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Doctoral Degrees (Nursing)

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    Analyzing and strengthening the clinical support of undergraduate midwifery students and developing a mentorship training program at a higher education institution in KwaZulu-Natal, South Africa: a mixed method and action research design.
    (2022) Amod, Hafaza Bibi.; Mkhize, Sipho Wellington.
    The competence of midwifery students is highly dependent on the quality of clinical support they receive during clinical placement. Offering support and training to midwifery practitioners, who supervise students during placement, is necessary in South Africa. This study aimed to analyze and strengthen the clinical support of undergraduate midwifery students, and develop a mentorship-training program. This study adopted a mixed-method and action research approach incorporating a descriptive and exploratory design. A convenient and purposive sampling technique, multiple research tools (systematic scoping review protocol, questionnaires, interviews and focus groups), and three different study populations (60 midwifery students, 28 practitioners and 10 educators) complimented the aim of conducting a mixed-methods study. Data collection commenced for Cycle 1 in May 2019 and concluded with Cycle 4 in April 2022. Quantitative data was inserted into SPSS version 27 for descriptive and comparative analysis whilst qualitative data used a thematic content analysis approach. Cycle 1 results highlighted that 93% of students had support from midwifery practitioners and found that the clinical placement benefitted their learning outcomes. Although students received three types of clinical support, namely clinical supervision, mentorship and preceptorship, 80% of clinical support was clinical supervision. Postclinical placement, students were incompetent in 11.4% of their clinical requirements. In Cycle 2, a two-round Delphi method evaluated the quality of a mentorship-training program using midwifery experts in round 1 and midwifery practitioners in round 2. There was an overall quality score achieved of 81% round 1 and 96% in round 2. In Cycle 3, three themes emanated from the focus group discussions. Mentorship training was a new phenomenon, empowered mentorship abilities, and an investment toward midwifery leadership. Interview results showed that the mentorship training program was a new, well-structured and valuable program; a refresher course for midwifery clinical practitioners and educators, adequate to support midwifery practitioners in their mentorship roles and responsibilities, and produced recommendations for midwifery practice and education. Mentorship during clinical placement is likely to strengthen the clinical support of midwifery students. A mentorship training program for midwifery practitioners developed in this study is valuable to midwifery educators and practitioners in South Africa.
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    A grounded theory inquiry: establishing communities of practice among Hiv/Aids nurse practitioners through the use of critical reflection at selected hospitals in KwaZulu-Natal.
    (2011) Naidoo, Joanne Rachel.; Mtshali, Ntombifikile Gloria.
    Introduction: Nurse practitioners in South Africa are challenged daily to provide comprehensive care under resource constrained conditions while at the same time trying to cope with the changes and care strategies related to HIV/Aids. The use of critical reflection within a shared learning space fostered by Communities of Practice is a plausible strategy to support ongoing meaningful learning that can support nurse practitioners to deal with the challenges related to the dynamic nature of HIV/Aids. Aim of the Study: This study aimed to analyze the processes of developing critical reflective skills and establishing Communities of Practice among a sample of nurse practitioners working in the field of HIV/Aids and to develop a middle range theory which explains the process of establishing Communities of Practice (CoP) among HIV/Aids nurse practitioners grounded in critical reflection. Methodology: Using a qualitative approach, a grounded theory design guided by Strauss and Corbin (1990) was used. Two district level hospitals from the province of KwaZulu-Natal, was sampled, within which a group of nurse practitioners working in the discipline of maternal and child health was sampled. Data collection was progressive over a period of seven months. The use of focus group discussion, in-depth individual interviews, reflective journals and researcher observation was used to elicit the data. Concurrent with data collection, open axial and selective coding was used to make sense of the data. Results: The results of this study revealed that there are a number of causal conditions which relates to the need for establishing a CoP and that the process of establishing a CoP requires engagement with the relevant stakeholders and members of the group. Three phases characterized the process of participants becoming critically reflective and a fully functional CoP. The concept of a CoP for HIV/Aids nurse practitioners is made up of core characteristics namely that it is an organic practice space, it promotes flexibility in learning, it is a support network where collaborative purpose driven working occurs and that it promotes learning on demand to name a few. There were also a number of intervening conditions which influenced the process of establishing the CoP and the findings of this study led to the emergence of a middle range theory which is both process and outcomes focused. This theory and its related model, demonstrates that establishing a CoP for HIV/Aids nurse practitioners occurs within a context and is made up of six major concepts namely (i) Context; (ii) Group Formation; (iii) CoP Establishment Process; (iv) Fully Functional CoP; (v) Outcomes; (vi) Sustainability and Continuity, and several sub-concepts. Conclusion and Recommendation: The recommendations of this study were classified into areas of practice, education and research, with regard to the usability of this theory in encouraging a transformed way of nursing aimed at improving nursing practice. In summary, this research lends insight into the complex challenges of nursing in a dynamic context of HIV/Aids. It further demonstrated that one of the overall outcomes was engagement in evidence informed practice and knowledge stewarding in HIV/Aids knowledge generation. Keywords: Communities of Practice (CoP); HIV/Aids Nurse Practitioners; Critical Reflection; Transformation; Knowledge Generation; Process; Outcomes.
