health Sciences Education and the Access for Success in Health Sciences Education in Universities Policy briefs were informed by the results. Universities have implemented a number of initiatives to address the past injustice in higher education access however the issue of enabling access for those who are socio-economically disadvantaged is very much more complex and challenging to address. Transformation of health sciences education in universities is essential to the transformation of the health service to reflect a health service that is accessible, available, affordable and agreeable, something that every South African citizen.
Alarms in ICU : a study investigating how ICU nurses respond to alarm limits for patient safety.
(2015) Ramlaul, Amy.; Brysiewicz, Petra.
Introduction There is a need to identify alarm management challenges in South African ICU units, to revise and structure educational and training programmes to ensure ICU nurses utilise technological resources for patient safety and to deliver quality patient care. Aim This research study is aimed to investigate the responses of ICU nurses to alarm limits in their ICU environment for patient safety. Research methods This descriptive survey study was conducted with permanent and sessional ICU nurses at a private healthcare institution in Durban, KwaZulu-Natal. A quantitative design was used with a structured questionnaire as the data collection instrument. The total of 120 ICU registered and enrolled nurses were chosen as the sample population and a total of 91 questionnaires were completed and returned. Results The results indicated that the challenges with alarm management experienced were related to inadequate education and training on alarm management and the distraction of managing frequent and numerous false alarms in the ICU facility contributed to delayed responses of the ICU nurses to alarming limits. Recommendations Recommendations included reviewing the current content and methods of education and training of alarm management and medical equipment that was done on a frequent basis. Conclusion Alarm specific training is required to keep ICU nurses updated with changes in technology so that they are better equipped to ensure patient safety and quality of care.
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.
A description of the forensic nursing role in the emergency departments in Durban Metro.
(2006) Abdool, Nomusa N. T.; Brysiewicz, Petra.
Aim: The aim of the study was to describe the forensic role behaviour and expectations of the nurses working in the emergency departments. Design: An exploratory descriptive survey was used, using the quantative approach. The respondents comprised of registered and enrolled nurses who were registered with South African Nursing Council (SANC) and had the minimum of 6 months experience in the emergency department (ED). The emergency departments of two provincial and two private hospitals as well as two comprehensive care clinics were used. Instrument: A survey was conducted using a questionnaire consisting of forty items. The questionnaire was designed to describe the forensic role behaviour and expectations of nurses working in the ED. Data analysis: The quantative data was analysed using the Statistical Package for Social Sciences (SPSS) program version 11.5 Findings: The findings revealed that the emergency department (ED) nurses were not certain about their role regarding forensic nursing. Most of the tasks to be performed by the ED nurses were rated as never done or seldom done. The reason was due to lack of training and knowledge in the field of forensic nursing. The ED nurses strongly felt that forensic nursing was very important to their daily activities especially in the emergency departments where they handle the trauma victims and suspects. Recommendations were suggested for the nursing practice, nurse educators and for future research in an attempt to expose the emergency nurses to forensic practice.
Descriptive survey of women’s childbirth experiences in two state hospitals in KwaZulu-Natal.
(2017) Mutabazi, Uwonkunda Providence.; Brysiewicz, Petra.
Background Giving birth is one of the most important events in a woman’s life, and is a highly individualistic and unique experience with many physical, physiological and psycho-social changes in the woman’s life that requires support, help and motivation, not only from professional carers but also from family members. Aim The aim of this study was to survey women’s childbirth experiences in two state hospitals in KwaZulu-Natal (KZN) Province in South Africa, in an attempt to identify women’s experiences of labour and birth. Method A non-experimental, quantitative survey was conducted in two state hospitals in the eThekwini District of KZN. Population included all post-partum patients in urban KZN hospitals where the research was conducted. Purposive sampling was used. Two hundred and one low risk mothers; 119 (59%) from hospital A and 82 (41%) from hospital B responded to the Childbirth Experience Questionnaire (CEQ). Data were analysed using descriptive and inferential statistics. Results Results denoted both positive and negative childbirth experiences with positive childbirth experiences being dominant on almost all domains of the Childbirth Experience Questionnaire. A high level of women’s experienced capacity and experienced good professional care and support as well as professional skills were found to be associated with a positive childbirth experience. Negative childbirth experiences were reported mostly in additional comments by few respondents. These negative experiences were found to be linked to women’s poor relationships with staff, a lack of information, neglect and abandonment and not receiving pain relief. Problems such as the shortage of staff and an unfriendly environment were identified to affect childbirth support, leading to a negative experience. Uncleanliness and lack of privacy contributed to feeling unsafe, and fear, anxiety and a lack of support influenced the experience of pain. Conclusion No birth story is exactly the same, and the study results showed that negative and positive experiences coexisted; however positive and satisfying childbirth experiences were dominant amongst the majority of the respondents in the current study. How mothers feel about their labour and birth, whether positive or negative, was found to depend on their individual labour process and outcome. Thus, from the women’s perspective, the study described childbirth experience as a multi-dimensional experience.
