Doctoral Degrees (Nursing)

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A social constructionist analysis of talk in episodes of psychiatric student nurse-psychiatric client community clinic based interaction.
(2007) Middleton, Lyn Elizabeth.; Uys, Leana Ria.
The study seeks to explore and to offer a critical account for the 'discursive doings' of student psychiatric nmsing practice as they are jointly constructed in the episodes of conversation between the nmse and client-speakers within the context of the communitybased psychiatric clinic. The study is built around a social constructionist framework and is concerned with the analysis of the discursive activities present within seven (7) transttibed, audio-recordings of student nurse-psychiatric client interactions. A thick and sometimes critical description of three of the contextual forces back grounding/foregrounding the discursive processes of psychiatric nursing is given. These include the public health psychiatric care context, the problem-solving approach of the undergraduate psychiatric nursing curriculum and the assumption and effects of modem psychiatric nursing theory. The first level of analysis is an aspect of the methodology and offers a descriptive and interpretive analysis of the talk in the texts. Various conversational discourse analytic tools were used here to transform talk into text and to develop the starting point for the subsequent positioning theory analysis. The second level of analysis is a positioning theory analysis of happenings within these texts. Some of the textual descriptions generated in the first level of analysis are used to illuminate and to add substance to the accounts of these positioning theory happenings. The analysis has shown that from a social constructionist positioning perspective, the unfolding nurse-client dialogue in these texts operates in four potentially distinct ways - highlighting, herding, hectoring and heeding - with specific effects for their going on together in conditions of relationship. These ways of talking are shown to be contrary to the person-eentered rhetoric of modem psychiatric nursing and more aligned with the bio-medical format of talk in helping contexts. Can these activities be dismissed as non-nursing activities? The implications for a modem psychiatric nursing theory that holds the person-centred approach to be its quintessential essence are considered and a number of ideas for how client-authorised expressions may be jointly manifest in conversations situated in this practice context are offered.
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.
The analysis of knowledge construction in community based service-learning programmes for basic nursing education at two selected nursing schools in South Africa.
(2011) Mthembu, Sindisiwe Zamandosi.; Mtshali, Ntombifikile Gloria.
Community based service-learning is one of the fastest growing reforms in higher education, especially in the field of health care. The increased interest in this phenomenon is based on the demands by government and society that higher education institutions should be more responsive to the needs of the community. Literature, however, reflects that service learning lacks a sound theoretical base to guide teaching and learning due to limited research in this area. This study was, therefore, aimed at exploring the phenomenon knowledge construction in basic nursing programmes in selected South African nursing schools with the intention to generate a middle range theory that may be used to guide the process of knowledge construction in community-based service-learning programmes. This study adopted a qualitative approach and a grounded theory research design by Strauss and Corbin. Two university-based schools of nursing were purposively selected to participate in the study. There were a total number of 16 participants. The collection of data was intensified by the use of multiple sources of data (participant observation, documents analysis and in-depth structured interviews). The data analysis process entailed three phases; open, axial and selective coding. The results of the study revealed that the phenomenon “knowledge construction” is conceptualised as having specific core characteristics, which include the use of authentic health-related problems, academic coaching through scaffolding, academic discourse-dialogue and communities of learners. The findings showed that there are a number of antecedent conditions and contextual circumstances contributing to how knowledge is constructed in a community based service learning programme. The process of knowledge construction emerged as cyclical in nature, with students, facilitators and community members having specific roles to play in the process. A number of intervening variables were identified that had an influence on the expected outcomes on knowledge construction in community based service learning programmes. These findings led to the generation of a conceptual model. Knowledge construction according to this model takes place in an environment which is characterised by interactive learning, collaborative learning, actively learning and inquiry-based learning through continuous reflective learning processes. The main concepts in this conceptual model include concrete learning experiences, continuous reflection, problem posing, problem analysis, knowledge deconstruction and knowledge generation, knowledge verification, knowledge generation, testing of generated knowledge and evaluation of generated knowledge. The sub-concepts include learning through senses, an initial situation, health-related triggers, social interaction, reflection-in action, reflection-on action, hypotheses generation, conceptualisation of learning experiences, information validation and community interventions. Recommendations were categorised into education and training of academic staff, application of the model and further research with regard to quality assurance in CBSL programmes as well as the use of other research designs for similar studies.