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    Developing an intervention model to manage caregiver burden experienced by family caregivers of patients living with end-stage renal disease in Nigeria.
    (2017) Oyegbile, Yemisi Okikiade.; Brysiewicz, Petra.
    The purpose of the study was to develop and implement an intervention model to manage caregiver burden experienced by family caregivers of patients with End-Stage Renal Disease in South-West Nigeria. The model that was developed may be used by nurses to assist these family caregivers. Methodology Using an action research process, a complementary mixed-method data collection strategy explored and described the extent of caregiver burden, and described family caregivers’ experiences of caregiving. With assistance from the research team, 96 participants were selected for the quantitative aspect of the study, and 15 for the qualitative aspect. Through the cyclical nature of the action research, establishing and exploring the experiences of family caregivers later resulted in the emergence of the crucial concepts and the development of the model. The knowledge process development of Chinn and Kramer (2011) guided the development of an intervention model, and the model implementation process was facilitated by the use of an implementation checklist. Findings On measuring the caregiver burden, the family caregivers experienced moderate to severe burden in all domains of care. Family caregivers’ descriptions of their experience of family caregiving led to the identification of five categories, namely: disconnectedness with others and self; never-ending burden; “feeling like “a fool being tossed around”; obligation to care and promoting a closer relationship. The diagrammatical model to manage caregiver burden resulted from the collaboration of the research team members, and the crucial concepts emerged from the integration of the findings from the study and the interrogation of the existing literature. Model implementation was not evaluated and feedback from nurses and family caregivers indicated that they were excited that the process helped them to manage their burden as caregivers. Conclusion and recommendations Family caregivers’ need for support should be addressed when they begin caregiving, and then subsequently as they continue to provide care, so that they their health is not compromised. There is a need for the implementation and evaluation of this model to assist family caregivers cope with the challenges of prolonged caregiving.
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    Participation of nurse leaders in health policy development: an action research approach.
    (2016) Dlamini, Zanele Faith.; Bhengu, Busisiwe Rosemary.; Bhengu, Busisiwe Rosemary.
    Introduction All aspects of nursing education, practice and research are influenced by health policy. Proactive participation in the policy arena is key to excellence in clinical practice and education for nursing. Nurses constitute the majority of healthcare personnel in most countries, playing a major role in providing quality care. South Africa has a nurse-based healthcare system with nurses comprising 80 per cent of health professionals. The nursing leadership is instrumental in influencing both policy and nursing practice. Therefore it is important that nurses understand and influence the public policy process. However, their participation in health policy development is limited, even though they play a critical role in providing care for individuals. This study contributes to the body of knowledge on the participation of nurse leaders in health policy development. It is hoped that the knowledge gained from this study may, at some point, be put into practice. Purpose To determine and analyse the extent of nurse leaders’ participation in the health policy development process in selected regional and tertiary hospitals in the province of KwaZulu-Natal in South Africa. Methodology This study adopted an action research design using convergent mixed methods. Statistical data was also required to measure the effectiveness of research interventions. Both qualitative and quantitative data sources were given equal emphasis and equal weight. Eight face-to-face in-depth interviews of a minimum length of 20 minutes were conducted. Quantitative data was collected through self-administered questionnaires to 81 participants to allow for generalisation. Data were collected during 2015 to inform the diagnostic phase of the action research process. The second phase of the study consisted of a knowledge translation policy workshop and the development of a policy brief document. Results Findings from all data sources in the current study showed that the participation of nurse leaders in health policy development was limited, especially at provincial and national levels. Those who had participated did so at an institutional level. Nurse leaders participated only at the implementation stage. Their level of knowledge and confidence in health policy development was low, which has implications for the interpretation and implementation of the policies. Conclusion The findings of the study suggest that there is an increasing disconnection between policy and delivery. This serves as a barrier to involving the people who are in the frontline and responsible for delivering results, in policy development. Since nurse leaders are implementers of policy, their involvement in policy development would encourage greater ownership and result in better assessment of policy feasibility. The findings and recommendations of this study have implications for practice, education and policy-making in South Africa.
