Research Articles (Nursing and Midwifery)

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Adolescent human immunodeficiency virus self-management : needs of adolescents in the Eastern Cape
(AOSIS, 2021) Adams, Leone; Crowley, Talitha
Background: Human immunodeficiency virus (HIV) is a chronic illness and adolescents living with HIV (ALHIV) need the support of the whole family to self-manage (handle, direct and control) their chronic illness. Little is known about self-management amongst ALHIV in the context of the Eastern Cape, South Africa. Aim: This study explored the self-management needs of ALHIV in the Nelson Mandela Bay area of the Eastern Cape to make recommendations that can be used in further research to develop a programme to support adolescents with self-management. Setting: The study was conducted at two primary healthcare clinics in the Nelson Mandela Bay area of the Eastern Cape. Methods: A qualitative descriptive design was applied. Thirteen adolescents between the age of 14 and 19 years were interviewed. The data were collected through individual interviews. Data analysis was done using the six steps described by Creswell. Results: Adolescents living with HIV have limited knowledge and understanding about HIV and sexual reproductive health. Some ALHIV lack self-regulation skills related to decisions about disclosure, managing stigma and emotions, taking treatment, effective communication and setting goals. Human immunodeficiency virus services were not adolescent-friendly, with long queues and no dedicated services for adolescents. Family and friends were a key self-management resource for ALHIV. Conclusion: Adolescents living with HIV have several self-management needs in the domains of knowledge and beliefs, self-regulation skills and abilities, and self-management resources. Healthcare workers should support adolescents and their caregivers to acquire self-management skills as this may lead to better treatment and health outcomes.
Adolescent mothers’ lived experiences whilst providing continuous kangaroo mother care : a qualitative study
(AOSIS, 2020) Robertson, Anneline E.; Crowley, Talitha
Background: Kangaroo mother care (KMC) is the practice of skin-to-skin contact between an infant and parent and has been found to improve the growth and decrease the morbidity and mortality of low-birth-weight and premature infants. Adolescent pregnancy is associated with a preterm birth or low-birth-weight infant; therefore, it is possible that an adolescent mother may have to provide KMC. The adolescent mother, who is likely to have her first experience of motherhood, may have to be supported to ensure that she is able to provide KMC and the routine care for her preterm infant. The literature review did not reveal any research conducted in the Western Cape province on the experiences of adolescent mothers whilst providing KMC. It is, therefore, important to conduct research on this phenomenon so that the lived experiences of adolescent mothers whilst providing KMC can be described. Aim: The aim of this study was to explore the lived experiences of adolescent mothers whilst providing continuous KMC. Setting: The study was conducted in a district and central hospital KMC wards in Cape Town in the Western Cape province of South Africa. Methods: A qualitative, descriptive, phenomenological research design was used. Ten adolescent mothers were selected through purposive sampling. Semi-structured in-depth interviews were conducted, transcribed and analysed using Colaizzi’s framework. Results: Three themes emerged from the data: providing KMC, the interactions and the support received. Conclusion: Supportive educative environments should be established in the KMC wards to ensure that the adolescent mothers receive holistic support.
Adolescent mothers’ lived experiences whilst providing continuous kangaroo mother care : a qualitative study
(AOSIS, 2020-12) Robertson, Anneline E.; Crowley, Talitha
Background: Kangaroo mother care (KMC) is the practice of skin-to-skin contact between an infant and parent and has been found to improve the growth and decrease the morbidity and mortality of low-birth-weight and premature infants. Adolescent pregnancy is associated with a preterm birth or low-birth-weight infant; therefore, it is possible that an adolescent mother may have to provide KMC. The adolescent mother, who is likely to have her first experience of motherhood, may have to be supported to ensure that she is able to provide KMC and the routine care for her preterm infant. The literature review did not reveal any research conducted in the Western Cape province on the experiences of adolescent mothers whilst providing KMC. It is, therefore, important to conduct research on this phenomenon so that the lived experiences of adolescent mothers whilst providing KMC can be described. Aim: The aim of this study was to explore the lived experiences of adolescent mothers whilst providing continuous KMC. Setting: The study was conducted in a district and central hospital KMC wards in Cape Town in the Western Cape province of South Africa. Methods: A qualitative, descriptive, phenomenological research design was used. Ten adolescent mothers were selected through purposive sampling. Semi-structured in-depth interviews were conducted, transcribed and analysed using Colaizzi’s framework. Results: Three themes emerged from the data: providing KMC, the interactions and the support received. Conclusion: Supportive educative environments should be established in the KMC wards to ensure that the adolescent mothers receive holistic support. Keywords: Adolescent; Kangaroo mother care; Preterm infant; Experiences; Holistic support.
