Doctoral Degrees (Nursing)

Permanent URI for this collectionhttps://hdl.handle.net/10413/6964

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AN Analysis of nonverbal communication between nurses and hospitalised older adults in selected hospitalsi in Cameroon.
(2023) Keutchafo, Esther Lydie Wanko.; Kerr, Jane.
Background: Nurse-patient communication has been recognised as one of the most important aspects of successful patient outcomes. In relation to older adults, whose numbers are growing worldwide, nurses’ communication with older adults is essential because older adults will seek medical assistance more than before. Since most rely on nonverbal communication because of hearing deficits, and changes in attention and coding of information – all restrictions in interaction and effective verbal communication – nurses’ nonverbal communication will be a vital skill to develop good nurse-older patient relationships. In a context where there are no long-term care settings, nurses will be required to achieve effective nonverbal communication when older adults are admitted to the wards. Aim: This study aimed at analysing nonverbal communication between nurses and hospitalised older adults in selected hospitals in Cameroon, to develop a model for effective nonverbal communication between nurses and older adults. Methods: A mixed-methods approach was used in this study. A total of 372 participants were included through overt, theoretical, and convenience sampling. To collect the qualitative data through participant observations and individual interviews, twenty-seven (27) nurses were observed, of which 13 nurses were interviewed, and 29 older adults were observed, of which eight (8) were interviewed. In addition, 316 nursing students participated in the survey. Qualitative data analysis was composed of open coding, axial coding, and selective coding, which were intertwined as the researcher moved back and forth between data collection and data analysis. Additionally, comparative analysis, theoretical sensitivity, and memos were used during the process of analysing the qualitative data. Quantitative data were analysed using SPPS version 25, where descriptive and inferential analyses were run. Additionally, an explanatory factor analysis based on the principal component analysis method with varimax rotation was conducted, to determine the common factors that explain the order and structure among measured variables. Results: Firstly, the results showed that there was limited evidence of studies on nonverbal communication between nurses and cognitively intact hospitalised older adults in clinical settings. Secondly, the results showed that hospitalised older adults made both positive and negative interpretations of nurses’ nonverbal communication. They also had specific nonverbal communication needs. Thirdly, the results showed that nurses mainly used haptics, kinesics, and proxemics to communicate nonverbally with hospitalised older adults to build relationships with them, convey affection, reassure them, and support verbal communication. Further, the results showed that nursing students held slightly positive attitudes towards older adults; yet, the tool used to assess their attitudes showed moderate psychometric properties and two factor loadings. Finally, the results showed that the proposed model for effective nonverbal communication with hospitalised older adults, which emerged from the data, encompassed all six categories of Strauss and Corbin’s framework, which are: causal conditions, contextual conditions, core phenomenon, action/interaction strategies, intervening conditions and expected outcomes. Conclusions: This study revealed that nurses mainly use few nonverbal communication techniques to communicate with hospitalised older adults, which cannot achieve effective communication, vital in nurse-patient relationships. The proposed model provides a guide for effective nonverbal communication with older adults and acknowledges that older adults’ interpretations and needs of nonverbal communication, as well as attitudes towards them, all influence effective nonverbal communication with hospitalised older adults. It is hoped that nurses will consider these to improve their nonverbal communication with hospitalised older adults for better patient outcomes such as: patient satisfaction, shorter lengths of stay in hospitals and improved quality of care.
Analysing the implementation of patient safety incident reporting and learning guidelines in specialised care units, in the selected hospitals in KwaZulu-Natal, South Africa.
(2023) Mathe, Thusile Mabel Hycinth.; Mkhize, Sipho Wellington.
