Nursing

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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 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, 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.
Alarms in ICU : a study investigating how ICU nurses respond to alarm limits for patient safety.
(2015) Ramlaul, Amy.; Brysiewicz, Petra.
Introduction There is a need to identify alarm management challenges in South African ICU units, to revise and structure educational and training programmes to ensure ICU nurses utilise technological resources for patient safety and to deliver quality patient care. Aim This research study is aimed to investigate the responses of ICU nurses to alarm limits in their ICU environment for patient safety. Research methods This descriptive survey study was conducted with permanent and sessional ICU nurses at a private healthcare institution in Durban, KwaZulu-Natal. A quantitative design was used with a structured questionnaire as the data collection instrument. The total of 120 ICU registered and enrolled nurses were chosen as the sample population and a total of 91 questionnaires were completed and returned. Results The results indicated that the challenges with alarm management experienced were related to inadequate education and training on alarm management and the distraction of managing frequent and numerous false alarms in the ICU facility contributed to delayed responses of the ICU nurses to alarming limits. Recommendations Recommendations included reviewing the current content and methods of education and training of alarm management and medical equipment that was done on a frequent basis. Conclusion Alarm specific training is required to keep ICU nurses updated with changes in technology so that they are better equipped to ensure patient safety and quality of care.
AN Analysis of nonverbal communication between nurses and hospitalised older adults in selected hospitalsi in Cameroon.
(2023) Keutchafo, Esther Lydie Wanko.; Kerr, Jane.
Background: Nurse-patient communication has been recognised as one of the most important aspects of successful patient outcomes. In relation to older adults, whose numbers are growing worldwide, nurses’ communication with older adults is essential because older adults will seek medical assistance more than before. Since most rely on nonverbal communication because of hearing deficits, and changes in attention and coding of information – all restrictions in interaction and effective verbal communication – nurses’ nonverbal communication will be a vital skill to develop good nurse-older patient relationships. In a context where there are no long-term care settings, nurses will be required to achieve effective nonverbal communication when older adults are admitted to the wards. Aim: This study aimed at analysing nonverbal communication between nurses and hospitalised older adults in selected hospitals in Cameroon, to develop a model for effective nonverbal communication between nurses and older adults. Methods: A mixed-methods approach was used in this study. A total of 372 participants were included through overt, theoretical, and convenience sampling. To collect the qualitative data through participant observations and individual interviews, twenty-seven (27) nurses were observed, of which 13 nurses were interviewed, and 29 older adults were observed, of which eight (8) were interviewed. In addition, 316 nursing students participated in the survey. Qualitative data analysis was composed of open coding, axial coding, and selective coding, which were intertwined as the researcher moved back and forth between data collection and data analysis. Additionally, comparative analysis, theoretical sensitivity, and memos were used during the process of analysing the qualitative data. Quantitative data were analysed using SPPS version 25, where descriptive and inferential analyses were run. Additionally, an explanatory factor analysis based on the principal component analysis method with varimax rotation was conducted, to determine the common factors that explain the order and structure among measured variables. Results: Firstly, the results showed that there was limited evidence of studies on nonverbal communication between nurses and cognitively intact hospitalised older adults in clinical settings. Secondly, the results showed that hospitalised older adults made both positive and negative interpretations of nurses’ nonverbal communication. They also had specific nonverbal communication needs. Thirdly, the results showed that nurses mainly used haptics, kinesics, and proxemics to communicate nonverbally with hospitalised older adults to build relationships with them, convey affection, reassure them, and support verbal communication. Further, the results showed that nursing students held slightly positive attitudes towards older adults; yet, the tool used to assess their attitudes showed moderate psychometric properties and two factor loadings. Finally, the results showed that the proposed model for effective nonverbal communication with hospitalised older adults, which emerged from the data, encompassed all six categories of Strauss and Corbin’s framework, which are: causal conditions, contextual conditions, core phenomenon, action/interaction strategies, intervening conditions and expected outcomes. Conclusions: This study revealed that nurses mainly use few nonverbal communication techniques to communicate with hospitalised older adults, which cannot achieve effective communication, vital in nurse-patient relationships. The proposed model provides a guide for effective nonverbal communication with older adults and acknowledges that older adults’ interpretations and needs of nonverbal communication, as well as attitudes towards them, all influence effective nonverbal communication with hospitalised older adults. It is hoped that nurses will consider these to improve their nonverbal communication with hospitalised older adults for better patient outcomes such as: patient satisfaction, shorter lengths of stay in hospitals and improved quality of care.
Analysing 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.
Analysing utilisation of a self-directed clinical skills laboratory by undergraduate nursing students in higher education: a mixed methods design.
(2016) Laari, Luke.; Dube, Barbara Makhosazane.