Developing an intervention model to manage caregiver burden experienced by family caregivers of patients living with end-stage renal disease in Nigeria.
(2017) Oyegbile, Yemisi Okikiade.; Brysiewicz, Petra.
The purpose of the study was to develop and implement an intervention model to manage caregiver burden experienced by family caregivers of patients with End-Stage Renal Disease in South-West Nigeria. The model that was developed may be used by nurses to assist these family caregivers. Methodology Using an action research process, a complementary mixed-method data collection strategy explored and described the extent of caregiver burden, and described family caregivers’ experiences of caregiving. With assistance from the research team, 96 participants were selected for the quantitative aspect of the study, and 15 for the qualitative aspect. Through the cyclical nature of the action research, establishing and exploring the experiences of family caregivers later resulted in the emergence of the crucial concepts and the development of the model. The knowledge process development of Chinn and Kramer (2011) guided the development of an intervention model, and the model implementation process was facilitated by the use of an implementation checklist. Findings On measuring the caregiver burden, the family caregivers experienced moderate to severe burden in all domains of care. Family caregivers’ descriptions of their experience of family caregiving led to the identification of five categories, namely: disconnectedness with others and self; never-ending burden; “feeling like “a fool being tossed around”; obligation to care and promoting a closer relationship. The diagrammatical model to manage caregiver burden resulted from the collaboration of the research team members, and the crucial concepts emerged from the integration of the findings from the study and the interrogation of the existing literature. Model implementation was not evaluated and feedback from nurses and family caregivers indicated that they were excited that the process helped them to manage their burden as caregivers. Conclusion and recommendations Family caregivers’ need for support should be addressed when they begin caregiving, and then subsequently as they continue to provide care, so that they their health is not compromised. There is a need for the implementation and evaluation of this model to assist family caregivers cope with the challenges of prolonged caregiving.
Developing an intervention to manage professional isolation among emergency nurses working in Lesotho: an action research approach.
(2023) Kutoane, Mahlomola.; Brysiewicz, Petra.; Tricia, Scott.
Introduction: Professional isolation is described as a deficiency in one’s network of social relations at work and is associated with compromised health service delivery and quality of life among health professionals, particularly those working in low-resource environments. Aim: to develop an intervention for managing professional isolation among emergency nurses working in Lesotho. Method: A mutually collaborative action research study, with an exploratory-descriptive qualitative design, was conducted in the emergency departments of five selected hospitals in Lesotho, with 25 purposively sampled registered nurses. A needs assessment was conducted through a scoping review and focus group discussions, followed by the establishment of a three-member research team (Cycle One). Thereafter, 13 individual interviews were conducted to explore the perceptions of professional isolation among emergency nurses (Cycle Two). The intervention, a Digital Community of Practice, was developed (Cycle Three) and facilitated through WhatsApp platform, then was implemented and evaluated in Cycle Four. Results: The scoping review highlighted there is limited literature on professional isolation among health professionals and the focus group discussions revealed that participants acknowledged that there was a need for such a study. Qualitative interviews exploring professional isolation resulted in an overarching theme of ‘feeling like an island’ and three categories; lack of interprofessional collaboration and consultation, skills mismatch, and enforced loneliness. Following consultation with the research team, a digital community of practice was developed for emergency nurses using the WhatsApp platform and then implemented. Conclusion This study revealed that emergency nurses in Lesotho do experience professional isolation and a digital community of practice developed using social media, such as WhatsApp, as a communication tool, could be considered as an intervention strategy for managing professional isolation among emergency nurses working in low-resource environments. However, it is recommended that a larger-scale study be undertaken to encourage the motivation for developing contextual interventions for addressing professional isolation in emergency care settings.
