Masters Degrees (Nursing and Midwifery)

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Barriers and facilitators in the meticulous compilation and adaptation of standardised nursing care plans in a public hospital of the Eden district, South Africa : a nursing perspective
(Stellenbosch : Stellenbosch University, 2018-12) Van As, Saria; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Background: South African Nursing Council Regulation, No. R.2598 (as amended) requires that registered nurses (RNs) develop, implement and evaluate nursing care plans as part of their legal scope of practice. Keeping meticulous records forms an indispensable part of nursing care in order to provide continuity and quality patient care. Risks associated with poor care planning can include non-attainment of patient goals, patient dissatisfaction with care received, inferior quality of nursing care and lengthened hospitalisation. Document audits conducted in the study hospital provided evidence that standard care plans were often incomplete, inaccurate and not relevant to the patient’s condition. However, these audits cannot provide insights into why this poor practice occurs. The aim of this study was to describe the particular barriers and facilitators RNs experienced in the meticulous compilation and adaptation of standardised nursing care plans as part of their patient care activities in order to inform strategies that may be developed to promote meticulous practice in this aspect of care planning by RNs. Four study objectives were formulated, namely: to describe (i) barriers and (ii) facilitators influencing RNs in the meticulous compilation and adaptation of standardised nursing care plans, (iii) to determine if associations exist between demographic data and the most reported barriers and facilitators, and (iv) to identify strategies suggested by RNs to reinforce facilitators or minimise barriers. Methods: A quantitative approach with a descriptive design was used to meet the stated objectives. A 41-item structured questionnaire which was developed by the researcher, consisting of three sections, was used as the data collection tool. It was available in Afrikaans and English. Data were collected from RNs working in medical and surgical units of a public hospital in the Eden District. Of the 43 possible respondents, 29 respondents completed the questionnaire, with a response rate of 67% (n=29). A descriptive analysis of each of the scale items was conducted. Hypothesis tests between each of the five demographic variables and all the scale items were performed to identify trends showing associations between these variables and scale items by using the non-parametric Kruskal-Wallis and Mann-Whitney U tests. Results: The most prominent barriers reported included lack of multidisciplinary collaboration, failure to update objectives and plans daily, a lack of plans for every type of diagnosis, lack of involvement in the development of plans, and workload. Facilitators included ease of identifying priorities of care, compiling individual care plans when necessary, adequate knowledge, and predominantly positive attitudes towards the application of standardised nursing care plans. Significant associations were found between age and availability of a policy as well as the availability of plans for every diagnosis, and also between gender and completion of plans being a waste of time. Furthermore, type of basic qualification showed significant associations with validation of plans, minimising unnecessary documentation, careful use, aiding in the provision of high-quality care, and continuity of care. The type of qualification, specifically the 4-year diploma, impacts on how RNs view and experience the use of standardised nursing care plans. Meliorating strategies included the use of individual care plans or a combination of standardised and individual care plans, regular refresher training, as well as more audits – specifically aimed at the content of the standardised nursing care plans. Conclusion: Study results confirmed that RNs experience various barriers and facilitators in the meticulous compilation and adaptation of standardised nursing care plans, and associations exist between demographic variables and the identified barriers and facilitators. RNs offered meliorating strategies regarding the most reported barriers that were incorporated into the study recommendations.
Chlorhexidine in the prevention of ventilator associated pneumonia : a systematic review
(Stellenbosch : Stellenbosch University, 2011-12) Snyders, Olivia Gayle; Khondowe, Oswell; Bell, Janet; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: Ventilator-Associated Pneumonia (VAP) is a hospital acquired infection, not present or incubating at the time of admission and developing in patients during the process of care within the hospital setting. Between nine and twenty-seven percent of patients who are mechanically ventilated will develop ventilator-associated pneumonia. Mortality rates for ventilated patients who develop ventilator-associated pneumonia are estimated to be between 33-50%. The Institute for Healthcare Improvements (IHI) in 2006 recommended the use of ‘care bundles’ to reduce VAP but no statistically significant decline has been noted. Despite the completion of an extensive literature search for purposes of this review, no statistical data on nosocomial infections or nosocomial pneumonia relevant to South Africa was found. Mechanical ventilation, a support therapy used in approximately one third of patients, significantly increases the patient’s risk of developing this nosocomial pneumonia. Critically ill patients are by virtue of their critical illness more prone to the development of infections, especially ventilator-associated pneumonia. Consistent evidence suggests that oropharyngeal colonization can be associated with the development of VAP. Studies focusing on standard oral care, with or without the concurrent use of chlorhexidine, have not provided sufficient evidence for the use of chlorhexidine in VAP prevention. Chlorhexidine is an antiseptic agent, which when tested, proved to reduce total respiratory tract infections by up to 69% (DeRiso et al, 1996:1558). Objective: The aim of this study was to systematically appraise and review evidence on the effectiveness of chlorhexidine in reducing the incidence of ventilator-associated pneumonia in adult patients. The secondary aim was to systematically summarize evidence on the use of chlorhexidine in reducing mortality. Methodology: An extensive literature search of studies published in English was undertaken. Electronic databases searched were CENTRAL, CINAHL, EMBASE and MEDLINE. Reference lists of articles, textbooks and conference summaries were examined. Literature searches were conducted using Medical Subject Headings (MeSH). These included: Ventilator-associated pneumonia, chlorhexidine, VAP and oral care. Eight randomized controlled trials, investigating the efficacy of Chlorhexidine in ventilator-associated pneumonia prevention in adults met the inclusion criteria. The effect measure of choice was Risk ratio with 95% confidence intervals for dichotomous data using the random effects (Mantel-Haenszel) model; (p=value of 0.05). Heterogeneity was assessed using the Cochrane Q statistic and I². Results: Eight randomized controlled trials met the inclusion criteria for this review. Pooled risk ratio for the incidence of ventilator-associated pneumonia was 0.64 (95% CI; 0.44-0.91; p =0.18). Treatment with chlorhexidine decreased the risk of ventilator-associated pneumonia by 36%. There was no evidence of Chlorhexidine reducing mortality. Conclusions: Chlorhexidine is a cost effective safe treatment in the prevention of VAP. The use of 2% chlorhexidine may be more effective in reducing the incidence of VAP. No studies were found conducted in developing countries. More rigorously designed trials using 2% chlorhexidine are recommended.