Background Nursing qualifications at institutions of higher learning have a strong focus on knowledge acquisition to ensure that the students are well equipped to know both how and why to maximise patient care. This knowledge needs to be balanced with clinical skills, acquired through both supervised and self-directed experiences, the latter being an increasingly important part of student learning in higher education institutions clinical skills laboratories. Aim The study aimed to analyse the utilisation of the self-directed clinical skills laboratory by undergraduate nursing students in a selected higher institution, and make recommendation on how teaching and learning in this area can be strengthened as a learning space. Methods A non-experimental convergent parallel design was used. A sample of 118 nursing students was collected through systematic random sampling for the quantitative questionnaire survey, semi-structured interviews were conducted using purposive sampling of six clinical facilitators, and focus group discussions were conducted with 32 nursing students, one group from each of the 4 undergraduate years. Results The findings suggested that students using the self-directed clinical skills laboratory applied the self-directed learning principles in their learning. The learning space is perceived to be used in line with the South African Nursing Council requirement, and the students using the learning space were positive about its use as a learning environment. Conclusion While both staff and students found the self-directed clinical skills laboratory to be a useful learning environment, its use would be improved by providing adequate human and material resources, and ensuring that what was taught was in line with clinical practices in hospitals.
An analysis of clinical supervsion [sic] and support for bridging programme students in the clinical settings in the greater Durban area.
(2005) Pillay, Padmini.; Mtshali, Ntombifikile Gloria.
The purpose of the study was to describe the nature of clinical supervision and support provided to bridging programme students in the clinical settings. A descriptive and an exploratory design were most appropriate. There were one hundred-and-twenty-two participants in the study. Data was collected by means of a questionnaire and a critical incident report. The questionnaires included semi-structured questions where the respondents were able to discuss the effects of clinical supervision and teaching behaviours that would enhance learning during clinical accompaniment. The subjects were the second year students in the bridging programme. Only those students who consented participated in the study. The campuses that were used were the Prince Mshyeni College of Nursing, Netcare Nursing Academy and Afrox College of Nursing. These campuses were conveniently selected because they were in the greater Durban area and were thus easily accessible to the researcher. Students described the positive and negative experiences they received from the clinical supervisor and the ward staff. Positive experiences included the feelings of confidence, and the gaining of interpersonal skills. Gaining self- confidence as a nurse is an essential aspect of the student nurse's professional development. The negative experiences were that the students were treated as the normal workforce because of their experience as enrolled nurses. The challenges of clinical supervision are to help the student to evaluate critically the effect of actions taken, to assist him/her to perform procedures skilfully and to enable him/her to relate to patients in an ethical and caring manner. The critical incident analysis revealed that the student nurses continued to use informal support networks as well as their supervision sessions to discuss clinical issues. Respondents reported an enthusiasm for the opportunity to talk meaningfully to a trusted colleague about personal circumstances at work. Such opportunities were particularly welcomed by nurses who wished to reflect upon their own practices with patients, especially when dealing with clinical conditions that were upsetting, or otherwise challenging. Respondents pointed out that more time would make clinical supervision sessions longer and more effective.
Analysis of cognitive levels of examination questions set in the Bachelor of Nursing programme at the University of KwaZulu-Natal.
(2010) Garekwe, Masaitsiweng.; Mtshaji, N.G.
Background: 'The literature reveals that a large percentage of teachers ask questions aimed at lower cognitive levels irrespective of the underpinning philosophy. They fail to set challenging questions at higher order levels when setting examination papers. Purpose of the Study: This study is aimed at describing and analysing the examination questions set over a four year academic period, at the University of KwaZulu-Natal School of Nursing, in terms of Bloom's levels of cognitive domains. Research Methodology: A quantitative approach and content analysis was used. A total of 1319 questions were examined, SOUTCed from 39 examination papers, from 2003-2007. These questions were independently reviewed by two coders according to Bloom's taxonomy's template. Research Results: The findings revealed that all six categories of the cognitive domains in Bloom's taxonomy were used across the four levels in the Bachelor of Nursing (BN) programme. Overall about 57 % of the questions were aimed at lower level (knowledge, recall and comprehension) whilst only 43.4% were aimed at higher levels (application, analysis, synthesis and evaluation). In the first year lower order questions averaged at 62% with higher order questions at 51 %. In second year the lower order questions took up 51% of the paper \\~th higher order questions at 49%. During third year there was an equal (50/50) split between higher order and lower order questions. In fourth year there was the highest percentage of lower level questions (66%) was seen, with only 34% of questions being of the higher order. Regarding the increase in the complexity of questions within the programme, a change of 13% was seen between first and second year. Whilst there was an increase of 1% reported between second and third year. However, there was a significant drop (16%) in the complexity ofquestions in the fourth year, with lower order questions clearly dominating. Recommendations: The nursing education curriculum, and staff development progranune, should pay special attention towards developing educators in the setting of questions ensuring appropriate examination criteria are met. Exercises during the capacity building initiatives should cover aspects such as how to plan an assessment for the whole programme ensuring the appropriate increases in complexity as the programme progresses, as well as setting, or critiquing, of examination papers and coming up with recommendations to improve the quality of questions. Special attention should be given to how to align teaching and assessment in such a way that the level ofcomplexity increases as the students' progress through the programme. Lastly, further research should be conducted, using mixed methods, to explore the assessment of learning and in order to address certain questions which could not be answered quantitatively; for example questions regarding the construction of questions, because it impacts the nature of the question Also it should be noted that there was a disjuncture between the scenario and the questions in some cases.
