Masters Degrees (Nursing and Midwifery)

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Adolescent-friendly services : experiences of adolescents living with HIV attending healthcare services in Botha-Bothe District in Lesotho
(Stellenbosch : Stellenbosch University, 2020-03) Mabandla, Mamoferefere Tatapa Zim; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : There is an increased focus on the promotion of health and wellbeing amongst adolescents. Adolescents living with HIV (ALHIV) need to access high-quality and comprehensive health services. Adolescent-friendly services are services which are easy to reach, are appealing, and are delivered in acceptable ways to adolescents, to meet their health needs. Considering the health of adolescents, the need for adolescent-friendly services was identified, to lessen the load of diseases and to decrease the number of deaths that occur amongst adolescents. The adolescent HIV burden is still a concern and countries are struggling to establish interventions that are effective for positively influencing HIV related outcomes in this group. There are few studies on the experiences of ALHIV about accessing health services in different countries and various health facilities. Little is known about adolescent-friendly services for ALHIV in the context of Lesotho. Aim: The study aimed to explore and to describe the experiences of ALHIV regarding attending healthcare services in Botha-Bothe District Lesotho, in order to make recommendations towards improving adolescent-friendly services. Method: A qualitative exploratory-descriptive research design was applied. The Health Research Ethics Committee (HREC) from Stellenbosch University and the Research Coordinating Unit (RCU) from the Lesotho Ministry of Health approved the study. Twelve ALHIV between the ages of fourteen (14) and nineteen (19), who were attending healthcare services at Baylor or Ngoajane health facilities and were aware of their HIV status, were purposively selected to participate in the study. For adolescents under eighteen (18) years old, written informed adolescent assent and parental consent was obtained. Written informed consent was obtained from adolescents aged between eighteen and nineteen (18 and 19). Individual interviews were conducted by the researcher. The six steps of data analysis described by Creswell were applied when analysing the data. The researcher ensured trustworthiness by adhering to the principles of confirmability, transferability, credibility and dependability. Results: Five themes were identified: the social environment of the health facility, the physical environment of the health facility, services, support and expectations regarding healthcare services. Communication between the participants and the healthcare workers was challenging. It seemed that it was difficult to communicate effectively because of the generation gap and the adolescent stage of development. Healthcare workers were more likely to communicate in a consistent respectful manner if adolescents were adherent to treatment and care. Health facilities do not have a dedicated space to allow adolescents to interact with peers and share their experiences. Services that adolescents use in the facilities are counseling and HIV care and treatment. Family members seemed to be involved minimally in the care and in the treatment of adolescents. Adolescents prefer services to be provided on a Friday after school, or on a Saturday when they are not attending school. Conclusion: ALHIV need to access comprehensive adolescent-friendly services, as this may improve their health outcomes. The elements of adolescent-friendly services that could be improved include providing a dedicated space, the provision of ageappropriate educational materials, encouraging care partnerships and the training of healthcare workers to ensure technical and attitudinal competences, in providing healthcare services to adolescents.
Compassion satisfaction, compassion fatigue, and intention to leave among critical care nurses in private hospitals of the Cape Metropole
(Stellenbosch : Stellenbosch University, 2023-03) Shelton, Jamie Lee; Van der Heever, Mariana; Baron, Justine; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY: Background: Global studies have found that compassion fatigue is a problem among critical care nurses, causing them to lose empathy and compassion for their patients and, moreover, to leave the profession. Since nurse recruitment and retention rates are already low in South Africa, compassion fatigue could have particularly serious consequences. This study investigated the levels of and relationships between compassion satisfaction, compassion fatigue, and intention to leave among critical care nurses in private hospitals in the Cape Metropole, South Africa. Methods: The study was conducted using a quantitative research approach with a cross-sectional descriptive correlational design. Critical care nurses were recruited through Facebook advertising and n=78 nurses completed the online survey. Our survey used a custom demographic and intention to leave scale in addition to the established Professional Quality of Life (ProQOL) instrument. The demographic, intention to leave, and ProQOL variables were described and visualized using descriptive statistics. The direction and strength of the relationships between variables were examined using Spearman's rank correlation coefficient. Ethical principles of autonomy, privacy, confidentiality, justice, beneficence, and nonmaleficence were maintained throughout the study. Results: The findings showed that the nurses experienced average levels of compassion satisfaction, burnout, and secondary traumatic stress. Compassion satisfaction and burnout had a strong negative correlation (r=-0.761, p<0.01). Likewise, compassion satisfaction and secondary traumatic stress had a moderate negative correlation (r=-0.539, p<0.01). Secondary traumatic stress and burnout had a strong positive correlation (r=0.743, p<0.01). Males scored significantly lower on compassion satisfaction (mean=38.6, SD=3.7) than females (mean=50.5, SD=9.9) (t=2.056, p=0.04). The mean scores of compassion satisfaction (t=-0.993, p=0.38), burnout (t=0.706, p=0.48), and secondary traumatic stress (t=1.249, p=0.22) did not differ between participants with or without a postgraduate critical care nursing diploma. However, nurses who were critical care trained had slightly higher compassion satisfaction mean scores (mean=51.1, SD=10.3) compared to nurses who were not critical care trained (mean 49.0, SD=9.7). Almost half of the nurses in the study expressed an intention to leave nursing (42.3%, n=33). Burnout was moderately positively correlated with intention to leave (r=0.633, p<0.01) and secondary traumatic stress (r=0.438, p<0.01), while compassion satisfaction was moderately negatively correlated with intention to leave (r=-0.615, p<0.01). Conclusion: Burnout and secondary traumatic stress were among the physical, mental, and emotional stresses critical care nurses experienced during the COVID-19 pandemic. However, despite the reported burnout and secondary traumatic stress, nurses still reported average levels of compassion satisfaction. Recommendations: The work environments of critical care nurses must be improved to prevent compassion fatigue, prevent nurse attrition, and assist them in finding fulfilment at work. Support and assistance should be provided to younger and less experienced critical care nurses as they grow in their careers to prevent anxiety and burnout, and postgraduate training should be encouraged to improve clinical competence and critical care knowledge. Compassion fatigue needs to be identified and combated by nurses and healthcare organizations to protect nurses and the nursing profession.
