School of Nursing & Public Health

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A description of midwives’ perceived roles in health educating pregnant women at primary healthcare clinics in a Sub-District of eThekwini, KwaZulu-Natal, South Africa.
(2020) Ramnund , Sanveer.; Baloyi , Olivia Baorapetse.; Jarvis , Mary Ann.
Introduction and background Antenatal care (ANC), the care preceding birth, is described as a careful, systematic assessment and follow up of pregnant women through their pregnancy, culminating in the delivery of the foetus (Al-Ateeq and Al-Rusaiess, 2015). Health education has shown it can result in better pregnancy outcomes (Al-Ateeq et al., 2015). ANC health education is frequently conducted in PHC clinics by midwives (Phillips, 2014; Susuman, 2015), but with the advent of mHealth, it is not confined to the PHC setting (Skinner et al., 2018; Susuman, 2015). Aim/Purpose The aim of the study was to describe midwives’ perceived roles in maternal health education and their acceptance of mHealth in health educating pregnant women during and between antenatal visits at Primary Healthcare clinics in a sub-district of EThekwini, KwaZulu-Natal, South Africa. Methodology A quantitative approach was used, with an explorative and descriptive design, framed within a merged model of Donnabedian’s quality framework and the Unified Theory of User Acceptance of Technology (UTAUT) model. Purposive sampling selected a sub-district of eThekwini, and the participating midwives and unit managers. Data collection occurred over three and a half weeks, in February 2020, using a self-administered questionnaire with the midwives and a researcher-developed survey of the health education landscape with the unit managers. The four-part questionnaire included two validated scales to measure health education (Aldossary et al., 2013) and mhealth (Yakubu et al., 2019). Findings were grouped according to the sections of the questionnaire, namely Section A: Demographics, Section B: Roles and perception of health education, Section C: Acceptance of technology and mHealth in the PHC clinic and Section D: Actual health education conducted. Data was entered into IBM SPSS version 24, and descriptive and inferential statistics calculated. All ethical considerations were adhered to. Results Response rate was 88.5% (n= 92) for the completion of the self-administered questionnaire and 16 surveys of the health education landscape of the PHC clinics The mean age of the respondents was 39 years, with the majority of midwives being female (87%). Responsibility of midwives (m= 18.17/24 [CI95% 17.68-18.67]) was the highest of the subscales, emphasising the important role that midwives play in health education towards pregnant women. Performance Expectancy (m= 16.61/20 [CI95% 15.92 – 17.29]) was the highest of the mHealth subscales. Significant differences were found in the midwives >50 years of age for responsibilities of midwives, and in the male midwives for responsibilities of midwives and perceptions of patient’s responses to health education and midwives perceptions of their role in delivery of health education. During the survey of the health education landscape in the PHC clinics (n=16), the midwives mainly focused on ANC care with 730 sessions conducted in PHC clinics, but less mHealth registrations (n=22, 23.9%). Maternity health policies were available in all clinics (n=16), but just over half (n=10; 62.5%) were able to provide policies on mHealth. Conclusion The study identified both structure and process related information in its description of midwives’ perceived roles in maternal health education and their acceptance of mHealth in health educating pregnant women during and between antenatal visits. Structurally, mHealth polices need greater visibility in the clinics and increased facilitating conditions, such as support for the midwives for mHealth. In particular, midwives older than 50 years and male midwives could add further resistance to the seamless implementation of health education, when utilising both digital and face-to-face approaches. However, from the process perspective of quality care, the midwives showed positive perceptions towards both their roles and responsibility in health education, with high Performance Expectancies of a mHealth application to deliver maternal health education. The level of Performance Expectancy can be drawn on in the COVID-19 pandemic, to ensure continued maternal and neonatal health, despite constraints brought about by social distancing and thereby mitigate against increased maternal mortality rates. Recommendations Studies to identify mitigating circumstances and barriers towards mHealth applications as well as further investigation towards male midwives perceptions of their roles, and responsibilities towards maternal health education. Limitations The use of one district resulted in a small number of clinics and respondents. During this study the Chronbach α scores of the highest subscale ‘responsibilities of midwives’ was low (α= 0.37), thereby affecting the generalisability of that subscale to the population of studies.
A descriptive survey of nurses` attitudes regarding family importance in nursing care in four selected emergency departments in eThekwini district.
