Africa Journal of Nursing and Midwifery - latest Issue
Volumes & issues
Volume 18, Issue 2, 2016
Author Thandisizwe R. MavundlaSource: Africa Journal of Nursing and Midwifery 18, pp 3 –5 (2016)More Less
Welcome to yet another issue of Africa Journal of Nursing and Midwifery (AJNM). In 2015 AJNM started publishing its issues on Open Journals System (OJS) platform. This process has been carefully monitored by both the publisher, Unisa Press, and the editorial board of AJNM. This means that authors had to register their profiles as users of the journal. Being a user of AJNM OJS publishing platform means that one has to function in either of the following roles at one point in time, that is, as an author, a reader or a reviewer. The system also comes with additional roles for those who are part of the editorial team.
Source: Africa Journal of Nursing and Midwifery 18, pp 6 –26 (2016)More Less
The diagnosis of HIV impacts the lives and the relationships of both people living with HIV (PLWH) and their partners. The researchers aimed to describe the influence of a community-based HIV stigma reduction intervention on PLWH and their partners by means of a case study as well as their lived experiences during and after the intervention in both an urban and a rural setting in the North West Province, South Africa. A qualitative holistic multiple case study design and interpretive description approach through in-depth interviews was used. Purposive voluntary sampling was used for the PLWH and snowball sampling for their partners. The case record included multiple sources. Document analysis and open coding were used for analysis. No real differences were noted between the urban and rural groups and the data was then pooled. Participants expressed experiences that were evident of a successful intervention. Follow-up interventions with PLWH and partners are suggested.
Source: Africa Journal of Nursing and Midwifery 18, pp 27 –41 (2016)More Less
The practice environment plays an important role in nursing. Currently, limited information seems to exist on the nature of practice environments within the primary health care (PHC) context of the public health care sector of South Africa. This study describes the demographic profile of community health care centres (CHCs) and professional nurses (PNs) as well as the current status of the practice environment of nurses in the PHC context. A quantitative, descriptive cross-sectional survey design was used. Firstly, demographic data of the CHCs (N=41; n=26) was obtained. Secondly, PNs (N=291; n=195) were surveyed using the Practice Environment Scale of the Nursing Work Index (PESNWI)and questions focussing on their demographic profile. The demographic profile of CHCs and PNs was described and the confirmatory analysis of the PES-NWI showed that the survey was valid in the PHC context of South Africa. The Cronbach alpha ranged between 0.68 and 0.86. Nurses disagreed that the sub-scales named staffing and resource adequacy and nurse participation in PHC/CHC affairs were present in their practice environments. Development and implementation of a positive practice environment programme for the South African PHC context could improve the well-being of nurses and assist in the delivery of quality care to patients.
Experiences of health care providers in the fast queue service point in primary health care facilities in Ethekwini district, South AfricaSource: Africa Journal of Nursing and Midwifery 18, pp 42 –56 (2016)More Less
Public health facilities are congested from increased access and burden of disease. In 2011, the National Department of Health introduced the National Core Standards for health establishments, which reflect the new vision for South Africa's health services. These are standard guidelines aimed at providing quality health services, enhancing the current health outcomes and restoring patient and staff confidence in the health system. One such guideline is the Fast Queue Service Point, a service for people who are usually chronically ill, who have already consulted at higher levels, and who come to collect medications from the Primary Health Care facilities. It also serves people who need short consultations. This study used a descriptive qualitative survey methodology with content analysis to describe the experiences of 13 purposively sampled health care providers assigned to work in the Fast Queue Service Point. All staff performed their duties as allocated and as would be expected according to their scope of practice, though the workload was seen as high. They all knew what the purpose of this service point was and they liked that users got through the system quickly. Participants verbalised lack of support from supervisors. Delays were prevented through well organised patient flow. However, patients would miss out on health education opportunities if they were perceived as 'old' and thought to know everything about their treatment. The study shows that there is a need to make available more health care providers of lower categories to support registered and enrolled nurses and relieve them of the high workload.There is also a need for structured supervisory visits, which can assist in ensuring that facilities receive the necessary support. Nursing staff perceived that users of the Fast Queue Service Point went through the system quicker than other users. Due to the shortage of staff, they felt that the workload was too high and this compromised care for these users .