The development of a clinical practice assessment portfolio for the clinical nursing science, health assessment, treatment and care programme
(Stellenbosch : Stellenbosch University, 2014-04) Rosenberg, Mariam; Kitshoff, Danine; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing.
ENGLISH ABSTRACT: The support for portfolio-based learning as an authentic assessment method is increasing globally. However, there are no guidelines in South Africa for a clinical practice assessment portfolio (CPAP) for primary clinical practitioner training. The study set out to develop a CPAP for the Clinical Nursing Science, Health Assessment Treatment and Care programme. An exploratory, descriptive design was used that developed over three phases. In phase one, a CPAP was developed based on an extensive review of the literature. The CPAP was validated in phase two by experts and finally, student primary clinical practitioners assessed the possible contribution of the developed CPAP to their learning in phase three. The study sample for the three phases comprised of selected relevant studies published on portfolio development (n=15); experts in the field of primary health care and education in the Cape Metropole (n=11); and student primary clinical practitioners of one higher education institution in the Cape Metropole (n=45). Structured questionnaires were used for data collection from expert and student participants after they reviewed the CPAP. Ethical approval was obtained from the Health Research Ethics Committee of the Faculty of Health Sciences (N09/09/233), Stellenbosch University. Permission to conduct the research was obtained from the higher education institution. The content validity index for items (I-CVI) was used to determine the degree to which expert participants agreed with the content of the CPAP. Results identified an I-CVI of between 0.91 and 1.00, indicating that the contents and technical format of the CPAP constitute a suitable learning tool for student practitioners. Experts suggested minor revisions regarding the clarity of items, and those were included in the final CPAP. The data analysis of the student’s responses showed that adequate guidance was provided to complete the activities in the CPAP and that the CPAP would have a positive contribution to learning. Portfolio-based learning is an important teaching and learning strategy in the Clinical Nursing Science, Health Assessment Treatment and Care programme, whereby students can demonstrate their acquired clinical competencies. Recommendations include the use of a competency framework and consensus amongst stakeholders when developing the contents of a portfolio.
The development of a self-management intervention for adolescents living with HIV in a South African context : views of experts and key stakeholders
(Stellenbosch : Stellenbosch University, 2022-04) de Lange-Cloete, Frances; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY: Background Globally, many adolescents are living with human immunodeficiency virus (HIV). In South Africa, an estimated 360 000 adolescents were living with HIV in 2019. Adolescents also have poor health outcomes when compared to adults and children living with HIV. HIV is no longer recognised as an acute but rather a chronic condition involving lifelong medication and long-term holistic support and care. Self-management is an approach that may be helpful in changing behaviours, which could essentially lead to positive health outcomes. More research on self-management interventions is needed in the South African context to serve the unique needs of the adolescents to improve their treatment outcomes and quality of life. An adolescent HIV self-management intervention was developed in the context of South Africa using intervention mapping. As part of the development process, expert and stakeholder input is required. Aim: The study aimed to explore the views of experts and key stakeholders as part of the development of a self-management intervention for ALWH in a South African context, to refine the intervention. Methods For this study, a descriptive qualitative design was used. The intervention’s content validity was determined by consulting nine national and international experts. Moreover, the revised intervention was presented to 18 key stakeholders (11 adolescents living with HIV and 7 healthcare workers) during four focus groups in the Cape Metropole of the Western Cape to obtain further feedback. Data were analysed using the content validity index (CVI) and thematic analysis. Ethical approval was obtained from the Health Research Ethics Committee of the University of Stellenbosch, and permission was obtained from the Western Cape Department of Health. The researcher aimed to meet the four criteria of dependability, confirmability, credibility, and transferability to ensure trustworthiness. Results: Item relevancy for all the components (outcomes, objectives, strategies, format, setting, timing, and facilitators) had a CVI rating of more than 0.8, indicating validity. Experts and key stakeholders agreed on the need for and importance of the intervention, emphasising the focus on ALWH’s well-being, and objectives and content beyond HIV. The practical strategies appeared acceptable and feasible, but individual counselling/coaching may require additional human resource support. Components were revised based on the feedback, and several parameters for effective implementation were identified. Conclusion: Progress in health outcomes among ALWH is lagging. Interventions and programmes that are showing promising results in supporting ALWH should be placed at the forefront of development. Following further refinement, this intervention might be a solution to ALWH in South Africa and the African context, which may support and guide them and healthcare workers in reaching treatment targets and ensuring a thriving population of ALWH.
Enrolled bridging course learners’ perspectives related to factors influencing their learning in the clinical environment
(Stellenbosch : Stellenbosch University, 2012-12) Hess, Cecilia; Crowley, Talitha; Stellenberg, E. L.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: Exposure to the clinical learning environment forms an essential part of nursing education. Being a nurse lecturer in the private sector, the researcher observed that bridging course learners do not always perform academically as satisfactorily as they should. For the purpose of the current study, the researcher investigated enrolled bridging course learners’ perspectives related to factors influencing their learning in the clinical environment. The study focused on bridging course learners in the private sector. The objectives of the study were to determine whether the following was valid for the population under consideration: - a shortage of staff is a barrier to learning in the clinical environment; - an orientation programme has been implemented for bridging course learners in the clinical environment; - bridging course learners in the clinical environment have to take charge of wards; - the attitude of staff members is a barrier to the learners’ learning experience. - there is a learner/mentor relationship in the clinical environment; - opportunities to gain practical competence exist in the clinical environment. An exploratory descriptive design with a predominantly quantitative approach was applied. The population for the study consisted of bridging course learners at the three private nursing colleges in the Cape metropolitan area (N = 89). Due to the small size of the population, all available learners who voluntarily gave consent were included in the study. The sample size for this study constituted 62% (n = 55) of the target population. A semi-structured questionnaire was used to collect data, and both open and closed ended questions were used. Reliability and validity were assured by means of a pilot study and the use of experts in the field of nursing education and statistics. Data were collected personally by the researcher. Ethical approval was obtained from the Committee for Human Science Research at the Faculty of Medicine and Health Sciences at Stellenbosch University. Statistical associations were determined using the Spearman and Mann-Whitney U tests. The results of this study are presented in percentages and tables. The majority (n = 46/84%) of the participants disagreed that the staffing in units was sufficient. Most (n = 40/73%) participants disagreed with the statement that working conditions were conducive to learning. Qualitative analysis revealed that the participants perceived the clinical environment to be hostile, and the majority (n = 47/85%) of the participants agreed that staff members had a negative attitude towards them. Furthermore, only five (n = 5/9%) participants indicated that they always spent time with their mentor, and the majority (n = 36/65%) of the participants disagreed with the statement that they could achieve specific outcomes before moving to another ward. A shortage of staff, being placed in charge of wards in the absence of a registered nurse, negative attitudes of staff members, and the lack of a mentor–learner relationship were identified as factors that impacted negatively on learning in the clinical environment. Several recommendations, grounded in the study findings, were identified, including: - Sufficient staff should be on duty to improve the learning environment, in order for learners to achieve their outcomes according to the curriculum. - Learners should receive adequate supervision and support. - Sufficient time should be allocated for practical procedures, such as releasing learners on practical days to practise procedures. Factors influencing enrolled bridging course learners’ learning experiences in the clinical environment were identified. Strategies to address these factors may improve their clinical experiences and ultimately their clinical competence.