Development of a cultural and contextual appropriate HIV self-management instrument using interpretive phenomenology and focus group cognitive interviews
(Elsevier, 2020) Crowley, Talitha; Van Der Merwe, Anita; Skinner, Donald
Qualitative methods are valuable to ensure the important cultural and contextual appropriateness of research instruments but not often used. Interpretive phenomenology (IP) and focus group cognitive interviews are well placed to inductively develop and refine items used to measure adolescent HIV self-management in a South African context. IP was used to situate the experiences of adolescents, caregivers and healthcare workers, as narrated in individual interviews and focus groups, in their social and cultural context. Components of adolescent HIV self-management were developed based on the participants’ experiences, behavioural theory and literature. The components and items were further validated in focus groups using cognitive interviews to refine, revise and add items as suggested by the participants. This study contributes to qualitative research methods and the rigor of instrument development by unpacking how to use IP and focus group cognitive interviews meaningfully in instrument development.
Factors influencing patient falls in a private hospital group in the Cape Metropole of the Western Cape
(AOSIS, 2020) Janse van Rensburg, Renee; Van der Merwe, Anita; Crowley, Talitha
Background: The fall rate of patients in hospitals is a worldwide concern due to the impact falls have on patients, the family or relatives, as well as the healthcare setting. Factors influencing patient falls are categorised as intrinsic and extrinsic. Intrinsic factors refers to physical conditions and the extrinsic factors include the environment of the patient, nursing staffing levels and skill mix. Aim: The study aimed to determine the factors that influence patient falls. Setting: A private hospital group in the Cape Metropole of the Western Cape. Methods: A quantitative retrospective descriptive research approach was used by analysing 134 records of patients that have fallen from October 2016 to February 2018. Data was collected using a data extraction sheet and analysed using the Statistical Package for the Social Sciences (SPSS). Results: Intrinsic factors contributing to patient falls includedthe patient’s age, hypertension, co-morbidities and the use of benzodiazepines as a sedative. Extrinsic factors were the incorrect use of bed rails and the skill mix of the staff. In over half of the cases (n = 68; 50.7%), risk assessments were not performed according to the protocol. Only 5 (3.7%) patients sustained major injuries due to the falls. However, the risk of more severe falls increased 2.4 times with the lack of risk assessment. Conclusion: The lack of accurate and consistent patient fall risk assessments, use of benzodiazepines as a sedative and the staff skill mix were contributors to the fall rate in these hospitals.
Factors influencing patient falls in a private hospital group in the Cape Metropole of the Western Cape
(AOSIS, 2020-06) Janse van Rensburg, Renee; van der Merwe, Anita; Crowley, Talitha
BACKGROUND: The fall rate of patients in hospitals is a worldwide concern due to the impact falls have on patients, the family or relatives, as well as the healthcare setting. Factors influencing patient falls are categorised as intrinsic and extrinsic. Intrinsic factors refers to physical conditions and the extrinsic factors include the environment of the patient, nursing staffing levels and skill mix. AIM: The study aimed to determine the factors that influence patient falls. SETTING: A private hospital group in the Cape Metropole of the Western Cape. METHODS: A quantitative retrospective descriptive research approach was used by analysing 134 records of patients that have fallen from October 2016 to February 2018. Data was collected using a data extraction sheet and analysed using the Statistical Package for the Social Sciences (SPSS). RESULTS: Intrinsic factors contributing to patient falls includedthe patient's age, hypertension, co-morbidities and the use of benzodiazepines as a sedative. Extrinsic factors were the incorrect use of bed rails and the skill mix of the staff. In over half of the cases (n = 68; 50.7%), risk assessments were not performed according to the protocol. Only 5 (3.7%) patients sustained major injuries due to the falls. However, the risk of more severe falls increased 2.4 times with the lack of risk assessment. CONCLUSION: The lack of accurate and consistent patient fall risk assessments, use of benzodiazepines as a sedative and the staff skill mix were contributors to the fall rate in these hospitals.
Factors influencing the confidence and knowledge of nurses prescribing antiretroviral treatment in a rural and urban district in the Western Cape province
(AOSIS Publishing, 2019) Solomons, Deborah J.; Van Der Merwe, Anita S.; Esterhuizen, Tonya; Crowley, Talitha
Background: Since the introduction of nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa in 2010, initiation of antiretroviral therapy (ART) in primary care has become the responsibility of nurses. The continued success of this approach is dependent on factors such as adequate training and effective support systems. Objectives: This study aimed to investigate factors influencing the knowledge and confidence of professional nurses in managing patients living with human immunodeficiency virus (HIV) in primary healthcare settings in a rural and urban district in the Western Cape. Methods: A cross-sectional survey was conducted amongst 77 NIMART-trained nurses from 29 healthcare facilities to measure demographic details, influencing factors, HIV management confidence and HIV management knowledge. Results: The majority of participants had adequate HIV management knowledge and reported being very confident or expert in the HIV management skills or competencies. Participants trained recently on local guidelines (Practical Approach to Care Kit) (3 years 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 NIMART mentoring over a period of 2 weeks had a higher mean confidence score compared to other periods of mentoring. A higher caseload of patients living with HIV was also associated with higher knowledge and confidence. Conclusion: 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 regular updates and sufficient opportunities for clinical practice.