Developing, implementing and evaluating a midwifery simulation package on post-partum haemorrhage for undergraduate midwifery students at a university in KwaZulu-Natal.
Amod, Hafaza.; Brysiewicz, Petra.
Background: Training undergraduate midwifery students in the skills that are necessary to prevent, identify and manage post-partum haemorrhage, is essential. Aim: The aim of this study was to develop, implement and evaluate a Simulation Learning Package on Post-partum Haemorrhage using High Fidelity Simulation. Methods: A pragmatic approach using a mixed methodology was undertaken and experts in nursing /midwifery education and 4th year nursing students enrolled in an undergraduate baccalaureate programme participated. Data were analyzed using descriptive statistics and content analysis. The research was conducted in three phases. In phase 1, the simulation learning package was developed and evaluated by nursing experts. In Phase 2 the simulation learning package was implemented into a simulation scenario where 2 groups of students participated as role-players in the clinical skills laboratory. In Phase 3, the package was evaluated using a student satisfaction survey and focus group sessions. Results of Phase 1: The findings revealed that most experts found the quality of the contents of the SLP to be suitable for undergraduate students in terms of the appropriateness of the contents, clarity of the learning objectives, currency of the information, relevance to the level of the student and the accuracy of the contents. The Simulation Learning Package was also found to be effective as it included a combination of active learning strategies, collaboration and diversity in learning and high expectations. The package was as easy to use as it was well presented and offered feedback opportunities. Results of Phase 3: The majority of students found that using high fidelity simulation improves clinical skills, knowledge, critical thinking, self-confidence and learner satisfaction. Using high fidelity simulation also provides an in-depth learning experience and diverse learning styles to practice midwifery skills in a safe learning environment. Two focus group sessions were also conducted in the third phase of this study. The results of the focus group were condensed into 9 categories that revealed that using high fidelity simulation is an innovative teaching method; promotes teamwork; stimulates critical thinking skills; improves clinical competence; enhances learner satisfaction; identifies gaps; student empowerment; integrates psycho-social care; increases self-confidence. Recommendations: Simulation learning complements clinical training and should be integrated into the undergraduate programme, annual simulation training sessions should be held staff members to sustain the implementation process . Sufficient time needs to be set aside in order to develop such learning packages. Conclusion: High fidelity simulation within the undergraduate nursing curriculum can be very rewarding for both students and nurse educators and therefore should be prioritized as a ‘need for change’ to a simulation based module. KEYWORDS: High fidelity simulators, simulation learning packages, post-partum haemorrhage, undergraduate nursing students.
The development of an intervention model for managing abrupt death trajectories in KwaZulu-Natal level 1 emergency departments.
(2004) Brysiewicz, Petra.; Uys, Leana Ria.
AIM: The aim of this research was to describe how the health professionals manage sudden/abrupt deaths in the ED and to foster change in current practice by involving the clients (dead or dying clients and their families) and the health professionals. METHOD: Action research was the approach used in this four year research project, and co-researchers (nurses) from three Level I ED's in KwaZulu-Natal were actively involved in shaping and guiding the project. The participants involved in the research were health professionals, bereaved families and mortuary staff members. FINDINGS: An intervention model, the Dealing with Sudden Death Model, was developed in order to guide the therapeutic management of sudden/abrupt deaths in ED's. Along with this was the development of the family pamphlet, the Preparation Checklist and the Incident Evaluation Checklist. Following the implementation of this model the health professionals emphasized the fact that this model provided guidance and meaning to the care rendered to the dead or dying client, the bereaved families and fellow colleagues. The Dealing with Sudden Death Model had resulted in a production of knowledge and planned changes in the management of sudden/abrupt deaths in the ED's.