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 analysis of the current basic nursing education systems of francophone African countries of the World Health Organization Afro region.
(2001) Ganga-Limando, Richard Makombo.; Gwele, Nomthandazo S.
It is against the background of new developments and initiates taking place in various countries to make basic nursing education systems more responsive and relevant to the ever-changing nature of society that a cross-national study of the current systems of basic nursing education of francophone African countries of WHO Afro Region was undertaken. The aim of the study was to describe and analyze the current systems of basic nursing education in Francophone African countries of WHO Afro Region with 'a view to providing guidelines for change toward a basic nursing educatian system that is in line with the recommendations of WHO (1994, 1985, 1984, 1966) and the various countries' health care delivery systems' policies. In the first phase, data was generated by means of a self-completion mailed questionnaire, administered to the members of the national regulatory bodies of nursing and nursing education from eighteen countries. The design of the above named questionnaire was based on the WHO (1994, 1985, 1984, and 1966) recommendations pertaining to basic nursing education systems. The main results of the findings of this phase showed two major trends. Firstly, more differences than similarities existed between the WHO (1994, 1985, 1984, and 1966) recommendations and the current basic nursing education systems of the countries under study. Secondly, discrepancies existed between the various countries' health care delivery systems' policies and the existing systems of basic nursing education. Finally, all the respondents expressed the views that the current basic nursing education systems are faced with educational and organizational changes and they agreed that there is a need to change the current basic nursing education systems. In the second phase, data was generated by means of three rounds Delphi questionnaires, administered to the national members of the regulatory bodies of nursing and nursing education as well as the members of national nursing associations from eighteen countries. The design of the first round Delphi questionnaire was based on the results of the first phase of this study, while the preceding round informed the design of the questionnaire of the next round. The main results of the findings showed similarities between the future orientation of the basic nursing education systems and the recommendations of the WHO as well as the global trends in the development of the basic nursing education. The stakeholders expressed the view that the national governments, the National Associations of Nurses and the Regional Office of WHO Afro Region need to play an active role in the transformation and the development of the basic nursing education systems in the Region. They suggested that the systems of educating nurses should move toward meeting the demands of the health care services and the global trends in the development of nursing and nursing education.
An analysis of the influence of multilevel leadership on the effectiveness of provincial hospitals in the Kwazulu/Natal Province.
(1998) Mabaso, Mokgadi Susan.; Uys, Leana Ria.
The purpose of this study was to describe and identify the leadership style that prevails in health care institutions, in order to establish the influence of multilevelleadershipon the effeciveness of hospitals in KwaZulu-Natal. Hunt's extended multilevel leadership Model was used as a conceptual framework. Six institutions were selected by random sampling, categorised into three sizes i.e. large institutions with number of beds above 400, midddle sized between 200-400 and smaller institutions with a bed state below 200. Three categories of leaders were as top, middle and operational leadership. The 8 leaders included the chief medical superintendent, the hospital secretary, the chief nurse manager, two area nurse managers and the three operational nurse managers in each of the six institutions. A total of 48 MLQ instruments designed by Bass and Avolio (1989) focused on leadership style was used to identify transformational, transactional and nonleadership styles. 121 Questionnaires were distributed to staff and community to measure hospital effectiveness. Interviews were carried out on patients and visitors to establish patients' satisfaction. The effectiveness of health care services was described by goal attainment, level of support and system's achievement. The instruments to measure goal attainment and level of support were designed by the researcher. The 6 institutions were measured for system's achievement by using the instrument designed by Beattie, Rispel and Cabral (1995). The criteria used to assess infrastructure, access to the institution, management of personnel, management of resources, patient satisfaction, community outreach programmes and the process of care, was based on the criteria developed by Beattie, Rispel, and Cabral (1995). A correlation was done to establish the relationship between leadership style and hospital effectiveness. Findings; the area manager exhibited the leadership style that is predominantly Transformational, the other four categories identified in the study, revealed a leadership style that was predominently Transactional. Of the six institutions two revealed a transfomational leadership style and three revealed a transactional leadership style. One institution reflected a Laissez-Faire leadership style. The overall leadership style was transactional. On comparing the three effectiveness criteria goal attainment was identified as the most effective area of achievement followed by system's achievement and the least being level of support. A MANOVA multivarate analysis of variance revealed that the relationship between leadership style and goal attainment was not significant. The relationship between leadership style and level of support was significant. On further analysis using the Shetre test, it was found that the level of support was significantly related to transformational leadership. The relationship between leadership style and stystem's achievement was not established, because the sample size of six institutions was too small. The overall relationships between leadership style and hospital effectiveness was significant at p-< 0.01 level. Recommendations; included that all all categoties of leadership at institutions are to increase their diagnostic level of awareness of their leadership styles. Rigorous education and training on leadership and support were essential. A further recommendation was that the methodology used in this study to measure hospital effectiveness be used more widely as a management tool. A common instrument used to evaluate acceptable standards of health care assessment should be used to ensure comparison between and within institutions in KwaZulu- Natal There was a need for further research to establish the influence of leadership style on hospital effectiveness in order to ensure quality care by health care providers and to increase professional efficiency and effectiveness in the hospitals of KwaZulu-Natal.
