Health SA Gesondheid

Obstetric ultrasound training programmes for midwives: A scoping review

Yasmin Casmod — 2023-04-06

Background: Antenatal care is essential for all expectant mothers and assists in reducing maternal mortality rates thus addressing the Sustainable Development Goal 3. Obstetric ultrasound complements antenatal care and is used in pregnancy to identify and monitor high-risk pregnancies. However, disparities exist and in low- and middle-income countries, ultrasound services are not readily available. This contributes to maternal and neonatal morbidity and mortality within these populations. Short ultrasound training programmes for midwives can be beneficial in alleviating some of the challenges experienced.

Aim: The aim of this scoping review was to identify global ultrasound education programmes for midwives.

Method: Articles containing suitable keywords were retrieved from databases suitable to nursing, education and ultrasound. Themes were developed based on the articles included in the review.

Results: A total of 238 articles were identified, and after the duplicates and irrelevant studies were removed, 22 articles were included. Articles were analysed and discussed under the identified themes and categories.

Conclusion: It is essential that sufficient training is provided to medical professionals performing obstetric ultrasound so that adequate and safe care is offered to expectant mothers. With the introduction of ultrasound in low- resource settings, the knowledge of safety and competencies required to operate the equipment necessitate adequate training. Developed programmes have been found to meet the demands of the ever-changing workforce and allow for midwives to perform focused obstetric ultrasound examinations.

Contribution: This scoping review highlighted ultrasound training programmes for midwives and provided guidance on the development of future midwifery ultrasound training programmes.

Implementation of antimicrobial stewardship programmes in private healthcare settings in Africa: A scoping review

Andile P. Dlungele — 2023-04-06

Background: An Antimicrobial Stewardship Programme (ASP) is one of the strategic objectives of the World Health Organization’s (WHO) global action plan to combat antimicrobial resistance. There have been numerous publications on the implementation of ASPs in both private and public sectors globally. However, there are no reviews and interpretive scholarly research publications on successful implementation of ASPs in private healthcare settings in Africa.

Aim: The aim of this study was to systematically gather relevant information from published findings and to interpret those findings into a coherent body of lessons learnt from successful ASP implemented in private healthcare settings in Africa.

Method: Google Scholar and PubMed, which are online databases, were extensively searched, and studies, which met the inclusion criteria for this review, were retrieved. A data-charting list was developed to extract relevant data.

Results: Only six South African studies reported on successful implementation of ASPs in private healthcare settings in Africa. The main focus areas include locally driven prescription audits as well as pharmacist-led interventions.

Conclusion: Although private healthcare settings in Africa utilise antibiotic therapy for various infectious diseases, reports on implementation of ASPs in these settings are limited. To win the battle against antimicrobial resistance, private healthcare settings in Africa need to implement evidence-based guidelines and report on the rational use of antibiotics.

Contribution: The private healthcare sector in Africa needs to play a more meaningful role in the implementation of ASPs.

Students’ knowledge, attitude and practices towards pressure ulcer prevention and management

Franco R. Abrahams — 2023-04-06

Background: Student nurses provide nursing care to patients during clinical allocation, and their competence may affect the quality of care given to the patients. Good knowledge and positive attitudes enhance early detection for prevention and management of pressure ulcers.

Aim: To determine undergraduate nursing students’ knowledge, attitude and practices (KAP) towards prevention and management of pressure ulcers.

Setting: A nursing education institution in Windhoek, Namibia.

Methods: A quantitative, cross-sectional research design was used to conveniently sample (n = 50) student nurses and collect data using a self-administered questionnaire. Data were analysed using the statistical software programme (SPSS) version 27. Descriptive frequencies were applied, and Fishers exact test was performed. A statistical value of p < 0.05 was considered significant.

Results: Fifty (n = 50) student nurses consented to participate in the study. Student nurses reported good levels of knowledge (n = 35; 70%), attitude (n = 39; 78%), practices (n = 47; 94%). There was no statistically significant association between demographic variables and the level of knowledge, attitudes and practices, p > 0.05.

Conclusion: Student nurses have good knowledge, positive attitudes and practices on prevention and management of pressure ulcers. By the implications, the study concludes that the nursing students will competently manage the pressure ulcers occurring in the clinical setting. An observational study is recommended to assess practices in the clinical setting.

Contribution: The findings of this study will help to close the gap in the implementation of standard operating procedures for the prevention and management of pressure ulcers.

Nursing students’ experiences of clinical assessment at a university in South Africa

Gabieba Donough — 2023-04-06

Background: Nursing education includes both classroom and clinical teaching. The clinical teaching was explored through this research. The successful training of the undergraduate nursing students can be attributed to effective clinical teaching and supervision and is determined by both training requirements and services provided. Although there have been several researches on clinical supervision, there is still a dearth of information of the realities of supervision regarding assessment of undergraduate nursing students. The authors’ original thesis formed the foundation of this manuscript.

Aim: This study aimed to explore and describe nursing students at the undergraduate level experiences regarding clinical supervision.

Setting: The research was conducted at a nursing school at a South African university.

Method: After ethical clearance, focus group interviews were conducted to explore undergraduate nursing students’ experiences of clinical supervision using a descriptive design and qualitative approach. Two qualified practitioners in the field collected the data. A purposive method was utilised to select nine participants from each year’s level of education. Enrolled undergraduate nursing students at the institution under study formed the inclusion criteria. Utilising content analysis, the interviews were analysed.

Results: The findings confirmed the students’ experiences of clinical supervision and voicing their concerns regarding clinical assessment versus a developmental training; clinical teaching, learning and assessment and formative assessment procedures.

Conclusion: A responsive clinical supervision system to strategically respond to the needs of undergraduate nursing students will aid in developmental training and assessment.

Contribution: Understanding of the realities of clinical teaching and supervision regarding clinical assessment and development of undergraduate nursing students.

Exploring initiation schools’ impact on HIV and AIDS management in the Vhembe district of South Africa: An ethnography

Avhatakali A. Ndou-Mammbona — 2023-04-06

Background: This article presents the positive and negative impact traditional initiation schools have on the management of HIV and AIDS in the Vhembe district in South Africa.

Aim: To explore the impact of initiation schools regarding the management of HIV and AIDS.

Setting: This ethnographic study was conducted in rural villages in the Vhembe district.

Methods: Nine purposively sampled key informants from the Vhavenda traditional healers and leaders participated in the study. Data were collected using semi-structured face-to-face interviews guided by an interview and observation guide. Data were analysed using ethnographic content analysis.

Results: The results indicated that the Vhavenda have different traditional initiation schools for boys and girls. For boys, there is Muḽa [traditional male circumcision], while Musevhetho [first stage of girls’ traditional initiation before puberty], Vhusha [girls’ second stage of traditional initiation] and Domba [final stage of girls’ traditional initiation] are for girls. Some of the information provided perpetuates engagement in multiple concurrent relationships predisposing them to contract HIV. Boys are encouraged to be strong and to control women when it comes to sexual activities to suit their desire, whether the woman consented or not, while girls are taught to be submissive to their husbands which can fuel the spread of HIV.

Conclusion: As the initiates are attentive to whatever is said during those initiation schools, there is an opportunity for using these initiation schools for proper prevention of HIV and instilling positive behaviours by using Leininger’s cultural care modalities which focus on preservation of beneficial practices and repatterning of practices which fuel the spread of HIV.

Contribution: The study findings will aid in the review and update of the manuals and procedures for HIV and AIDS management.

Indigenous practitioners’ views on causes of female infertility

Banabotlhe G. Baakeleng — 2023-04-06

Background: The use of indigenous practices has increased remarkably throughout the world. Subsequently, society uses this practice for the treatment of various health problems, including infertility. This research focussed on the role of indigenous practitioners (IPs) using a holistic approach to explore the causes of infertility in women.

Aim: This study aimed to explore and describe the views of IPs on the causes of female infertility in Ngaka Modiri Molema health district.

Setting: The study was conducted in Ngaka Modiri Molema, North West Province, one of the most rural provinces in South Africa.

Methods: The study followed a qualitative explorative design. A purposive sampling technique identified five IPs who were experts in managing infertility. Individual semistructured interviews were conducted, and data analysis used Creswell’s method of qualitative data analysis.

Results: Findings revealed that IPs offered a wide range of services in the treatment and management of infertility among rural women. Hence, the following themes emerged, namely, history taking regarding infertility, treatment of infertility and holistic care on infertility.

Conclusion: The IPs are important providers of healthcare in the management of infertility in indigenous communities. The findings revealed that there are various causes of female infertility according to the indigenous healthcare system.