The development of an intervention model to manage secondary traumatic stress in mental health workers in Rwanda.
(2010) Iyamuremye, Jean Damascene.; Brysiewicz, Petra.
Introduction: It was previously established that mental health workers in Rwanda experience secondary traumatic stress when working with trauma survivors. The effects of secondary traumatic stress can be serious and permanent in mental health workers when working with traumatized clients. It interferes with mental health worker’s ability to do their work effectively. Aim: This study aimed to explore STS and to develop an intervention model to manage secondary traumatic stress in mental health workers in Kigali, Rwanda. Methodology: This study was carried out into five cycles using action research approach. In the first cycles of the study a quantitative design was used to explore secondary traumatic stress in mental health workers in Rwanda. For this cycle, the particular aim was to determine the extent of the secondary traumatic stress in mental health workers in Rwanda. A total of 180 participants were selected using convenience sampling to be part of the quantitative study. In the second cycle of the study a qualitative design was used to explore mental health workers’ experiences of secondary traumatic stress. For this cycle 30 unstructured interviews were conducted. The third cycle aimed at developing the model to manage secondary traumatic stress. Action research approach was used in this phase. Experts from mental health services involved in the study were asked to participate in the study based on their availability as research team members. The fourth cycle of the study consisted of implementing the model in one mental health service and the fifth cycle consisted evaluation of the implementation of the model after six weeks period. The main aim of this cycle was an observation of the model implantation. Results: A diagrammatical model to manage secondary traumatic stress was developed by mental health professionals. In the model development cycle of the study, it emerged that there are very strong concurrence between the findings from experts in mental health care system and literature in terms of what needs to be included in the intervention model to manage secondary traumatic stress in mental health workers in Rwanda. The key elements to include in the model were based on preventive, evaluative and curative strategies to manage secondary traumatic stress in mental health workers in Rwanda. During the evaluation of the implementation, it emerged that participant noticed a change in coping strategies when facing the stressful incident in the practice. Recommendations: include an emphasis on more psychological support for mental health professional in their workplace and for more concrete aids such as supervision, guidelines on stress management on workplace, education on secondary traumatic stress management and implementation of counseling service for mental health workers. Conclusion: The model developed in the present study outlined different ways to manage STS at the individual, social and organizational levels. There is a need to translate the interventions to manage STS into active ongoing coping activities to be conducted at the individual, group and organizational levels. Organizational responses, such as creating a supportive organizational culture that acknowledges the potential for secondary traumatic stress, may help mental health workers to deal with workplace related secondary traumatic stress.
Evaluation of a protocol to control methicillin resistant staphylococcus aureus (MRSA) in a surgical cardiac intensive care unit.
(2008) Kindness, Karen.; Brysiewicz, Petra.
Introduction. MRSA is a major healthcare problem with particular relevance to morbidity and mortality in ICU (Byers & Decker 2008). Due to the increased infection risks associated with cardiac surgery, MRSA screening and surveillance is widely used as a standard preoperative Investigation In many settings (Teoh, Tsim & Yap, 2008). The results, in conjunction with appropriate hygiene precautions, are used to control and prevent infection with MRSA. Following an outbreak of MRSA in cardiac patients an MRSA protocol (MRSAP) was implemented In the cardiac intensive care unit in this study. Purpose. To evaluate how nurses implement the MRSAP in the surgical cardiac intensive care unit in this study, and to evaluate the change in MRSA infection rates following implementation of the MRSAP. From the results obtained, to identify any areas for improvement in nursing practice with respect to the MRSAP. Methods. Nursing staff knowledge with respect to the MRSAP was assessed using a survey questionnaire. Their compliance with required Infection control practice for control of MRSA was assessed through periods of observation on the unit. Screening compliance and reduction in infection rates were investigated using a retrospective records review. Results. The survey revealed good awareness of the MRSAP (88%, n=23), but knowledge of the detailed content was variable. Most staff were apparently satisfied with the existing standards of infection control in CICU (84.6%, n=22). Observation revealed that, compliance with routine hygiene measures was good (66% correct contacts, n=144) by the standard of other studies, but, given the high risk of postoperative infection for these patients improvements are required. Inadequate data in sampled records prevented meaningful analysis of screening compliance, and hence the systems for handling screening swabs and results need to be reviewed. The change in infection rates between the pre and post MRSAP periods, which incorporated use of infection risk stratification data to demonstrate comparability of the two groups of patients, revealed that despite the high MRSA infection rate in 2005 (1.18%), and subsequent drop post MRSAP (0.35%), the actual number of cases found was too small to test statistically for significant difference. An incidental finding was that female cardiac surgery patients were getting significantly younger (p<0.01). There was a significant decrease in hospital MRSA infection rates for matched periods (p<0.0001 ). Conclusions. Evidence was found to support the efficacy of the MRSAP in the reduction of MRSA infections. Deficits in staff knowledge and infection control practice were identified and feedback has been implemented in order to improve compliance with the MRSAP and maintain the improved infection rates. Further research with respect to implementation of, and compliance with, infection control measures could both improve quality of patient care and decrease the burden of preventable infectious disease such as health care associated infections (HAls) in South Africa.