The experiences of adolescent mothers on providing continuous kangaroo mother care to their infants in a hospital
(Stellenbosch : Stellenbosch University, 2018-03) Robertson, Anneline Ernestine; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY: Background Kangaroo mother care (KMC) is the practice of skin-to-skin contact between an infant and parent and was introduced as a complementary approach to neonatal intensive care for low birth weight and premature infants. KMC has been shown to reduce infant mortality, decrease illness, decrease infection and the length of stay in hospital for infants. The most frequently reported complication of adolescent pregnancy is preterm labour. Adolescents are thus at high risk of having to provide KMC to their infants and may have difficulty in caring for an infant. The adolescent mother therefore requires support while providing KMC. The aim of this study was to explore the experiences of adolescent mothers on providing kangaroo mother care to their infants in a hospital. Methods A qualitative approach with a descriptive phenomenological design was used to explore the experiences of adolescent mothers aged 15 to 19 years on providing kangaroo mother care to their infants in a hospital. The study applied purposive sampling to select participants from Karl Bremer and Tygerberg hospitals in the Western Cape. The Health Research Ethics Committee of Stellenbosch University, Tygerberg Hospital and the Department of Health of the Western Cape granted permission to conduct the study. Ten individual semi-structured interviews were conducted, transcribed and analyzed using Colaizzi’s framework. Findings The themes that emerged were: Becoming and being a mother; KMC: Being cared for and caring for; and Ineffectual support. The adolescent mothers had to adapt to many changes throughout pregnancy, labour, post-delivery and when providing KMC. The adolescent mothers were all shocked and disappointed about the pregnancy but narrated that they had to accept the pregnancy and later accepted motherhood after they have gained self confidence in caring for their infants. They all received information on how to practice KMC. However, they had not received any information about the benefits of KMC and the specific care of a preterm infant. Interactions with the other mothers in the ward were amicable and supportive. Interactions with the doctors and nurses were formal and were only directed at the care of the infant. Occasionally interactions between the adolescent mothers and the nurses were incompatible. Care and support was provided for the infant but was lacking for the mother. The mothers did not receive any physical support despite still being in the postnatal period. Social support was provided to the adolescent mothers who were referred to the social worker. They received some discharge support but it was only focused on the care of the infant. Conclusion The findings demonstrated that adolescent mothers providing KMC to their infants in a KMC ward in a hospital lack the understanding of KMC, its benefits and the specific care of a preterm infant. The focus of care should not only be on the infant, but also on the adolescent mother. These mothers require continuous information and holistic support to develop their skills and confidence to provide effective care for their infants while in the KMC ward, but also for when they are discharged home.
Experiences of mothers administering HIV post-exposure prophylaxis to their infants in Lusaka, Zambia
(Stellenbosch : Stellenbosch University, 2018-03) Lusaka, Mildred Mwewa; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY: Background Effective Prevention of Mother-to-Child-Transmission (PMTCT) programs require women and their infants to have access to and to participate in a cascade of interventions including antenatal, postnatal and child health services. This includes HIV testing during pregnancy and the use of antiretroviral treatment (ART) with good adherence. HIV-positive mothers should be guided to practice safe childbirth, provide appropriate infant feeding, bring their infants for HIV testing and to administer antiretroviral (ARV) Post-Exposure Prophylaxis (PEP) to their infant’s post-delivery, for the prescribed period. Currently contextual information relating to the experiences of mothers administering ARV drugs for prophylactic purposes in Lusaka, Zambia is limited. The research endeavoured to explore the experiences of mothers administering PEP to their infants in Lusaka, Zambia. Methods The study followed a qualitative methodology with a descriptive design to explore the mothers’ experiences of administering PEP to their infants. Fifteen semi-structured individual interviews were conducted using open-ended questions. The targeted population were mothers that were required to administer PEP to their infants. Data analysis was guided by Creswell’s six-step model of data analysis. The study was approved by the Health Research Ethics Committee (HREC) of the University of Stellenbosch Faculty of Medicine and Health Sciences, the University of Zambia Bio-Medical Research Ethics Committee (UNZABREC) and the Ministry of Health (MOH). Trustworthiness was ensured by following the four principles of credibility, transferability, dependability and confirmability. Findings The participants experienced emotional stress and demonstrated a lack of knowledge and understanding about the need for PEP. Challenges experienced by them included difficulties with PEP administration, attending healthcare appointments, cultural and religious influences, lack of partner involvement and stigma and discrimination. Other social challenges that affected the administration of PEP were lack of disclosure to partners for fear of stigma and discrimination with possible abandonment. However, some participants’ own belief in the efficacy of PEP made them continue attending postnatal care. Conclusion Most women accepted and understood that PEP reduced the possibility of HIV infection of their infants and accepted it as part of the PMTCT programme. However, several challenges to PEP administration were identified. Administering PEP is emotionally challenging due to fear and apprehension that the baby may become HIV-positive. Although some women are supported in the administration of PEP, lack of knowledge, cultural and religious practices and stigma deter women from continuing to administer PEP. Long waiting times for laboratory results, insufficient supplies of Nevirapine and ineffective counselling were identified as health system barriers to continued PEP administration. Support for women to administer PEP can be enhanced through cultural empowerment, involving partners and family members and the training of healthcare workers.