Source: Africa Journal of Nursing and Midwifery 18, pp 57 –73 (2016)More Less
The South African Nursing Council promulgated the compulsory community service (CCS) policy, in regulation R765 of 2007, for nurses of the four-year diploma or degree in nursing. The implementation of the CCS policy takes place at public health institutions. There have been no studies to date on how nurse managers experience this process of the CCS policy implementation. The findings of the study will inform future changes to the policy, such as guidelines for nurse managers on how to handle community nurse practitioners (CNPs) that are placed in their institutions. This study explores the experiences of nurse managers with nurses who are placed at their institutions to carry out compulsory community service. Descriptive qualitative design was used to gather data from nurse managers using individual interviews and data were analysed using Tesch's content analysis. The main categories that were identified were: valuing the CNPs, role modelling behaviours, benefiting from mentoring, dealing with challenges and following the process. The community nurse practitioners were valued by two groups of nurse managers. Support and professional development were provided on an ad hoc basis, leading to inconsistencies in their management. The following are recommended: the guidelines of the CCS policy to provide structured guidelines for the development of the CNPs during the CCS year; mentorship for the CNPs that is evaluated at regular intervals through formalised reports; and a scope of practice for the CNPs.
Nurses' knowledge of Glasgow coma scale in neurological assessment of patients in a selected tertiary hospital in Edo State, NigeriaSource: Africa Journal of Nursing and Midwifery 18, pp 74 –86 (2016)More Less
Glasgow Coma Scale (GCS) is a reliable and objective neurological assessment tool used for assessing and recording the level of a person's conscious state. An assessment of consciousness levels is considered a primary action of doctors and nurses who care for patients with neurological or neurosurgical problems. This study assessed the knowledge of Glasgow coma scale in neurological assessment of patients among nurses working in a tertiary hospital, in Edo state, Nigeria. A descriptive survey design was used. The respondents were all nurses (226) working in wards/units where unconscious patients are nursed. The instrument for data collection was the pre-tested and administered questionnaire developed by the researchers. Data collected were analysed in proportions and percentages and means; and inferential statistics were used for test of hypotheses at P ≤0.05 level of significance. Result showed that 41.7% of respondents had good, 25.2% moderate and 33.0% had poor knowledge of the GCS. Respondents scored highly (>75%) on knowledge questions eliciting purpose, components, and the behavioural rating scores of GCS domains, but poor (<36%) to moderate (<67%) on questions that concern clinical application of results and GCS use in special situations. Significant differences were found in the GCS knowledge of the nurses across the various wards/units (p= 0.000) with neurological ward nurses having the highest (31.8%) score. There were no significant associations (P> 0.05) between nurses' age, gender, educational level, years of experience, and GCS knowledge. Continuous professional development and update training for nurses on GCS were recommended.
Developing guidelines for managing a nursing workforce infected with HIV and TB in South African hospitalsSource: Africa Journal of Nursing and Midwifery 18, pp 87 –102 (2016)More Less
Workplace sickness and poor work attendance are simple to manage, unlike incapacity leave and ill health, which involve complicated processes in the management of the employees' illness. Managing incapacity leave and ill health results in nurse managers having to source many documents to obtain the information they need. The study's purpose was to create guidelines to support nurse managers in managing an ill nursing workforce. A qualitative, ethnographic study was used to develop the guidelines. Four (4) purposively selected public sector hospitals were visited and the four (4) nurse managers planning work placement for each hospital were participants. Data were collected using participant observation, in-depth interviews, field notes and document analysis of statutes and policies around poor work attendance and employment. Interviews were transcribed verbatim. Data were analysed using thematic analysis. Guidelines for managing a nursing workforce infected with HIV and/or TB (Kerr, Brysiewicz & Bhengu, 2014:166) are the result of this study.The rationale for developing the guidelines was to collate information on the management of HIV- and/or TB-infected nurses into a single document. These guidelines can be used in clinical practice by nurse managers and included in the nursing education curricula. They could be considered for use by other services within the public sector of South Africa.