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.
Exploring knowledge, attitudes and practices among undergraduate female students living in tertiary institution residences in KwaZulu-Natal with regards to the use of contraceptives.
(2015) Gopaul, Precelia.; Wentzel, Dorien Lesley.; Brysiewicz, Petra.
Background: Risky sexual behaviour is a significant part of an undergraduate student life, which can often result in unintended pregnancies, leading to major social and public health concerns. Despite the free availability of contraceptives at tertiary institutions in KwaZulu-Natal, the number of undergraduate students becoming pregnant continues to increase. Aim of the Study: To explore the knowledge, attitudes and practices among female undergraduate students in tertiary institution residences in KwaZulu-Natal with regards to contraceptive use. Method: A quantitative exploratory descriptive survey was conducted to explore the knowledge, attitude and practice among ninety-seven female undergraduate students living in campus residences in a tertiary institution in KwaZulu-Natal. The conceptual framework used for this study was the Health Belief Model, according to which healthrelated actions can be influenced positively by one’s knowledge, attitude and practice if one perceives the severity of a negative health condition. A hand-delivered, selfadministered questionnaire was used to collect data, containing 27 items divided into five sections, including the demographic profile of participants, and questions pertaining to knowledge, attitude and practice, as well as barriers /factors promoting contraceptive use. Data was entered and analysed using the SPSS version 23 package. Results: Among the participants, n=95 (97.9%) indicated that they were knowledgeable of the contraceptives methods, while n=89 (91.8%) participants indicated that contraceptives prevented pregnancies; yet, unintended pregnancies remain a major problem amongst university students. A majority of the students had a positive attitude towards contraceptive use, where n=75 (77.3%) of the participants indicated that contraceptive education should begin at puberty. Results indicated that a large percentage of the participants were not aware of some of the methods of contraception that are available to them, namely spermicidal: n=93 (95.9%); dermal patch n=82 (84.5%); natural family planning: n=78 (80.4%); and the intra-uterine device: n=76 (78.4%); which may be the reason for the low percentage of participants that practice these methods. It was found that n=3 (3.1%) of the participants practiced the spermicidal method; n= 2 (2.1%) the dermal patch; n=3 (3.1%) natural family planning and n=5 (5.2%) the intra-uterine device. The contraceptive participants practiced most with was condoms n=59 (60.8%), followed by injectable contraceptives n=34 (35%), and oral contraceptives n=14 (14.4%), respectively. A low percentage of the participants indicated that there were barriers to contraceptive use, where n=6 (6.2%) participants indicated that they do not know how close a reproductive health service is to them, n=18 (18.6%) indicated that they cannot easily access the family planning clinic at their campus and n=15 (15.5%) indicated that the clinic hours are not convenient for them. A majority of the participants n=80 (82.5%) indicated that the campus clinics promoted the use of contraceptives amongst students. The results in the current study indicated a high level of awareness of contraceptive methods, as shown in Table 5, p. 36, and a low percentage of practice of those very same contraceptive methods as shown in Table 8, p. 42. Conclusion: A majority of the students were knowledgeable about the convenient contraceptive methods, and have positive attitudes towards them, but practices with contraceptives remained inadequate, although participants indicated minimal barriers to reproductive health services. There is a need to further explore student-friendly methods to reach out to students to accept and practice contraception as part of their daily lives.