The experiences of women who have used the sub-dermal contraceptive implant (Implanon) and their reasons for the early removal in the Cape Metropole, Western Cape
(Stellenbosch : Stellenbosch University, 2020-03) Hlana, Sylvia Nompucuko; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Background: Many women of reproductive age still have unmet contraceptive needs, despite considerable increases in contraception coverage. The progestin-only implant (Implanon) releases hormones that prevent pregnancy for three years. After Implanon was introduced in 2014, there was a growing concern about the number of women who are returning for early removal, some within a few months of insertion. Aim: The aim of the study was to explore the experiences of women regarding the use of the sub-dermal contraceptive implant (Implanon) and describe their reasons for early removal in the Cape Metropole, Western Cape. Objectives: -To explore women’s experiences on the use of the sub-dermal contraceptiveimplant (Implanon). -To describe the reasons for the early removal of the sub-dermal contraceptiveimplant (Implanon). Population and setting: The target population included all women from the age of eighteen (18) and above, who were requesting the removal of the Implanon before the recommended two and a half (2.5) to three (3)years of utilization, for any reason during the study period. The study was conducted atNew Somerset Hospital and the Du Noon Community Health Centre. Methodology: The study employed an exploratory-descriptive qualitative approach. Data was collected by using semi-structured individual in-depth interviews (face to face), conducted by the researcher. Eleven (11) participants, including a pilot interview participant, were interviewed. Data was analysed using content analysis. Ethics approval was obtained from the Stellenbosch University Health Research Ethics Committee and permission was obtained from the Western Cape Department of Health. Findings: Five themes were identified: knowledge and understanding; physical and emotional changes after inserting Implanon; feelings and emotions; decision-making and support. In general, participants had a good understanding of the mechanism of action, the benefits and the risks of using Implanon. Information about Implanon was mostly communicated by nurses. Negative feelings and emotions towards Implanon emanated from the physical and emotional changes participants experienced after inserting Implanon, which they perceived as being side-effects. In most instances, the inability to effectively manage or control these side-effects, coupled with the impact on their personal needs, led to the decision to remove the Implanon. Conclusion and recommendations: Although the participants in this study regarded Implanon as a highly effective contraceptive method, unwanted side-effects and the apparent ineffective management of these side-effects by healthcare workers, deterred them from continuing its use. Healthcare workers should perform a comprehensive assessment of clients before commencing Implanon. Pre-insertion and continuous counselling should empower women towards the management of side-effects, so they are better able to make an informed decision on discontinuation and transition to other options. This could increase the uptake and continuation of Implanon. Exploration of the experiences and attitudes of healthcare workers in rendering Implanon is recommended.
Exploring the role of patient care workers in private hospitals in the Cape Metropole
(Stellenbosch : Stellenbosch University, 2015-04) Aylward, Louise Annet; Crowley, Talitha; Stellenberg, Ethelwynn; Stellenbosch University. Faculty of Health Sciences. Interdisciplinary Health Sciences. Nursing.
ENGLISH ABSTRACT: Controversy was observed regarding the opinions of nursing managers on the role of patient care workers (PCWs) in private hospitals. These opinions ranged from praise for their contribution towards patient care to serious concerns about the impact of their role on patient safety. The aim of this study was therefore to explore the role of PCWs in private hospitals in the Cape Metropole, South Africa. A qualitative approach with a descriptive design was applied to explore the role of PCWs as perceived by unit managers, nurses and patient care workers. Purposive sampling was used to select participants from medical and surgical wards from three different private hospitals, one each from the three major private hospital groups in South Africa (n=15). Permission to conduct the study was obtained from the Health Research Ethics Committee of the Stellenbosch University, as well as from the private hospital organisations. Fifteen semi-structured interviews were conducted, transcribed and analysed. Six themes emerged from the data. These included PCW activities, care organisation, position in the patient care team, training, reasons for employment and concerns about the PCW role. The findings indicated strong similarities with the health care asistant role as described in the literature study. The activities of PCWs are focused on direct patient care and they spend much time with patients. They are close observers of the patient’s condition and report to nurses. PCWs seem to be well integrated into the patient care team and are mostly seen as nurses. Yet, there are concerns about their evolving role despite their limited training programmes and the lack of direct supervision. The researcher recommends that the work of PCWs should be regulated, but that the nursing profession should critically evaluate the need for another nursing category in addition to that of the enrolled nurse auxiliary.
Exploring the self-management needs of adolescents living with HIV in the Nelson Mandela Bay area of the Eastern Cape
(Stellenbosch : Stellenbosch University, 2019-04) Adams, Adian Leone; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Background: An increased number of human immunodeficiency virus (HIV) infected children are progressing to adolescence and beyond because of effective antiretroviral therapy (ART). Adolescents receiving ART tend to have poorer treatment outcomes compared to adults. HIV is now classified as a chronic illness and adolescents need the support of the whole family to self-manage (handle, direct and control) their chronic illness. When individuals and their families acquire self-management skills, they become responsible for the management of their chronic conditions, are able to control the illness and acquire healthy behaviours. Little is known about self-management amongst adolescents who live with HIV (ALHIV) and no self-management support programmes exist in the context of the Eastern Cape, South Africa. Aim and objectives: This study aimed to explore the self-management needs of ALHIV in the Nelson Mandela Bay area of the Eastern Cape in order to make recommendations that can be used to develop a programme to support adolescents’ HIV self-management. Specific objectives were to explore adolescents’ beliefs, knowledge and understanding of their illness; describe their self-regulation skills and abilities and identify the resources adolescents utilise to facilitate them to manage their illness. Methods: A qualitative descriptive design was applied. Thirteen adolescents between the ages of 14 and 19 years attending the West End and Booysen Park clinics were purposely selected. The data were collected through individual interviews. Data analysis was done by using the six steps described by Creswell. Trustworthiness was enforced by adhering to the principles of credibility, confirmability, transferability and dependability. Results: The research findings demonstrated that ALHIV, have limited knowledge and understanding about HIV and safe sex. Some ALHIV lack self-regulation skills and abilities such as taking their treatment, coping mechanisms, effective communication and disclosure of their HIV status to people outside the family. HIV services were not adolescent-friendly, with no dedicated services for adolescents and long queues. Support from family and friends plays a key role in the lives of the adolescents living with HIV. Self-management programmes should include strategies to improve HIV and sexual health knowledge and self-regulation skills, particularly through using technology. Adolescent-friendly healthcare services and the involvement of parents and peers may be important to improve self-management support for ALHIV. Conclusion: As an adolescent grow older, the responsibility of their care is transferred to them and they become more independent. The study revealed that ALHIV have several self-management needs; a programme that will support adolescents and their caregivers to acquire self-management skills may lead to better treatment and health outcomes.