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    A focused ethnographic study on management of chronic comorbid (diabetes and hypertension) conditions among adults in selected primary health care settings in Kenya.
    (2016) Marwa, Immaculate Nyaseba.; Mtshali, Ntombifikile Gloria.
    Abstract available in PDF file.
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    An analysis of the utilisation of e-learning platform at a selected nursing school in Rwanda : a participatory action research study.
    (2017) Harerimana, Alexis.; Mtshali, Ntombifikile Gloria.
    Background: E-learning is a commonplace in nursing and healthcare professional education, and generally the importance of Information and Communication Technology (ICT) and the internet in tertiary education is recognised. The use of technology is a policy directive in Rwanda. Aim of the study: The aim of this study was two-fold, that is to: (i) Collaboratively analyse the utilisation of the e-learning platform in selected nursing school campuses at University of Rwanda (UR), in Rwanda; (ii) Develop a middle-range theory on the implementation of e-learning in selected nursing school campuses at UR, in Rwanda. Methods: Participatory Action Research, and convergence parallel mixed methods (quantitative and qualitative data) also known as concurrent triangulation design were used, where quantitative and qualitative data were collected simultaneously as recommended by Creswell and Clark (2007). Quantitative data was analysed using SPSS 23, and for qualitative data, the framework of grounded theory by Strauss and Corbin guided the analysis. Triangulation of results was done in chapter six of discussion of the results. Results: The quantitative findings of this study indicated that in e-learning, a blended mode was used and included 40% of face-to-face, and 60% of online teaching. ICT was reported to be pivotal in teaching and learning. Of 44 nurse educators, 95.5% reported using ICT applications to prepare presentations for lessons; 95.5% reported using ICT to provide feedback and/or assess students’ learning. Of 227 students, 96.9% used the internet to access full web-placed courses, and 93% for communication with their lecturers. Qualitative findings reflected E-learning as the core phenomenon of the investigation. E-learning was conceptualised as a mechanism to advance a political agenda, as a student-centred approach, as blended learning, and as a tool to open access to education for working nurses and midwives. The context of e-learning in nursing education is subjected to both internal and external influences in which education, health and technology originate. Data from this study indicated a number of intervening conditions which influenced the process of developing the middle range theory. There are two major processes involved in this model: Catalyst agents and hybrid teaching and learning. The catalyst agent process focuses on institutional support for students and teachers. The process of hybrid teaching and learning represents the actual facilitation of teaching and learning, through two phases: course development, and course delivery. The outcome of this is to improve the quality of nursing education, to fast-track production of the nursing workforce, to enhance nursing care and services, to enhance collaborative partnership, and to promote lifelong learning. Conclusion: E-learning is inspiring many in nursing education, and its success depends on adequate technology-based tools and guidelines that can be used in the establishment of a supported network learning space by using technology in teaching and learning. Keywords: blended learning, web-based learning, e-learning, distance learning, ICT in education.
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    Developing an intervention model for data quality management and health information use at community and district levels in Rwanda
    (2014) Ndabarora, Eleazar.; Uys, Leana Ria.
    The purpose of this study was to develop an intervention model for health data quality management (DQM) and health information use at community and district levels in Rwanda and similar settings, based on a situation analysis of current practices and performance in Rwanda and existing evidence found in similar settings. This thesis is by publication and comprises three research papers based on the findings of three evaluation studies conducted, and reports on the study four which describes the model developed. Methods The study was initiated based on a systematic review of health DQM and best practices at community and district levels in low-and middle-income countries (LMIC). A retrospective design was used to evaluate the quality of clinical and community health data, and a survey of health information users was conducted. The mixed methods approach was adopted to collect quantitative and qualitative data, and the teamwork in “Group Model Building” (GMB) process through a workshop was used to develop the model.Findings Poor health DQM and health information use at community and District levels in Rwanda and other LMIC was found, particularly at the sources of data. Best practices were also found, but several issues hindering the quality of health data and utilization namely poor management of District Health Information System, lack of institutional support to all stakeholders involved in DQM, and lack of information culture. Variables that influenced the quality of health data and use included the training of the staff and community health workers (CHWs), regular formative supervision and monitoring and evaluation, involvement of all stakeholders, Data Quality Audit (DQA), feedback initiatives, understanding and perception of data usefulness, use of electronic and computerized systems, and proper leadership and coordination. Those variables were included in the model developed. Conclusion Based on the identified barriers to high quality data systems, an intervention model for health DQM and health information use at community and District levels in Rwanda was developed as the main achievement of this study.