Contribution: In contribution, the study described the unique practices found in the community as executed by the IPs. This care focusses on holistic care, including treatment and continuous care for the healthcare user and the family. Noteworthy to mention, this holistic care extends to subsequent pregnancies. However, there is a need for further research to valorise the indigenous knowledge unearthed in this study.

Experiences of nurse educators regarding the use of the clinical skills laboratory at the School of Nursing in the Free State province

Siphiwe T. Madlala — 2023-04-06

Background: Integration of theory to practice by student nurses is a challenge in most training institutions accredited by the South African Nursing Council (SANC). Nurse educators require a fully equipped and functional clinical skills laboratory to impart clinical competency knowledge to student nurses.

Aim: The purpose of this study was to understand the experiences of the nurse educators in teaching clinical skills to student nurses using the clinical skills laboratories.

Setting: The study was conducted at the School of Nursing in the Free State province in 2021.

Methods: A qualitative descriptive design was employed. Purposive sampling was used to select participants for the study. Unstructured one-on-one interviews were conducted with 17 nurse educators until data saturation was reached. Data were analysed thematically.

Results: The three major themes that emerged during data analysis and were discussed to make recommendations of the study are as follows: clinical skills laboratory environment; human and material resources; financial constraints.

Conclusion: This study revealed that there is a need for the use of the clinical skills laboratory by nurse educators to teach clinical practice to student nurses. Therefore, it is imperative that the study recommendations be considered for implementation to improve the use of the clinical skills laboratory.

Contribution: The importance of integrating theory to practice by using the clinical skills laboratory during clinical practice teaching by nurse educators will be understood.

Mentoring community service nurses in public health settings: Guidelines for nurse managers

Sisinyana H. Khunou — 2023-04-06

Background: Adequate mentoring and support of community service nurses (CSNs) in transitioning from the learning environment to the public health setting is pivotal. Despite this notion, the mentoring of CSNs is inconsistently implemented. It was therefore imperative that the researchers developed the guidelines that can be used by managers to mentor the CSNs.

Aim: This article shares nine guidelines to ensure adequate mentoring of CSNs in public health settings.

Setting: The study was conducted in public health settings designated for placement of CSNs, in South Africa.

Methods: This study followed a convergent parallel mixed-methods design whereby qualitative data were obtained from purposefully selected CSNs and nurse managers. Quantitative data were obtained from 224 CSNs and 174 nurse managers, with the use of mentoring questionnaires. Semi-structured interviews were used on focus groups of nurse managers (n = 27) and CSNs (n = 28). Quantitative data were analysed with Statistical Package for Social Science software version 23, ATLAS.ti 7 software was used to analyse qualitative data.

Results: The merged results evidenced that CSNs were not adequately mentored. The public health setting was not conducive to mentoring CSNs. Mentoring activities were not well structured. Monitoring and evaluation of mentoring of CSNs were not properly done. Evidence from merged results and literature were applied to develop mentoring guidelines for operationalising a mentoring programme for CSNs.

Conclusion: The guidelines were: (1) creation of a positive mentoring environment, (2) enhancement of collaboration between stakeholders, (3) attributes of CSNs and nurse managers in the mentoring relationship, (4) enhance orientation for nurse managers and CSNs, (5) facilitation of mentor– mentee matching process, (6) conducting mentoring meetings, (7) capacity development for CSNs and nurse managers, (8) monitoring and evaluation of mentoring process, and (9) reflections and feedback.

Contribution: This was the first CSNs’ guidelines to be developed in the public health setting. These guidelines could facilitate adequate mentoring of CSNs.

Effect of receiving mobile text messages on cortisol concentrations in students at the University of the Free State

Roné Vorster-De Wet — 2023-04-06

Background: Texting has become central to social life, with adverse effects on physiological functioning. Research into the impact of texting on cortisol secretion is limited.

Aim: Thus study aimed to determine how receiving mobile text messages affected salivary cortisol concentrations and investigate the moderating effects of stress, anxiety and depression on cortisol secretion.

Setting: Undergraduate physiology students attending physiology lectures at the Faculty of Health Sciences, University of the Free State, 2016.

Methods: An experimental, crossover, quantitative design was used. Participants were involved over two consecutive days, receiving mobile text messages (intervention) on one day and acting as their own control on the other. Self-reported data on stress, anxiety, depression and subjective experience of the study, and saliva samples were collected. Text frequency and wording (neutral, positive, negative) were varied among participants.

Results: Forty-eight students participated in the study. Salivary cortisol concentrations did not differ significantly between the intervention and control days. High anxiety levels were associated with increased cortisol concentrations. No associations with cortisol concentrations were documented in low to moderate anxiety, stress, depression or how participants experienced the intervention. There were no significant differences between text frequency, text emotion and change in cortisol concentrations on the intervention day.

Conclusion: Receiving mobile text messages did not elicit a significant cortisol response in participants.

Contribution: Findings added to the body of knowledge about the effect of texting on student learning by measuring salivary cortisol concentrations in a lecture setting, with investigation into the moderating effects of stress, anxiety, depression and participants’ subjective experience.

Exploring the discord between pharmacy education and practice in antimicrobial stewardship

Devina Chetty — 2023-04-06

Background: Antimicrobial stewardship (AMS) is a critical global intervention aimed at optimising antimicrobial use and decreasing antimicrobial resistance (AMR) with pharmacists playing a pivotal role within AMS teams. However, AMS is not comprehensively taught in pharmacy curricula and little is known about the relevance of pharmacists’ training to meet AMS needs in South Africa.

Aim: This study aimed to explore the attitudes, knowledge and perceptions of clinical pharmacists towards AMS participation and training in South Africa.

Setting: This study was conducted among clinically practicing pharmacists in public and private healthcare sectors in South Africa.

Methods: A quantitative exploratory research design was selected for this study. The study was conducted using a self-administered structured survey. Categorical variables were analysed using simple descriptive statistics. Mann–Whitney and Kruskal–Wallis tests were applied to determine differences between variables.

Results: Pharmacists demonstrated good attitudes knowledge and perceptions towards AMS (median 4.3). There was statistical significant differences in AMS participation between pharmacists of different years of experience (p = 0.005), sector of employment (p = 0.01), position of employment (p = 0.015) and presence of AMS programmes (p = 0.004). Pharmacists indicated that their Bachelor of Pharmacy undergraduate studies inadequately prepared them for their role in AMS (median 4.3).

Conclusion: Pharmacists show positive attitudes, knowledge and perceptions towards AMS. Education and training in AMS principles is obtained through master’s programmes, short courses, Continued Professional Development (CPDs) and workshops and insufficiently incorporated in undergraduate programmes.

Contribution: This study confirms that undergraduate pharmacy programmes inadequately prepare pharmacists for their role in AMS.

Work-related support needs of registered nurses in a neonatal intensive care unit in the Tshwane District

Funzani Nefale — 2023-10-02

Background: Registered nurses in neonatal intensive care units (NICU) are working under stressful environment caused by the need and commitment to provide care for the critically ill neonates. Therefore, there is an imperative need to know and understand the work- related support strategies that can be adapted for registered nurses working in a NICU in the Tshwane District to enable them to provide quality care for the admitted neonates.

Aim: To explore and describe the work-related support needs of registered nurses working in a specific NICU situated in the Tshwane District. Setting: The study was conducted in a selected NICU in Tshwane District.

Method: A qualitative, exploratory, descriptive, and contextual design was used in this study. In-depth unstructured individual face-to-face interviews were conducted with nine registered nurses working at the selected NICU of an academic hospital. Thematic data analysis was conducted. Results: Three themes, namely teamwork between registered nurses and doctors, staff development in the form of peer seminars, workshops and in-service training, and availability of adequate resources within the workplace arose.

Conclusion: This study revealed that the registered nurses working in the NICU in the Tshwane District are in need of work-related support, as it will improve their well-being.

Contribution: The contribution of this study will be used by the hospital management to plan strategies that can be adapted for the betterment of the work environment for registered nurses in the NICU and the hospital in general.

Caregivers’ knowledge, attitudes, and oral health practices at long-term care facilities in KwaZulu-Natal

Sonam Balwanth — 2023-10-02

Background: Vulnerable individuals residing at long-term care facilities require special oral health consideration. Examining concepts of oral health and hygiene practices of caregivers becomes essential for understanding the quality of oral health services provided to residents.

Aim: This study explored the oral health–related knowledge, attitudes and practices (KAP) of caregivers.