Factors influencing condom utilisation amongst female students at a higher education institution in the Northern Cape province
(Stellenbosch : Stellenbosch University, 2023-03) McCarthy, Danelia Maude; Felix, Rehanna; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY: Background: In South Africa, women's sexual and reproductive health are linked to several human rights, including the right to privacy and the right to health services, including sexual and reproductive health (SRH) services. Consistent condom use remains low among female students in South African higher education institutions. There could be several reasons for the low use of condoms. These reasons could include low risk perceptions, a lack of knowledge and a lack of condom access or services distributing the condoms. Factors influencing condom utilisation have not yet been explored in higher education institutions in the Northern Cape Province. The aim of this study was to explore the factors that influence condom utilisation among female students at a higher education institution in the Northern Cape Province. The personal and environmental factors that influence condom utilisation behaviours among female students at a higher education institution in the Northern Cape Province were investigated. Methods: A quantitative research approach was used, with an exploratory-descriptive design. Female students between the ages of 17 and 24 from one higher education institution in the Northern Cape Province were the study's target population. The researcher used convenience sampling. A self-administered questionnaire was used to collect data from 385 participants between 7 September and 10 October 2021. Data was analysed by a biostatistician using SPSS version v28. The study was guided by ethical considerations such as informed consent, confidentiality and privacy, as well as a consent waiver for participants between the ages of 17 and 24 years, which was approved by Stellenbosch University Health Research Ethics Committee. Results: Most study participants (n=340, 88.3%) agreed that having safe sex is critical for their future sexual and reproductive health and 64.9% (n=250) reported using condoms to prevent pregnancy, sexually transmitted infections (STI) and the human immunodeficiency virus (HIV). With regard to condom use behaviour, 32.2 % (n=124) practised consistent condom utilisation, 45.3% (n=174) inconsistently/never used condoms, whilst 22.6% (n=87) indicated they were sexually abstinent. Study participants' attitudes and risk perceptions about SRH were not associated with consistent condom use behaviour. However, participants using condoms consistently were 1.08 times more likely to know how to use a condom properly (p=0.02). Condom use self-efficacy was associated with the consistent use of condoms. Those who used condoms consistently were 9.14 times more likely to negotiate for a condom with their partners and 8.05 times more likely to have confidence in putting one on for their partner/s. Environmental factors such as condom and SRH accessibility depicted that participants who used condoms consistently were 82.6% less likely to have ever used SRH services (p<0.01). Condoms were most frequently accessed from the campus clinic. The majority of participants (n=293, 76.1%) found it easy to access condoms, with male condoms being the most accessible. Participants who used condoms consistently were nearly three times more likely to be encouraged to use a condom by their peers (p<0.01). Conclusion: Female students at a higher education institution in the Northern Cape Province reported average levels of the use of condoms. SRH access, condom use, self-efficacy, knowledge of how to put a condom on for one's partner and positive peer influence were all associated with consistent use of condoms. This indicates that prevention efforts should concentrate on educating young females in order to strengthen condom use, self-efficacy and encouraging STI discussions with sexual partners.
Factors influencing the confidence and knowledge of professional nurses prescribing antiretroviral therapy in a rural and urban district in the Western Cape
(Stellenbosch : Stellenbosch University, 2018-03) Solomons, Deborah Judy; Crowley, Talitha; Van der Merwe, A. S.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY: Introduction: Since the introduction of nurse-initiated and -managed antiretroviral therapy (NIMART) in South Africa in 2010, there has been an increased demand for the training of professional nurses in Human Immunodeficiency Virus (HIV) management in primary healthcare settings. Task shifting from doctors to nurses to prescribe antiretroviral therapy (ART) became essential to ensure that more patients living with HIV are initiated on life-saving ART. Although the shifting of tasks is a timely solution for human resource constraints, the continued success of the approach is dependent on factors such as adequate training and effective support systems. However, there is limited evidence on how these factors influence the confidence and knowledge of nurses who prescribe ART in primary health care settings. Aim: The study aimed to investigate factors influencing the knowledge and confidence of professional nurses in managing patients living with HIV in rural and urban primary health care settings in the Western Cape. Methods: A quantitative research approach was used with an analytical, cross-sectional study design. The researcher, based on the literature and previous instruments, designed a self- completion questionnaire. The questionnaire measured demographic details, influencing factors, HIV management confidence and HIV management knowledge. Approval for the study was obtained from the Health Research Ethics Committee (HREC) of Stellenbosch University, the Department of Health and the City of Cape Town. Seventy-seven participants from 29 healthcare facilities completed the questionnaire. Data was entered into Microsoft Excel by the researcher, imported and analysed with a statistical analysing programme, IBM SPSS (version 23). Descriptive statistics were used to describe the data and appropriate statistical tests were used to test for relationships between variables. Results: The majority of participants had adequate HIV management knowledge and reported to be very confident or experts in the HIV management skills / competencies. With regard to the Factors influencing HIV management knowledge and confidence, the research results revealed that participants trained recently in PULSA PLUS / PACK (3years ago or less) had significantly higher knowledge scores. Regular feedback about clinic and personal performance was associated with higher HIV management knowledge. Participants who received mentoring over a period of two weeks had a higher mean confidence score compared to other periods of mentoring. A higher caseload of HIV-positive patients was also associated with higher knowledge and confidence. Conclusion: The results show that training, mentorship and clinical practice experience are associated with knowledge and confidence. Recommendations include the strengthening of current training and mentoring and ensuring that NIMART-trained nurses are provided with sufficient opportunities for clinical practice.