An analysis of the utilisation of e-learning platform at a selected nursing school in Rwanda : a participatory action research study.
(2017) Harerimana, Alexis.; Mtshali, Ntombifikile Gloria.
Background: E-learning is a commonplace in nursing and healthcare professional education, and generally the importance of Information and Communication Technology (ICT) and the internet in tertiary education is recognised. The use of technology is a policy directive in Rwanda. Aim of the study: The aim of this study was two-fold, that is to: (i) Collaboratively analyse the utilisation of the e-learning platform in selected nursing school campuses at University of Rwanda (UR), in Rwanda; (ii) Develop a middle-range theory on the implementation of e-learning in selected nursing school campuses at UR, in Rwanda. Methods: Participatory Action Research, and convergence parallel mixed methods (quantitative and qualitative data) also known as concurrent triangulation design were used, where quantitative and qualitative data were collected simultaneously as recommended by Creswell and Clark (2007). Quantitative data was analysed using SPSS 23, and for qualitative data, the framework of grounded theory by Strauss and Corbin guided the analysis. Triangulation of results was done in chapter six of discussion of the results. Results: The quantitative findings of this study indicated that in e-learning, a blended mode was used and included 40% of face-to-face, and 60% of online teaching. ICT was reported to be pivotal in teaching and learning. Of 44 nurse educators, 95.5% reported using ICT applications to prepare presentations for lessons; 95.5% reported using ICT to provide feedback and/or assess students’ learning. Of 227 students, 96.9% used the internet to access full web-placed courses, and 93% for communication with their lecturers. Qualitative findings reflected E-learning as the core phenomenon of the investigation. E-learning was conceptualised as a mechanism to advance a political agenda, as a student-centred approach, as blended learning, and as a tool to open access to education for working nurses and midwives. The context of e-learning in nursing education is subjected to both internal and external influences in which education, health and technology originate. Data from this study indicated a number of intervening conditions which influenced the process of developing the middle range theory. There are two major processes involved in this model: Catalyst agents and hybrid teaching and learning. The catalyst agent process focuses on institutional support for students and teachers. The process of hybrid teaching and learning represents the actual facilitation of teaching and learning, through two phases: course development, and course delivery. The outcome of this is to improve the quality of nursing education, to fast-track production of the nursing workforce, to enhance nursing care and services, to enhance collaborative partnership, and to promote lifelong learning. Conclusion: E-learning is inspiring many in nursing education, and its success depends on adequate technology-based tools and guidelines that can be used in the establishment of a supported network learning space by using technology in teaching and learning. Keywords: blended learning, web-based learning, e-learning, distance learning, ICT in education.
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.
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.
The assessment of the aggregate health status of an organisation.
(1993) Grainger, Linda Denise.; Uys, Leana Ria.; Kortenbout, Wilhelmina Petronella.