Critical thinking : perspectives and experiences of critical care nurses
(Stellenbosch : Stellenbosch University, 2012-12) Hendricks, Lucia Elizabeth; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: The increasingly complex role of the critical care nurse in an intensive care environment demands a much higher level of critical thinking and clinical judgment skill than ever before. Critical thinking in nursing practice may be defined as the cognitive ability to analyse, predict and transform knowledge, ensuring quality nursing care. To reason from a nurse’s perspective requires that we learn the content of nursing; this includes the concepts, ideas and theories of nursing. The aim and objectives of the study were to explore critical care nurses’ perspectives and experiences with regards to the concept of critical thinking, facets influencing the application of critical thinking skills in clinical practice and how these impact on the delivery of quality nursing care. A qualitative approach, using a case study design was utilised. A sample of six participants, who met the study inclusion criteria and consented to participate, were interviewed individually. Subsequently, five of these six participants took part in a focus group discussion to capture additional data to clarify and enrich the individual interview data. A field worker was present during the interviewing processes to note non-verbal data and later verify transcribed data. Feasibility of the proposed study was established by conducting a pretest which elicited relevant information. Ethical approval for the study was obtained from the Health Research Ethics Committee at the Faculty of Medicine and Health Sciences, Stellenbosch University. Permission and consent was obtained from the relevant hospital group to interview nurses working in the intensive care units. Qualitative content analysis, which focuses on the content or contextual meaning, was used to analyse interview data. Coding of the data through emergent themes and sub-themes was done by the researcher and supported through independent coding to verify and strengthen the analysis and interpretation of the researcher. . The results depicted how the participants personally understood the concept of critical thinking and the components influencing the application of critical thinking skill in clinical practice. The study of the participants’ perspective of the concept of critical thinking and portrayed how they experience analytical and independent thinking, competence and confidence, as well as knowledge, skill and expertise, to influence the quality of patient care. The data revealed several themes that facilitated critical thinking in critical care nurses. These themes were ‘team support’, ‘experience and exposure’ and ‘empowering the mind’. Emergent themes elaborating the limitations of critical thinking included ‘being stressed’, ‘professional boundaries’ and ‘being busy’. Several recommendations and suggestions for future research were offered.
The expected role of the critical care clinical nurse specialist in private hospitals
(Stellenbosch : University of Stellenbosch, 2010-03) Prins, Aletta Jacoba; Bell, Janet; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: The trend towards specialisation in nursing has resulted in the development of the role of the Clinical Nurse Specialist (CNS) since the 1960s and 1970s in North America and the United Kingdom respectively. A Clinical Nurse Specialist should demonstrate excellent skills in leadership, communication, critical thinking, clinical and collaborative ethical decision-making, as well as mentoring. Research done internationally has shown that advanced practice nursing leads to higher patient satisfaction and compliance, fewer hospitalisations and shorter length of stays. The development of the CNS role in SA is slow in implementation. The South African Qualifications Authority has only recently published qualification rules for a master’s certificate and master’s degree in Nursing for advanced specialist nurses in SA. This situation led to the following research question: What is the expected role of the Critical Care Clinical Nurse Specialist in private hospitals in the northern and southern suburbs of the Cape Peninsula, South Africa? A non-experimental, explorative, descriptive study with a quantitative orientation was conducted in eight private hospitals in the Cape Peninsula. Through non-probability sampling 73 critical care health professionals (critical care professional nurses, clinical nurse specialists, nursing managers, unit managers, nurse educators, clinical facilitators, clinical coordinators and doctors) out of a population of 170 critical care health professionals participated in the study. A survey tool was designed and validated to collect the data. Quantitative data was analysed through Statistica® and qualitative data was analysed thematically. It was found that 81% of the participants agreed that Clinical Nurse Specialists should be appointed in the South African critical care environment as soon as possible to improve patient outcomes, to contribute to safer nursing care, to relieve work stress of shift leaders and bedside nurses and to improve the professional status of nursing. It is recommended that greater awareness regarding the Clinical Nurse Specialist should be developed. The relevant educational requirements should be finalised and a clear job description should be compiled. Nursing managers should appoint Clinical Nurse Specialists in each critical care unit as soon as possible.