Setting: Long-term care facilities in the eThekwini District, KwaZulu-Natal.

Methods: A cross-sectional study was conducted at seven long-term care facilities among 188 caregivers who completed a self-administered questionnaire. Data were collated and analysed using the Statistical Package for the Social Sciences (SPSS) version 24. Inferential techniques included an analysis of variance (ANOVA) test. A p-value ≤ 0.05 was considered to be statistically significant. Results: Participants reported that dentures do not to be cleaned (n = 139; 73.9%). Participants (n = 70; 37.2%) reported that some medications have oral side effects. Most participants (n = 173; 92%) were optimistic about improving their oral health knowledge and skills. Participants (n = 108; 57.4%) only reported flossing when they had food trapped between their teeth. Few participants (n = 30; 16%) reported visiting the dentist every 6 months.

Conclusion: Participants had a positive attitude to improve their oral health-related knowledge and practices. However, the study showed that there is a need to scale-up oral health education and training activities for caregivers.

Contribution: It is envisaged that findings of this study will demonstrate the importance of oral health-related knowledge among caregivers in providing better oral health care through improved attitudes and practices.

The acceptability and perceived use of HIV self-testing among technical vocational education and training students in Limpopo province

Mimi E. Teffo — 2023-10-02

Background: Human immunodeficiency virus self-testing (HIVST) is a most recent testing modality to reach young people to test for HIV, due to their increased vulnerability of contracting HIV. Limited literature is available describing sexual behaviours and the acceptability of HIVST and its perceived use among students.

Aim: The aim of this study was to assess the acceptability and perceived use of HIV selftesting among students in Limpopo province, South Africa.

Setting: The study was conducted in Limpopo province, at a technical and vocational education and training (TVET) college.

Methods: A cross-sectional study was conducted with a sample of 396 students recruited from a TVET college.

Results: The mean age of the students was 22.9 years, with the majority of the students being female (77.2%). The majority (81.4%) of the students sampled reported regular sexual activity. Sixty per cent of the students had used condoms during their last sexual encounter. The acceptability of HIVST was high, with more women showing the willingness to take up HIVST (82.5%). Being sexually active (odds ratio [OR] 1.23; (confidence interval [CI]: 2.14 -6.94; p = 0.000), a number of sexual partners (OR 1.045; CI: 1.98 -10.02; p = 0.000) and condom use during the last sexual encounter (OR 0.62; CI: 3.81 -9.59; p = 0.000) were factors associated with HIVST.

Conclusion: The high acceptability of HIV shows a need for innovative demand creation in sexual and reproductive health (SRH) programming.

Contribution: The study contributes to the body of literature about the acceptability and perceived use of HIV self-testing among students. Findings can be used for improving HIVST interventions using innovative approaches

The role of community health nurses in promoting school learners’ reproductive health in North West province

Tshiamo N. Ramalepa — 2023-10-02

Background: Reproductive health education is a major component in schools, which is delivered through Life Orientation and Life Science subjects. Providing sexual and reproductive health education and services remains a challenge in schools of many countries, as well as South Africa. Community health nurses have the responsibility to initiate and participate in reproductive health promotion initiatives in schools.

Aim: To explore the roles of community health nurses in the promotion of school learners’ reproductive health in schools.

Setting: This study was conducted in the clinics of Madibeng municipality in North West province, South Africa.

Methods: An exploratory qualitative research study was conducted using in-depth interviews for data collection. The population included community health nurses who were sampled purposively.

Results: Community health nurses revealed that their primary role was to provide health education to learners, particularly in clinics. Furthermore, they revealed that they did not visit schools and had no communication with teachers regarding learners’ reproductive health issues.

Conclusion: The Department of Education has opened a platform for the provision of reproductive health education in schools through various teacher-led initiatives. However, this has posed a significant challenge to teachers as they may not be willing to deliver sensitive and sexually themed information to learners. To ensure effective delivery of reproductive health education in schools, community health nurses, teachers and other relevant stakeholders must collaborate in schools.

Contribution: This article highlights the importance of community health nurses visiting schools to promote the reproductive health of school learners.

Collaboration in the formulation and implementation of policies for noncommunicable diseases in South Africa

Richard M. Rasesemola — 2023-10-02

Background: Collaboration between health and other sectors is necessary and much
needed when addressing health issues. The health sector alone does not possess all the
necessary resources to address health problems in the country. Thus, the burden of
disease because of the noncommunicable diseases (NCDs) requires interventions that are
sometimes beyond the health sector’s mandate.
Aim: To investigate collaboration in the policy formulation process for prevention and
control of NCDs in South Africa. This article presents strategies that could aid South African
government to ensure collaboration by various sectors in addressing the NCDs.
Setting: This study took place in the provincial Department of Health (DoH) of seven South
African provinces.
Methods: This was quantitative descriptive study done among purposefully sampled
respondents from various health portfolios from seven provincial Departments of Health.
Data were collected using questionnaires and analysed using descriptive statistical data
analysis techniques.
Results: The results indicated that the DoH collaborates with private and government
stakeholders in the policy formulation and implementation process but excludes them in
the setting the health agenda, adoption of policy options and policy evaluation.
Conclusion: The lack of participation by other stakeholders in the critical phases of policy
formulation will result in continued burden of disease because of poor prevention and control
of NCDs in the country.
Contribution: This article provides recommendations that would ensure collaboration
among various sectors to accelerate the response to the prevention and control of NCDs
in South Africa.

Effects of COVID-19 lockdown on physical, mental and emotional parameters among sportspersons

Amaarah Khan — 2023-10-02

Background: The coronavirus disease 2019 (COVID-19) lockdown was a strange and new occurrence, which left many individuals ill- equipped to cope with the new way of living. Sportspersons had to adapt to a new training style within a new environment, both physically and mentally. Aim: The purpose of this study was to understand the physical, mental and emotional parameters among sportspersons during the COVID-19 lockdown regulations. Setting: The study consisted of 105 regular sportspersons (from South Africa). Methods: This was a quantitative research study design using an online questionnaire. An online questionnaire was adapted and distributed via online social platforms (WhatsApp, Twitter and Instagram) to collect data in which sportspersons (n = 105) answered questions about the effects that they experienced during lockdown on their physical, mental and emotional well-being. Results: Sportspersons participated in cardiovascular training, flexibility training, strength training and bodybuilding exercises during pre- lockdown. During lockdown, more than 74% of sportspersons had adequate training space, equipment and the time to perform physical activity. However, more than 43% of these sportspersons experienced a decrease in flexibility, muscle mass and muscle strength. Exercise was used as a form of stress relief by 77.1% of sportspersons throughout lockdown. In addition, sportspersons who used exercise as a form of stress relief continued to experience an increase in stress throughout lockdown. Conclusion: The outcomes from this study demonstrated how the COVID-19 lockdown had adverse effects on the overall health and well-being of most sportspersons. Other outcomes included the effects that physical inactivity had among sportspersons, including changes in diet and sleep. Contribution: This study highlights the urgency for the sports fraternity to adopt measures to provide various methods of stress relief (as well as opportunities for physical activity) during similar periods of lockdown (or exercise restrictions) for those who rely on exercise as their daily physical, mental and emotional outlet.

Nurses’ awareness of the availability of HIV and AIDS research

Justin O. Rojaye — 2023-10-02

Background: Hardship of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) transmission in Nigeria needs research-based strategies that scientifically inform research findings for relevant research advocacy.

Aim: This study aimed to enhance nurses’ awareness of the availability of HIV and AIDS research in Nigeria.

Setting: The research was carried out in a general hospital, a tertiary hospital in Ijebu Ode, Ogun State, Nigeria.

Methods: A qualitative technique was used, as well as an exploratory-descriptive design was employed. Semi-structured interviews were carried out. Three focus group interviews with seven participants in each group were used to gather data.

Results: This study showed the value of nurses’ awareness of the availability of HIV and AIDS research in overcoming obstacles to successfully controlling HIV and AIDS transmission in a hospital context in Nigeria. The study results demonstrated the nurses’ understanding of local and global research. The result of the study also demonstrated the essential role of collaboration with partners in enhancing nurses’ awareness of the availability of HIV and AIDS research in Nigeria.

Conclusion: The study found that nurses in Nigeria were usually unaware of their role in healthcare research development in the context of HIV and AIDS. They preferred to go with the flow of events.

Contribution: This study affirms the importance of nurses’ awareness of the availability of HIV and AIDS research in overcoming obstacles to successfully controlling HIV and AIDS transmission in a hospital context in Nigeria.