As adults spend the major portion of their lives at work, it is essential that the reciprocal relationship between their work and health be recognised. In this regard, occupational nurses have an important function, through the provision of effective occupational health programmes in the workplace, although this is a challenging task and programmes often bear little relevance to health needs. The process of identifying health needs involves the measurement of health status, requiring a clear understanding of the nature of health and how it is determined. However, conceptualisations of health in relation to work tend to be inadequate as they deal with it on an individualistic basis, often as a negative measure, do not include the various dimensions of health, and fail to take account of the influences of the wider community. This study sets out to overcome these problems. A model of aggregate (collective) health in the workplace was developed from a conceptual framework, to expain how influences inter-relate and contribute to health in this setting. Health is conceived in positive terms, with the individual represented as the core, passing through the organisation and community, thereby depicting the interrelationships between their health. At the aggregate level four sets of factors, human biology, environment, lifestyle and health care organisation, are shown to influence health. The subjective, objective, physical, psychological and social dimensions of health are incorporated, whilst the potential of work as a stressor or health strengthening influence on health is recognised. Concepts from the model have been operationalised into composites of variables, for the assessment of aggregate health status. A measurement strategy was then devised, involving the analysis of data collected by means of an examination of organisational records, interviews with key people, a survey of a random stratified sample of members, health hazard identification in the workplace and an assessment of the provision of health care in the wider community. The survey instrument, consisting of an interview and questionnaire, was developed and subjected to a field test. The model, strategy and instrument were revised according to the results.
A comparative analysis of adolescent sexual and reproductive health programmes in two African countries : Ghana and South Africa.
(2007) Shepherd, Joan Hannah Elizabeth Estella.; Adejumo, Oluyinka.
Sex and sexuality issues are still sensitive and controversial subjects despite the growing numbers of sexual and reproductive health (SRH) programmes for adolescents in subSaharan African countries (WHO, 2002; Department ofInternational Development (DFID), 2004). The purpose of this study was to examine and analyze the structure and procedural mechanisms adopted by adolescent sexual and reproductive health (SRH) programmes in two African countries. This study also explored the adolescents' perceived usefulness and relevance of these programmes in addressing their SRH needs. The study was conducted in Ghana (West Africa) and South Africa (Southern Africa) as a cross-national study in these two sub-Saharan African countries. A comparative case study design was adopted involving the use of both quantitative and qualitative approaches to data collection and analysis. Snowballing, critical case, and purposive sampling methods were used. A wide range of personnel from both countries including programme directors, managers, nurse/midwives, peer educators and youth counselors (n=48) were interviewed within the context of adolescent sexual and reproductive health (ASRH) programmes and adolescents (n=247) participated through client exit surveys and focus group discussions. Records review, document analysis and observation of the facilities were employed through a checklist. A Tri-dimensional conceptual framework adapted from Donabedian (1980) and WHO (2001) for: (1) Structure, (2) Process, and (3) Output of ASRH programmes, guided the study and served as the frame for analysis and comparison. Qualitative data were transcribed and analyzed using framework analysis and quantitative data through use of SPSS Version 13.0. Findings of the study revealed that both Ghana and South Africa have established ASRH structures through development of programmes and policies for young people. They also shared common features related to programme focus and philosophy on ASRH matters. Both countries face several challenges associated with sexuality issues, inadequate human and material resources. Religious, socio-cultural, logistical and structural factors were identified as barriers, which hindered access and use of the facilities. These barriers were found to have a profound influence on programme implementation, achievement of objectives and future development. Adolescents in the two countries are confronted with a range of issues affecting their sexual health and general well-being for which they seek services from ASRH programmes. These programmes in both countries were generally perceived as relevant and important by youth utilizing the facilities. The need for changes in the attitude of service providers, structural layout, logistical improvement and staffing composition was expressed. Despite efforts made, there are still programmatic issues needing attention, for which specific recommendations towards improvement were made on the basis of findings from both countries. Findings from this study have implications for nursing practice, management, education, research and relevant stakeholders involved with adolescent health, including policy makers. Recommendations are made that may contribute to the development of an effective model of "Adolescent-Friendly" programmes in the two countries.
The conceptions of sexual relationships among the Yoruba people in Nigeria.
(2005) Irinoye, Omolola Oladunni.; Uys, Leana Ria.