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    HIV and infant feeding : choices and decision-outcomes in the context of prevention of mother-to-child transmission among HIV-positive mothers in Zambia.
    (2015) Ngoma-Hazemba, Alice.; Ncama, Busisiwe Purity.
    Mother-to-child transmission of HIV is one of the key drivers of the HIV pandemic in Zambia and impacts infant feeding for HIV-exposed infants. The aim of infant feeding counselling is to facilitate informed decision on method of feeding in relation to prevention of mother-to-child transmission of HIV. However, HIV-positive mothers are faced with uncertainty on how best to feed their infants. While exclusive breastfeeding has potential to contribute to a reduction in infant and under-five mortality, the practice is not widespread in resource-poor settings of sub-Saharan Africa. The overall aim of this study was to analyse choices and decision-outcomes on infant feeding in the context of prevention of mother-to-child transmission of HIV to enhance safer feeding practices during the first six months of the infant’s life. The study was conducted using qualitative triangulation through participant observations, focus group discussions and individual interviews. The study included HIV infected mothers (n=30), health care workers (n=6), HIV infected men (n=7) and community based volunteers (n=20). The field work was conducted from January to September 2014. Data were managed in QRS NVivo 10 and analysed using framework analysis. While recognising promotion of exclusive breastfeeding as a public health approach in Zambia, the results showed that implementation was influenced by factors beyond the health care system. The findings highlight five thematic areas that explained and gave meaning to behavioural processes that determine decision-outcome on infant feeding in relation to prevention of mother-to-child transmission. Participants described breastfeeding as a cultural norm based on practices passed from generation to generation that impacted the understanding and behaviour change to practice exclusive breastfeeding for HIV-exposed infants. Therefore, choosing to exclusively breastfeed depended on how well mothers were counselled on infant feeding and prepared to practice exclusive breastfeeding in the first six months of the baby’s life. Although, health care workers reported that they supported mothers to choose and practice exclusive breastfeeding, mothers in this study lacked the necessary skills needed to successfully feed their HIV-exposed infants. Drawing on theories of behaviour change, the findings accordingly informed the development of a model that provides nurses, midwives and other front-line health care workers with simplified steps for consideration during infant feeding counselling of HIV-positive mothers.
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    The outcomes of implementing the Department of Health mental health clinical guidelines for the management of psychiatric patients at primary health care clinics.
    (2015) Dube, Faith Nana.; Naidoo, Joanne Rachel.
    Background: The South African (SA) government recognizes that the first step towards improving mental health and wellbeing of the people is to develop effective guidelines .After guidelines have been developed, there is a need for transferring them to the implementing settings. It has been noted that mental health guidelines are important tools for enhancing framework of the mental health system. Objectives: The objectives for the study were: (1) To analyse the process inherent in the implementation of the guidelines in PHC settings in KZN based on action research; (2) To analyze the awareness, knowledge, perceptions and implementation practices of Primary Health Care Nurses of the treatment guidelines for common mental health conditions in their primary health care practice; and (3) To evaluate the readiness for a change management programme for the sustainable implementation of appropriate clinical guidelines in selected primary health care practice contexts. Method: A survey was conducted amongst nurses working in PHC clinics in order to determine the outcomes of implementing the Department of Health mental health clinical guidelines for the management of psychiatric patients at primary health care clinics. Qualitative and quantitative methods were used. Results: The study found that quality of care was compromised when the implementation of a mental health policy was flawed in all seven major implementation themes. Services for psychiatric patients were only available daily in four of the sites (66.7%). Patients attending the other two sites (33.3%) were seen by a psychiatrically trained nurse on a dedicated day once a month. PHC nurse’s attitudes and beliefs toward people with mental illness were positive, but did not have adequate knowledge to manage psychiatric patients. Conclusion: The identified a number of gaps in the implementation of Standard Treatment Guidelines for Common Mental Health conditions in primary health care settings as an example of the policy implementation process in rural areas.
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    An ethnographic study of predictors of hypertension and its preventive strategies in a rural community in Delta State, Nigeria.
    (2014) Ofili, Mary Isioma.; Ncama, Busisiwe Purity.