Collaborative clinical facilitation in selected nursing and midwifery colleges in Northern Ghana

Francis Kobekyaa — 2023-10-02

Background: Collaborative clinical facilitation converges key players to guide students individually and within groups towards achieving clinical nursing competence. However, experiences of collaborative clinical facilitation among nurse educators, clinical preceptors and nursing and midwifery students are often fragmented and have been largely unexplored in Ghana.
Aim: To describe the experiences of collaborative clinical facilitation among nurse educators, clinical preceptors and final year nursing and midwifery students in Northern Ghana.

Setting: The study was conducted at two nursing and midwifery colleges and an academic hospital in Northern Ghana.

Methods: A qualitative, descriptive, exploratory design was utilized. Forty-six participants comprising 16 nurse educators, 10 clinical preceptors, 10 nursing students and 10 midwifery students were purposively sampled. Focus groups and in-depth interviews were used to gather data and analysed thematically.

Results: Three themes revealed facilitative experiences of collaborative clinical facilitation: team-based clinical mentorship and supervision, personalised preceptorship, and clinical conferences. Two themes emerged inhibitory to collaborative clinical facilitation: staff shortages and lack of timely communication.

Conclusion: This study found that team mentorship, preceptorship and conferences fostered collaborative clinical partnerships for students’ clinical learning. However, failure to engage in timeous communication in the midst of staff shortages hampered its smooth practice. Orientation workshops need to be organised for key players to share relevant updates and explore ways to navigate the challenges often experienced within the clinical training environment.

Contribution: This paper provides insight into the collaborative nature of clinical facilitation; and highlights the need for coordinated clinical placements to enhance students’ clinical learning.

Use of granulocyte colony-stimulating factor in patients with chemotherapy-induced neutropaenia

Lucky L. Shokane — 2023-10-02

Background: Febrile neutropaenia (FN) and resultant infections are the major cause of treatment-related morbidity and mortality in patients receiving chemotherapy. Clinical practice guidelines recommend the use of granulocyte colony-stimulating factors (G-CSF) to reduce the risk of FN and ensuing complications in patients receiving chemotherapy. Despite these recommendations, inappropriate usage of G-CSF has been reported.

Aim: To assess prescribing patterns and adherence to international guidelines of G-CSF in adult patients with chemotherapy-induced neutropaenia (CIN) at the haematology oncology wards of the Dr George Mukhari Academic Hospital (DGMAH) and compliance to guidelines.

Methods: Medical records of adult patients who received G-CSF were reviewed retrospectively between 01 January 2018 and 31 July 2018.

Results: Of the 128 patient files screened, 57 cases met the inclusion criteria. Duration of treatment with G-CSF was not in accordance with guidelines in more than 50% of the patients and in 43.86%, G-CSF dosing deviated from recommended guidelines.

Conclusion: The study demonstrated over-prescribing of G-CSF due to either increased doses or duration of G-CSF therapy. Although prescribed for the correct indication, the dosage was often too high or the duration was too long, even once an acceptable neutrophil nadir count was reached. Interventions to optimise the use of G-CSF are required and the pharmacist may play a role in this regard.

Contribution: The administration of the correct doses of G-CSF can reduce both the severity and duration of neutropaenia. Over-prescribing and incorrect dosing may contribute to patient morbidity and add to the financial burden of healthcare.

The mental health and wellbeing of healthcare workers during COVID-19 in South Africa

Jennifer Watermeyer — 2023-10-02

Background: Little is known about the experiences and impact of coronavirus disease 2019 (COVID-19) on the mental health and wellbeing of healthcare workers (HCWs), particularly in Global South contexts.

Aim: The authors aimed to explore the experiences of HCWs at different points during the COVID-19 pandemic in South Africa.

Setting: This study’s sample included 621 HCWs from various professions and health sectors who completed the survey during the pandemic peaks of waves I, II and III in South Africa.

Methods: The authors used a qualitative survey design exploring participants’ general work, life, mental health and wellbeing experiences, and their support mechanisms or strategies. Data were analysed using thematic analysis. Results: The authors identified three overarching themes in the data, namely stress, adjustment to work during COVID-19, and support experiences and needs. These themes were common across all three survey waves, with some minor differences noted across the waves.

Conclusion: An overarching thread of uncertainty seems central to HCWs’ experiences of working during COVID-19, related to pressures in the South African healthcare system that have been aggravated by the pandemic.

Contribution: These findings have the potential to inform the development of contextually relevant approaches to support the mental health and wellbeing needs of HCWs during and after a pandemic. In particular, workplaces need to actively offer psychological support to all HCWs, not just to workers traditionally defined as frontline.

Integrated vs non-integrated treatment outcomes in dual diagnosis disorders: A systematic review

Ashley Chetty — 2023-10-02

Background: The incidence of dual diagnosis (DD) (i.e. substance use disorders [SUD] and
co-occurring mental disorders) is widespread; however, they vary widely in permutation and
combination. As a result, establishing effective and empirically supported interventions for
this clinical population remains challenging.
Aim: This study aimed to examine current literature on the treatment outcomes for patients
with DD.
Method: A systematic review of randomised controlled trials (RCTs) published between 2009
and 2018 was conducted for two broad intervention categories identified by the literature: nonintegrated and integrated treatment. Multiple electronic databases were searched using the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA).
Results: The search generated a total of 743 studies, of which 11 satisfied the inclusion criteria.
These studies were thematically synthesised into two main analytical themes: ‘treatment
outcomes’ and ‘reported strengths and limitations of DD treatment’. Specifically, integrated
treatment held an advantage over non-integrated treatment in significantly improving
psychiatric symptomatology. However, no significant benefits were found between integrated
and non-integrated treatment regarding substance misuse and treatment retention.
Conclusion: Overall, the results provided insufficient evidence to support the enhanced
efficacy of integrated or non-integrated treatment over the other in treating patients with DD.
Contribution: The study’s findings were used to provide recommendations to inform the
clinical psychological service delivery of dual diagnosis treatment in South Africa and also to
identify gaps in the literature and highlight areas for future research.

Challenges in the working relationship between professional nurses and clinical associates in selected district hospitals in South Africa

Emmah M. Mokoena — 2023-10-02

Background: Clinical associates were introduced in South Africa to address physician
shortages in healthcare. Professional relationships between physicians and professional nurses
(PNs) have been widely researched, but none specifically between the new cadre of clinical
associates and PNs.
Aim: This study aimed to understand the professional working relationship between PNs and
clinical associates.
Setting: Selected district hospitals within Mpumalanga Province, South Africa.
Method: A qualitative descriptive design was used. Professional nurses were purposely
sampled, and an all-inclusive sampling method was used for clinical associates in selected
district hospitals within Mpumalanga Province, South Africa. Twelve (N = 12) semi-structured,
individual interviews (PNs n = 6; clinical associates n = 6) guided by an interview guide were
conducted in English. The interviews were audio recorded and transcribed verbatim by an
independent transcriptionist. Tesch’s eight steps of data analysis were employed to analyse the
data. An independent co-coder assisted with data analysis.
Results: This study yielded four themes: (1) professional relationship defined, (2) professional
relationship characteristics, (3) professional challenges applicable to both PNs and clinical
associates and (4) personal professional challenges applicable to clinical associates only.
Conclusion: This study demonstrated that the professional relationships between PNs and
clinical associates are affected by various challenges, which could be resolved within the
department through in-service training and good communication.
Contribution: This is one of the first studies that highlight the professional relationship
challenges between PNs and clinical associates.

Optimal home and hospital laundering of reusable surgical scrubs: Systematic literature review

Je’nine Horn-Lodewyk — 2023-10-02

Background: Theatre personnel can spread healthcare-associated infections through contaminated surgical scrubs. Decontamination of surgical scrubs through optimal methods is important to minimise transmission of microorganisms from theatre personnel’s clothing to different areas in the hospital and their homes.

Aim: This study aimed to review the literature on the optimal home and hospital laundering methods for the decontamination of reusable surgical scrubs worn by theatre personnel.

Method: A systematic literature review of previous studies on laundering reusable surgical scrubs was performed. A review question was formulated using the patient, intervention, comparison and outcome (PICO) framework. A literature search was performed using ScienceDirect, Web of Science, ProQuest, EBSCOhost and Google Scholar.

Results: A direct link could be established between the cycle length and water temperature. The higher the water temperature, the shorter the washing cycle required. After a load has been washed in low or medium water temperatures, tumble drying and ironing should follow. Despite the water temperature, a disinfectant must be added to the load.