Factors influencing the self-management youth living with HIV in Lesotho
(Stellenbosch : Stellenbosch University, 2022-04) Nagenda, Mapaseka Chabalala; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY: Background: Many adolescents and youth live with the human immunodeficiency virus (HIV) worldwide. The HIV treatment goals and health outcomes of adolescents and youth living with HIV (YLWHIV) are lagging. One way to improve outcomes is through supporting YLWHIV to acquire self-management (SM) skills. Self-Management is a youth’s ability to take control of their health and adopt good health practices. Although SM is associated with improved health outcomes, condition-specific, environmental, individual and family contextual factors influence SM. Knowledge of contextual factors influencing SM of YLWHIV in Lesotho could assist in tailoring SM support strategies. Aim: The study aimed to describe the factors that influence SM of YLWHIV in Lesotho. The specific objectives were to determine the condition-specific, physical, and social environmental factors as well as the individual and family characteristics influencing SM of YLWHIV in Lesotho. Methods: An exploratory-descriptive, cross-sectional quantitative research design was used. Youth living with HIV (n=184), aged 15-24, were conveniently sampled from two HIV treatment sites in Lesotho. The data were collected through a validated self-report questionnaire available in English and Sesotho. Data analysis was done using the Statistical Package of Social Sciences (SPSS) version 27 to obtain descriptive and inferential statistics. The Stellenbosch University Health Research Ethics Committee waived parental consent for adolescents younger than 18. Results: Participants had high SM scores (mean 92.7%), which corresponded with their treatment outcomes. Almost all the participants (98.9%; n=181) indicated that they never missed a dose of their antiretroviral treatment (ART). All the participants (100%; n=183) had viral load values of less than 1000 copies/ml. Although SM scores were high, YLWHIV had lower item mean scores in relational and participatory components, which are crucial for their transitioning to adult care, negotiating condom use and accessing community services. High SM scores in this sample could be attributed to condition-specific factors, including once-daily doses (100%; n=182) and a longer duration on treatment (81.4%; n=149) on ART for more than 10 years). Regarding the physical and social environmental factors, participants had access to youth-friendly health services; 97.9% (n=179) were satisfied with the services. Regarding individual and family factors, participants were older (median age 22; IQR 4) and the majority had stable living conditions (61.7%; n=113) living with their current caregiver for more than 10 years). Individual strengths were associated with higher SM scores (p<0.01); mental health problems were associated with lower levels of SM (p<0.05). Conclusion: The study supports the notion that uncomplicated treatment regimens, longer duration on treatment, access to adolescent-friendly services, and stable living conditions may lead to better SM. However, further exploration of factors influencing SM across various healthcare settings and with more diverse YLWHIV are needed to contextualise SM support interventions for YLWHIV, particularly those transitioning to adult care, to ensure meeting global targets.
Factors that promote exclusive breastfeeding amongst mothers at a hospital in Windhoek, Namibia
(Stellenbosch : Stellenbosch University, 2021-03) Nangolo, Ruusa Megameno; Crowley, Talitha; Robertson, Anneline E.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Background: Exclusive breastfeeding (EBF) refers to the practice of giving a newborn infant only breast milk up to the age of six months. EBF rates remains low at 42% globally and according to the World Health Organization (WHO), 823 000 infant deaths can be avoided annually if EBF is universally implemented. The WHO targets an EBF rate of 70% globally by 2030 and the Namibian rate was only 19% in 2017. There is limited information in Namibia on the factors promoting EBF. The purpose of the study was to investigate the factors that promote EBF amongst mothers at a public health facility in Windhoek, Namibia. Methods: A quantitative, cross‐sectional and comparative descriptive design was used. The target population was all mothers aged 18 years or older, with infants aged between 0 and 6 months who attended the public health care facility within the three months’ study period. The researcher collected data from 270 mothers. The participants completed a self-administered questionnaire. Data was analysed with the assistance of a biostatistician using descriptive and inferential statistics. Ethical considerations of the rights to self-determination, confidentiality, anonymity, as well as the right to protection from harm were observed. Ethics approval was obtained from the Health Research Ethics Committee of Stellenbosch University (S19/06/112) and from the Research Ethics Committee of the Ministry of Health and Social Services in Namibia (17/3/3/RMN) prior to data collection. Results: The study revealed that the overall prevalence of EBF was 87.8% (n=237) among the participants. No significant socio-demographic or sociocultural predictors of EBF were identified. Among the biophysical factors, having more than two pregnancies and more than two children were found to be significant predictors of EBF (OR=2.9, CI=1.0 to 8.4, p=0.05), (OR=3.2, CI=1.0 to 10.1, p=0.05). The mothers had an average knowledge score of 76.3% (SD 10.7) and an average attitude score of 76.2% (SD 7.8) with no significant difference in the scores between the EBF group and the non-EBF group. Conclusion: The prevalence of EBF in this study was high compared with the national prevalence and may be an indication that if mothers can be encouraged to attend maternal health services, the general EBF prevalence can increase. It appears if having more than two children promotes EBF practices and that other factors may have a smaller effect on EBF practices as contradictory results were reported in the literature. Therefore, it can be recommended that the current breastfeeding policies should be implemented in full to support mothers, in particular new mothers. Health education on EBF should be provided during the perinatal period and up to six months to ensure that mothers practice EBF.
HIV knowledge and sexual risk behaviour of grade 12 learners in the Cape Metropole, Cape Town
(Stellenbosch : Stellenbosch University, 2013-12) Jaars, Cleopatra; Crowley, Talitha; Marais, Frederick; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: The HIV pandemic threatens the social, emotional, and physical development of all persons, especially the youth. Adolescents are more at risk of contracting HIV as their lifestyle often involves sexual exploration and experimentation. Effective educational interventions are central to HIV prevention in South Africa. Being a clinical nurse practitioner in a primary health care (PHC) facility, the principal investigator observed that school learners failed to practice safe sex and demonstrated little knowledge about HIV/AIDS prevention. The aim of the study was to investigate the reported level of HIV knowledge and sexual risk behaviour of grade 12 school learners in the Eastern Sub-District of the Cape Metropole, Cape Town. A descriptive, non-experimental, research design was employed with a primarily quantitative approach. The study population comprised grade 12 learners from high schools in the Eastern Sub-District of the Cape Metropole in Cape Town (N=7940). A total of 92 participants from four schools (2 public and 2 private) were included in the sample by using a cluster sampling method. A self-completion semi-structured questionnaire was used to collect the data. Data was collected by the principal investigator and a trained field worker. Ethical approval was obtained from the Health Research Ethics Committee of the Faculty of Health Sciences, Stellenbosch University (N11/07/225). Permission to conduct the research was obtained from the Department of Education. Reliability and validity were assured by means of a pilot study and the use of experts in the field of nursing research and statistics. Descriptive statistics were used to analyse data. Statistical associations were determined using ANOVA and the Mann-Whitney U tests. The qualitative data was analysed thematically and then quantified. The results show that the average HIV/AIDS knowledge score of participants was 60.73%. However, many gaps in HIV/AIDS knowledge were identified. Only 77.2% (n=71) of participants knew the meaning of HIV, 80.4% (n=74) did not know all the ways in which HIV can be transmitted and only 8.7% (n=8) knew how to safely use a condom. The majority of participants (67.4%; n=62) believed in the myth that HIV can be cured and 18.5% (n=17) reported that a traditional healer can cure HIV. With regard to risky behaviour, half of the participants at the time of the study (51%; n=47) reported sexual engagement and 20% (n=9) of these respondents did not use condoms. Furthermore, 25% (n=23) had used alcohol before having sex. There were no association found between the knowledge about HIV/AIDS of participants and their sexual risk behaviour. In view of these study findings, participants are exposing themselves to high risk sexual behaviour that may increase their chances of acquiring sexually transmitted infections including HIV. Several recommendations were identified, including the strengthening of HIV and STI education linked to sexual risk reduction, open communication and additional information sources, availability of condoms at schools and improved access to HIV testing at schools.