Background: Despite the implementation of patient safety strategies, patient safety incidents (PSIs) in specialised care units (SCUs) remain high and are of serious concern worldwide, including in South Africa. Implementing Patient Safety Incident Reporting and Learning (PSIRL) Guidelines is critical in guiding clinical practice and improving clinical outcomes in SCUs. There is limited research on evidence of the implemented PSIRL Guidelines in SCUs at the global level. Aim: To analyse the implementation of the PSIRL Guidelines in SCUs and to develop a strategy for the effective implementation of the PSIRL Guidelines in selected hospitals in KwaZulu-Natal, South Africa. Methods: A convergent parallel mixed methods or embedded strategy was used to collect quantitative and qualitative data. A descriptive, non-experimental, cross-sectional survey was used to collect the quantitative data via online questionnaires from March 2021 to May 2021. A purposive sample targeted 237 healthcare professionals. Furthermore, a descriptive, explorative, qualitative approach was used to collect qualitative data from senior healthcare professionals through focus groups and individual interviews, for in-depth information, from August 2021 to October 2021. Content data analysis was performed using Tesch’s method of analysis process. The quantitative and qualitative data were analysed separately and then converged to provide a comprehensive analysis of the research problem. Results: For a quantitative study, a total of 181 questionnaires were returned, yielding a response rate of 76%. Notably, 83% of respondents had high-perceived knowledge of the PSIRL Guidelines, while 98% had low perceptions of the implementation. For the qualitative study, the main themes that emerged during data analysis were ineffective reporting systems affecting the communication of PSI guidelines, inadequate institutional management for the healthcare professionals, insufficient education and training of healthcare professionals and poor human resources affecting the implementation of PSI guidelines. The findings highlighted that there were more major barriers to the implementation of the PSIRL Guidelines. Conclusion: For the quantitative study, the respondents demonstrated good perceptions of knowledge of the PSIRL Guidelines; however, the perception of the implementation was poor. The qualitative study confirmed that the PSIRL Guidelines are still not successfully implemented in the SCUs and the barriers to implementation were highlighted. For rigorous implementation in South Africa, the study recommends revised PSIRL Guidelines, designed in consultation with the frontline healthcare professionals, consisting of standardised, simple -user-friendly reporting processes as well as an implementation strategy to guide the healthcare professionals.
Analyzing and strengthening the clinical support of undergraduate midwifery students and developing a mentorship training program at a higher education institution in KwaZulu-Natal, South Africa: a mixed method and action research design.
(2022) Amod, Hafaza Bibi.; Mkhize, Sipho Wellington.
The competence of midwifery students is highly dependent on the quality of clinical support they receive during clinical placement. Offering support and training to midwifery practitioners, who supervise students during placement, is necessary in South Africa. This study aimed to analyze and strengthen the clinical support of undergraduate midwifery students, and develop a mentorship-training program. This study adopted a mixed-method and action research approach incorporating a descriptive and exploratory design. A convenient and purposive sampling technique, multiple research tools (systematic scoping review protocol, questionnaires, interviews and focus groups), and three different study populations (60 midwifery students, 28 practitioners and 10 educators) complimented the aim of conducting a mixed-methods study. Data collection commenced for Cycle 1 in May 2019 and concluded with Cycle 4 in April 2022. Quantitative data was inserted into SPSS version 27 for descriptive and comparative analysis whilst qualitative data used a thematic content analysis approach. Cycle 1 results highlighted that 93% of students had support from midwifery practitioners and found that the clinical placement benefitted their learning outcomes. Although students received three types of clinical support, namely clinical supervision, mentorship and preceptorship, 80% of clinical support was clinical supervision. Postclinical placement, students were incompetent in 11.4% of their clinical requirements. In Cycle 2, a two-round Delphi method evaluated the quality of a mentorship-training program using midwifery experts in round 1 and midwifery practitioners in round 2. There was an overall quality score achieved of 81% round 1 and 96% in round 2. In Cycle 3, three themes emanated from the focus group discussions. Mentorship training was a new phenomenon, empowered mentorship abilities, and an investment toward midwifery leadership. Interview results showed that the mentorship training program was a new, well-structured and valuable program; a refresher course for midwifery clinical practitioners and educators, adequate to support midwifery practitioners in their mentorship roles and responsibilities, and produced recommendations for midwifery practice and education. Mentorship during clinical placement is likely to strengthen the clinical support of midwifery students. A mentorship training program for midwifery practitioners developed in this study is valuable to midwifery educators and practitioners in South Africa.
Developing a competence-based framework for theprovision of mental healthcare in patients with mental health problems and HIV in primary healthcare in Maseru, Lesotho = Ukuthuthukisa uhlaka olususelwa ekukwazini ukuhlinzekela iziguli ezigula ngokomqondo eziphinde zibe negciwane le-HIV ezelashwa ngonakekelo oluphezulu eMaseru, eLesotho.
(2023) Posholi, Malerotholi Thabida.; Ngcobo, Winnie Baphumelele.