Source: Africa Journal of Nursing and Midwifery 18, pp 103 –118 (2016)More Less
The purpose of this study was to explore and describe the structure and processes of quality patient care at the University Central Hospital of Kigali (CHUK)/Intensive Care Unit (ICU), using Donabedian's model and the Joint Faculty of Intensive Care Medicine (JFICM) minimum standards for quality patient care. A descriptive and exploratory quantitative study was conducted using self-reporting questionnaires for healthcare workers and a self-developed checklist for document analysis. The sample consisted of 32 healthcare workers in the ICU and the researcher observed the files of 20 patients during the period of data collection from 20 June 2010 to 20 July 2010. The results showed that while the ICU was in a self-contained area, access to other departments was not easy; and, the actual work environment did not comply with the recommendations of the JFICM minimum standards for ICUs.The equipment was not adequate for the workload in the unit. The documents showed that policies, procedures, guidelines and protocols were not available. Patient assessment and monitoring were done without any guidance. The findings demonstrated that quality patient care was inadequate and needed improvement.
Contraceptive use and reasons for termination of pregnancy among women attending a reproductive health clinic at a district hospital, Free State, South AfricaSource: Africa Journal of Nursing and Midwifery 18, pp 119 –131 (2016)More Less
Unplanned and unwanted pregnancies happen in all societies, regardless of medical, economic, educational or religious status. The reasons for seeking termination of pregnancy (TOP) vary with the majority of women seeking TOP for socio-economic reasons. This article seeks to identify the reasons for women seeking TOP and to establish their knowledge and use of contraceptives. It is a descriptive study conducted at a reproductive health clinic at a district hospital in Bloemfontein, Free State, South Africa. In total 534 patients attending the clinic between April to June 2007 participated. Data were collected through a questionnaire, which included demographics, age at first sexual encounter and first pregnancy, reasons for seeking TOP, and knowledge and use of contraceptives. The results are summarised by frequencies and percentages. Most participants (64.2%) were between 20 and 29 years, single (75.8%) and unemployed (44.4%). Participants had their first sexual encounter (82.4%) and first pregnancy (51.3%) at the age of 20 years. Three-quarters were aware of contraceptives; only 37.1% used contraceptives to prevent the current pregnancy. The most frequently mentioned reasons for the TOP were: 'I am still at school', 'Partner not prepared for the parenthood', and 'Not supported by the family'. Although women knew about contraception, the use of contraceptives by participants of this study is low compared with the contraceptive prevalence rate in the country. Interruption of studies, problems in the relationship and nonacceptance of the pregnancy by the partner were the most frequent reasons for requesting TOP.
Author R.M. Mmusi-PhetoeSource: Africa Journal of Nursing and Midwifery 18, pp 132 –145 (2016)More Less
High maternal mortality ratios (MMRs) remain a major challenge to health systems worldwide. Developing countries account for more than 99% of the estimated maternal deaths worldwide. The South African MMR is of particular concern because of the perceived underestimation of maternal deaths. The absence of comprehensive information about maternal deaths means misguided decision-making on health provision to improve outcomes. It is within this premise that the author seeks to unravel the perspectives from South African experts on the magnitude of the South African MMR. Data was collected as part of a larger study here qualitative face-to-face interviews were held with six (6) experts in the field of reproductive health. The data was analysed using the WHO's Commission on Social Determinants of Health (CSDH) framework. The findings confirmed that under-reporting of community maternal deaths was an underlying factor in the underestimation of the South African MMR. Robust strategies to collect comprehensive, reliable and consistent estimates are needed to develop focused interventions for handling maternal deaths.