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 patients' awareness and attitude concerning end of life issues.
(2002) Khanyile, Bathini Purity.; Ncama, Busisiwe Purity.; Bhengu, Busisiwe Rosemary.
This study was conducted using a qualitative descriptive approach. It was based on an analysis that was done to determine awareness and attitude of patients in end of life issues. The semi-structured interviews were conducted for data collection. A sample of ten patients, five inpatient and five outpatient, was purposively chosen. Permission was obtained from the hospital superintendent and heads of departments, and also consent from patients, for the study. Data was analyzed, using the NVIVO program, a computer software, for data coding, and a conceptual model for categorization. From the findings, the researcher concluded that poor communication causes lack of knowledge in patients, which in turn limits the capacity for decision making in patients. The researcher also noted that participants were not aware of their autonomy in decision-making.
An analysis of quality improvement by nurses at a selected tertiary healthcare facility in Rwanda.
(2017) Batunga, Antoinette.; Kerr, Jane.
BACKGROUND: Improving and maintaining the quality of care in healthcare institutions is not easy and has become a continuous challenge. Though quality improvement continues to be a global issue, the Government of Rwanda, guided by its Vision 2020, has made significant progress in the health field, especially in providing accessible quality care and services to all Rwandan citizens. Furthermore, the Rwanda Ministry of Health, through its 2015 health policy, has introduced a number of interventions to improve quality of care, such as promoting customer care, ongoing training and capacity building of the staff in the health sector, and decentralising health care infrastructures. A number of constraints have been noted which hinder effective quality improvement, such as shortage of human and material resources. It has become important to analyse quality improvement by nurses at a selected tertiary healthcare facility in Rwanda. Purpose of the study: The purpose of this study was to analyse quality improvement by nurses; in order to develop guidelines for nurses on effective quality practices at a selected tertiary healthcare facility in Rwanda. Methodology: A concurrent mixed methods approach (quantitative and qualitative), was used in this study. Data were collected by the researcher over a two month period. In a quantitative approach, data were collected using a checklist to conduct an audit of quality improvement activities by nurses and purposive sampling was used to identify 13 quality improvement documents in 11 units/departments. In a qualitative approach, data were collected from registered nurses and patients who were seeking healthcare services at the time of data collection. Interview guides were used. Purposive sampling was used to identify 15 registered nurses; and 17 patients for the qualitative data collection and 12 nurse managers and experts in guideline development to participate in guideline development process. Quantitative data were analysed using SPSS version 23, while qualitative data were analysed using thematic content analysis. Nominal group technique was used to develop guidelines for nurses to improve the quality of care at the selected facility. Findings: Out of 11 departments from the selected hospital, the majority (90.9 %) of departments had incident reporting documents. Seventy-two per cent of departments reported having an audit tool for measuring the quality of care that was available and accessible to users. It was found that 36.6 % had a copy of quality policy document; 18.2% reported having registration books for complaints, however it was found that these complaints books were not used on a daily basis. Furthermore, it was noted that only 18.2% of departments had a copy of the quality action plan. Concerning annual quality report findings indicated that of 11 departments, none had a copy of the annual quality report. Findings from qualitative data in this study revealed a number of factors related to quality improvement, which were grouped into three categories: organisational resources, managerial roles, and customer care. Regarding the organisation resources, a number of subthemes emerged in this study: lack of materials and equipment, shortages of nurses and doctors, lack of guidelines to guide nurses on improving the quality of nursing care and lack of sufficient drugs in the hospital pharmacy (reported by both nurses and patients). Construction and renovation of buildings has been happening which has reduced congestion for patients. Regarding managerial role, factors that hindered quality improvement were nurses’ resistance to change, lack of knowledge concerning quality improvement, lack of supervision, and lack of health education for patients. Regarding customer care, patients were dissatisfied with the lack of sufficient drugs, long waiting times, lack of sufficient beds and rooms. Although a number of challenges were reported that hinder quality of care, patients appreciated effective performance and care from their healthcare workers that increased their satisfaction with the quality of care provided. Proper explanations and orientation made it easy for patients to seek healthcare services in the different departments and pharmacy turn around time has improved. It was also noted that nurses recognised that career development and support was helping them to improve the quality of care. Based on the findings from this study, quality improvement guidelines for nurses have been developed for the selected tertiary hospital where this study was conducted. Recommendations: Increase in-service training on quality improvement to raise employees’ knowledge and skills levels. Emphasise proper staffing and staff management of employees to avoid work overload in some units. Reduce waiting times and provide sufficient essential drugs in the hospital pharmacy reducing the need for patients to buy drugs from private pharmacies. Remedy lack of equipment and materials to enable nurses to work in a suitable environment. Conclusion: Despite challenges faced by the healthcare facility, there has been remarkable progress in quality improvement through response to needs in human and material resources. Improvement of quality care is a cornerstone in the health of the population of Rwanda. Keywords: Quality improvement, Quality of care, Standards of care, Patient Satisfaction.