Exploring secondary traumatic stress experienced by nurses working in mental health service in Rwanda.
(2008) Iyamuremye, Jean Damascene.; Brysiewicz, Petra.
It has been suggested that a unique feature of some mental health nurses' work is exposure through their role as therapists to clients' descriptions of, and reactions to, trauma, and that these experiences may actually indirectly cause distress and traumatization to the nurse. This proposed phenomenon has been termed "secondary traumatic stress" and is the focus of the current study. Aim: The aim of this study was to explore secondary traumatic stress experienced by nurses working in mental health services in Rwanda. Methods: The research was conducted in Ndera Psychiatric Hospital. The questionnaire consisted of items of the Trauma Attachment Belief Scale (T ABS), demographic characteristics of participants, personal trauma history, work related aspects and support systems. A convenient sampling of 50 nurses who provide a mental health care to trauma survivors and mentally ill patients in the Ndera Psychiatric Hospital was adopted. Results: Results of the study indicate that there is belief disruption in the respondents. The mean scores of most of the respondents were high in all areas of cognitive believe. Of the respondents, 98% (n=49) had T -score of 80 for other-safety which was extremely high. The nurses identified the psychiatric nurses and a psychiatrist as their main support systems in dealing with secondary traumatic stress and generally believed in the usefulness of supervision. Conclusion: In summary, this study expanded on knowledge into the effects of secondary traumatization, particularly with concern to mental health clinicians, a population often ignored. This study was considered to be a contribution to trauma literature as it provides much needed empirical evidence.
Exploring the role of the intensive care nurse in the antimicrobial stewardship team at a private hospital, eThekwini, South Africa.
(2015) Rout, Joan Allison.; Brysiewicz, Petra.
Background: The care of the critically ill patient across the world has become progressively challenging with increasingly resistant pathogens resulting in difficult to treat infections. This is compounded by the decreasing effectiveness of many antibiotics. Severe infections increases the length of time spent in an ICU, increases morbidity and mortality, and increases healthcare costs. Antimicrobial stewardship (AS) has the aims of slowing resistance and the protection of patients and the wider community through the promotion of correct antimicrobial use by education and guidelines. Infection control measures are an essential part of AS in preventing emergent resistant pathogens and hospital-acquired infections. Research purpose: The identification of the role of the ICU nurse in an AS team in a private ICU in South Africa. Research approach: A qualitative approach was used in this study in order to obtain meaningful contributions that a questionnaire may not have been able to provide. Purposive sampling was used to identify participants from an ICU multidisciplinary AS team in a hospital in the private healthcare sector. Semi-structured interviews were conducted with fifteen participants; ICU clinical nurses, nursing management, surgeons, anaesthetists, physicians, microbiologists and pharmacists. Data were analysed and categorised using content analysis. Findings: Perspectives of the various members of the multidisciplinary AS team identified the role of the ICU nurse in an AS team as being organisational, advocatory, clinical and collaborative. Suggestions were made to further develop this nursing role by supporting proactive behaviour, teaching and learning, and teamwork. Concerns were raised about this role relating to resource barriers, knowledge deficit, poor attitude towards work, ineffective teamwork, working in isolation, and economic pressures. A limitation to this study is that it is a small study in a single setting, which may limit generalizability. Conclusion: The ICU nurse’s role in AS is essential for the successful implementation of an AS programme. Recommendations to develop this role are made for clinical practice, education, research and policy development.
Factors that facilitate adherence to haemodialysis therapy amongst patients with chronic renal failure.
(2004) Shabalala, Thandekile M.; Brysiewicz, Petra.; Bhengu, Busisiwe Rosemary.