(2022) Ngiba, Ntombifuthi Jennet.; Brysiewicz , Petra.; Oyegbile, Yemisi Okikiade.
Introduction: Family members have been found to provide valuable support in the emergency department where patients are critically ill and dependent on their loved ones (family) for decision-making and to communicate their wishes to healthcare workers. Literature documents reactions and responses of nurses to the presence of families, which appears to question their relevance in the emergency department. Purpose: This study described the attitude of nurses regarding family importance in nursing care in the emergency departments at four hospitals, in eThekwini district, KwaZulu-Natal. Methodology: This study adopts a quantitative, non-experimental, descriptive design and utilised the Families Importance in Nursing Care Nurses` Attitude (FINC-NA) questionnaire to obtain responses. The FINC-NA consists of 26 question items, and four subscales measured on a five-point Likert scale. Purposive sampling was used to collect data from 137 enrolled nurses and professional nurses working at the emergency department in one tertiary and three regional hospitals. Descriptive and inferential statistics were used to analyse the data. Results: These revealed that enrolled nurses and professional nurses demonstrated supportive attitude towards families and recognised their importance in providing nursing care. The results shows that there are significant associations between the three sub-scales measured in the study. Although the family as a resource in nursing care (Fam-RNC) score was lower for nurses less than 40 years of age, p= 0.038; family as a burden (Fam-B) score was high for nurse managers and this corresponds with supportive attitude, p= 0.029; family as own resource (Fam-OR) scores were low for nurses with less than five years of working experience in the emergency department, p=0.03. Conclusion: The study revealed that nurses generally have positive attitude towards family importance in the emergency department. However, elderly nurses and nurse managers appear to demonstrate supportive attitude to family members. These findings have significant implications for nurses to see family members as resources rather than perceived as burdens. Nurse managers should train and support nurses to demonstrate positive attitude towards family members in the emergency department.
A prospective study of the value of the oesophageal electrocardiogram in the differentiation of wide complex tachycardias.
(1990) Moodley, Rajendran.; Sewdarsen, Mohan.
The accurate differentiation of a ventricular from a supraventricular origin of a wide QRS tachycardia (QRS > 120 milliseconds) is an important clinical problem. Misdiagnosis of this arrhythmia can lead to institution of inappropriate drug therapy acutely with potentially catastrophic consequences. Various diagnostic aids have been used to obtain electrocardiographic potentials to aid in the differentiation. This report assesses the clinical usefulness of oesophageal electrocardiography in the differentiation of wide complex tachycardias and describes a simple, safe technique to obtain oesophageal electrocardiograms. Eighteen consecutive patients between the ages of 27 and 71 years who were haemodynamically stable were selected for this study. The technique was performed in the following manner: A temporary pacing catheter was lubricated and passed nasally and advanced with the patient being instructed to swallow. Adjustments in catheter depth were made as necessary to obtain an optimal recording on a standard electrocardiograph recorder. Satisfactory placement with minimal patient discomfort was achieved within 6.5 minutes (average 4.5 minutes) in all cases. High quality tracings were obtained in every instance. In the 18 patients with tachyarrhythmia, AV dissociation consistent with ventricular tachycardia was demonstrated in 11 instances; in the remainder the diagnosis was supraventricular tachycardia. Of the 11 patients diagnosed as ventricular tachycardia, 9 were initially misdiagnosed as supraventricular tachycardia, whilst only 1 of 7 patients with supraventricular tachycardia was misdiagnosed. This study has demonstrated that oesophageal electrocardiography is useful in the differentiation of wide complex tachycardias. The technique outlined in this report is simple and offers the following advantages: the temporary pacing catheter is associated with minimal discomfort; the catheter allows easy manoeuverability within the oesophagus which allows proper depth to be easily obtained; the equipment used is routinely available. Therefore the technique offers a rapid, safe and simple method of obtaining an oesophageal electrocardiogram which is invaluable in the electrocardiographic differentiation of a wide complex tachycardia.
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.
Acceptability and effectiveness of rapid ART initiation: patients’ and healthcare workers’ perspectives.
(2022) Govere, Sabina May.; Chimbari, Moses John.