Conclusion: Health professionals and hospital management should be aware of optimal laundering guidelines for hospital and home laundering as part of infection control. Water temperature, time, mechanical action, type of disinfectant and heat are factors influencing the successful removal of bacteria and other pathogens and represent the baseline of this article.

Contribution: Home-laundering of reusable surgical scrubs should follow strict guidelines. When these specific guidelines are applied, the effects of home-laundered scrubs will not negatively impact either the theatre or the home environment.

The burden of suspected strokes in uMgungundlovu – Can biomarkers aid prognostication?

Juan M. Jansen van Vuuren — 2023-10-02

Background: The burden of stroke is increasing worldwide. The hierarchical healthcare referral system in South Africa (SA) poses unique challenges to clinicians when caring for people with suspected strokes (PsS). To improve health outcomes, novel strategies are required to provide adequate care, including prognostication, in SA.

Aim: To determine the subjective burden of and challenges posed by suspected stroke cases and the potential usefulness of biomarkers in prognostication.

Setting: This study was conducted in the uMgungundlovu Health District (UHD), KwaZuluNatal, SA.

Methods: An online questionnaire was distributed to doctors within the UHD. Demographic data and answers to a series of 5-point-Likert-type statements were collected.

Results: Seventy-seven responses were analysed. A third of doctors worked in primary healthcare facilities (PHCare) and saw ≥ 2.15 suspected strokes-per-doctor-per-week, compared to ≥ 1.38 seen by doctors working in higher levels of healthcare. Neuroimaging was relied upon by > 85% of doctors, with nearly half of PHCare doctors having to refer patients to facilities 5 km – 20 km away, with resultant delays. Knowledge about prognostic biomarkers in strokes was poor, yet most doctors believed that a biomarker would assist in the prognostication process and they would use it routinely.

Conclusion: Doctors in this study faced a significant burden of strokes and rely on neuroimaging to guide their management; however, many challenges exist in obtaining such imaging, especially in the PHCare setting. The need for prognostic biomarkers was clear.

Contribution: This research lays the platform for further studies to investigate prognostic biomarkers in stroke in our clinical setting.

Psychosocial experiences of mothers caring for children with cerebral palsy in the eThekwini district

Sibongile Seroke — 2023-10-02

Background: Cerebral palsy (CP) is the most prevalent neurological illness in children, and it can cause permanent sensory, motor and cognitive problems for the rest of one’s life. Raising a child with special needs necessitates extensive resources. Women in the middle and lower income brackets are more likely to care for children with CP.

Aim: To explore and describe the psychosocial experiences of mothers of children with CP in eThekwini.

Setting: This study was conducted at KwaZulu-Natal Children’s Hospital and rehabilitation centre.

Methods: The research methods were exploratory and descriptive in nature, with a qualitative approach. Purposive convenience sampling was used to select 12 participants who were parents of children with CP under the age of 18. For data collection, semistructured interviews were utilised. The purpose of thematic analysis is to uncover, analyse and summarise themes and patterns within a data set. Semistructured interviews were used to collect data.

Results: The psychosocial experiences of mothers of children with CP revealed three key themes. Themes included the burden of care, a lack of social support and the impact of children with CP on mothers.

Conclusion: Participants whose children with CP experienced physical, emotional, psychological and social issues, including inaccessible services and buildings and social isolation from family, friends and the community.

Contribution: This study helps to strengthen the development and review of policies on care, support interventions and mother empowerment for children with CP.

Experiences of migrant mothers attending vaccination services at primary healthcare facilities

Stephan Acheampong — 2023-10-02

Background: Migration to South Africa is currently dominated by women and children, for socio-economic and refugee reasons or to utilise the healthcare system for various services. Migrants and refugees are at risk of vaccine-preventable diseases, and many of their children have an incomplete or unknown immunisation status.

Aim: This study aimed to explore the experiences of migrant mothers in utilising child immunisation services in primary healthcare facilities.

Setting: Ten primary healthcare facilities that were providing immunisation services, located in the Buffalo City Metropolitan Municipality, Eastern Cape province, South Africa.

Methods: A qualitative research design, making use of in-depth interviews (IDIs) from 18 purposefully selected migrant women, was used for data collection. Thematic content analysis was used to analyse the recorded data of the experiences of study participants in their access to immunisation services.

Results: From the IDIs, four themes were identified: difficulty in communicating with the healthcare workers because of language barriers, access challenges, interpersonal barriers and interpersonal relationships were identified in this study, which influenced the utilisation of immunisation services by migrant mothers.

Conclusion: The findings of this study support and reinforce the duty of the South African government and healthcare facilities to work together to improve migrant women’s access to immunisation services.

Contribution: A positive relationship between healthcare workers and migrant mothers while accessing immunisation services should contribute to reducing child mortality in South Africa and achieving Sustainable Development Goal 3 by the year 2030.

Job satisfaction among health professionals in a District of North West province, South Africa

Reabetswe A. Mere — 2023-10-02

Background: Job satisfaction has become an area of relevance and debate in public health as it is directly linked to staff absenteeism, retention and turnover of the workforce and as such, influences the organisational commitment of the workers and the quality of health services provided. It is therefore essential to discern what drives healthcare professionals to remain working in the public health sector.

Aim: This study aimed to determine job satisfaction and its associated factors among healthcare professionals.

Setting: North-West province South Africa.

Methods: A cross-sectional study was conducted among 244 healthcare professionals of different categories in three district hospitals. A self-administered structured questionnaire with 38 questions to measure job satisfaction was used to collect data. The chi-square test was used to compare groups, and a p-value < 0.05 was considered statistically significant.

Results: Overall, 62% of the participants were not satisfied with their job. The most common factors that participants were not satisfied with include job security (52%), standard of care (57%), opportunity to develop (59%), payment or wages (76%), workload (78%) and working environment (89%). Job satisfaction was significantly influenced by age, job category and years of service.

Conclusions: The predictors of job satisfaction include age, category of employees and years of service. Interventions are required to improve the degree of job satisfaction among health care professionals.

Contribution: Findings of this study will assist informing plans that are geared towards enhancing healthcare worker job satisfaction, retention and consequent health systems strengthening.

Exploring the role of CBT in the self-management of type 2 diabetes: A rapid review

Elne Visagie — 2023-10-02

Background: Type 2 diabetes has been recognised as a global health concern: one that requires intervention to lessen the incumbrance caused by the chronic illness. This rapid review was conducted to determine the scientific evidence available on how Cognitive Behaviour Therapy (CBT) interventions improved the self-management of individuals with type 2 diabetes.

Aim: The aim of the review was to synthesise current scientific evidence regarding CBT-based interventions and self-management practices.

Method: The rapid review served as a framework to appraise current national and international literature. The researchers used Google Scholar, Journal Storage (JSTOR), PsycINFO, APA PsycArticles, SAGE journals and EBSCO Discovery Services to search for relevant studies. This was performed by employing keywords. Nine relevant studies were identified. The studies were heterogenous in methodology. Seven of the nine studies were conducted in developing countries.

Results: The study found that the context of developmental countries plays a significant role in the development of type 2 diabetes and requires tailored intervention because of socioeconomic variabilities. The main themes identified in relation to improving self-management included: the characteristics of the CBT-based interventions, namely the format, duration, and outcomes, and identifying the techniques and components used in the CBT-based interventions.

Conclusion: The review emphasised the need to further investigate the role of CBT in improving self-management of type 2 diabetes, especially in a South African context.

Contribution: The review summarised the techniques that have proven to be effective for the self- management of type 2 diabetes.

Blended learning during and beyond the COVID-19 pandemic: Attitudes of nurse educators in Gauteng

Sarah Namulondo — 2023-10-02

Background: The use of blended learning (BL) pedagogy has become inevitable due to contemporary technological innovations in the nursing education sector. As of late, the need to use BL pedagogy has resulted by the sudden occurrence of the COVID-19 pandemic. However, several nurse educators still experience uncertainties in using BL due to technological, psychological, infrastructure and equipment readiness barriers.

Aim: To report the attitudes of nurse educators towards the use of BL pedagogy as a new norm of teaching and learning in public nursing education institutions (NEIs) in the Gauteng Province (GP), South Africa, during and beyond the COVID-19 pandemic period.

Setting: The study was conducted in five Gauteng public NEIs.

Methods: A descriptive non-experimental quantitative design was conducted with 144 nurse educators. Data was collected through a questionnaire. Statistical Analysis Software (SAS) was used to analyse data with the help of a biostatistician.