A study was done to examine factors that facilitate adherence to haemodialysis therapy amongst patients with chronic renal failure and the sources of support available to them. A self developed questionnaire was used to collect data from the respondents. The respondents were purposive and conveniently selected according to the set criteria. The sample consisted of 118 respondents that were selected from four hospitals, two provincial hospitals and two private hospitals. Permission to conduct the study was requested by means of written letters to all people concerned. Letters granting permission were obtained from the two provincial hospitals. The Heads of the Renal Units of the two private hospitals gave verbal permission. Data was analyzed using the Statistical Package for the Social Sciences (SPSS 11.5). Demographic data was analysed through frequency counts. Crosstabulations using Chi-square analysis was performed to test the relationship between the factors that facilitate adherence to haemodialysis therapy and the indicators for adherence. The results were presented in the form of Tables and Figures (Graphs). From the findings the researcher concluded that in order for a haemodialysis patient to adhere to therapy restrictions, the following should be adequate: physical factors, socio-economic factors, psychosocial factors which also encompasses cultural factors. Health education proved to be having a very good impact. Higher level of education is not that essential as long as the patient can read, write and understand the instructions. Religious factors did not have much effect on facilitation of adherence to haemodialysis therapy.
Lived experiences of community empowerment programme workers participating in a community empowerment programme.
(2013) Horn, Juliana Deidre.; Brysiewicz, Petra.
Nongovernmental organizations (NGOs) and governmental organizations are united in their goal to develop and implement community empowerment programmes (CEPs). The researcher explored the lived experiences of HIV/AIDS Community Empowerment Programme Workers (CEPWs) participating in two CEPs in Ladysmith, Kwazulu-Natal, South Africa, a lower socio-economic area. The researcher further explored recommendations for the development of CEPs based on the lived experience of CEPW’s. Methodologically, data was explored using a qualitative hermeneutic phenomenological approach as described by the phenomenologist Van Manen (1990). The researcher found that the CEPW participants “gave themselves” by responding to a need with passionate engagement. The successes of the CEP motivated CEPWs to remain involved and encouraged community members to approach the CEPWs for support and assistance. Community ownership of the CEP; seeing results; careful selection of the volunteers; monitoring and evaluation was viewed as factors contributing to the sustainability of a CEP. Particular emphasis was put on care in selection of volunteers, and there was a range of opinion on the preferred characteristics of a CEPW. Factors mentioned were humility, a caring, disposition, sensitivity and courteousness, commitment to their community, trustworthiness, ability to maintain confidentiality and respect for culture. The ability to read and write English was also seen as an advantage. Recommendation flowing from the research were that communities must be involved in all aspects of the CEP. Health professionals must respect the community, and their value systems. Upskilling and resource management were cited as important empowering factors. Participants felt that CEPs must reduce dependency yet still explore governmental and NGO support. Participants had divided views on the contractual engagement of CEPWs. The participants emphasized the importance of financial and resource-management reports and accountability of supervisors and CEP directors. Health professionals and CEPWs alike need to acknowledge and be prepared to defer to the first-hand knowledge and experience of the community members they serve.
The lived experiences of patients admitted to an intensive care unit in a public hospital in Ugu District.
(2015) Tshokovu, Piliswa.; Brysiewicz, Petra.
Introduction: During their stay in the Intensive Care Unit (ICU) most patients experience a lack of privacy, sleep disturbances, noise, pain and stress. Patients need continuous close monitoring in ICU. Purpose: The purpose of this study was to describe the lived experiences of patients admitted to an intensive care unit in a public hospital in the Ugu District. Methodology: A phenomenological approach was used to describe the lived experiences of patients admitted to an ICU in a public hospital in Ugu District. Two unstructured interviews were conducted with each participant; an initial and a verifying interview, each lasting approximately 15-30 minutes. The researcher applied the principle of saturation and a total of 6 participants took part in this study. Findings: The findings showed that the participants had positive and negative recollections of their stay in the ICU. The experiences indicated that they viewed the ICU as a hostile environment which was not conducive to meeting their needs while they were admitted to the ICU. Many of the participants experienced bad dreams which is common in critically ill patients admitted to an ICU. The findings showed that the various religious and cultural beliefs of the patients came into conflict with the functioning of the ICU environment and that this caused anxiety in the participants. Although the participants found certain of the procedures painful, some reported that these had been helpful in providing relief, as they were able to breathe more easily after the removal of secretions. The findings showed that, at the time of their transfer out, participants were not given much information concerning their discharge from the ICU to the ward. Recommendations: A number of recommendations were proposed for the ICU staff, for education and for further research in an attempt to focus more on patients' experiences. Conclusion: This study allows the voices of the patients to be heard so that ICU staff can pay special attention.