The Joint United Nations Programme on HIV/AIDS is leading the global effort to end AIDS as a public health threat by 2030. In achieving these goals, emphasis has been on the 95–95–95 targets that by 2030, 95% of people living with HIV know their HIV status. However, the focus is on achieving the second 95 and third 95; having 95% of people diagnosed with HIV initiating on treatment within the expected timeframe and 95% of those on treatment obtaining a suppressed viral load. Commendable efforts have been made in increasing HIV testing numbers however, same day initiation on treatment and achieving viral load suppression remains a challenge. According to the WHO recommendations; same day (ART) initiation should be offered to all people living with HIV following a confirmed diagnosis. This study determined the factors influencing the acceptability and implementation of Universal Test and Treat by both patients and healthcare workers. Universal Test and Treat is a prevention strategy encourages that if a person tests HIV positive, irrespective of the persons CD4 count and clinical staging at the time of testing they will have to begin treatment immediately. Furthermore, patient’s clinical outcomes following test and treat in eThekwini municipality in KwaZulu-Natal were determined. This study was cross-sectional and used prospective - mixed methodology to collect data from 403 patients who either accepted or deferred same day ART initiation from June 2020 to May 2021. A structured questionnaire was used to collect demographic information, sexual behaviour, acceptance of same day ART initiation and knowledge of Universal Test and Treat on the day of HIV diagnosis. Key informant in-depth interviews were conducted with healthcare workers and patients were followed up at 6 months after HIV diagnosis to determine clinical outcomes for both groups, rapid and deferred ART initiators using medical charts and electronic databases. Two different analysis univariate and multivariate logistic regression were performed to examine associations between same day ART initiation and several explanatory factors. Logistic regression was performed to examine associations between same day ART initiation and several explanatory factors, retention in care, clinical outcomes and facility related factors. Thematic analysis was used to assess experiences, knowledge and observations of healthcare workers in implementing the Universal Test and Treat policy. Among the 403 participants same-day initiation was 69.2% (n=279). In an adjusted analysis (age, gender, level of education were adjusted at 0.5 significance level in univariate level) number of sexual partners (aOR: 0.35; 95% CI: 0.15-0.81), HIV status of the partner (aOR: 5.03; 95% CI: 2.74-9.26), knowledge of universal test and treat (aOR: 1.97; 95% CI: 1.34-2.90), support from non-governmental organizations (chi-square = 10.18; p-value= 0.015 and provision of clinic staff (chi-square = 7.51; p value = 0.006) were identified as major factors influencing uptake of same-day ART initiation. In the bivariate analysis; gender (OR: 1.672; 95% CI: 1.002–2.791), number of sexual partners (OR: 2.092; 95% CI: 1.07–4.061), age (OR: 0.941; 95% CI: 0.734–2.791), ART start date (OR: 0.078; 95% CI: 0.042–0.141) and partner HIV status (OR: 0.621; 95% CI: 0.387–0.995) were significantly associated with viral load detection and retention in care. (All variables that were significant at e.g. 0.5 level in univariate). Our results suggest a steady increase in uptake of same day ART initiation with poor retention in care. The results also emphasise a vital need to not only streamline processes to increase immediate ART uptake further but also ensure retention in care in order to meet the 95-95-95 targets. The findings of the study contribute to knowledge useful for strengthening rapid ART initiation implementation by considering individual patient factors, healthcare workers’ perspectives and facility level factors. The qualitative findings revealed variations in UTT knowledge, experiences and observations among diverse healthcare workers from the four clinics in different geographical settings. While training on UTT and SDI of ART initiation was conducted at the inception of the implementation phase, the understanding and interpretation varied especially between clinicians and non-clinical healthcare providers. Denial, feeling healthy, fear of disclosure, limited knowledge about ART, fear of ART side effects, fear of stigma and discrimination were some of the factors HCW observed as hindering uptake of SDI. These findings relate to some of the reasons given by patients with fear of disclosure frequently mentioned by those who deferred SDI of ART.
The acceptability and efficiency of routine "opt-out" HIV testing in a South African antenatal clinic setting.
(2008) Van Wyk, Erika.; Giddy, Janet.; Roberts, C. B.; Naidoo, S. S.