    This study investigated the blood pressure profiles of residents in Ibusa community in Delta State Nigeria. Predictors of hypertension in the community were also established and traditional and cultural practices associated with hypertension management were explored, with the aim of developing guidelines for management of hypertension through a “System Support Strategy” combining appropriate and effective clinical care with community action, and taking into account facilities and social and environmental factors influencing the development of hypertension in rural settings. Conducted in three phases, the study has given rise to four articles: one covering the literature review and the other three linked to the three phases of the study. The first phase assessed the prevalence of hypertension and associated risk factors in adults in three villages in the community. From a simple random sample of homesteads in the three villages, all adults aged 18 and above who were available and willing to participate (134 individuals: 48 males; 86 females) were recruited into the cross-sectional study. Hypertension prevalence in this rural community was 44%. Increasing age, increasing body mass index and high salt intake emerged as prominent risk factors for hypertension. The second phase described the experiences of the community in terms of their cultural practices and how these influenced the management of hypertension. Ten known hypertensive patients who had used traditional practices for management of hypertension were purposively selected and an in-depth interview was conducted with each. The traditional and cultural practices identified include medicinal plants, sacrifices, scarification and tribal marks. Where these traditional practices fail, local diets serve as a remedy. Some cultural practices potentially predispose individuals to risk factors for certain diseases (e.g., high cholesterol palm kernel soup) while some potentially promote their health (e.g., medicinal plants). The third phase was development of guidelines for the prevention and management of hypertension using nominal group technique in a meeting with experts (six key stakeholders) knowledgeable in the field. Major concepts addressed included blood pressure measurement and assessment and pharmacological and non-pharmacological measures for management. This study will hopefully help in empowering individuals to take more and greater responsibility for their own health issues, reinforcing community self-reliance and self-determination.
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    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.
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    The influence of intrapersonal characteristics of individual nurses on their work performance : a predictive correlational study in a selected province in South Africa.
    (2015) Geyer, Nelouise-Marié.; Uys, Leana Ria.; Coetzee, S. K.; Naidoo, Joanne Rachel.
    Background Conflicting reports on the quality of nursing care highlighted the need to understand the influence of nurses’ intrapersonal characteristics on their work performance and caring behaviours. Aim The aim of the research was to describe the influence of selected intrapersonal characteristics of individual nurses’ on their work performance and caring behaviours. Objectives The research questions of the study were 1) What is the distribution and influence of demographic variables on nurses’ work performance and patients’ perceptions of caring behaviours? 2) What is the distribution of selected intrapersonal characteristics among nurses working in clinical settings in hospitals? 3) What is the self-assessment of their work performance by nurses working in clinical settings in hospitals’? 4) How do patients perceive the caring behaviours of nurses in clinical settings in hospitals? 5) Is there a relationship between nurses' intrapersonal characteristics and their self-assessment of work performance and caring behaviours of nurses as perceived by patients? 6) What model can be developed to test the influence of selected intrapersonal characteristics on work performance and caring behaviours of nurses? 7) What predictions can be made about the relationship between intrapersonal characteristics with the work performance and caring behaviours of nurses? Method A quantitative, cross-sectional survey, predictive, correlation model-testing design with multi-layered and stratified sampling was used. The population was professional nurses and patients in medical and surgical wards in public and private hospitals. A questionnaire including the 6-DSNP, NPVS-R, STEM, CSES, EQ-short and the Kanungo Job Involvement instruments was completed by nurses. Patients completed the CBI instrument. Descriptive and inferential statistics were generated. Results The professional values of nurses were the only selected intrapersonal characteristic with a statistically significant positive relationship with nurses’ work performance and caring behaviours. While some of the other selected intrapersonal characteristics had statistically significant relationships, effect sizes were small, making them not of practical importance. If nurses have high professional values (NPVS-R), NPVS-R as predictor for work performance (6-DNSP) is two to three times that of any other predictor that can be added to the equation at the 10% level of significance. Conclusion and Recommendations Professional values influence the work performance and caring behaviours of nurses. Recommendations are provided for individual nurses, practice, education, management and research.
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    Developing and evaluating a community-based HIV/AIDS stigma reduction intervention in Ongenga constituency of Ohangwena Region, Namibia.
    (2012) Angula, Penehafo.; Ncama, Busisiwe Purity.; Fröhlich, Janet Ann.