The study explored the cultural dynamics of construction of sexual intercourse within gender constructions of masculinity and femininity among the Yoruba people of South western Nigeria. The Explanatory Model Interview Catalogue (EMIC/ETIC) framework, a cultural explanatory social analytic framework with guides to looking at the insiders' perspectives, was used as the theoretical base to the study. The study was conducted to broaden understanding of sexual relationships in order to generate culturally relevant programmes that can promote sexual health, control sexual coercion, sexual violence and reduce the transmission and spread of HIV. It explored information about the conceptions of sexual relationships, social dynamics of sexual negotiations in marital and non-marital relationships, the expressions and process of knowledge acquisition as such translates to sexual behaviour by men and women. The prevalence of consensus, coercive and forced sexual intercourse and sexual morbidity were determined. Perceived link of sexual coercion and sexual violence to HIV transmission was also explored. Traditional practices, including regulatory mechanisms for the control of sexual behaviour of men and women in the culture were also explored. Equally focused in the study were differences in the conceptions of sexual relationships among the study population as moderated by sex, age, educational background and marital status, along with experiences of sexual coercion, forced sex, and sexual intercourse related morbidity. Adopting the ethnographic method, qualitative data from historical review of existing information about the Yoruba people, focus group discussions, in-depth individual interviews and observations were complemented by quantitative data generated through a survey in a sample Yoruba community of lIe-Ife. Findings showed the conception of sexual relationships and sexual intercourse built around the conception and social constructions of active masculinity and passive femininity. Conceptions of sexual relationship evolved as a transitional phenomenon that individuals were expected to learn informally instinctually and as they attain sexual biological maturity through language use and observations of practices among older people. Two typologies of masculinity and femininity were discernible in the study population that also give specifications to social and sexual behaviour of men and women. There appeared a changing conception of femininity especially among young people below 30 years, which is also informing sexual behaviour of young women. Relationships were moderated by age, economic status and marriage, which invariably put women in subordinate position to men either in social or sexual relationships. Behaviour of men and women were dictated by social role assignment of leadership through economic provisions for family and control of sexual act by the man. This was within a contractual relationship of older men with younger women with the primary motive of procreation in traditional orientation. Sexual intercourse was seen as a compulsory act for both men and women especially as it results to procreation though the initiation and control were part of the social responsibility of the man. It was socially approved within marriage but pre-marital and extra marital relationships were tolerated more for men. The act was also used "as a prove of self", for economic gains, to demonstrate love, for enjoyment and as a tool of punishment of women by some men. Knowledge acquisition about sexual relationships and sexual intercourse tended to be inadequate throughout the life span. There was never a time when individuals, even after marriage, have access to correct information about sexual intercourse. There was gross assumption of what sexual partners know about sexual intercourse in the population. Within the context of 13 identifiable topical knowledge areas desirable for sexual health, more than 50% of males and females expressed lack of knowledge. There were significant differences in expressed knowledge by male and female respondents of what sexual intercourse is and the motives of sexual intercourse
The delivery of cultural care by health professionals among the hospitalized AmaXhosa male initiates of traditional circumcision in the Eastern Cape.
(2009) Ntsaba, Mohlomi Jafta.
Traditional male circumcision is a rite of passage among the AmaXhosa in South Africa. According to the custom of male traditional circumcision, initiates should remain in the bush for the entire seclusion period. The AmaXhosa male initiates encounter complications due to a ritual that has gone wrong. Common complications are penile sepsis, dehydration, penile amputations and septicaemia. As a last resort, when the AmaXhosa male initiates do not improve from complications associated with the custom they are referred to hospital for admission (Meintjes, 1998; Warren-Brown, 1998). The main purposes of this study were, first to explore and describe the delivery of care to the hospitalized AmaXhosa male initiates whilst in the hands of healthcare professionals and professional care system. Second, to describe what constitutes culturally appropriate care for hospitalized AmaXhosa male initiates. This study took place in three research sites, that included one rural hospital and two urban hospitals which admitted the AmaXhosa male initiates of traditional circumcision. A total of 13 hospitalized AmaXhosa male initiates and nine health professionals took part in this study. Leininger's ethnonursing qualitative research approach was used to guide this study. Data were collected, using purposive sampling, by means of unstructured interviews using guides, tape-recorder, and field notes. The study was first piloted at Umlamli Hospital using the same data collecting strategies as for the major study. Data from key and general informants were analysed separately using Leininger's (1991) four-phase method. This was carried out in order to answer the research questions and research purposes. Major themes and patterns emerged from this process.