Background and Objectives The improved uptake of antenatal Opt-out testing has been documented internationally. In South Africa little is known about the efficiency and die acceptability of Opt-out testing. This study compared VCT with Opt-out testing by measuring the efficiency (defined as uptake of testing, number of women identified as HIV positive and consultation duration of the testing approach) and the acceptability to patients and staff. Methodology We conducted a prospective, quasi-experimental equivalent time-samples clinical trial in which we enrolled a consecutive sample of women who presented at die McCord Hospital antenatal clinic from June to August 2006. The study consisted of 2 phases. During the 6 week intervention period women were offered HIV testing with the Opt-out mediod. During die 6 week control period women were offered midwife-provided VCT. Efficiency was measured in each phase, with 150 participants in the VCT arm and 150 in die Opt-out arm. Participants also completed a survey questionnaire. In depth interviews were conducted with 9 purposefully selected participants from each arm. Two focus group discussions were held with staff. The staff focus group findings were followed-up and validated by conducting in-depdi interviews with die staff members who participated in die focus groups 18 mondis later. Results The uptake of HIV testing during the VCT period was 134/150(89.3%) compared to 147/150(98.0%) in die Opt-out period (p<0.001). The percentage of women identified as being HIV positive during the VCT period was 7.33% (11/150) vs. 12.6% (19/150) during the Opt-out period (p=0.133). Time was saved as a decrease in the duration of midwife consultations from 34 min (VCT) to 26 min (Opt-out) was found with p<0.001. Qualitative analysis revealed Opt-out testing to be an acceptable way of testing. Patients found Opt-out emotionally less distressing than VCT (p<0.05). Staff reported that Opt-out decreased the burden on human resources (only one person needed to facilitate the group and shorter consultations) while it identified more women infected with HIV. Conclusion Opt-out testing is significantly more efficient and acceptable than VCT. Opt-out testing should include a group pre-test information session, adequate and ongoing post-test counselling, to be effective and acceptable.
Acceptability, knowledge and perceptions of pregnant women towards HIV testing in pregnancy at Ilembe district.
(2005) Dube, Faith Nana.; Nkosi, Zerish Zethu.
This research study aimed at investigating the acceptability, knowledge and perceptions ofpregnant women towards IDV testing in pregnancy in Ilembe District. An exploratory research design guided the study. A systematic random sampling was used to select fourty pregnant women who were attending clinic for the first time in their current pregnancy. Self-administered questionnaires with close-ended questions were used in the collection ofdata. The questions included the women's demographic details, their views towards IDV testing, knowledge and acceptability ofIDV testing. Forty questionnaires were distributed and they were all returned. Quantitative method was used to analyse data. The fmdings ofthe study revealed that women in the sample were relatively young (18-25) with the percentage of45% and most ofthem were unmarried (90%). The majority ofwomen (92.5%) said testing was a good idea and 85% said it is necessary. However only 52.5% said they will opt for HIV testing. Uptake ofHIV testing was found to be low. Eighty-seven and a half percent (87.5%) women were ofthe opinion that IDV testing in pregnancy was ofbenefit to the mother and her baby. Women in the study were found to have good understanding and good perceptions towards IDV testing in pregnancy, but thus was not consistent with their behaviour. Meaning that in spite of their good understanding and good perceptions towards IDV testing in pregnancy, only a small percentage (52%) of respondents said they will opt for the IDV test. The researcher's expectations were one hundred percent response.
The acceptance of males in midwifery practice in the Seychelles.
(2001) Agricole, Winifred Jeanneton.; Gwele, Nomthandazo S.; Cassimjee, Rabia.
The aim of the study was to discover, describe and analyze factors related to the perceived acceptance of male nurses in the practice of midwifery in the Seychelles as perceived by nurses, pregnant women and their partners. A descriptive study using the qualitative approach was used. Theoretical sampling was employed and thirty-four participants comprising nurses, pregnant women and their partners were interviewed using an interview guide. Probing was done throughout. The nurses, the pregnant women and their partners were interviewed both in focus groups and individually. Participants taking part in individual interview were different from those taking part in focus group interview. The focus groups were homogeneous comprising professional nurses and consumers of service (pregnant women and their husbands) respectively. The findings revealed multitude of factors associated with the perceived acceptance of males in the practice of midwifery. These were classified as positive, negative and ambivalent. The major positive themes were unconditional acceptance, conditional acceptance, and equitable treatment, by all three groups of informants while traditional belief was the major negative theme. Other positive themes by the nurses were change of attitudes over time, and males as caring professionals, while for pregnant women; it was viewed as prior acceptance of male obstetrician. Both the nurses and partners saw the intimate nature of midwifery as a negative factor while only the nurses identified fear of competition and religious belief. Lack of trust was another negative factor identified by the partners/husbands. Professionals and the husbands identified societal versus individual readiness as an ambivalent factor while the pregnant women and professionals saw conditional acceptance as an ambivalent factor. Recommendations made from this study have implications for nursing research, nursing practice, and nursing education. The study could also be helpful for decision makers at different levels in the health care system.