An exploration of undergraduate nursing students experiences of an HIV/AIDS support group and its activities
(Stellenbosch : Stellenbosch University, 2014-12) Sixaba, Nqabisa Lucia; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences:. Division of Nursing Science.
ENGLISH ABSTRACT: The Human Immunodeficiency Virus infection (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are critical concerns worldwide; this is particularly true of South Africa. The consequences of HIV infection and complications of AIDS are a challenge that extends into the nursing profession and into the community of student nurses. Support groups can form an important part in educating nursing students about HIV and AIDS, as well as in supporting nursing students through the processes of counselling, testing and managing the physical, as well as other impacts of this syndrome. When considering the current situation at an Eastern Cape nursing college and the literature reviewed on this topic, the research question posed for this study was: ‘Why is the support offered by the HIV support group to the nursing students having such a limited effect on the students’ motivation to participate in HIV counselling and testing (HCT) and support activities to de-stigmatise HIV/AIDS?’ The aim of this study was to explore and describe the nursing students’ experiences and perceptions of the support group activities in order to improve the relevance of this initiative for students. The objectives of this study were to - Explore and describe the student’s experiences and perceptions of the support group activities - Identify and describe the student’s expectations of the support group. A qualitative approach with an exploratory and descriptive design was used to elicit data to answer the research question. Ethical approval was obtained from the Health Research Ethics Committee and access to the college campus was obtained through the appropriate authorities. The accessible population for this study were 1st, 2nd, 3rd, and 4th year students at one campus of the provincial nursing college in the Eastern Cape. In-depth individual interviews were conducted with eight participants who met the study inclusion criteria of having had experience of the support group and its activities. Interviews were recorded and transcribed by the researcher. Content analysis was used to analyse the interview data through applying Tesch’s eight steps of analysis. Data analysis revealed that participants did not experience the support group as helpful; although they had joined the support group they remained fearful of receiving test results and what their future may hold should they be diagnosed as being HIV positive. The participants experienced rejection and discrimination by the support group committee members; they also identified that the committee displayed hypocritical behaviours and a lack of respect for confidentiality of information which further undermined the functioning and influence of the group. Results revealed that joining the support group means one is automatically stigmatised as being HIV positive. The support group committee members were seen to be inaccessible having only limited communication with participants. Recommendations from the study were to hold personal and group development sessions for the committee and interested students to assist them in learning how to manage ethical issues related to counselling and testing, how to conduct effective campaigns to de-stigmatize HIV/AIDS, and to determine clearly what the purpose of this particular group is that it may better meet the needs of the student group. Limitations of this study were that the qualitative research approach that was applied limited the generalisation of the findings. The study focused only on experiences and perceptions of the undergraduate nursing students on one campus of the nursing college about the support group and its activities. Thus, the study offered an initial insight into the current negative perceptions of students towards the support group and offered a foundation for further investigation. In conclusion, experiences and perceptions of the support group were explored and elaborated on. Currently, the support group does not offer the support the students would like to be available as the fundamental functioning of the group is compromised by a lack of trust between students and the committee members.
Exploring adult patients’ perceptions of what enables them to make sense of their intensive care experience
(Stellenbosch : Stellenbosch University, 2019-04) Harmuth, Keryn; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Critical illness requiring admission into an intensive care environment is a significant stressful event in any person’s life. Good caregiving in an intensive care environment is supported by appropriate, correct assessment and monitoring, drug and organ support interventions, patient comfort measures, psychological support, and early detection of complications. All these interventions and activities create experiences the critically ill person must make sense of in order to manage long-term consequences of this traumatic encounter (Leach, 2004:13). Critically ill patients’ experiences are an important component of a person’s perceptions of the quality of care provided in the intensive care unit (Wahlin, Ek & Idvall, 2009:332). During my clinical experiences as a critical care nurse and through listening to patients’ and colleagues’ accounts of their experiences of intensive care, it appears that in many instances the person’s negative experiences outweigh the positive ones. I was keen to explore adult patient’s perceptions of what aspects of the intensive care experience had an enabling influence on them making sense of their intensive care encounter and how these aspects enabled the patient to make sense of their experience of intensive care in order to move through the experience and make the experience tolerable. A qualitative descriptive phenomenological research approach was used. This study aimed to explore a participant’s own lived intensive care experience through their personal recollections in the intensive care unit. The participant’s experience of their time in an intensive care unit was the key event. A purposive sampling strategy using a network sampling method was applied to identify and include participants who had experienced an ICU admission, had recovered and moved from ICU to the ward or home, was able to give informed consent and able to talk with me about their admission and journey through their ICU stay. It was found that participants were enabled to make sense of their ICU experience when they were part of a trusting relationship with their caregiver. A trusting relationship also encompassed the patient knowing that they mattered to their caregiver and allowed the patient to feel at ease and in turn feel safe. Distrust in the caregiver erodes this notion of feeling safe and hindered the patient being able to make sense of their experience of ICU. It is recommended that education and training programmes should include specific content and application of trying to live in a critically ill person’s shoes in order to enable a nurse or doctor to have some insight as to what this experience means to a critically ill person. The study will be beneficial to nurses and other healthcare personnel who can offer care that is influenced by insights from this work and optimize a patient’s sense of being able to make sense of, tolerate and move through an experience of intensive care.