Management of the long term psychological effects of rape among women survivors of the 1994 genocide in Rwanda : a grounded theory approach.
(2013) Mukamana, Donatilla.; Brysiewicz, Petra.; Collins, Anthony John Louis.
In the 1994 Rwandan genocide, rape was widely used as a strategic weapon against Tutsi women. This study explored the long term psychological effects of rape experienced by these women in order to develop a middle range theory to guide the management of the lasting psychological effects of rape in the context of genocide. A Grounded Theory approach using Strauss and Corbin’s paradigm (Strauss and Corbin, 1990) was used. Data collection entailed in-depth interviews of twenty nine participants, twelve of whom were rape survivors, ten were women who had not been raped, and seven were men from their community. Open coding, axial coding and selective coding were used to analyse the data. The results have shown that women were negatively affected, physically, psychologically and socially, by the rape. Genocide Rape Trauma emerged as a concept that defines these outcomes. It includes unbearable memories, overwhelming feelings, sense of helplessness, somatic distress, negative self-image, altered intimate relationships and social isolation. The extreme brutality, the humiliation that accompanied the experience of rape and multiple losses were reported as risk factors for the lasting psychological effects of rape. These negative outcomes were maintained by poverty, poor physical health, the burden of raising the children born of rape, hostility and stigma from their community, and lack of appropriate support and effective health care services. Facilitating the management of Genocide Rape Trauma emerged as the core category of the middle range developed theory. Recovery from Genocide Rape Trauma required formal and informal support, including psychological and medical care, sensitivity in dealing with genocide rape survivors, and advocacy. Economic empowerment was a key element, while educating the community contributed to the social integration of rape survivors and their children born of rape into their community. Women had developed coping mechanisms of their own to attain psychological relief, and had organized themselves into support groups. This study contributed to clinical practice by providing a holistic approach to taking care of rape survivors. The inclusion of such theory in the curriculum of health care professionals should contribute to the understanding of the lasting impact of rape and how to handle it in an efficient manner. Key words: Rwanda, Genocide, women survivors, Genocide Rape Trauma, Management of the long term psychological effects of rape and Grounded theory.
Promoting clinical scholarship in the clinical arena.
(2017) Almaze, Jean-Paul Bryan.; Emmamally, Waheeda.; Brysiewicz, Petra.
Background: Across healthcare, the importance of clinical scholarship has been increasing in the clinical arena. Applying clinical scholarship in daily nursing practice is vital. Aim: The aim of the study was to explore and describe clinical scholarship in order to develop recommendations to promote clinical scholarship in the clinical arena. Methodology: The study was conducted at a university in South Africa and adopted a sequential explanatory mixed-methods approach. Data collection was done in two phases. Phase One, the quantitative phase, focused on questionnaires involving eighty-one clinical specialist nursing students (CSNS). Phase Two focused on individual interviews with CSNS and clinical experts. Data saturation was reached after interviewing eight CSNS and four clinical experts. The interviews were analysed using latent-content analysis. Findings: Quantitative findings revealed that funding was the most common barrier to clinical scholarship. Re-examining criteria for promotion and reward all forms of scholarship was identified as preferred solutions to clinical scholarship. Qualitative findings revealed nine categories that of: academic excellence, importance of research to practice, scholarship overlooked, poor communication, resources, encouragement of scholarship activity scholarship culture, responsive teaching and attibutes in teaching clinical scholarship. These were further divided into subcatogories. Recommendation: In order to promote and develop CS, nurses should embrace a culture of CS as a fundamental principle in clinical practice. Further to that, the academic institution and clinical arena should support each other to promote nurses’ progress on the CS front, and resources should be made available to encourage nurses to pursue a CS track. Conclusion: The CSNSs and CEs are enthusiastic supporters of CS. Their support expressed a positive perspective towards clinical scholarship, where a synergy between academia and clinical management is needed to promote a CS culture.