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.
Adapting the WHO Health Promoting Hospitals strategy for South African hospitals : an evaluation.
(2008) Geddes, Rosemary Veronica.; Jinabhai, Champaklal Chhaganlal.; Knight, Stephen Eric.
Objective To conduct an evaluation of the pilot implementation of the World Health Organization Health Promoting Hospitals initiative and its self-assessment tool in public hospitals in KwaZulu-Natal in 2004/2005 Study design This evaluation utilised a cross-sectional design that incorporated both qualitative and quantitative research methods. Main measures Throughout the Health Promoting Hospital pilot project the opinions and responses of those with a legitimate interest in the initiative were monitored. Data collection methods utilised in this evaluation included participant observation, the World Health Organisation metaevaluation questionnaire, records of workshops and feedback meetings and secondary analysis of all data collected by the six pilot hospitals during the implementation of the project in KwaZulu-Natal. Results Major constraints were found to be time, human and financial resources, lack of training and expertise and insufficient support for the project. The self-assessment tool was found to be insufficiently adapted and not all outcomes were found to be reliable and useful. Despite this, institutional staff found the Health Promoting Hospital project to be capacity building and morale boosting. Relationships between health service levels improved. All hospitals who participated recommended that other hospitals become Health Promoting Hospitals. Conclusion If the World Health Organisation Health Promoting Hospital initiative with its selfassessment tool is to be rolled out to the rest of KwaZulu-Natal province, then substantial changes have to be made to the process. Amongst these are: further adaptation of the selfassessment tool, improved methods of data collection, provision of sufficient resources and increased and sustained provincial support for the project. In addition it is imperative that outcome and impact evaluations be done.
Adherence to antiretroviral therapy by HIV infected patients in rural UMkhanyakude District, South Africa.
(2008) Mthiyane, Italia Nokulunga.; Taylor, Myra.
The background. HIV and AIDS is a huge problem in sub-Saharan Africa where an estimated 22.5 million people were living with HIV in 2007.1 South Africa has the worst epidemic in the world.1 There were about 5.5 million people living with HIV and 1000 AIDS deaths daily in South Africa by the end of 2005.17 In 2007 the number of people living with HIV in South Africa increased to 5.7 million.1 The HIV prevalence in Umkhanyakude district, KwaZulu Natal, where Hlabisa subdistrict is situated, amongst public antenatal clinic attenders was 39.8% in 2007.19 AIDS is the cause of 50.0% of deaths in the Hlabisa sub-District.15 In 2003 the South African government decided to provide antiretroviral therapy (ART) in the public health sector, giving hope to thousands of people who are in need of this intervention to improve their quality of life and reduce premature deaths.7,13 However adherence to antiretroviral drugs is essential for successful treatment. Adherence to antiretroviral therapy in South Africa as in other African countries was expected to be low31 (<95.0%), however, in a study that was done in Cape Town during 1996 – 2001, the authors concluded that adherence was high.28 The aim of that study was to identify predictors of low adherence (<95.0%) and failure of viral suppression (>400 HIV copies/mm3). Pill counts and records of treatment refills from pharmacy were used to measure adherence.28 The results revealed no significant difference in adherence between patients on protease inhibitor based regimens and/or those on nonnucleoside based regimens nor with socioeconomic status, sex and HIV stage. Independent predictors of low adherence were English language speaking, age, and three times per day dosing. The following were found to be independent predictors of failure of viral suppression: baseline viral load, <95.0% adherence, age and dual nucleoside therapy.28This study however was done in an urban area before the antiretroviral therapy (ART) roll out in South Africa when the cost of treatment limited the accessibility of ART. These patients may have been different to patients who access free treatment in public health facilities today. Other South African studies have also reported good adherence rates.39,40 In another study in Soweto, South Africa, adherence was high, 88.0% of patients achieved > 95.0% goal, 9.0% achieved 90.0-95.0% adherence and only 3.0% achieved <90.0%.39In a study done at Khayelitsha, adherence was also high, viral load level was < 400 in 88.1%, 89.2%, 84.2%, 75% and 69.7% of patients at 3, 6, 12, 18 and 24 months.40 However, Soweto and Khayelitsha are urban and different from Hlabisa, and it is difficult to generalize these results to the sub-district. This study intended to assess how adherent patients are to antiretroviral therapy in a typical rural district in order to inform policy to enhance adherence to ART.