Description and analysis of the process of implemetation of the national qualifications framework (NQF) in nursing education (NE) in South Africa.
(2001) Maqutu, Lucy Kathleen Nonkosi.; Uys, Leana Ria.
The intention of this study was to describe the implementation process of the NQF in nursing education at central and provincial levels in order to explore the change process. It deals with this process as follows: Implementation of NQF in nursing education.; Organizational health at central and provincial levels.; The change strategies used at these levels.; The implementation level reached. It is a qualitative study of an enthographic type to describe and document the implementation of the NQF as it occurred. The researcher who was part of the group that generated the culture of learning in nursing, directly participated in the activities and events as they occurred at this initial stage of implementation of the NQF. A discussion between the researcher and nurse educators took place on strategies used and whether they find the existing environment promoting changes. The research techniques used for gathering information were interviews and documents. With this information the researcher was able to reflect, make inferences and interpretations. The state of nursing education was described within the organizational self-renewal strategies described by Owens (1998). The description of the process of implementing the NQF was viewed against the change strategies as described by Bennis, Benne and Chin (1969), which are the empirical rational, normative re-educative and power coercive. The stage of implementation of the NQF in NE that has been achieved has been assessed using the NQF principles as a yardstick. The data collected is largely qualitative and its analysis has been qualitative. The categories of the theoretical framework which are inputs (organizational health); process (change theories); and outcomes (awareness, planning, use and refinement) of the NQF principles, have been used to analyze the data. The findings on organizational health reveal that nursing education is a healthy organization at both central and provincial levels. It has taken the opportunity presented by the NQF to address some of its organizational problems such as the Scope of Practice for nurses and midwives. There are, however, problems in making final decisions about the planned implementation of the NQF because of differences in vision about the future of nursing education. The movement of nursing education (NE) to higher education (HE) is hampering progress because the National Government is not implementing the Education Act No. 101 of 1997 which has moved NE to HE. Both the South African Nursing Council (SANC) and Natal College of Nursing (NCN) have no coherent human resources development policy. At both the central and provincial levels of NE normative re-educative strategies are ones that have been used extensively rather than power coercive strategies. Empirical rational strategies were also made use of to identify the advantages of the NQF policy and to incorporate them into the planned changes. There is full awareness and planning for the implementation of all the principles of the NQF. The principles of the NQF that are already in use and are being refined are integration of education and training, relevance, credibility and legitimacy.This is because they had already been in use in nursing education and practice before the inception of the NQF policy.
Developing a competence-based framework for theprovision of mental healthcare in patients with mental health problems and HIV in primary healthcare in Maseru, Lesotho.
(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. Purpose of the study 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. Methods 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 soft ware called Nvivo and thematic framework analysis. Findings 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 in this study 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. Conclusions and recommendations 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. There is a need to train health professionals about mental health services and also hire at least one psychiatric nurse in each primary health care. Competence-based frame work was therefore developed in this study to enable health professionals to provide mental health services in people presenting with mental health problems and Human immunodeficiency virus.
Developing an intervention model for data quality management and health information use at community and district levels in Rwanda
(2014) Ndabarora, Eleazar.; Uys, Leana Ria.
The purpose of this study was to develop an intervention model for health data quality management (DQM) and health information use at community and district levels in Rwanda and similar settings, based on a situation analysis of current practices and performance in Rwanda and existing evidence found in similar settings. This thesis is by publication and comprises three research papers based on the findings of three evaluation studies conducted, and reports on the study four which describes the model developed. Methods The study was initiated based on a systematic review of health DQM and best practices at community and district levels in low-and middle-income countries (LMIC). A retrospective design was used to evaluate the quality of clinical and community health data, and a survey of health information users was conducted. The mixed methods approach was adopted to collect quantitative and qualitative data, and the teamwork in “Group Model Building” (GMB) process through a workshop was used to develop the model.Findings Poor health DQM and health information use at community and District levels in Rwanda and other LMIC was found, particularly at the sources of data. Best practices were also found, but several issues hindering the quality of health data and utilization namely poor management of District Health Information System, lack of institutional support to all stakeholders involved in DQM, and lack of information culture. Variables that influenced the quality of health data and use included the training of the staff and community health workers (CHWs), regular formative supervision and monitoring and evaluation, involvement of all stakeholders, Data Quality Audit (DQA), feedback initiatives, understanding and perception of data usefulness, use of electronic and computerized systems, and proper leadership and coordination. Those variables were included in the model developed. Conclusion Based on the identified barriers to high quality data systems, an intervention model for health DQM and health information use at community and District levels in Rwanda was developed as the main achievement of this study.