    Background: Namibia has been affected by the HIV/AIDS pandemic with infected and affected persons experience stigma at different levels. As there were no local stigma reduction intervention tools, this study aimed to develop, implement and evaluate tools at different levels in a rural Namibian community. Methods: An intervention research with a quasi-experimental non-equivalent control group pre-and post-test sample plan was used, with both qualitative and quantitative approaches. Four groups of participants participated: People Living with HIV/AIDS (PLWHA), their family members, community leaders and health care workers (n=224). The LINMODEL community participation and Frohlich Model informed the participant selection, and the Diffusion of Innovations theory provided the framework for justifying the use of targeted intervention tools in specific groups. Seven communities and a clinic were divided into the control (n=107) and intervention (n=117) arms. The study consisted of pre- and post-intervention questionnaires for both arms, intervention training workshops for the PLWHA and community leaders, and in-depth interviews for the community and opinion leaders. The post-intervention results showed that stigma decreased significantly in social isolation (p=0.017), workplace stigma (p=0.008) and negative self perception (p=0.006) in the PLWHA intervention arm. Verbal abuse (p=0.07) has slightly decreased but there was no statistically significant difference between the two study arms. Fear of contagion (p=0.12) has slightly increased after intervention in both arms. All mean scores (PLWHA) for the control arm increased significantly after the intervention. Regarding the family and vii community leaders results, only the household stigma score (p=0.01) decreased significantly in the intervention arm. Health care workers reported increased stigma after intervention, stigma against PLWHA (p=0.04) and associated stigma towards health care providers (p=0.005). Discussion: A comparison of the results in both arms indicated that the intervention was effective in reducing stigma in the intervention arm in three groups (group 4 excluded) with varying degrees of success. Stigma scores were significantly decreased in PLWHA from the intervention arm. The intervention was effective although it did not decrease all stigma scores significantly. This may require more time for the issues addressed in the intervention workshops to diffuse through the different groups.
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    Developing, testing and refining of a model for implementation of HIV/AIDS self-management education in a semi-rural area in KwaZulu-Natal, South Africa.
    (2011) Omisakin, Folorunso Dipo.; Ncama, Busisiwe Purity.
    The purpose of this study was to develop, test and refine a model for implementation of self-management education for people living with HIV/AIDS (PLWHA) in semi-rural KwaZulu-Natal, South Africa. The study consists of a purposive sample of 88 men and women over 18 years of age living with HIV/AIDS. A Quasi-experimental design, incorporating pre-test and post-test interventions and comparison groups, was used. These groups, equal in number and matched in other respects at baseline in terms of the recruitment criteria used, were designated Group A and Group B. Group A received seven weeks of intensive self-management education; Group B received only traditional health education. Group B, however, received (and its members were informed that they would do so) self-management education immediately after my intervention had concluded. Arrangements were made to prevent the two groups from interacting, or even meeting. A conceptual model derived from the relevant literature on self management, and in particular on the teaching of self management to PLWHA, was tested using data from participants’ health-related quality of life, CD4 counts, and viral loads before and after the self-management education intervention. Testing comprised an investigation into whether or not the outcomes included in the model adequately reflected those reported in the literature on effective self-management education, and also whether or not the predicted relationships between intervention and those outcomes existed in practice. A priori assessment produced data for preparation and development of the new intervention devised by the researcher. The assessment process involved the collection of data on participants’ perceptions of health, their difficulties of living with HIV/AIDS, self-management education needs; preferred methods of learning and perceived barriers to participation in this self-management education programme. Participants’ health-related quality of life was measured at baseline and at the twenty-fourth week, using an SF-36 questionnaire. Data on participants’ CD4 cell counts and viral loads were obtained from the clinic records at baseline and in the twenty-fourth week; comparisons were made for sample means using the data available on all participants in both groups. In-depth group interviews were conducted for systematic sampling of the intervention group after intervention to substantiate the effectiveness of the intervention. Results indicated a significant trend toward improvement in health-related quality of life. The indepth group interview results demonstrated that participants showed improvement in their health status through the acquisition of self-management skills, health practices, and communication with healthcare providers. Post-intervention results showed that the two groups were statistically significantly different in terms of their mean scores on physical functioning (t=3.900; df=79; p<0.0001 < 0.05), vitality (t=3.285; df=79; p=0.002< 0.05) and general health (t=2.107; df=79; p=0.039 < 0.05), physical health (p=0.001< 0.05) and role limitation due to emotional problems (p=0.007 < 0.05). No statistically significant difference appeared in terms of their mean scores on mental health (t=1.422; df=79; p=.158 > 0.05), bodily pain (t=-.138; df=79; p=0.891> 0.05) and social functioning (p=0.249 > 0.05). Post-intervention, the two groups are statistically different in terms of their CD4 count mean scores (t=3.741; df=80; p<.0001 <0.05). The mean CD4 cell counts increased over the period of investigation; paired t-tests for difference between intervention and comparison groups were statistically significant (p < 0.05) for these variables. However, the differences between the two groups in terms of their viral load were not statistically significant. This may be the result of the fact that as researcher, I had no influence over the process by which viral load data were obtained: both at baseline and after the intervention, they were retrieved from patients’ records, in which viral load was expressed, for example, as ‘below 25 copies per mil’. This was of course an approximation; after the intervention, they were expressed similarly as ‘below detectable limits’, or ‘below 80 copies per mil.’ My conceptual model provides a consistent, reproducible approach to assessment, monitoring, and evaluation of the key components of self-management education and allows for measurement over time and the tracking of changes; it has in addition a predictive ability. Overall, the programme seemed to have a positive impact on the health-related quality of life of PLWHA. The study confirms the effectiveness of self-management education in improving the health and well-being of PLWHA, even in a resource-limited semi-rural setting.