Adherence-monitoring practices by private healthcare sector doctors managing HIV and AIDS patients in the eThekwini metro of KwaZulu-Natal.
(MedPharm, 2009) Naidoo, Panjasaram.; Taylor, Myra.; Jinabhai, Champaklal Chhaganlal.
Background: The danger of poor adherence to treatment by patients with HIV infection is that poor adherence correlates with clinical and virological failure. Understanding how private-sector doctors monitor adherence by their HIV-infected patients could assist in developing interventions to improve adherence by these patients. Information about such practices amongst private-sector doctors in the province of KwaZulu-Natal, however, is limited. This study was, therefore, undertaken to assess the private-sector doctor adherence-monitoring practices of HIV-infected patients in the eThekwini metro of KwaZulu-Natal. Methods: A descriptive cross-sectional study was undertaken amongst private general practitioners (GPs) and specialists managing HIV/AIDS patients in the eThekwini metro. Anonymous semi-structured questionnaires were used to investigate adherence-monitoring practices by these doctors and their strategies to improve adherence. Results: A total of 171 doctors responded, with over 75% in practice for over 11 years and 78.9% indicating that they monitored adherence. A comparison between the GPs and the specialists found that 82.6% of the GPs monitored adherence compared with 63.6% of the specialists (p = 0.016). The doctors used several approaches, with 60.6% reporting the use of patient self-reports and 18.3% reporting the use of pill counts. A total of 68.7% of the doctors indicated that their adherence monitoring was reliable, whilst 19.7% indicated that they did not test the reliability of their monitoring tools. The most common strategy used to improve adherence by their patients was through counselling. Other strategies included alarm clocks, SMSs, telephone calls to the patients, the encouragement of family support and the use of medical aid programmes. Conclusions: Private-sector doctors managing HIV/AIDS patients in the eThekwini metro of KwaZulu-Natal do monitor adherence and employ strategies to improve adherence.
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.
Alcohol use and the availability of supportive services in a white urban community.
(1986) Miller, Atholl Jonathan.
This study identifies the alcohol intaKe patterns of 274 white patients attending an Urban General Practice. The average consumption rate was 6.5 drinKs per person per weeK (d/p/w). 40X of the surveyed group did not consume any alcohol. The drinkers averaged 11 dIp/wo 72X of the males drank and 501: of the females dranK. 4.31: of the population surveyed were drinking more than 28 dIp/wo Marital status made no real difference to consumption rates but unemployment (16 d/p/w) and being a manual labourer (11.7 d/p/w) did. People who had lost either their occupation (11.7 d/p/w) or a close family member (9.3 d/p/w) in the preceeding year had higher than average (6,5 d/p/w) consumption levels and these were increased further if they had identified an alcohol abuser in their family. This study also identifies the useful supportive services available to this particular community and its health care worKers with a brief discussion of the type of service prOVided and method of access to the service. The appendix contains a list of the services with the relevant address. telephone number and where possible the name of a contact person.
Ambient sulphur dioxide (SO2) and particulate matter (PM10) concentrations measured in selected communities of north and south Durban.
(2006) Gounden, Yoganathan.