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 and evaluating a community-based HIV/AIDS stigma reduction intervention in Ongenga constituency of Ohangwena Region, Namibia.
(2012) Angula, Penehafo.; Ncama, Busisiwe Purity.; Fröhlich, Janet Ann.
Background: Namibia has been affected by the HIV/AIDS pandemic with infected and affected persons experience stigma at different levels. As there were no local stigma reduction intervention tools, this study aimed to develop, implement and evaluate tools at different levels in a rural Namibian community. Methods: An intervention research with a quasi-experimental non-equivalent control group pre-and post-test sample plan was used, with both qualitative and quantitative approaches. Four groups of participants participated: People Living with HIV/AIDS (PLWHA), their family members, community leaders and health care workers (n=224). The LINMODEL community participation and Frohlich Model informed the participant selection, and the Diffusion of Innovations theory provided the framework for justifying the use of targeted intervention tools in specific groups. Seven communities and a clinic were divided into the control (n=107) and intervention (n=117) arms. The study consisted of pre- and post-intervention questionnaires for both arms, intervention training workshops for the PLWHA and community leaders, and in-depth interviews for the community and opinion leaders. The post-intervention results showed that stigma decreased significantly in social isolation (p=0.017), workplace stigma (p=0.008) and negative self perception (p=0.006) in the PLWHA intervention arm. Verbal abuse (p=0.07) has slightly decreased but there was no statistically significant difference between the two study arms. Fear of contagion (p=0.12) has slightly increased after intervention in both arms. All mean scores (PLWHA) for the control arm increased significantly after the intervention. Regarding the family and vii community leaders results, only the household stigma score (p=0.01) decreased significantly in the intervention arm. Health care workers reported increased stigma after intervention, stigma against PLWHA (p=0.04) and associated stigma towards health care providers (p=0.005). Discussion: A comparison of the results in both arms indicated that the intervention was effective in reducing stigma in the intervention arm in three groups (group 4 excluded) with varying degrees of success. Stigma scores were significantly decreased in PLWHA from the intervention arm. The intervention was effective although it did not decrease all stigma scores significantly. This may require more time for the issues addressed in the intervention workshops to diffuse through the different groups.
Developing, testing and refining of a model for implementation of HIV/AIDS self-management education in a semi-rural area in KwaZulu-Natal, South Africa.
(2011) Omisakin, Folorunso Dipo.; Ncama, Busisiwe Purity.