Results: Technologically, only 50% (N = 72) found BL easy to use while 48% (n = 69) were ready and willing to use the BL Psychologically, more than half, that is, 65% (n = 94) lacked the confidence to use BL pedagogy. About 55% (n = 79) reported having inadequate BL infrastructure, while 32% (n = 46) seemed to be satisfied with the availability of effective equipment to support BL pedagogy.

Conclusion: Based on the results, it is apparent that nurse educators in Gauteng are not technologically and psychologically ready, since the infrastructure and equipment to support the BL are not adequately provided.

Contribution: The study emphasised the purpose of performing regular assessments to establish the overall readiness of nurse educators to successfully implement the BL pedagogy.

Lived experiences of diabetic outpatients attending clinics in rural areas of Limpopo province in South Africa

Mabitsela H. Mphasha — 2023-10-02

Background: Prevalence of diabetes mellitus is increasing in South Africa (SA), with many people unknowingly living with undiagnosed diabetes. Living with a long-term illness like diabetes significantly impacts every aspect of one’s life. It is essential to understand the lived experience of patients to ensure better management and intervention.

Aim: To explore the lived experiences of diabetic outpatients.

Setting: Clinics of Senwabarwana, in Blouberg Local Municipality of the Capricorn District Municipality in Limpopo province of SA.

Method: Qualitative phenomenological exploratory descriptive study design was adopted to collect data from 17 diabetic patients. Purposive sampling was utilised to choose respondents. Data were collected through one-to-one interviews using voice recorders and field notes for nonverbal cues. Data were analysed using the eight steps of Tesch’s inductive, descriptive and open coding technique.

Results: Respondents detailed difficulty disclosing their diagnosis due to feelings of shame. They also experienced stress and an inability to perform duties they used to perform before diagnosis. Male respondents detailed their experiences of sexual problems and a fear of losing their wives to other men as a result.

Conclusion: Patients living with diabetes are unable to perform some tasks that they were able to perform before diagnosis. This could be attributed to poor dietary choices and a lack of social support, leading to patients missing critical elements of diabetes care. Quality of life of patients who are unable to perform their daily tasks should be assessed, with appropriate interventions introduced to curb further deterioration. Male diabetes patients experience sexual dysfunction and a fear of losing their wives, which exacerbates their stress.

Contribution: This study encourages the adoption of a family-centred approach, partnering with family members in the care of diabetic outpatients since most of the care takes place at home. Further studies are also recommended to design interventions which would address the experiences of patients for better outcomes.

Midwives’ descriptions of avoidable causes of negative perinatal outcomes

Kagiso P. Tukisi — 2023-10-02

Background: The Perinatal Problem Identification Programme (PPIP) is used to rule out the avoidable and nonavoidable causes of negative maternal and perinatal outcomes through file audits. Perinatal Problem Identification Programme serves as a tool for midwives and obstetricians to pinpoint missed opportunities that could prevent avoidable causes of negative perinatal outcomes.

Aim: The study aimed to describe and explore the avoidable causes of negative perinatal outcomes in Bojanala District through the lens of the midwife.

Setting: This study was conducted in the two selected facilities in the Bojanala District in the North West Province of South Africa.

Methods: The study derived from a larger study that focused on midwives’ experiences of obstetric triage in the Bojanala District. A qualitative, exploratory and descriptive research design was used with purposive sample of nine midwives. Participants had over 5 years of clinical midwifery experience and were employed in the Bojanala District. Semi-structured interviews were utilised with data analysed using Colaizzi’s descriptive method of data analysis.

Results: Three major themes with eight subthemes emerged. Midwives noted space constraints, medicine and medical supply constraints, and constraints in availability of medical equipment. Access to identified constraints would enable prompt and appropriate management.

Conclusion: The study highlighted the experience of midwives in accessing needed space, medicines, medical supplies and equipment, potentially impacting negative perinatal outcomes.

Contribution: This study provides insight into administratively related avoidable causes of negative perinatal outcomes through the lens of frontline maternity care providers – midwives. Findings should be of particular utility to health service managers working to reduce maternal mortality and morbidity.

Radiation exposure of Staff handling ¹⁸FluorineFluorodeoxyglucose in a new positron emission tomography/computed tomography centre

Lerato Mosima — 2023-10-02

Background: Positron emission tomography/computed tomography (PET/CT) is an imaging modality that combines images from high- energy gamma rays emitted by a positron emitting radiopharmaceutical and those from the CT component. The images are then used in the diagnosis of severe diseases. Procedures with PET radiopharmaceuticals introduce a risk of high occupational radiation exposure to staff handling them. 18Fluorine-Fluorodeoxyglucose ([18F] FDG) is the most commonly used PET radiopharmaceutical.

Aim: To determine the radiation exposure of staff working at the PET/CT facility.

Setting: Academic hospital in Gauteng.

Methods: The study was quantitative and descriptive. The radiation exposure data of participants were collected using Polimaster®electronic pocket dosimeters, ring dosimeters and thermoluminescent dosimeters. The participants’ workflow was tracked and the tasks that led to the highest radiation exposure were identified.

Results: Radiopharmacists had 129 dispensing days with the resultant daily radiation exposure ranging between 0.01 μSv and 0.32 μSv. The radiographers’ daily radiation exposure ranged between 7.08 μSv and 19.14 μSv. Radiographers received the highest radiation dose during radiopharmaceutical injection (average = 1.86 µSv).

Conclusion: The study found that staff working at a new PET/CT facility in Gauteng were not at risk of radiation exposure above the accepted annual limits, which are 20 mSv per annum, averaged over 5 years, and with no more than 50 mSv in 1 year.

Contribution: The findings revealed the need for continuous training in radiation protection measures for all staff working in the PET/CT facility.

The use of the World Health Organization Surgical Safety Checklist in operating theatres

Mariet van Zyl — 2023-10-02

Background: There is a global concern over intraoperative patient safety, as adverse events are on the rise. When the World Health Organization Surgical Safety Checklist (WHO SSC) is used correctly, it has the potential to prevent such events. Unfortunately, the intraoperative team in the designated hospital lacked the cooperation to successfully use the checklist.

Aim: This study, therefore, aimed to explore and describe the factors that affect the use of the checklist in the operating theatres in a designated hospital.

Methods: A qualitative research approach together with an implementation science strategy structured according to the Consolidated Framework for Implementation Research was used. Individual interviews with nine surgeons and focus group interviews with six operating theatre professional nurses provided sufficient data for inductive and deductive analysis.

Results: A deeper understanding of the contextual and interventional factors that affect the use of the WHO SSC is provided by the findings. A high demand for surgery, the hierarchy in the surgical team, their uncertainty about hospital policies and reluctance to adjust to change contributed to the poor use of the checklist.

Conclusion: A sustainable implementation process is crucial and should be embraced and promoted by the intraoperative team.

Contribution: The article contributes a description of the factors that address the use of a checklist for intraoperative patient safety. It recommends that the factors that hinder the use of the checklist be timeously addressed.

Experiences of operational managers regarding record keeping by new professional nurses in public hospitals in the North West province, South Africa

Naomi L. Nkoane — 2023-10-02

Background: Documentation can be written or computerised and is used to communicate healthcare and treatment among healthcare professionals. Documentation is the tool that records and measures the healthcare provided to patients, and it must be accurate, complete and timely.

Aim: This study aims to explore and describe the experiences of the operational managers regarding record keeping by new nurses in selected public hospitals in South Africa.

Setting: The study was conducted in selected public hospitals in the North West province.

Method: This study used a qualitative, explorative and descriptive approach with a purposive sampling method. A total of 35 operational managers participated in the process of data collection.

Results: The following themes emerged from this study: gaps in record keeping, the impact of inaccurate documentation and the need for improvement in record keeping.

Conclusion: The study has shown the need to bring technological innovation to strengthen the effective improvement of digitalisation in nursing record keeping in the facilities furthermore, nurses should be supported through programmes on intentional and mindful record keeping curbing the incidences of inaccuracy and incompleteness.

Contribution: This study’s findings confirmed that new nurses were not consistent with accurate documentation of patient records, and this needs further strengthening in public hospitals to have an impact on the health and safety of the patient.

Self-management guidelines for youth who have lost a family provider through HIV/AIDS

Siphesihle D. Hlophe — 2023-10-02

Background: When parents die from HIV/AIDS-related causes, children often experience emotional instability and are given additional obligations, such as caring for siblings. Youths may react in a variety of ways, including increasing alcohol consumption, and their relationships with their siblings may be altered positively or negatively.