Infant feeding practices in the prevention of mother to child transmission in Onandjokwe district hospital, Namibia
(Stellenbosch : Stellenbosch University, 2011-12) Ikeakanam, Ottilie Tangeni Omuwa; Crowley, Talitha; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: The impact of infant feeding practices in the prevention of mother-to-childtransmission of HIV raised concerns in the field of health services. Breast feeding adds an additional 15-30% risk of HIV transmission to the infant; therefore, mothers who are HIV-positive are in need of information regarding safe infant feeding. A descriptive design for this particular study was applied with a primary quantitative approach. A convenient sample of sixty (n=60) participants between the ages of 15 – 37 were taken from subjects that enrolled in the prevention of mother-to-child transmission (PMTCT) programme in Onandjokwe district. The sample formed 85% of the target population (N=71). A structured questionnaire with closed and openended questions was used and completed by the researcher. Ethical approval for the study was obtained from the Ethics Committee at the Faculty of Health Sciences, University of Stellenbosch. Permission to conduct the research was obtained from the Ministry of Health and Social Services, Namibia, and the Onandjokwe district Hospital. A pilot study was conducted that constituted 25% of the sample. Validity and reliability was insured by the pilot study and the consultation of an expert in HIV research and an expert in nursing research. The presentation of results was mostly descriptive in nature by using frequency tables and a pie chart. The results showed that all participants (n=60/100%) were offered HIV counselling and testing during antenatal care. Mothers who were HIV positive knew that there is a possibility that the baby might be infected through breast milk. Furthermore, the study found that 70% (n=42) of participants used breast feeding exclusively, 20% (n=12) used replacement feeding and 10% (n=6) used mixed feeding practices. It was concluded that pregnant women and mothers known to be HIV-infected should be informed of the infant feeding practice recommended by the national or subnational authority to improve HIV-free survival of HIV-exposed infants. This includes information about the risks and benefits of various infant feeding options based on local assessments and guidance in selecting the most suitable option for their own situation.
The knowledge of basic neonatal resuscitation among midwives at district hospitals
(Stellenbosch : Stellenbosch University, 2017-03) Ndzima-Konzeka, Florence Fezeka; Cramer, Jenna Morgan; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Background:Globally there is an increase of neonatal deaths resulting in part from intra-partum asphyxia or hypoxia related to ineffective neonatal resuscitation at birth. Midwives can play a pivotal role in reducing neonatal deaths. The researcher was concerned about an increasing rate of early neonatal deaths, in the Chris Hani Health District, Eastern Cape. Consequently, a multi-pronged approach was put into place by the district, to address neonatal mortality by means of training midwives in basic neonatal resuscitation. The resulting question was whether the Chris Hani Health District midwives have the ability to conduct deliveries with the required knowledge in neonatal resuscitation, which could improve neonatal outcomes. Aim and objectives: The study aimed to determine the knowledge level of registered midwives with regards to basic neonatal resuscitation, in the Chris Hani Health District Hospitals in the Eastern Cape. The focus was on the identification of midwives’ training, qualifications and experience in neonatal resuscitation; determining the knowledge of midwives on neonatal resuscitation at birth; and describing the relationships among the afore-mentioned. Methods: A quantitative approach with a descriptive correlational design was adopted. The sample included 110 registered midwives allocated in the maternity wards of the 13 district hospitals of the Chris Hani Health District. A structured self-administered questionnaire was developed specifically to determine the extent of midwives knowledge with regards to the resuscitation of neonates at birth. Data was analysed with STATA (version 13) programme. Results: The knowledge score of the participants ranged from 63% to 97%, with a mean of 79% (SD 7.8). An acceptable knowledge level was 80% or more. Though there were no relationships found between midwives’ training, qualifications and their knowledge; years of experience as a midwife were found to be associated with knowledge of basic neonatal resuscitation. Although the knowledge scores were high, some midwives did not have adequate knowledge on critical components of neonatal resuscitation. Conclusion: The study underpins knowledge in empowering midwives to carry out basic neonatal resuscitation. Recommendations of the study include a retention strategy for advanced midwives; equipping advanced and / or experienced midwives to train and mentor young midwives in the profession; and a review of the need for training of midwives on neonatal resuscitation and its impact on their knowledge. These study findings and recommendations may strengthen the health systems that are in place to end preventable neonatal deaths; through imparting updated basic neonatal resuscitation knowledge to midwives.
The lived experiences of women diagnosed with HIV in the antenatal period in a rural area
(Stellenbosch : Stellenbosch University, 2016-03) Fords, Genevieve Marion; Crowley, Talitha; Van der Merwe, Anita; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing.