Exploring continuing professional development in critical care : registered nurses’ perspectives of elements influencing completion of a CPD programme in a South African private hospital group
(Stellenbosch : Stellenbosch University, 2021-03) Van Heerden, Wilma-Jean; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Background: Continuing professional development is education throughout the duration of professional life to maintain competence and increase professional proficiency and expertise. A complex reality of nursing practice in South Africa is that approximately 25% of nurses working in the critical care environment hold a critical care qualification. Therefore, healthcare services have to rely mostly on novice registered nurses and those new to this environment to care for the critically ill. In this context some South African private and public hospitals initiated structured internal continuing professional development programmes to offer a way of knowledge and skills improvement for nurses working in critical care environments without a critical care qualification. A private healthcare group has offered a well-established structured continuing professional development programme in fundamental critical care nursing since 2003 to develop appropriate knowledge, gain practice exposure and clinical skills nurses may be unfamiliar with. In addition this programme has the aim to enhance safe and quality patient care as well as to avoid errors. The aim of this study was to explore and describe the perspectives of registered nurses of elements that influence their successful completion of a continuing professional development programme in critical care nursing to strengthen the fit for purpose of this programme. The assumption by Knowles that adult learners are selfdirected, and is motivated by information new and relevant in their personal lives or jobs, formed the basis in the conceptual framework for this study. Method: A qualitative exploratory, descriptive research design was used by means of employment of semi-structured individual interviews. The target population was identified as RNs who participated in and completed a critical care continuing professional development programme within this private hospital group from the beginning of 2017 to the end of 2018. The accessible population was registered nurses who participated in the critical care continuing professional development programme in the Western Cape, Johannesburg, and Tshwane regions. A sample size of 14 participants concluded data saturation by means of a self-created openended interview guide. Findings: The following three themes and related sub-themes emerged and concluded the data analysed: 1. Participants perceived a multitude of supporting elements to successfully complete this critical care continuing professional development programme namely readiness to learn, support and communication. 2. Similarly elements that detracted participants from successful completion of this continuing professional development programme were experienced as obstacles intra-person and also obstacles extra-person. 3. Participants finally provided their recommendations on elements that may be adapted to strengthen the fit for purpose of this programme. These elements concluded changes to be made by registered nurses themselves internally and changes to be made external to registered nurses. Relevant literature and recommendations offered by the participants were used to formulate recommendations. Action steps for management, nurse educators and registered nurses to complete this continuing professional development programme successfully were formulated.
Exploring newly qualified nurses experiences of their compulsory community service year at an urban district hospital
(Stellenbosch : Stellenbosch University, 2020-03) Scheepers, Vanessa Christina; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Background: Compulsory community service in the South African health sector was initiated by the National Department of Health with two distinct goals (Parker, Steyn, Mchiza, Wentzel-Viljoen, Dannhauser, Mbhenyane, Nthangeni & Moeng, 2011: 1412) firstly, to ensure improved delivery of health services to all South Africans; and secondly, to provide opportunities for newly qualified health professionals to develop their knowledge, practical skills, critical thinking abilities and professional behaviour (Hatcher, Onah, Kornik, Peacocke & Reid, 2014: 2). Despite the secondary goal (providing newly qualified health professionals with opportunities to develop their knowledge, practical skills, critical thinking abilities and professional behaviours), literature shows there are facilitators and barriers that seem to influence a person’s experience of the community service year (Reid et al., 2018: 44-45; Netshisaulu & Maputle, 2018: 4-6). It seems that, similarly to the experiences of other healthcare professionals, nurses engaged in community service at the public health facility where the researcher is employed do not seem to benefit from this stated secondary goal. The purpose of this study was therefore to explore and describe newly qualified nurses’ experiences of the compulsory community service year at an urban district hospital. Methods: A qualitative approach with an exploratory, descriptive research design was used for the study. A purposive sampling method was applied, and the final study sample comprised of five participants out of the 13 community service nurses. A semistructured interview guide was used to collect narrative data from participants and field notes were made. Qualitative content analysis was used to analyze the data collected. Results: Three overarching themes and eight sub-themes emerged through the data analysis process. The first theme, a complex experience, described the varied experiences of the participants during their compulsory community service year. The second theme, support, highlighted participants’ experience of the support they had received. The third theme, on the floor, described the positive experiences and challenges the participants encountered in the clinical environment. Conclusion: The research question of this study was answered through an analysis of the participants’ rich, in-depth experiences. Community service nurses had varied experiences of the community service year. The overall experience was positive, with community service nurses being able to develop their knowledge, practical skills, critical thinking abilities and professional behaviour. Their experiences identified specific facilitators and barriers that influence newly qualified nurses’ experience of the community service year. This understanding can inform a review and revision of the current support strategies for newly qualified nurses doing compulsory community service in public urban hospitals.