In 2017 there were approximately 792 million people with mental health problems globally. mental health problems are increasing rapidly globally but mental health services are lacking. Approximately 80% of people living with Human immunodeficiency virus have mental health problems yet these disorders have been absent from the global health agenda. Around 90% of people who require MHS do not obtain them in Low and middle-income countries. The aim of the study was to develop a competence-based framework for mental health provision in people living with Human immunodeficiency virus in primary Health Care in Lesotho. A mixed method study was used. In total, 88 questionnaires were returned by the respondents and 50 interviews were conducted. The findings from the quantitative and qualitative study were supportive and used to develop a competence-based framework that would facilitate the provision of mental health services for people presenting with mental health problems and Human immunodeficiency virus in primary health care. The quantitative data was analysed using an appropriate software package, in this case SPSS version 26. Qualitative data was analysed using the software called Nvivo and thematic framework analysis. 92 % of the participants needed competence-based frame work to enable them to successfully manage mental health problems in people presenting with mental health problems and Human immunodeficiency virus however the majority (69.7%) of the participants had inadequate knowledge regarding mental health. Competence-based frame work was developed to enable health professional to successfully manage people with mental health problems and Human immunodeficiency virus. Currently, mental health services are lacking in primary health cares in Lesotho. There was lack of knowledge regarding mental health in health professionals, mental health was also not an in-country priority as the professionals are taught about mental health in colleges, but do not practice it in their professional work. Availability of competence-based framework was seen as a great need by health professionals to manage mental health problems. Many studies emphasized the need to integrate mental health services with Human immunodeficiency virus services as they are related. However, in Lesotho it was still a serious problem during the time of the study. Iqoqa. Enyakeni wezi-2017 kwakunabantu abacishe babe yizigidi ezingama-792 abanenkinga yokugula ngokomqondo emhlabeni jikelele. Izinkinga zokugula ngokomqondo zikhula ngesivinini esikhulu emhlabeni jikelele kodwa izindawo zokwelapha ukugula ngokomqondo azanele. Cishe abantu abangama-80% abaphila negciwane lesandulela ngculazi banezinkinga zokugula ngokomqondo nakuba lezi zifo kade zingekho ohlelweni lwezempilo yomhlaba. Abantu abacishe babe ama-90% abadinga i-MHS abayitholi emazweni anengenisomali eliphansi nelimaphakathi. Inhloso yocwaningo wukuphucula uhlaka olugxiliswe ekukwazini ukuhlinzekela impilo yangokomqondo kubantu abaphila negciwane lesandulela ngculazi kweZempilo ezihamba Phambili eLesotho. Kusetshenziswe indlelakwenza engxube. Sekukonke, izinhlumibuzo ezingama-88 ezabuyiswa ababephendula nezimposamibuzo ezingama-50 zenziwa. Okutholakele ocwaningweni lwekhwantithethivu nowekhwalithethivu kweseka kwaphinda kwasetshenziselwa ukuthuthukisa uhlaka olugxile ekukwazini, okuzokwenza kwenzeke ukuhlinzeka izinsiza zokugula ngokomqondo kubantu abanezinkinga zokugula ngokomqondo kanye negciwane lesandulela ngculazi abasonakekelweni oluphambili. Imininingo yekhwantithethivu yacutshungulwa kusetshenziswa iphakheji yesofthiwe eyiyo, okuyi-SPSS uhlobo 26. Imininingo yekhwalithethivu yahluzwa kusetshenziswa uhlelokusebenza olubizwa nge-Nvivo nokuhluza uhlaka lwezindikimba. Ama-92 % ababambiqhaza babedinga uhlaka olugxiliswe ekukwazini ukuze bakwazi ukulawula ngempumelelo izinkinga zokugula ngokomqondo kubantu ababonakala benezinkinga ngokomqondo kanye negciwane lesandulelangculazi kodwa iningi (69.7%) lababambiqhaza banolwazi olungenele olumayelana nempilo yokomqondo. Uhlaka olugxile ekukwazini lwathuthukiswa ukusiza abasebenzi bezempilo ukuba balawule ngempumelelo abantu abanenkinga yokugula ngokomqondo nabanegciwane lesandulelangculazi. Njengamanje, izinsizakusebenza zempilo yokomqondo ezindaweni zokunakekela eziphambili eLesotho zisaswelekile. Kunokuntuleka kolwazi olumayelana nempilo yokomqondo ezisebenzini zezempilo, impilo yokomqondo yayingeyona into ephambili ezweni njengoba izisebenzi bezifundiswa ngezempilo yokomqondo emakolishi, kodwa zingasebenzi ngalokho emsebenzini wabo wansuku zonke. Ukuba khona kohlaka olugxiliswe ekukwazini kwabonakala kuyisidingo esikhulu kubasebenzi bezempilo ukulawula izinkinga zokugula ngokomqondo. Ucwaningo oluningi lugcizelele isidingo sokudidiyela imisebenzi yokwelapha ukugula ngokomqondo nezinsizakusebenza zokwelapha igciwane lesandulela ngculazi njengoba kuhlobene. Kodwa, eLesotho bekuseyinkinga enkulu lokhu ngesikhathi sokwenziwa kocwaningo.

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