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    Facilitation of behaviour change communication process for maternal, newborn, and child health at primary health care level of midwifey practice in Kaduna State, Nigeria.
    (2012) Akin-Otiko, Bridget Omowumi.; Bhengu, Busisiwe Rosemary.
    Background: Nigeria’s unacceptably high maternal and child mortality rates are related, among other things, to the people’s lack of access to appropriate information to assist them in making decisions about their health, and to promote their utilization of available services. Midwives’ skills for result-oriented client education and friendly services are fundamental to women’s behaviour change for favourable maternal and child outcomes. Aim: The purpose of the study was to appraise and facilitate behaviour change communication (BCC) by midwives at primary health care level of maternal, newborn, and child care. Methods: Action research, with concurrent transformative mixed method data collection strategy, was adopted for the study, and the maximum variation sampling technique was employed to recruit participants. Fifteen, representing sixty-eight percent of the twenty-two recruited midwives continued through the three phases of the study. The diagnostic, intervention, and monitoring phases of the study were arranged in line with the objectives of the study, and each succeeding phase built on the findings of the previous one. At the diagnostic phase, the strengths and weaknesses in behaviour change communication by midwives in the facilities, and the appropriate solution to bridge the gaps were identified at a three-day search conference. At the intervention phase, a training manual was developed. A capacity building programme, made up of a training component for the midwives, and an interactive session between the government and the midwives, was designed and implemented at a three-day workshop. The monitoring phase comprised the midwives’ hands-on practice, using the developed training manual, core messages, and interpersonal communication (IPC) observation checklist for three months. The implementation of the midwives’ action plans in their respective work places was also monitored. Both qualitative and quantitative data collection and analysis methods were utilized at each phase of the study. Results: The diagnostic phase revealed that midwives lacked the essential knowledge, skills and attitudes for effective behaviour change communication activities in the facilities. Health talks were seen as midwives’ responsibility, however, they were unplanned, difficult, and given routinely, providing inadequate information, and without focus on behaviour change. Socio-cultural and environmental factors such as inadequate staff, material and time were barriers. The midwives’ knowledge, attitudes, and skills responded positively and significantly to the training, to hands-on practice, and to the use of reminders at their workplaces. In addition, midwives were able to network for support from the community and other workers in the facilities, to implement their action plans. Through exhibition of innovative behaviour in the implementation of their action plans, the midwives in most of the facilities were able to effect changes to facilitate utilization of maternal and child health (MCH) services. The gross shortage of staff, staff transfers, lack of drugs and supplies, heavy workload, and midwives’ lack of trust in their employers, however, hindered optimum implementation of some of the plans. Conclusion: The women living in the communities where the midwives worked, desired to know more about the role of midwives and to have competent ones; while the midwives were willing to assist their clients to adopt desired health and health-seeking behaviours, because they were duly recognized and empowered during the project. The study showed that the grave disconnection between the midwives and the government policies / programmes to facilitate behaviour change, and promote maternal and child health, can be corrected. The findings and recommendations have implications for practice, education, research and policymaking in Kaduna State and similar settings.
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    Improving detection of depression and/or anxiety as comorbidities of epilepsy in primary health care settings in Zambia.
    (2013) Mbewe, Edward Kondwelani.; Uys, Leana Ria.; Birbeck, Gretchen L.
    The focus of this study was on common psychiatric comorbidities of depression and anxiety in people with epilepsy (PWE). While international published data show that up to 60% of PWE suffer from depression and/or anxiety, most primary care (PHC) settings in developed countries display some oversight in this area. The study was conducted in Zambia, in three phases; which each culminated in submissions for publication in an internationally peer reviewed journal. Phase one involved chart review to establish the rate of detection of depression and/or anxiety in PWE at the outpatient clinic of Chainama Hills College Hospital. The detection rate was only 1%. This formed the basis for phase two where we developed a ten item screening tool for depression and/or anxiety for use by PHC workers in busy clinical settings. The tool was validated, its sensitivity and specificity were determined and the inter-rater reliability was also calculated. Phase three involved implementation of the tool validated screening tool. We measured the ability of PHC workers to use and interpret the screening tool in busy clinical settings. One month after training and implementing the use of the screening tool, a retrospective chart review was undertaken using the same tool that was employed in phase one chart review. There was a marked improvement when 120 files of PWE were reviewed as the percentage of screening for depression and anxiety increased from 1% to 49%.