Exploring registered nurses' understanding of the concept of critical thinking in a private hospital in the Gauteng Province, South Africa
(Stellenbosch : Stellenbosch University, 2023-12) Mboqoka, Khululwa Nomangwekazi; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY: Background: In hospital environments, registered nurses are faced with difficult scenarios needing appropriate critical thinking skills. As health care systems become more sophisticated, these critical thinking abilities help registered nurses to be able to synthesise information and make swift, appropriate clinical decisions that lead to safe and efficient health care delivery. The current study was based on the researcher’s concern regarding an apparent lack of disposition towards critical thinking amongst registered nurses working in medical and surgical wards. Registered nurses are essential healthcare professionals in meeting patient needs in a health care system. Method: This study aimed to explore and describe registered nurses’ understanding of critical thinking in their clinical practice in medical and surgical wards in a private hospital in South Africa. The objective of this study was to explore how registered nurses understand critical thinking as a concept in their clinical practice. The researcher used a qualitative approach for this study. The approach applied an exploratory, descriptive design to explore the understanding and description of the concept of critical thinking by registered nurses who are working in medical and surgical wards. Data was analysed using a thematic analysis approach, which entailed a process of reading and re-reading data, coding, and generating themes from which data was interpreted and findings deduced. To conduct this research study participants were drawn from the group of registered nurses working in the medical and surgical wards of the study site who met the inclusion criteria. The final sample size comprised twelve registered nurses (RNs). Semi-structured individual interviews supported by an interview guide were used to gather data from participants. Results: The findings indicated a lack of understanding of the concept of critical thinking by registered nurses. Even though some nurses had an idea of the concept, it appeared that there is a big gap in nursing education and clinical teaching when facilitating achieving critical thinking as one of the objectives. The themes that emerged from the data indicated that there are factors that have a negative influence on how registered nurses think and apply their minds in clinical wards. Conclusion: The study concludes that registered nurses need support in developing critical thinking skills. It was also deduced that some demarcations and limited resources impede critical thinking in the wards.
Exploring the perceptions of medical officers and registered nurses about family presence during cardiopulmonary resuscitation
(Stellenbosch : Stellenbosch University, 2020-03) Russell, Hanilene Juliana; Hector, Dawn; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Background: In emergency units, cardiopulmonary resuscitation (CPR) occurs daily as a life- saving intervention for crittically ill patients. Traditionally, families are told to wait outside when CPR commences. Family presence during CPR is when one or more family members witness all interventions performed and who provides physical or visual contact to the patient during the resuscitation event. Ever since family members requested to be present during CPR in 1980’s at Foote Memorial Hospital in Michigane America, to allow this practice has been a controversial concept amongst healthcare providers. In a secondary provincial hospital in the Western Cape of South Africa, family members are mostly not allowed, or are seldom offered the opportunity to be present during a resuscitative event as no standardised practice or protocol is in place. Some medical and nursing personnel conventiently do not allow family to witness the CPR on their family members, which create confusion amongst families, navigating away from facilitating family-centred care. Methods: A qualitative approach with an exploratory-descriptive design was utilised. Data was collected by a fieldworke using in-depth individual interviews with healthcare providers. A self-developed, semi-structured interview guide with openended questions and probes were used. A final total of 10 participants took part in the study after giving informed concent. Trustworthiness was maintained throughout the study. Member checking took place during the interviews to summarise the participants’ information as well as a follow-up meeting. Transcribing was done by the primary researcher. The data was analysed by the primary researcher who followed the content analysis process. Results: Five main themes surfaced from this analysis: Information communication; benefits and challenges of family presence; the family’s choices and reactions, types of CPR cases and the health professional’s professional’s interactions and skills during the CPR process. The findings of the research study illustrated the importance of communication to the family and to provide them with accurate information. The choices to be present or not to be present as well emotional reactions of the family have an impact on the decision to allow family to be present or not. The types of CPR cases and prognosis of the patient influences the decision to allow the family in the resuscitation room and the different reactions families can experience, have an impact on the decision to allow family to be present or not. The professional skills and interactions of the healthcare team are an important aspect that influences the decision to allow family to be present. Conclusion: The perceptions of medical officers and registerd nurses about family presence during cardiopulmonary resuscitation at a secondary hospital provide the emergency department with a deeper understanding and knowledge around family presence practices.