ENGLISH ABSTRACT:Background In South Africa women are diagnosed with HIV at antenatal clinics and simultaneously initiated on antiretroviral treatment (ART). An HIV diagnosis together with the initiation of ART have an emotional impact on the pregnant woman that may influence how she will cope with the pregnancy as well as her adherence to a treatment plan. Only a few studies in South Africa have focused on the experiences of pregnant women in rural settings who have tested HIV positive in pregnancy. The aim of the study was to explore the lived experiences of women diagnosed with HIV in the antenatal period in a rural area in the Eastern Cape province of South Africa. Methods A qualitative approach with a descriptive phenomenological design was utilized to explore the lived experiences of women who were diagnosed with HIV in the antenatal period. The study applied purposive sampling to select participants from the Matatiele community clinic, in the Eastern Cape. The Health Research Ethics Committee of Stellenbosch University and the Department of Health of the Eastern Cape granted permission for conducting the study. Ten semi-structured interviews were conducted, transcribed and analysed using Colaizzi’s framework. Four themes emerged from the data. Results The themes that emerged were: reality hits raw, a loneliness that hurts, hope for a fractured tomorrow and support of a few. The reality of an HIV diagnosis was a life changing event. Participants experienced a painful loneliness even though they had support from a few significant people in their life. Although for some an HIV diagnosis meant a death sentence, the love and concern for the unborn child’s safety provided a fractured hope for the future. Conclusion An HIV diagnosis during pregnancy remains a life altering experience for women. By improving the support systems in health facilities such as counselling services and the mental health skills of midwives, the experience of pregnancy could be more positive for women who are diagnosed with HIV during pregnancy.
The lived experiences of young women on the use of HIV pre-exposure prophylaxis in Namibia
(Stellenbosch : Stellenbosch University, 2021-12) Vasco, Ester Kandambo; Crowley, Talitha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Background: Young women have a higher risk of acquiring HIV than other population groups. In sub-Saharan African, at least five in six new HIV infections happen in girls between the ages of 15-19 years. This age group is particularly at a high risk of acquiring HIV due to issues affecting young women such as gender based violence, sexual abuse, limited access to education and health services, and inequalities and injustice. Pre-exposure prophylaxis (PrEP) is the use of antiretroviral medicines by HIV negative individuals before HIV exposure to avert HIV infection. However, since its introduction in Namibia, in 2016, PrEP uptake amongst young women remains low. Various conditions may influence women‟s decisions to initiate and continue PrEP. Little is known about the lived experiences of young women on the use of PrEP. Aim and objectives: The aim of the study was to explore the lived experiences of young women on the use of PrEP in Namibia. The objectives were to: - explore the knowledge and understanding of young women about PrEP, - describe the socio-cultural, educational and informational conditions that influenced their decision to use PrEP, - describe the physical, emotional and social support needs of young women using PrEP. Methods: A qualitative descriptive phenomenological design was used. The study inclusion criteria were: young women aged between 21 and 24 years; current or previous use of PrEP; and attendance of at least one follow-up visit after commencing PrEP. The sample included nine participants from five clinics in and around the town of Rundu, in the Rundu district of the Kavango East region of Namibia. A purposive sampling method was used to obtain maximum variability. Data collection involved face-to-face in-depth interviews using a semi-structured interview guide. Colaizzi’s seven-step process was used to analyse data. Ethics approval was obtained from the Stellenbosch University Health Research Ethics Committee reference number, S19/02/031. Furthermore permission was obtained from the Ministry of Health and Social Services and the regional health director of Kavango East region. Findings: Three themes were identified: risk awareness, empowered for self-care, and persisting despite the challenges. Young women in this study were aware of their risk of acquiring HIV and this prompted them to use PrEP. These risks included lack of awareness of their partne’s HIV status coupled with a lack of trust in their partners; or being in a sexual relationship with a partner living with HIV. Awareness also emanated from information provided by healthcare workers, peers and the media. Using PrEP empowered young women for self-care through enabling them to make choices about managing their risk. Some of the women persisted using PrEP despite several challenges which included the lack of privacy, stigma and inadequate support. Conclusion and recommendations: PrEP is an empowering HIV prevention strategy for young women, however, much still needs to be done to promote young women‟s willingness to initiate and continue PrEP. PrEP awareness campaigns should be expanded to address myths and misconceptions and positively influence social norms. Differentiated PrEP delivery models should be implemented, including integration with other services such as sexual reproductive health services, effective counselling and peer support.
Nurses’ experiences on the use of Afrikaans for nursing documentation and handovers at a central hospital in the Western Cape
(Stellenbosch : Stellenbosch University, 2017-03) Mgoqi, Mangoyi; Crowley, Talitha; Van der Heever, M.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Background: A traditionally Afrikaans central hospital in the Western Cape continues to use mostly Afrikaans for handovers and documentation despite an increase in the presence of isiXhosa speaking nurses. As not all isiXhosa speaking nurses are Afrikaans competent, it was necessary to explore the experiences of nurses regarding the use of Afrikaans for documentation and handovers, and how it may influence team cohesion and the quality of patient care rendered. Methods: A qualitative approach with a descriptive phenomenological design was used to explore nurses’ experiences on the use of Afrikaans for nursing documentation and handovers at a central hospital in the Western Cape. Purposive sampling was applied to select 12 participants of different language backgrounds and nursing categories. Permission to conduct the study was granted by the Health Research Ethics Committee of Stellenbosch University, the central hospital where the study took place and the individual participants. Data collection occurred with the use of semi-structured interviews which were transcribed verbatim and analysed using Colaizzi’s seven-step phenomenological method. Results: The four themes that formed the essential structure of the phenomenon were: differences which disunite, reverberations, historical influences and language discourses. Participants from different racial and language groups had varying experiences of the use of Afrikaans in the workplace. Language incompatibilities and the hegemonic role of Afrikaans in certain wards caused feelings of being ‘othered’, isolation and team divisions. Non-Afrikaans speaking participants felt that the use of Afrikaans for handovers and documentation impeded their ability to perform certain nursing duties and contributed to instances of omitted nursing care which may affect the quality of care rendered. Participants cited historical occurrences such as Apartheid as contributing to the use of Afrikaans at the institution and implicated those in higher positions for perpetuating the disregard for non-Afrikaans speakers. Certain Afrikaans speakers were adamant about holding on to their language lest it go into extinction. Some participants from both language groups felt that a common language, preferably English, would benefit all nurses involved in patient care. Conclusion: The findings of this study demonstrated that the use of Afrikaans for documentation and handovers does not contribute to team cohesion and the rendering of quality patient care. This could be attributed to the perceived lack of managers to enhance the implementation of language practices that accommodates non-Afrikaans speaking staff. It is recommended that institutions should implement language policies relevant to their nursing population demographics in order to improve quality of patient care delivered and increase cohesion of multi-cultural teams.

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