The industrial basin in the south of Durban is an area of ongoing contention between the residents and major industries, regarding environment health issues especially poor air quality resulting from industrial air pollution. This region is a result of poor urban planning that began in the early 1960's which saw rapid industrialisation alongside expanding communities, which has now resulted in a major environmental dilemma for the city of Durban, eThekwini Municipality. Durban is seen as a key area of growth in South Africa: it has the busiest harbour on the continent; it is a regional hub of the chemical industry and a major motor and metal manufacturer centre; and Durban's population continues to grow at ~4% per annum, all of which are destined to have significant environmental impacts. As part of a large epidemiological study and health risk assessment in this industrial basin, particulate matter smaller than 10 microns (PM10) and sulphur dioxide (S02) were measured in seven community sites across Durban: four in the South, (Wentworth, Bluff, Merebank and Lamontville) and three in the north (Kwamashu, Newlands East and Newlands West). The south sites are located in an industrial basin near two petroleum refineries and a paper mill, while the north comparison sites are ~25 km North West from major industries in the Basin. 24 hour PMIO samples were collected gravimetrically every day during four, three-week intensive phases and thereafter every 6th day using high, medium and low volume samplers. S02 was monitored every 10 minutes with active continuous analysers (European monitor labs and API) according to internationally accepted methods. Rigorous quality assurance methods were followed for both pollutants. S02 followed a distinct spatial distribution where the mean difference in S02 concentrations between the southern and the northern region was 6.7 ppb, while for PMIO similar concentrations were found across all sites with the highest mean concentration at Ngazana in the north (59 Ilg/m3) > Assegai in the south (~58 Ilg/m3) with all other sites ~ I to 10 Ilg/m3 less in mean concentration. S02 diurnal variations display two maxima from 5:00AM to 10:00AM being repeated in the latter part of the day from 20:00PM to 24:00PM. Seasonal pattern of PMIO and SOz to a lesser extent, display very similar mean variations for all sites - the highest levels seen in the colder months of May; June, July of 2004 and 2005. Weak to strong intersite correlations were found for SOz ranging from 0.16 to 0.22 among the south sites; 0.06 to 0.64 among the north sites, while PM10 ranged from 0.73 to 0.88 among the south sites and 0.86 to 0.91 among the north sites. A cross regional correlation of PMIO by sites displayed a moderate to strong correlation ranging from 0.73 to 0.88, while intrasite SOz with PMIO correlations displayed weak to moderate correlations from 0.35 to 0.53. Meteorological conditions wind speed, temperature, pressure and humidity differed across Durban. The difference in temperature and humidity between "summer" and "winter" was on average, approximately 7 °c and 10-15% respectively. These temperature and humidity patterns closely track the increase in SOz and PM10 during "winter" explaining the effects of winter inversions on pollutant levels. Also of interest is the variability of meteorological parameters between south and north Durban with the two regions being 35 km apart. Meteorological conditions impact differently on each pollutant e.g. rain is more likely to decrease PMIO concentrations than it would SOz In general relationships between pollutants and meteorological parameters differ on a site-bysite basis. For instance, wind direction at Assegai increases SOz levels whereas wind direction at Ngazana decreases SOz levels. Another independent variable that proved to be a consistent and important predictor for SOz and PM10 across most sites was the previous day's pollution events; this was a much stronger predictor for PM10 rather than SOz. These findings suggest that pollutants are not fully removed from the atmosphere during a 24 hour period and that the previous day's pollution levels will contribute to current levels, a finding that has important implication when implementing early warning pollution systems as envisaged for the Durban South Basin.
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.
An integrated model of aftercare for substance use disorder clients in KwaZulu-Natal.
(2023) Mpanza, December Mandlenkosi.; Govender, Pragashnie.; Voce, Anna Silvia.
Background: There is currently a high global burden of substance use, which is burdensome to the public health and welfare system. Adequate treatment, including aftercare services, tends to be limited worldwide. In South Africa (SA), substance abuse contributes considerably to morbidity and mortality and treatment services are not only limited but also fragmented among stakeholders. These problems are compounded by a number of factors, including the absence of aftercare policies, treatment models, a lack of resources, and an absence of norms and standards for aftercare services. Consequently, most persons with Substance Use Disorders (SUDs) do not receive aftercare. Furthermore, there is high relapse and many re-admissions of persons with SUDs, which exacerbates the burden on the health care and welfare systems. The situation appears to be worse in rural districts. South African policies have called for the development of an aftercare model of care for persons with SUDs, which has not been realised to date. Aim: The aim of the study was to propose an integrated model of aftercare for persons with SU post-inpatient treatment phase in a public facility in KwaZulu-Natal. Methodology: A qualitative study in two phases. The first phase: policy analysis, and the second phase had two stages: Stage one was semi-structured and focus group interviews with forty-six participants who represented all five levels of the Beer’s Viable System Model (VSM) from governmental and non-governmental organisations (NGOs). Stage two semi-structured interviews with five persons with SUDs and their family members (n=5). Data was analysed thematically using the Braun and Clarke approach. Results: Findings indicated that South African policies did not provide clear guidelines on aftercare. Aftercare was found to be lacking, fragmented, poorly coordinated among service providers and not well integrated into the substance use treatment system. The needs of service users demonstrated the extent and nature of aftercare required. Conclusion: The extent and nature of aftercare services warranted aftercare services that are integrated into SUD treatment systems, lifelong orientated, and responsive to the needs of persons with SUDs and their families. An integrated recovery management model of care is proposed together with relapse management strategies.