Factors influencing Nurses’ decisions and actions when applying standard precautions for infection prevention in a private hospital in Namibia
(Stellenbosch : Stellenbosch University, 2019-04) Hoes, Maureen Shirley; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Background: Healthcare-associated infections (HAIs) are considered a leading risk factor for patients and healthcare workers in healthcare environments (Haile, Engeda & Abdo, 2017:1). Both nurses and patients are exposed to infections that use various transmission modes, including droplets, contact and airborne transmission (Haile et al., 2017:1). Standard Precautions for infection prevention and control (IPC) must form part of nursing activities to break the chain of infections and to manage and reduce HAIs. The increase in the number of HAIs occurring among patients means that nurses should comply with Standard Precautions to protect themselves and the patients. However, research shows that there are a number of factors that influence nurses when they have to implement Standard Precautions while engaged in nursing practice Purpose: The aim of this study was to explore and describe the contextual factors that influence nurses' decisions and actions with respect to applying Standard Precautions as part of their nursing practice. This was done in a Namibian private healthcare setting with the goal of informing IPC training and strategies in an effort to facilitate nurses' consistent and correct application of Standard Precautions at the study site. Methodology: The study used a qualitative approach with a descriptive study design. Participants contributed data during three focus group discussions where discussion was stimulated with semi-structured open-ended questions as triggers. The study sample was drawn from the population of nurses (registered nurse/midwife and enrolled nurses) working at the study site in November 2017. A thematic analysis guided by Boyatzi’s approach was used to analyse the narrative data. Findings: Four broad themes emerged from the data. These themes and their accompanying sub-themes referred to the healthcare giver’s knowledge of Standard Precautions, stumbling blocks, factors that help and Reinforcing Behaviour Change.
Fluid balance monitoring in critically ill patients
(Stellenbosch : Stellenbosch University, 2012-12) Diacon, Annette; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: Motivation. Homeostasis is a dynamic and balanced process that must be maintained in order to for health to be sustained (Scales & Pilsworth, 2008:50-57). In critically illness, homeostasis is disrupted and along with inadequate tissue perfusion potentially leads to multiple organ failure (Elliot, Aitken & Chaboyer, 2007:437). The fluid balance of a patient is essential for preserving homeostasis and to maintain optimal tissue perfusion, thus monitoring fluid balance plays an important role in the managing a critically ill patient. Current literature and best nursing practice emphasise the importance of accurate and correct fluid balance monitoring in critically ill patients including recording fluid intake and output on a purpose designed fluid balance sheet. Research has shown that the patient’s outcome after critical illness is influenced by the fluid balance management including fluid balance monitoring (Vincent, Sakr, Sprung, Ranieri, Reinhart, Gerlach, Moreno, Carlet, Le Gall & Payen, 2006:344-353), while several studies have questioned accuracy of fluid balance calculation in various acute care settings (Johnson & Monkhouse, 2009:291; Smith, Fraser, Plowright, Dennington, Seymour, Oliver & MacLellan, 2008:28-29). In an informal audit performed in a local critical care unit, seven out of ten fluid balances were incorrectly calculated. Clinical experience of nurses’ inattention to fluid balance monitoring, together with the informal audit data, reveals that fluid balance monitoring is generally not performed correctly or accurately by nurses working in critical care units. The aim of the study was to describe the perspectives and practices of registered nurses in critical care units with regard to fluid balance monitoring. Methods. A quantitative approach in the form of an audit was applied to establish the current practice of fluid balance monitoring. A survey was conducted among registered nurses to gain insight into their perspectives and knowledge of fluid balance monitoring. The sample for the audit was drawn from fluid balance records, which met the study inclusion criteria. The survey was conducted with a sample of participants from registered nurses in critical care units from a particular hospital group, in compliance with the inclusion criteria. The researcher collected the data using a purpose designed audit tool and questionnaire. Results. The audit revealed that 90 % of the sampled fluid balance records were inaccurate (tolerated deviation 0-10ml) and 79% were inaccurate if a deviation of 50ml would be tolerated. Furthermore the inaccuracy in calculation was larger in patients whoreceived diuretics. The questionnaire data revealed that registered nurses considered fluid balance monitoring as an important part of patient nursing care and were aware that inaccuracy can pose a risk to the patient. The nurses feel responsible for performing fluid balance monitoring. In addition the nurses gave recommendations for the practice. Discussion. The results of this study are similar to other studies done internationally. The nurses are aware of the importance of the fluid balance, and recognise the inaccuracies. With our limited resources, both financial and in terms of nursing staff, the solutions have to be very basic and practical. Key words: fluid balance, critical care, accuracy and auditing, best practice
Horizontal violence among nurses working in intensive care environments within the private healthcare sector