Aim: The purpose of this article is to examine the lived experiences of youths in managing themselves after losing a family member to HIV/AIDS and suggest developed guidelines for nurses to advise youths on self-management after losing a family member to HIV/AIDS.

Setting: Khayelitsha, Western Cape province, South Africa.

Method: A descriptive phenomenological design for this study was followed. The researcher conducted 11 semi-structured interviews with participants. The study was conducted with participants that were youth aged between 18 and 25 years.

Results: The study revealed that the death of a family provider can be difficult for the youth left behind to deal with the changes in their daily lives.

Conclusion: The findings demonstrated that the death of a family member has a significant impact on the family. One of the more senior family members must assume charge and remain strong to help their siblings focus on the future. The death of a family member might result in a cascade of forced changes that necessitate new behaviours to maintain stability.

Contribution: This study’s context- based data focuses on how the Community Health Centre (CHC) may assist young people in managing themselves after a family provider has died from HIV/AIDS, using the developed guidelines.

A qualitative study on traditional healers’ perceptions and management of epidermolysis bullosa

Antoinette V. Chateau — 2023-10-02

Background: Epidermolysis bullosa (EB) is a rare, incurable genodermatosis causing blisters that can result in multisystemic complications and death. Limited data exists on EB in South Africa. Research indicates that the majority of African patients consult traditional health practitioners (THPs) before seeking allopathic healthcare.

Aim: This study aims to understand THPs belief systems, experiences, perceptions and management of EB patients and their families in the social and cultural context to improve the healthcare of EB patients.

Setting: The study setting is Nelson Mandela School of Medicine, Durban, and Grey’s hospital, Pietermaritzburg, KwaZulu- Natal.

Methods: Qualitative in-depth interviews were conducted with 10 THPs. A non-probability, purposive sampling method was used. A two-site qualitative study was guided by interpretative phenomenological analysis. Guba’s trustworthiness framework was used to ensure rigour.

Results: Three male and seven female THPs were interviewed, including sangoma, inyanga and umthandazi. The integration presented five global themes: (1) THP practices, (2) perceptions of THP, (3) experiences of THP with patients with EB, (4) diagnosis and management plans of THP and (5) vision and role of THPs. There were multiple divergent perspectives among the THPs with the shared African worldview.

Conclusion: Understanding THPs belief systems and therapeutic options is crucial for holistic patient management. Knowledge exchange can promote safe healthcare practices and facilitate collaboration between traditional and allopathic health practitioners.

Contribution: This is the first study to explore THPs perceptions and practices regarding EB, a rare disease.

Participation of nurses in research development

Justin O. Rojaye — 2023-10-02

Background: Nurses’ experience in participation in research has been very diverse and culturally dependent. A shifting environment that appreciates and supports research growth necessitates studying who is involved in research and how and assessing present individual and organisational research capabilities.

Aim: This study aimed to ascertain the existing research capacity among nurses in a large public hospital in Ijebu Ode, Ogun State, Nigeria, to inform the development of a programme towards building a sustainable research culture.

Setting: A public hospital at Ijebu Ode, Ogun State, Nigeria.

Methods: A qualitative research design was utilised. Data were collected through semistructured interviews with 21 nurses from the general hospital. The data were then analysed thematically.

Results: Participants highlighted the need for more nurses to be engaged in research development, research development problems and recommended solutions. The critical requirement was that research has a direct impact on clinical practice.

Conclusion: The results from this study show that research development allows nurses to participate in research relevant to their practice and objectives. More focus should be placed on developing and implementing context-specific nursing research agendas and implementation research skills.

Contribution: The overall implications or benefits to the practice (as an example) with reference to the expanded nurses’ clinical knowledge in participating in research and expand nurses’ clinical knowledge in participating in research

Family members’ experiences of courtesy stigma associated with mental illness

Wada Gaolaolwe — 2023-10-02

Background: The stigma of mental illness has been in existence from medieval times to date and it is extended to families of people diagnosed with mental illness. Families with a member diagnosed with a mental illness experience courtesy stigma of mental illness and it affects the quality of their lives.

Aim: This study aimed to explore and describe the experiences of courtesy stigma of families with a member diagnosed with a mental illness in Lobatse, Botswana.

Setting: The study was conducted at a psychiatric hospital in Lobatse, Botswana.

Methods: A qualitative contextual phenomenological design was used for this study. The population comprised of members from families with a person diagnosed with a mental illness and the sample size was 15 participants. Semi-structured in-depth individual interviews were conducted telephonically.

Results: The study yielded three main themes and related subthemes. The themes were: families’ experiences of received stigma, families’ experiences of stigma by association, and families’ experiences of internal stigma.

Conclusion: Families with a member diagnosed with mental illness experience received stigma, associated stigma and internal stigma. The families experienced that they received dehumanising labels from the public because of their association with their mentally ill family members.

Contribution: With the insights gained from the findings of this study, programmes can be developed that raise awareness on stigma of mental illness and to promote support of families of people diagnosed with a mental illness.

Clinical indications for plain abdominal radiographs: A survey study among radiographers

Lynn Burrell — 2023-10-02

Background: Abdominal pain is a common complaint in the Emergency Department. Radiographers’ knowledge and practices regarding clinical indications for performing abdominal examinations are crucial in the results radiographs produced.

Aim: To determine the knowledge and practices of radiographers regarding the clinical indications for performing radiographic examinations of the abdomen.

Setting: Four public hospitals in the Eastern Cape province, South Africa.

Methods: A cross-sectional study was conducted, using a convenience, all-inclusive sample of n = 85 radiographers. A hard copy self-administered questionnaire was distributed between February and June 2020. Descriptive (mean and standard deviations) and inferential (chi² test) statistics were generated using IBM® SPSS® version 26.0 software package.

Results: Knowledge of clinical indications had a mean of 59.41. All four demographics (age, years of experience, attended a short course and attended pattern recognition course) were significantly associated with overall knowledge. Additionally, short course attendance was significantly associated with most practice items, and two knowledge items (which views are done for perforation; and which view(s) demonstrate a stab abdomen). Pattern recognition was significantly associated with one knowledge item (which views are regarded as an acute abdomen).

Conclusion: Despite the lack of short courses and pattern recognition courses, radiographers’ knowledge of clinical indications was good (>50%). Continuous training, accessible protocols for performing clinical indications for plain abdominal radiographic examinations for radiographers, audit, feedback and reminders to enhance protocol adherence are recommended.

Contribution: The study findings could be used to enhance knowledge and practices regarding clinical indications for plain abdominal radiographic examinations among radiographers.

Fear of dying dirty: Intimate care encounters during COVID-19 pandemic in South African context

Simangele Shakwane — 2023-10-03

Background: Physical distancing, personal protective equipment (PPE) and hand hygiene were encouraged during the pandemic of COVID-19. However, personal hygiene procedures for patients admitted to hospitals, such as assisted baths, oral care and elimination, were neglected.

Aim: This study aimed to describe intimate care and touch experiences for patients admitted to the hospital during the COVID-19 pandemic lockdown.

Setting: This study was conducted in the medical and surgical units of two hospitals in Gauteng province.

Methods: A generic qualitative approach was used to explore and describe the patients’ intimate care and touch experiences during the COVID-19 hard lockdown. In-patient individuals above 18 years were purposively sampled. Twelve patients aged between 28 and 60 years participated in semi-structured interviews. Data were analysed using thematic analysis.

Results: Three central themes emerged from the data: (1) Keeping away from the body, (2) Who is touching my body? and (3) Fear of dying dirty - a sense of losing bodily dignity. The participants felt that the nurses were trying to avoid them, as they were seen as potential carriers of the COVID-19 pandemic.

Conclusion: The cleanliness of a patient’s body gives them a sense of self-respect and dignity. Nurses should find ways to ensure that patients receive quality intimate care and touch, even during situations such as the pandemic.

Contribution: Patients’ religious or cultural beliefs and anxieties about dying dirty should be acknowledged and respected in nursing care to provide quality bodily care for all patients.

Psychological impact of violence on male nurses in forensic units in Gauteng, South Africa

Ntuthuko R. Thwala — 2023-10-03

Background: Male psychiatric nurses are pivotal in providing treatment, care and rehabilitation to state patients admitted to forensic units. The nature of patients admitted in forensic units increase the likelihood violence for male psychiatric nurses. Substantial evidence suggests that a high incidence of violence in such units is linked to lack of security personnel amongst other factors, adding to the strain. Fewer studies adequately explored the psychological impact thereof specifically on male psychiatric nurses.