Analysing cognitive levels of final examination questions for the Diploma Nursing programme using the revised bloom’s taxonomy at a selected nursing college in Eastern Cape.
(2017) Fayilane, Nontlantla Isabella.; Pakkies, Edith Ntefeleng.
Background: The main objective of the current reform is the production of graduates capable of facing challenges and adapt to changes that may be encountered post-graduation. According to the ICN (2009), employers perceived that graduates were not prepared for the realities of practice nor did they have the competencies needed for health care services. That necessitates higher education to prepare students to be competent graduates through teaching content and transferable skills. Appraised literature reveals that employing Bloom’s Taxonomy in class and integrating learning outcomes and assessment strategies, leads to production of graduates that are competent with skills expected from a professional. Previous literature also indicates that poor alignment of curriculum objectives with assessment strategies deprive students‟ development of crucial skills as well. Purpose: The purpose of the study was to analyse the cognitive levels of final examination questions for the Diploma Nursing Programme using the Revised Bloom’s Taxonomy at a selected nursing college in Eastern Cape. Methodology: The quantitative descriptive approach was adopted for the study where content analysis was used to analyse final examination questions. The study population consisted of the selected nursing modules’ examination question papers for a four-year Diploma Nursing Programme; selected from first year to fourth year level for the period of 2011-2015, for summative and supplementary examinations. A non-probability, convenience sampling method was adopted for the study and the sample consisted of a total of 1709 questions from 95 examination question papers which were analysed. Data collection was done using a template incorporating the six cognitive levels of the Revised Bloom’s Taxonomy. Questions were examined according to template and coding was done for single word, the action verb used in questioning, coded for frequency. Statistical Package for Social Sciences version 24 was used for data analysis. Findings: The results revealed that the highest percentage of questions set for the Diploma of Nursing Programme dealt with lower cognitive levels(remember, understand, and apply) of which, understand’ obtained the highest percentage across all levels in all modules, the higher order cognitive levels (analyse, evaluate, and create) were less assessed in the examination questions papers. Recommendations: The study recommends that the nurse educators who are curriculum developers should revise the assessment strategies and align it to curriculum and learning outcomes as well as to the changing health care systems and complexities of patients‟ care demands. The development of assessment guide is highly recommended, which will be in line with the current instruction methods. Further, for the college management, staff development is recommended in terms of assessment strategies through in-service trainings, workshops, and seminars conducted by assessment experts, to improve in the construction of examination questions in order to develop student’s required crucial skills
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.
Analysing the nursing students’ perceptions with regards to academic dishonesty at selected university in KwaZulu-Natal.
(2017) Maloka, Mosimotsana Jeanett.; Dube, Barbara Makhosazane.
Background: Academic dishonesty is a growing problem globally and represents unethical behaviour which results in students not acquiring the expected knowledge. Putting preventative measures in place would ameliorate the effects of academic dishonesty, but there was no idea of the prevalence of academic dishonesty in the School of Nursing at the University of KwaZuluNatal (UKZN). Accurate figures of the prevalence of this phenomenon were therefore not available for academic decision making at the university level, where the interventions were planned. In South Africa a study of this was only previously conducted in the Western Cape, and this is the reason why the researcher conducted the study. Methodology: A non-experimental, descriptive, exploratory design was used to guide the research process. 226 nursing students as participants. Data was collected by means of a questionnaire, and data analysis was performed using the SPSS version 24 software. Descriptive statistics and co-relational procedures were used to analyse the data. Results: The results showed that there was a significant relationship between gender and academic dishonesty. Evidence revealed that males were more likely to engage in cheating behaviour than females. Cheating behaviours associated with plagiarism, assignments when completing the workbooks and bringing and using unauthorised crib notes into tests and examinations were identified as the main problems. Recommendations: Nursing students at the selected institution were generally engaged in this academic dishonesty because of peer pressure and a lack of knowledge regarding the academic policies on the matter. It was recommended that the institution, together with the students, develop honour codes to accompany the existing academic policies and procedures. If students were included in the process they would become part of it, and if allowed ownership it would become easier for them to implement and abide by the honour code and reinforce the academic policies, and it would become easier for the faculty to inforce the policies. Key words academic dishonesty, nursing students, perception.

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