(Stellenbosch : Stellenbosch University, 2018-03) Rust, Hanri; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY: Background: Nurses are three times more likely to become victims of abuse in the workplace than any other profession, with 65% of American nurses having reported being abused in the workplace in 2008. Horizontal violence has a detrimental effect on a victim’s psychological and physical health and can lead to a decrease in the quality of care a patient receives when being cared for by a nurse who is a victim of horizontal violence. Aim: The aim of the study was to investigate horizontal violence among nurses in order to quantify and describe this phenomenon as it occurs in intensive care environments. Methods: This study applied a quantitative descriptive survey design. Control over the relevant research topic were over a period of five months from 2016 to 2017. A two-stage cluster sampling design was applied to include hospitals with intensive care environments in the private healthcare sector within the Cape Metropole (N = 13, n = 6) and participants who met the study inclusion criteria (N = 182, n = 118). The participants completed a self-administered questionnaire developed from relevant contemporary literature to quantify and describe the existence and effect of horizontal violence among nurses working in these environments. The data were analysed using the statistical package Stata version 14.2 for Windows. The data collected were organised by using frequency distribution in which the number of times each event occurs was counted. Results: A response rate of 65% was obtained (N = 182, n = 118). The results showed that both covert and overt abusive behaviours occur among nurses working in intensive care units. The most common form of covert abusive behaviour was a person being ignored by his or her colleagues (n = 35, 32%) and that of overt abusive behaviour was colleagues complaining about one another in the workplace (n = 25, 21%). Both covert and overt abusive behaviours occur daily; however, more participants (n = 68, 60%) experienced some form of covert and/or overt abusive behaviour at least a few times a year. The participants reported having negative psychological effects and physical symptoms, such as negative internalised feelings about self and headaches, as an outcome of experiencing abusive behaviours. Quality of patient care is seen to be negatively affected by horizontal violence due to a person’s fear of being victimised (n = 56, 46%). Further, horizontal violence is seen as a trigger to the victim making errors (n = 51, 46%) as well as choosing to engage in unsafe practices during patient care (n = 44, 36%), or to leave employment (n = 23, 16%). The participants identified that both colleagues and supervisors commit abusive behaviours. Conclusion: Horizontal violence is experienced by all categories of nurses working at patients’ bedside in intensive care environments in the private healthcare sector within the Cape Metropole. Nurses experienced both covert and overt abuse in the workplace and suffered from a variety of effects such a professional discouragement, internalised negative feelings and even physical symptoms such as headaches and abdominal pain. For some nurses, the only way to end this cycle of abuse was to resign from their current employment. The quality of patient care delivered by abused nurses was also reported to be affected in terms of unsafe practice, with nurses putting not only their patients but also themselves at risk.
An in vitro study to assess three different sterilising methods for infant feeding cups and bottles
(Stellenbosch : Stellenbosch University, 2012-12) Maloy, Natasha Quinta; Bell, Janet; Gouws, Pieter Andries; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: Background Diarrhoea (frequent, loose, watery stools) is one of the major causes of morbidity and mortality globally and affects mainly infants and children under the age of five years. Unhygienic feeding practices and feeding utensils contribute to diarrhoeal incidences. The most common causes of acute gastroenteritis worldwide are infectious agents, such as viruses, bacteria and parasites Aim The aim of the study was to investigate which out of three particular sterilising methods is the most effective for sterilising feeding bottles and cups. Methods An experimental quantitative approach was most appropriate for the current study. An in vitro experimental study with a descriptive design was utilised under controlled laboratory conditions. The study was conducted at the University of the Western Cape (UWC) in April 2009. Results The sample size consisted of 16 samples, of which two were used for each method of sterilisation, namely: two (2) bottles and two (2) cups for sunlight; two (2) bottles and two (2) cups for Milton™; two (2) bottles and two (2) cups for Sunlight™ dishwashing liquid; and control utensils that consisted of two (2) bottles and two (2) cups. The target population for the study comprised infant feeding bottles and feeding cups. The analysis for the APC cultures that was compared in the cups vs. bottles, in order to see whether there was a significant difference between the mean bacteria counts, shows that the average bacteria count (on the ln scale) was 6 cfu/ml and 9 cfu/ml for the cups and bottles, respectively. The t-value was -1.17524. As the ρ-value was 0.2595, no significant difference was found between the cups and bottles. The E. coli cultures were compared in the cups vs. bottles to see whether there was a significant difference between the mean bacteria counts. The results show that the average bacteria count (on the ln scale) was 7 cfu/ml and 7.6 cfu/ml for cups and bottles, respectively. The t-value was -0.211902. The ρ-value was 0.835237, and therefore there was no significant difference between cups and bottles. Conclusion The current study showed no significant difference between the sterilising methods or between the use of either bottles or cups. Therefore, a study with a larger sample size is recommended for further research. Recommendations The researcher recommends that future researchers conduct broader studies, with a larger sample size on the topic. Studies with a larger sample size enabled the real differences to be large enough to be significant. The use of sunlight is recommended as a sterilisation method for infant feeding utensils, as it is both time- and cost-effective. Sunlight is an inexpensive and readily available method of sterilisation; therefore, it can be used by relatively under resourced socio-economic communities.