Knowledge of the management of postpartum haemorrhage by doctors and midwives working in Free State district hospitalsSource: Africa Journal of Nursing and Midwifery 18, pp 146 –161 (2016)More Less
Postpartum haemorrhage is a major cause of maternal mortality with an estimated annual occurrence of 13.8 million globally. In South Africa, postpartum haemorrhage accounted for above 73% of the 688 maternal deaths from obstetric haemorrhage during 2008-2010, with the majority occurring in district hospitals. This study seeks to determine the knowledge of doctors and midwives, working in maternity units of Free State district hospitals in postpartum haemorrhage management. In this cross-sectional study, self-administered questionnaires were completed by doctors and midwives working in the maternity units of 14 district hospitals in 2012/2013. In total, 132 participants were included in the analysis. The majority (64.1%) of the participants with known occupation (n=131) were midwives. The highest percentage (24.4%) of doctors were medical officers. Most (94.1%) participants had working experience of over one year to five years, and 44.2% had completed Essential Steps in the Management of Obstetric Emergencies (ESMOE). Only 40 participants (30.3%) obtained scores over 80%, the acceptable mark for core knowledge. Doctors performed significantly better than midwives (p=0.0002). ESMOE training resulted in significantly better performance (p=0.0045). Issues identified were inadequate overall theoretical knowledge and an inability to practically demonstrate acquired theoretical knowledge. The self-assessment of doctors on obstetrics-related surgical skills revealed insufficient practice. The overall theoretical knowledge of doctors and midwives working in the maternity units of Free State district hospitals is limited. The article recommends that the roll-out of the ESMOE training should include all midwives and doctors in maternity units at district hospitals. Adequate skills training and exposure to obstetric emergencies through rotation should also be encouraged for district hospital medical staff.
Experiences of midwives regarding nursing practice breakdown in maternity units at a selected public hospital in KwaZula-NatalSource: Africa Journal of Nursing and Midwifery 18, pp 162 –178 (2016)More Less
Pregnant women have certain expectations about the midwife and their skills. If such expectations are not met, substandard care occurs. Such substandard care has a negative impact on both the pregnant women and the Department of Health. The aim of the study was to explore and describe the experiences of midwives regarding practice breakdown in maternity units at a public hospital in KwaZulu-Natal in order to improve the quality of care in maternity units. A qualitative research study that was exploratory, descriptive and contextual in nature was conducted. Semi-structured interviews were conducted with 13 midwives. Data was transcribed verbatim, then organised into codes. The study revealed that the majority of the participants faced practice breakdown, which mostly starts during ante-natal care visits. Midwives who attended to pregnant women during ante-natal care did not follow set protocols and guidelines and this resulted in complications during delivery. Midwives were of the opinion that the management did not care about their challenges and did not attempt to resolve the challenges. Therefore, strategies of retaining midwives must be put in place by the Department of Health. Midwives must be relieved in all non-nursing- related matters to allow them to focus on the pregnant women.
Impact of knowledge and attitude of primiparous women in Addis Ababa, Ethiopia, on achieving optimal breastfeeding practicesSource: Africa Journal of Nursing and Midwifery 18, pp 176 –195 (2016)More Less
Improving infant and young child feeding (IYCF) practices in children 0-23 months of age is critical to improved nutrition and development of children. Despite strong recommendations for optimal breastfeeding during the first six months, the practice remains lower than the desired targets globally. Socio-cultural and psychosocial factors, and mothers' breastfeeding knowledge and attitude, challenge optimal IYCF practices. The study was conducted to assess the impact of breastfeeding knowledge and attitude on the primiparous women's early initiation and exclusive breastfeeding practices during the first six months after delivery. A prospective follow-up health facility-based study design with quantitative methods was used. Both structured and semi-structured questions were used for data collection. Statistical Package for Social Sciences (SPSS) version 21 was used for data management. Findings at the 95% confidence interval and P-value of 0.05 (5%) were reported as statistically significant. The majority of the respondents (86.5%) had no comprehensive breastfeeding knowledge. Meanwhile, over 60% of the respondents had a positive attitude to breastfeeding. Medium, positive and statistically significant correlation was observed between breastfeeding attitude and exclusive breastfeeding (EBF) practices (x2(1df) =2.082 (P<0.00)), as well as between early initiation of breastfeeding practices and EBF practices (x2(1df) =0.973 (p<0.05)). A positive breastfeeding attitude and early initiation of breastfeeding can predict EBFpractices among primiparous women. Therefore, improving primiparous women's breastfeeding attitude and early initiation of breastfeeding practices, as well as further qualitative research to document perceptions and cultural factors affecting the practices of EBF among primiparous women, are strongly recommended.