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    Management of the long term psychological effects of rape among women survivors of the 1994 genocide in Rwanda : a grounded theory approach.
    (2013) Mukamana, Donatilla.; Brysiewicz, Petra.; Collins, Anthony John Louis.
    In the 1994 Rwandan genocide, rape was widely used as a strategic weapon against Tutsi women. This study explored the long term psychological effects of rape experienced by these women in order to develop a middle range theory to guide the management of the lasting psychological effects of rape in the context of genocide. A Grounded Theory approach using Strauss and Corbin’s paradigm (Strauss and Corbin, 1990) was used. Data collection entailed in-depth interviews of twenty nine participants, twelve of whom were rape survivors, ten were women who had not been raped, and seven were men from their community. Open coding, axial coding and selective coding were used to analyse the data. The results have shown that women were negatively affected, physically, psychologically and socially, by the rape. Genocide Rape Trauma emerged as a concept that defines these outcomes. It includes unbearable memories, overwhelming feelings, sense of helplessness, somatic distress, negative self-image, altered intimate relationships and social isolation. The extreme brutality, the humiliation that accompanied the experience of rape and multiple losses were reported as risk factors for the lasting psychological effects of rape. These negative outcomes were maintained by poverty, poor physical health, the burden of raising the children born of rape, hostility and stigma from their community, and lack of appropriate support and effective health care services. Facilitating the management of Genocide Rape Trauma emerged as the core category of the middle range developed theory. Recovery from Genocide Rape Trauma required formal and informal support, including psychological and medical care, sensitivity in dealing with genocide rape survivors, and advocacy. Economic empowerment was a key element, while educating the community contributed to the social integration of rape survivors and their children born of rape into their community. Women had developed coping mechanisms of their own to attain psychological relief, and had organized themselves into support groups. This study contributed to clinical practice by providing a holistic approach to taking care of rape survivors. The inclusion of such theory in the curriculum of health care professionals should contribute to the understanding of the lasting impact of rape and how to handle it in an efficient manner. Key words: Rwanda, Genocide, women survivors, Genocide Rape Trauma, Management of the long term psychological effects of rape and Grounded theory.
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    Policy implementation : implication on caregiving experiences of families and persons living with serious mental health problems in Nigeria.
    (2012) Jack-Ide, Izibeloko Omi.; Uys, Leana Ria.; Middleton, Lyn Elizabeth.
    No abstract available.
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    An exploratory study towards disclosure of status and reduction of stigma for people living with HIV/AIDS in a low income community : the development of a community-based framework.
    (2010) Razak, Ayisha.; Bhengu, Busisiwe Rosemary.; Brysiewicz, Petra.
    Introduction: Stigma associated with HIV/AIDS creates a barrier to prevention, care and treatment of HIV/AIDS. It further restricts PLWHA from learning about their status, disclosing their status, adopting safe behaviour and accessing services such as antiretroviral treatment. Disclosure of HIV status and a reduction in stigma may contribute to the decrease in new HIV cases. Purpose: The purpose of the study was to develop a community-based framework that would encourage people living with HIV/AIDS to disclose their HIV status and reduce the stigma associated with the disease. Method: This study used the action research method to explore the experiences of stigma and disclosure of HIV status and to develop a community based framework with PLWHA who encouraged disclosure and promoted the reduction of stigma in a community-based setting. The research setting was Bhambayi, an informal settlement in the district of Inanda. Non-probability purposive sampling was used. In-depth interviews with PLWHA that had disclosed their HIV status and focus group discussions with family members, adult children and community members were conducted. Findings: The data was analyzed manually and the following categories and subcategories emerged. The categories were experience of disclosure, stigmatizing reactions, lifestyle changes after disclosure and supports to reduce stigma. Some of the sub-categories were ‘opens out the illness’, gossiping and pointing fingers, discrimination against PLWHA by family and community, changes in relationships, community awareness and formation of support groups. The findings revealed that PLWHA that had disclosed their HIV status had changed their lifestyles. Recommendations were made on the need for nurses to develop community engagement projects and establish partnerships in order to reach out to communities regarding HIV/AIDS. Incorporate HIV/AIDS stigma and discrimination into the current nurses’ curriculum. The need for research is expressed on the evaluation of the framework and conducting similar research in larger communities. Conclusion: PLWHA who had disclosed their HIV-status shared their experience of being HIV-positive and encouraged other people to get tested. The community-based framework to facilitate disclosure and reduce stigma among PLWHA can be operationalised in other informal community-settings.
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    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.