Investigating the attitudes towards euthanasia held by registered nurses enrolled in post-graduate nursing programmes at a university in the Western Cape
(Stellenbosch : Stellenbosch University, 2022-04) Chencinski, Luna; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY: Background: Euthanasia is a controversial topic which affects nurses in their day-to-day practice. Aims: To determine the attitude towards euthanasia held by South African registered nurses and establish if there is any correlation between demographic variables of participants and attitude towards euthanasia in general, passive euthanasia, active euthanasia and non-voluntary euthanasia. Methods: A pre-validated self-administered online survey using a quantitative, descriptive, cross-section design was used to collect data about nurses’ attitudes towards euthanasia. Attitudes towards euthanasia were scored using a 5-point Likert scale. Approximately half of the questions were negatively scored to reduce response-set effect. Results: Overall, 39% of nurses supported euthanasia, 41% opposed euthanasia and 18% were neutral towards euthanasia. A correlation was found between nurses’ religiosity and support for active euthanasia and a correlation was found between nurses’ years of work experience and their support for non-voluntary euthanasia. No other correlations between nurses’ demographic data and attitudes towards euthanasia, passive euthanasia, active euthanasia and non-voluntary euthanasia was found. Conclusion: This study shows that religiosity determines nurses’ attitudes towards active euthanasia and that working experience determines nurses’ attitudes towards non-voluntary euthanasia. Furthermore, support and opposition of euthanasia among registered nurses is roughly equal.
The perceptions of primary healthcare clinic nurses on implementation of standard precautions, in Leribe District Lesotho
(Stellenbosch : Stellenbosch University, 2021-03) Tsita, Sebueng; Schutte, Loraine; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Background: Healthcare professionals are faced with the occupational risk of exposure to microorganisms in their daily routine work, leading to the acquision of healthcare associated infections. Suboptimal compliance to standard safety precautions, as the major infection prevention measures, was identified globally to be the major cause of healthcare associated infections affecting healthcare workers and, consequently, the patients. This study aimed to explore the perceptions of the nurses, the clinical healthcare providers at the clinics in Lesotho, on the implementation of standard precautions as protective measures against infections, in order to ensure safety in primary healthcare clinics. Methods: To explore the perceptions of primary healthcare nurses on the implementation of standard precautions in their workplace, individual interviews were conducted with participants from four purposefully selected clinics. Three participants from each of the three different nursing cadres were selected, adding up to a total of twelve participants. To establish these perceptions, understanding of standard precautions, individual practices as well as potential barriers to implementation of standard precautions were explored. Creswell’s method of data analysis was followed to reach the study objectives of this qualitative descriptive study. Results: Findings of this study reflect the participants’ adequate understanding of standard precautions among the participants, although standard precautions are not adequately enforced through training and supervision. Moreover, standard precautions are not adhered to as recommended and the barriers hindering adequate implementation of standard precautions, such as infrastructure limitations, procurement issues, cultural issues, work situations and discomfort were identified. Conclusion: There is a need to enforce the standard precautions through training and supportive supervision, whilst the guideline and operating procedure development can be followed to improve the consistent implementation of standard precautions. Procurement of adequate supply of equipment is also necessary in improving compliance to standard precautions.
A study on nurses knowledge, attitude and practices of infection prevention and control at a private hospital in Namibia
(Stellenbosch : Stellenbosch University, 2020-03) Shitemo, Kaverua Christina; Hector, Dawn; Bell, Janet; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Background: Healthcare-associated infections (nosocomial) are one of the leading adverse events within the healthcare sector worldwide. They are linked to an increasing number of morbidities and mortalities, an increased length of hospital stay and subsequent physiological, psychological and financial burden on the patient, their family, and the healthcare facility. In order to reduce these rates, consistent compliance with an effective infection prevention and control (IPC) programme is vital. It is for this reason that the purpose of this study was to determine nurses’ knowledge, attitude and IPC practices as these influence compliance of the IPC programme. Methods: A quantitative descriptive study was conducted in a Namibian private hospital. The target population (n=122) included all categories of nurses. Non-probability convenient sampling was done to ensure that all the nurses who were on duty during the data collection period were given opportunity to participate in the study. Data were collected from n = 90 (86%) of the target population. The data instrument was a questionnaire, which was adopted from a similar study in Nepal. A pilot test was conducted to determine the reliability and validity of the questionnaire. Ethical approval was obtained from the University of Stellenbosch’s healthcare research ethics committee, and the private hospital’s clinical research ethics committee. Results: The majority n=72 (80 %) of participants had adequate knowledge of IPC; n=76 (84.4%) had a positive attitude towards IPC and n=36 (40%) complied with the IPC practice. With regards to the relationship between the level of knowledge, attitude and infection prevention and control practices: of the participants (n= 72, 80%) with adequate knowledge, (n=7, 9.7%) have a significant negative attitude towards IPC (p = 0.002) and (n=38, 52.8%) are non-compliant with IPC practices (p=0.005) as well as participants with a positive attitude (n=76, 84.4%), (n=46, 60. 5%) are non-compliant with IPC practices (p=0.364, no relationship). Conclusion: The participants (nurses) had adequate knowledge and a positive attitude towards IPC. However, efforts should focus on improving their compliance of the IPC practice. It is recommended that IPC training should focus on information sharing, as well as on psychological motivation, in order to lead to a change in IPC behaviour.

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