Curationis - Volume 37, Issue 1, 2014
Volume 37, Issue 1, 2014
Factors influencing treatment outcomes in tuberculosis patients in Limpopo Province, South Africa, from 2006 to 2010 : a retrospective study : original researchSource: Curationis 37, pp 1 –7 (2014) http://dx.doi.org/10.4102/curationis.v37i1.1169More Less
Background : South Africa has a high burden of tuberculosis (TB), with high human immunodeficiency virus (HIV)-TB co-infection rates and the emergence of multidrug-resistant TB.
Objectives : To describe treatment outcomes and factors influencing outcomes amongst pulmonary TB (PTB) patients in the Limpopo Province.
Method : A retrospective review was conducted of data on the provincial electronic TB register (ETR.net) for the years 2006 to 2010 (inclusive), and a random sample of 1200 records was selected for further analysis. The Chi square test was used to examine the influence of age, gender, health facility level, diagnostic category and treatment regimen on treatment outcomes.
Results : Overall 90 617 (54.6% male) PTB patients were registered between 2006 and 2010. Of the sampled 1200 TB cases, 72.6% were in persons aged 22 to 55 years and 86.2% were new cases. The TB mortality rate was 13.6% (much higher than the World Health Organization target of 3%), whilst the default rate was 9.8%. There was a strong association between age (P < 0.001), diagnostic category (P < 0.001), treatment regimen (P < 0.001), and health facility level (P < 0.001) and treatment outcome. Those aged 22-55, and 56-74 years were more likely to die (P < 0.05). Poor treatment outcomes were also associated with initial treatment failure, receiving treatment at hospital and treatment regimen II.
Conclusion : The poor TB treatment outcomes in Limpopo, characterised by a high mortality and default rates, call for strengthening of the TB control programme, which should include integration of HIV and/or AIDS and TB services.
Pre-deployment preparation of military nurses of the South African National Defence Force for participation in peace support operations : original researchSource: Curationis 37, pp 1 –9 (2014) http://dx.doi.org/10.4102/curationis.v37i1.75More Less
Background : South Africa has dedicated itself to participate in peace support operations (PSOs). The concept of 'jointness', involving different arms of services, was adopted within the South African National Defence Force, thus involving nurses in PSOs.
Problem statement : Combat-readiness being a prerequisite for those involved in PSOs raised questions as to the readiness of forces to participate in these missions. There is a need for specific nursing care during PSOs, but the role and functions of nurses during such operations were not clearly defined; thus their preparation for these missions had very little scientific grounding.
Objectives : These were to explore the pre-deployment preparation needs of military professional nurses during PSOs, and to describe the experience of these nurses whilst being deployed.
Method : A quantitative exploratory, descriptive and contextual approach was used. Questionnaires were distributed to 99 professional nurses who had deployment experience, and 72 participated (73% response rate). Relevant peace mission concepts are the environment, jointness, behaviour and mission readiness, which served as the conceptual bases for the study.
Results : Findings indicated that the nurses were not fully informed of their responsibilities during deployment or the circumstances under which they would have to work and live. Their preparation is not fully integrated with that of the other armed forces, and deficiencies in their training and development were identified which negatively impact on their mission readiness.
Conclusion : Recommendations were made in terms of human resource requirements, psychological training, better integration of jointness training, and content of training and development to ensure mission readiness of nurses.
Using a simulated patient to transfer patient-centred skills from simulated practice to real patients in practice : original researchSource: Curationis 37, pp 1 –6 (2014) http://dx.doi.org/10.4102/curationis.v37i1.1184More Less
Background : Simulation in healthcare education is common practice. Although this teaching strategy increases patient safety, it is not proven to enhance patient-centred care in practice. Simulated patients are used to teach communication skills and to contribute to the authenticity of the simulation. Could this enhanced authenticity help bridge the gap from simulated practice to practice with live patients where patient-centredness is of crucial importance?
Objective : This study's objective was to determine whether students who acquired a skill in simulation using a simulated patient displayed more patient-centredness in practice than students who used a mannikin.