Analysis of sickness presenteeism prevalence among nurses working in selected health facilities in Swaziland.
(2016) Mdziniso, Bawinile Treasure.; Kerr, James.
Sickness presenteeism occurs when employees go to work when they would be justified in taking time off for complaints and ill health that can either be physical or mental or both (Johns, 2010; Demerouti, Le Blanc, Bakker, Schaufeli and Hox, 2009; Aronsson, Gustafsson, and Dallner, 2000; Jourdain and Vézina, 2013). Sickness presenteeism has drastic effects to the organization or employer, the health of the employee, the safety of the health care consumers (clients and patients) and families of the employees (Roelen, Jensen, Stapelfeldt Groothoff, Nielsen and Bültmann, 2014;Sendén, Løvseth, Schenck-Gustafsson and Fridner, 2013). Sickness presenteeism has been discovered to be prevalent among human service organizations such as nursing (Johansen, Aronsson, and Marklund, 2014; Leineweber, Westerlund, Hagberg, Svedberg and Alexanderson, 2012; Aronsson et. al., 2000). High job demands, inability to adjust amount and type of work to do in a given period of time, lack of social support and experiencing health problems are cited as some of the predisposing factors of sickness presenteeism (Jourdain and Vézina, 2013; Linnerud, 2013; Demerouti et. al., 2009 and Theorell, 1996). Amongst studies conducted, sickness presenteeism has been assessed based on varying degrees of nurse staffing levels and nursing work schedules of various shifts (Linnerud, 2013 and Zirwatul, Ibrahim, and Ohtsuka, 2012).
An analysis of the assessment of clinical learning in a nursing diploma programme in Kigali Health Institute in Rwanda.
(2007) Kayihura, Camille N.; Mtshali, Ntombifikile Gloria.
Assessment of clinical learning is imperative in order to ensure that those who become registered nurses are safe and competent practitioners. Assessment of clinical skills requires evaluation of the development of appropriate knowledge, skills and attitudes. Literature however reveals that the measurement of clinical skills performance continues to pose a challenge for nurse educators, the debate around the best assessment method in clinical learning, as well as, validity and reliability in assessing clinical learning is ongoing. This study was therefore aimed at exploring and describing current practices in assessment of clinical learning in a nursing diploma programme in Kigali Health Institute in Rwanda. The study was a quantitative descriptive exploratory design. Data were collected through the use of questionnaires. Nurse educators, students and external examiners were asked to report on the assessment strategies commonly used in Kigali Health Institute, their views about assessment strategies, and the strengths and weaknesses of clinical assessment strategies used in a nursing diploma programme in assessing practical competences of nursing students. The total number of participants who returned questionnaires in this study was 117. The results of this study revealed the commonly used assessment strategies included OSCEs (100%), case presentations (66%), direct observations (38%), standardized patients (31 %) and reflective diaries (2%). Furthermore, assessments were based on clinical learning outcomes. Assessments were conducted formatively and summatively to ensure validity in assessments and to ensure that a variety of clinical learning areas were assessed. Although there was no documented structured process of conducting clinical assessments, the findings revealed that the process included a number of phases; planning, preparation, implementation and evaluation phases. There were measures in place to ensure validity and reliability in assessments. The need for a policy on clinical learning assessment emerged so as to serve as a guide to ensure consistency in conducting assessments. The need to build the capacity of nurse educators and external examiners also came up as very few had educational preparation for their roles. Most of them were specialists in the discipline not in nursing education. The findings also revealed that not all nurse educators were involved in decision making regarding clinical assessments for quality assurance purposes. Issues such as welcoming of students on the assessment day, giving of instructions to students, time spent on performing tasks, feedback to students, returning to tasks which were not completed and improvising during assessments due to limited resources emerged as areas of concern. Recommendations made are related to the assessment process, the building of capacity of nurse educators and external examiners, preparation of students for clinical learning assessment, and further research for the in-depth exploration of this area.

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