Aim: To explore the psychological impact of violence on male nurses working in forensic units in Gauteng, South Africa, and the strategies used to deal with the impact of exposure to violence.

Setting: The study was conducted at a mental health institution in the west of Tshwane Gauteng, South Africa.

Methods: An exploratory, qualitative research design was used. In-depth interviews were used to collect data from 11 male psychiatric nurses. Data were analysed using thematic analysis.

Results: Two main overarching themes emerged: (1) Traumatic experience and (2) Survival strategies to deal with the experience. The results suggest that exposure to violence has a debilitating psychological effect on male nurses, prompting them to utilise various ways to cope with the experiences. Psychological support and skills development could benefit male psychiatric nurses to manage the impact of violence adequately.

Conclusion: Further research is recommended to explore the strategies to support male psychiatric nurses working in forensic units.

Contribution: The study findings may be used to improve the psychological well-being of male psychiatric nurses working in forensic units in South Africa.

Impact of the COVID-19 pandemic on audiology services in South Africa: A preliminary study

Katerina Ehlert — 2023-10-03

Background: Hygiene-, work practices, travel, personal interactions and access to healthcare services changed for the majority of the world during the pandemic.

Aim: This study aimed to discover the knowledge, impact and attitudes towards COVID-19 on the professional practices of public and private sector audiologists in South Africa.

Setting: The study included 76 audiologists registered with the Health Professions Council of South Africa (HPCSA) and employed in the public, educational, tertiary or private practice and private sector in South Africa.

Methods: A cross-sectional self-administered electronic survey study design was implemented.

Results: Audiologists had appropriate knowledge regarding COVID-19. During hard lockdown, 69% of respondents saw less than 40% of their usual patient load, only 31% saw 60% – 100% of their usual patient load. During lower lockdown levels, majority of respondents (73.7%) saw 60% – 100% of their patient load while 26.3% still saw less than 40% of their usual patient load. Only hearing aid reprogramming, hearing aid trouble shooting, cochlear implant pre-counselling and adult hearing screening could be offered via tele-audiology. The main challenges faced were fear of infection, infection control measures in the workplace, accessibility and limited services provided during the various lockdown levels.

Conclusion: The pandemic and lockdown levels had a definite impact on audiological service provision and many adaptations regarding service delivery and infection control in the workplace were required.

Contribution: The relevance of this work for health services is the identification of the challenges experienced by audiologists during the pandemic and the opportunities to prepare for the future.

July 2021 civil unrest: South African diagnostic radiography students’ experiences

Kathleen Naidoo — 2023-10-03

Background: South Africa (SA), in 2021, experienced a wave of civil unrest following political events that led to mass looting and the destruction of property. Civil unrests, among other disruptions, have been seen to cause ripple effects on healthcare education, particularly for radiography students who undergo work integrated learning within hospitals and universities, even during these times of unrest.

Aim: This study aimed to explore and describe the undergraduate diagnostic radiography students’ experience of the civil unrest that occurred in SA in 2021.

Setting: The study was conducted across five universities in South Africa, offering the diagnostic radiography programme.

Methods: A qualitative, interpretive phenomenological design was employed as it enabled the researchers to facilitate focus group interviews to gain insight into the lived experiences of the students during this time.

Results: Four themes emerged from the study data, namely: (1) Negative effects on students’ emotional and psychological well-being, (2) Academic and clinical support mechanisms during disruptions, (3) The influence of disruptions on clinical training, (4) Recommendations to support students for future disruptions.

Conclusion: The participants from this study described the negative effects that the civil unrest had on their emotional and mental well-being. There is a need for increased support mechanisms during times of disruptions from universities across South Africa.

Contribution: The findings highlight the ripple effects that disruptions, such as civil unrests, have on radiography students. This can assist universities to relook at their institutional support structures, in order to enhance the current support given to students across universities in times of disruptions.

The perceived effects of generational diversity on supervision of new professional nurses in public hospitals

Kholofelo L. Matlhaba — 2023-10-03

Background: The current global nursing workforce is a combination of personnel from three different generation cohorts, which are the Baby Boomers, Generation X and Generation Y (Millennials). These generational cohorts work side by side to provide quality nursing care to the patients on a daily basis.

Aim: This article aims to report the effects of generational diversity on the supervision of new professional nurses in selected public hospitals in North West province.

Setting: This study was conducted at seven public hospitals situated at three out of the four districts of North West province, South Africa. These public hospitals classifications consist of six districts and one provincial hospitals.

Methods: The study followed an exploratory, descriptive and contextual qualitative research design underpinning the constructivist paradigm was followed to pave a way for this study. Operational managers were purposively sampled and data were collected using the focus group discussion as well as individual interviews. Data analysis followed the guideline of the thematic analysis.

Results: This article reports on three themes that emerged from data analysis, namely: (1) generational differences, (2) insubordination and (3) impact on supervision.

Conclusion: Understanding the generational diversity and its impact on the supervision of new professional nurses might assist in improving the leadership styles for operational managers and will promote collegiality among colleagues and positively influence the provision of quality care for patients.

Contribution: These results provide a framework for future research and provide the basis for understanding the impacts generational diversity has on supervision of new professional nurses.

Influences of COVID-19 vaccination policy on students’ vaccine acceptance

Thuli G. Mthembu — 2023-10-03

Background: Higher education institutions (HEIs) developed and implemented a mandatory COVID-19 vaccination policy to facilitate vaccine acceptance and vaccination among universities’ staff and students. However, little is known about influences of the mandatory vaccination policy on health science students at a university and they tend to result in vaccine hesitancy.

Aim: To explore the influences of the mandatory COVID-19 vaccine policy on health sciences students’ vaccine acceptance at HEIs in South Africa.

Setting: The study was conducted in one of the universities in the Western Cape Province, South Africa.

Methods: An interpretive qualitative exploratory-descriptive research was conducted with 10 participants who were selected using the purposive sampling method to participate in semistructured interviews. Data were audio-recorded, transcribed verbatim and thematically analysed.

Results: Two themes and 12 sub-themes were identified during the data analysis, namely individual and group influencing factors, as well as contextual influencing factors.

Conclusion: This study revealed that the COVID-19 vaccination mandatory policy influenced the students’ quality of life, academic performance and well-being. The findings from this study indicate that there were perceived barriers related to personal and contextual influencing factors than benefits of COVID-19 vaccination.

Contribution: The understanding of and insight into the influences of the mandatory vaccination policy provided a basis for further strategies that may be developed to address COVID-19 vaccine infodemic, vaccine hesitancy and its risk effects. This can be done through collaboration with different stakeholders to educate health science students about the perceived benefits of COVID-19 vaccination.

Antiretroviral stewardship in a tertiary academic hospital: The need for a clinical pharmacist

Elmien Bronkhorst — 2023-10-03

Background: South Africa has the highest prevalence of people living with HIV globally. Although antiretroviral therapy provides solutions, evidence of antiretroviral resistance emerged, requiring the application of antiretroviral-stewardship programmes to curb medication-related problems.

Aim: Identify and describe antiretroviral-stewardship pharmacist interventions in an active antiretroviral- stewardship programme.

Setting: HIV-positive adults admitted to medical wards at a tertiary academic hospital in South Africa.

Methods: A descriptive quantitative study was performed, utilising an antiretroviral-stewardship assessment tool to determine antiretroviral-related recommendations in the treatment of HIVpositive adults. The study employed purposive sampling. Treatment charts were evaluated to identify antiretroviral-stewardship recommendations. The number of recommendations highlighted the need for a clinical pharmacist in an active antiretroviral-stewardship programme. Descriptive data analysis with Pearson correlations was employed to display the data.

Results: Medication-related problems were identified in 100% of study patients (n = 41), with an average of 2.46 interventions per patient. One-hundred-and-one medication-related problems were identified by using the antiretroviral- stewardship assessment tool. The identified problems included a lack of viral load testing (41, 100%), lack of CD4 count monitoring (15; 36.6%) and lack of prophylactic treatment against opportunistic infections (10; 24.4%). Medication-related problems included the presence of clinically significant drug–drug interactions and serious side effects, CD4 count decline despite being on antiretroviral therapy, unnecessary treatment interruptions including risk for IRIS, inappropriate antiretroviral therapy regimen, non-adherence and absence of treating tuberculosis as co-morbidity.

Conclusion: Present study demonstrates the need of an active antiretroviral- stewardship programme’s benefits. The possible role of the clinical pharmacist as active participant and leader in this programme is highlighted.

Contribution: Highlight the role of clinical pharmacists in antiretroviral stewardship.