Method : A pre-experimental, post-test-only design with a comparison group was used. The population sample comprised all second-year B.Cur. students (N = 36) at a tertiary institution, who were divided into two cohorts. Cohort 1 was trained to administer an intramuscular injection using a simulated patient with a strap-on injectable device, whilst cohort 2 used an injection model. All participants were assessed on their procedural skills as well as patient-centred care whilst administering an injection to a patient in hospital. A comparison was made of mean scores for patient-centred care rendered by the two cohorts.
Results : Fisher's exact test revealed that the mean score for patient-centredness of cohort 1 (88%) was significantly higher (p = < 0.001) than that of cohort 2 (74%).
Conclusion : Using a simulated patient to teach administration of an intramuscular injection enhanced students' patient-centredness when performing the procedure in practice. Recommendations include making use of a bigger sample and including a pre-test the next time research of this nature is carried out.
Views of professional nurses regarding low tuberculosis cure rate in Greater Giyani Municipality, Limpopo Province : original researchSource: Curationis 37, pp 1 –8 (2014) http://dx.doi.org/10.4102/curationis.v37i1.1148More Less
Background : Management of patients suffering from tuberculosis (TB) after discharge from hospital plays a critical role in the cure rate of TB. Despite interventions developed by the World Health Organization (WHO) to improve the cure rate, TB remains a worldwide health problem.
Objective : The purpose of the study was to explore and describe the views of professional nurses regarding the low TB cure rate in primary healthcare facilities of Greater Giyani Municipality in Limpopo Province, South Africa, with the aim of determining strategies that can be used to improve this low rate.
Method : This study was qualitative, exploratory, descriptive and contextual in nature. The population consisted of professional nurses working in primary healthcare facilities within Greater Giyani Municipality, which has a TB cure rate below the national target of 85%. Data gathering was through individual face-to-face interviews using an interview guide. Open-coding was used to analyse the data in this study.
Results : The theme that emerged from data was 'factors contributing to low TB cure rate'. This theme was supported by the following sub-themes: poor referral system, lack of knowledge about TB and its treatment, stigma attached to TB, and cultural and religious beliefs. The professional nurses suggested counselling of TB patients upon diagnosis, advice about patients' responsibilities and the involvement of family members.
Conclusion : The involvement of community stakeholders in TB prevention, health promotion and education activities devoted to disease spread and cure is vital so that the stigma attached to TB can be eliminated. TB education and awareness programmes should be included in the curriculum of primary schools.
Source: Curationis 37, pp 1 –6 (2014) http://dx.doi.org/10.4102/curationis.v37i1.1164More Less
Background : Clinical guidance and support of nursing students in rural hospitals is a challenge for novice nurses, who rotate amongst accredited hospitals throughout the province for clinical exposure, and find themselves in an unfamiliar environment. Theory learned at the training college is integrated with clinical exposure at hospitals and supplemented through teaching by hospital staff. Nursing students complain about lack of support and guidance from professional nurses within the hospital, some feeling restricted in execution of their nursing tasks by professional nurses and other staff. Students perceived negative attitudes from clinical staff, a lack of clinical resources, inadequate learning opportunities and a lack of support and mentoring during their clinical exposure.
Objectives : This article describes perceptions of guidance and support of nursing students by professional nurses in a rural hospital and suggests guidelines for clinical guidance and support of nursing students.
Method : A qualitative, explorative, descriptive and contextual design was used. Two focus group interviews were employed to collect data from a sample drawn from level II nursing students from one training college in Limpopo Province, South Africa, on different days (n = 13; n = 10). Qualitative content analysis was used to analyse data.
Results : Three themes (mutual distrust and disrespect, hospital environment, and clinical guidance and support) and subthemes (student behaviour and staff behaviour) emerged.
Conclusion : Failure to support and guide nursing students professionally may lead to high turnover and absenteeism, resulting in students' refusal to be allocated to a rural hospital for clinical exposure. Proposed guidelines have been formulated for clinical guidance and support of nursing students at the selected rural hospital. The college and hospital management should foster collaboration between the college tutors and professional nurses to ensure adequate guidance and support of nursing students.