Emotional challenges faced by nurses when taking care of children in a private hospital in South AfricaSource: Africa Journal of Nursing and Midwifery 18, pp 196 –210 (2016)More Less
Various studies have been conducted on children's experiences of hospitalisation. The experiences of nurses, however, have been neglected. Burn-out syndromeis common among nursing staff working with very sick children. The parents', children's and physicians' demands increase the nurses' workload and contribute to nurses experiencing intense emotions that may contribute to stress. This study explored the nurses' emotional challenges in order to improve quality care of children and working conditions of the nursing staff. An explorative descriptive and contextual research design, qualitative in nature, was used. Data were gathered by means of the nominal group technique. The sample comprised five nurses working in a paediatric ward in a private hospital. The main emotional challenge faced by nurses in the children's ward is to have job satisfaction despite stress, which may be overcome when committed nurses build a relationship of trust with the children they nurse. A further challenge is managing the diverse emotions they experience when taking care of the children. The participants explored solutions for the various emotional challenges they experienced. The findings suggest that the important solutions to the various challenges lie in child-centred nurses being passionate about caring for children, and unconditional commitment. Communication problems should be addressed during team-building events. In-service training will keep the nurses updated and enhance their clinical judgment, making them experts in their field.
Source: Africa Journal of Nursing and Midwifery 18, pp 211 –225 (2016)More Less
Nurse educators play a pivotal role in strengthening the nursing workforce. They serve as role models and provide the leadership needed to implement evidence-based practice. To be successful in this endeavour nurse educators should not only be role models as researchers, but must also be able to teach research methodology and supervise students who conduct research projects. Educators at some education institutions, who have recently entered the higher education sphere and are not in possession of a master's or a doctoral degree, ultimately lack a research background.The purpose of this article is to report on a study conducted to identify and describe the challenges faced by nurse educators in teaching research methodology and acting as supervisors when students have to conduct their own research. A qualitative, explorative, descriptive and contextual study was conducted. Data were collected by means of a focus group discussion with all nurse educators involved in the research module. Participants acknowledged that they face many challenges. They highlighted a lack of human resources; research experience and competencies; research guidelines; physical resources; and a lack of support from the management as major challenges, and provided suggestions to support them and enhance a research culture in the institution.
Conference report : the Forum for Professional Nurse Leaders (FPNL) - 20-year legacy : leading nursing into the future : nursing 2016 conferenceSource: Africa Journal of Nursing and Midwifery 18, pp 226 –227 (2016)More Less
The Forum for Professional Nurse Leaders (FPNL) hosted the Nursing 2016 Conference from the 25-27 May 2016 at the Hilton Hotel, Sandton, Gauteng, South Africa. The conference was dedicated to nurse leaders in the industry ready to lead a360° change in the nursing profession. The main objective of the conference was to foster the spirit of cooperation among professionals through networking and sharing of information, best practices, capacity building, and integrating nursing practice and education. The programme director was Dr Elizabeth Mokoka (Programme Manager, FUNDISA). She started the conference by thanking all conference sponsors, which were classified according to platinum, golden, silver and bronze partners. She further reminded conference delegates that nurses are backbones and heartbeats of healthcare services in South Africa and the whole world.
Author Leepile Alfred SehularoSource: Africa Journal of Nursing and Midwifery 18, pp 228 –229 (2016)More Less
The 6th edition of Africa Health Congress took place at the Gallagher Convention Centre, Johannesburg, South Africa from 8-10 June 2016. Africa Health is the continent's largest healthcare exhibition and is a leading platform for the industry to meet, learn and do business. There were 17 CPD accredited conferences that brought together locally and internationally acclaimed speakers to discuss, showcase and share their experiences and insights into the latest methods, developments and technologies in the healthcare industry. The congress featured a combination of clinical and non-clinical conferences and introduced six brand new tracks: Wound Care, Gastroenterology, Clinical Engineering (in association with CEASA & IFMBE), Medical Managers (in association with SASMM), South African Preventive Medicine (in association with SAPHMA), and Health Technology Assessment (in association with SAHTAS). Delegates to All Africa Health conferences were charged at a nominal fee of R100 per conference, and all proceeds were donated to the local charity, Childhood Cancer Foundation South Africa (CHOC).