The purpose of this study was to develop, test and refine a model for implementation of self-management education for people living with HIV/AIDS (PLWHA) in semi-rural KwaZulu-Natal, South Africa. The study consists of a purposive sample of 88 men and women over 18 years of age living with HIV/AIDS. A Quasi-experimental design, incorporating pre-test and post-test interventions and comparison groups, was used. These groups, equal in number and matched in other respects at baseline in terms of the recruitment criteria used, were designated Group A and Group B. Group A received seven weeks of intensive self-management education; Group B received only traditional health education. Group B, however, received (and its members were informed that they would do so) self-management education immediately after my intervention had concluded. Arrangements were made to prevent the two groups from interacting, or even meeting. A conceptual model derived from the relevant literature on self management, and in particular on the teaching of self management to PLWHA, was tested using data from participants’ health-related quality of life, CD4 counts, and viral loads before and after the self-management education intervention. Testing comprised an investigation into whether or not the outcomes included in the model adequately reflected those reported in the literature on effective self-management education, and also whether or not the predicted relationships between intervention and those outcomes existed in practice. A priori assessment produced data for preparation and development of the new intervention devised by the researcher. The assessment process involved the collection of data on participants’ perceptions of health, their difficulties of living with HIV/AIDS, self-management education needs; preferred methods of learning and perceived barriers to participation in this self-management education programme. Participants’ health-related quality of life was measured at baseline and at the twenty-fourth week, using an SF-36 questionnaire. Data on participants’ CD4 cell counts and viral loads were obtained from the clinic records at baseline and in the twenty-fourth week; comparisons were made for sample means using the data available on all participants in both groups. In-depth group interviews were conducted for systematic sampling of the intervention group after intervention to substantiate the effectiveness of the intervention. Results indicated a significant trend toward improvement in health-related quality of life. The indepth group interview results demonstrated that participants showed improvement in their health status through the acquisition of self-management skills, health practices, and communication with healthcare providers. Post-intervention results showed that the two groups were statistically significantly different in terms of their mean scores on physical functioning (t=3.900; df=79; p<0.0001 < 0.05), vitality (t=3.285; df=79; p=0.002< 0.05) and general health (t=2.107; df=79; p=0.039 < 0.05), physical health (p=0.001< 0.05) and role limitation due to emotional problems (p=0.007 < 0.05). No statistically significant difference appeared in terms of their mean scores on mental health (t=1.422; df=79; p=.158 > 0.05), bodily pain (t=-.138; df=79; p=0.891> 0.05) and social functioning (p=0.249 > 0.05). Post-intervention, the two groups are statistically different in terms of their CD4 count mean scores (t=3.741; df=80; p<.0001 <0.05). The mean CD4 cell counts increased over the period of investigation; paired t-tests for difference between intervention and comparison groups were statistically significant (p < 0.05) for these variables. However, the differences between the two groups in terms of their viral load were not statistically significant. This may be the result of the fact that as researcher, I had no influence over the process by which viral load data were obtained: both at baseline and after the intervention, they were retrieved from patients’ records, in which viral load was expressed, for example, as ‘below 25 copies per mil’. This was of course an approximation; after the intervention, they were expressed similarly as ‘below detectable limits’, or ‘below 80 copies per mil.’ My conceptual model provides a consistent, reproducible approach to assessment, monitoring, and evaluation of the key components of self-management education and allows for measurement over time and the tracking of changes; it has in addition a predictive ability. Overall, the programme seemed to have a positive impact on the health-related quality of life of PLWHA. The study confirms the effectiveness of self-management education in improving the health and well-being of PLWHA, even in a resource-limited semi-rural setting.
Development and implementation of a staff development plan for nurses in one district in Zambia based on a learning organization approach.
(2006) Libetwa, Miriam Chilembwe.; Adejumo, Oluyinka.
This study explored the existing planning systems that nurse managers in health institutions in the Lusaka district in Zambia used to plan staff development activities, with a view to developing a model suitable for a staff development plan for all nurses in Zambia. The learning organization and transformational learning theory frameworks were used to guide the study. The learning organization framework was based on Senge (1990), The Fifth Discipline, which addressed five components, namely, systems thinking, personal mastery, mental models, building shared vision and team learning. The transformational learning theory framework was based on (Gravette 2000), which addressed the reflective and constructive processes that employees go through during their learning. A survey and action research methods were used to explore the planning systems which nursing managers in the Lusaka district used to plan staff development activities. The total population of nurses designated as nursing managers, registered nurses and enrolled nurses working in the central hospital (734 nurses), in the specialized hospital (128 nurses), and in 31 health centres (980 nurses) in the Lusaka district constituted the target population. Systematic sampling was used to select a total of 614 participants; only 368 nurses returned completely filled questionnaires. A staff development tool jointly developed with the participants also served as a means of generating data for the study. The quantitative data were analyzed according to the Statistical Package of Social Sciences (SPSS) 11.5 version, using frequencies and percentage distributions. Framework analysis was used to analyze the collected qualitative data. The major findings of the study revealed that nursing staff in the urban district of Lusaka were not using systematic methods based on any known approach in planning staff development activities. Using a learning organization framework, a model of staff development was jointly developed with the participants, as well as a checklist for assessing staff when utilizing the model in a Zambian setting. The study concluded that the developed learning organization model was capable of facilitating the development of culture of lifelong learning among nurses and midwives in Zambia.

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