Integrating HIV care and treatment into primary healthcare : are clinics equipped?
(AOSIS Publishing, 2014-08-28) Crowley, Talitha; Stellenberg, Ethelwynn L.
Background: The demand for HIV care and treatment services is increasing rapidly and strategies to sustain long-term care should be employed. The decentralisation and integration of HIV care and treatment services into primary healthcare (PHC) is vitally important in order to ensure optimal access to life-saving antiretroviral therapy and ongoing chronic care. Conversely, the PHC system is fraught with the current burden of disease. Setting: The study was conducted in PHC clinics in the uMgungundlovu district, Kwa-Zulu Natal. Aim: The objectives of the study were to assess whether PHC clinics were equipped to deliver integrated HIV services and to evaluate the availability of resources as well as support systems for HIV care and treatment in PHC clinics. Methods: A quantitative, cross-sectional descriptive study was undertaken in 20 randomlyselected, eligible clinics in the uMgungundlovu district, KwaZulu-Natal, South Africa. An evaluation instrument was completed through observations and review of the clinic data records. Criteria were based on the World Health Organization’s guide to indicators for antiretroviral programmes as well as South African HIV standards for PHC facilities. Results: None of the clinics were equipped adequately. Clinics with a higher patient load had poorer scores, whilst clinics providing antiretroviral therapy were better equipped in terms of human resources and infrastructure. Conclusion: HIV services are an essential part of primary healthcare and clinics need to be equipped adequately in order to render this service. It is unlikely that the over-burdened health system would be able to cope with an increased number of patients on antiretroviral therapy in the long term, whilst maintaining quality of services, without support being given to PHC clinics.
The lived experiences of rural women diagnosed with the human immunodeficiency virus in the antenatal period
(Taylor & Francis, 2017) Fords, Genevieve Marion; Crowley, Talitha; Van der Merwe, Anita S.
Background: In South Africa, pregnant women are diagnosed with human immunodeficiency virus (HIV) at antenatal clinics and simultaneously initiated on antiretroviral treatment (ART). An HIV diagnosis together with the initiation of ART has an emotional impact that may influence how pregnant women cope with pregnancy and their adherence to a treatment plan. 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 utilised. The study applied purposive sampling to select participants from a local community clinic in the Eastern Cape. Ten semistructured interviews were conducted, transcribed and analysed using Colaizzi's framework. Results: Four themes formed the essential structure of the phenomenon being investigated: a reality that hits raw, a loneliness that hurts, hope for a fractured tomorrow and support of a few. Although the participants had to accept the harsh reality of being diagnosed with HIV and experienced loneliness and the support of only a few people, they had hope to live and see the future of their children. Conclusion: Women diagnosed with HIV during pregnancy are ultimately concerned with the well-being of their unborn children, and this concern motivates their adherence to ART. Women's lived experiences are situated in their unique sociocultural context, and although some known challenges remain, counselling and support strategies need to be informed by exploring context-specific issues and involving the local community.
Nurses’ views on promotion and the influence of race, class and gender in relation to the Employment Equity Act
(AOSIS, 2019) Van der Heever, Mariana M.; Van der Merwe, Anita S.; Crowley, Talitha
Orientation: Regardless of the implementation of the Employment Equity Act (EEA), No. 55 of 1998 and the abolishment of apartheid in 1994, African and mixed-race females are under-represented in managerial positions in the public sector of the Western Cape (WC) in South Africa and nationally in the private health sector. Research purpose: The purpose was to explore the views of nurses about promotion to managerial positions in view of the Employment Equity Act (EEA) and the possible influence of race, class and gender. Motivation for the study: South Africa has a history of racial hierarchies and gender inequities. It was therefore important to explore the influence of the EEA and race, class and gender on the promotion of nurses in the post-apartheid context. Research approach/design and method: A cross-sectional descriptive survey design was completed. Six hundred and eighty-eight (n = 688) nurses consented to participate and 573 (83%) questionnaires were returned. Main findings: Race as a social construct surfaced in the superior viewing of white and the inferior viewing of African nurses. Mixed-race and white nurses seemed disgruntled with the EEA because of the benefits it holds for African nurses. African nurses seemed angered by their under-representation in managerial positions in the private and public sectors in the WC. White nurses seemed convinced that African, mixed-race and Indian nurses experience upward mobility. Mixed-race nurses (public sector WC) showed concerns about the career successes of males in a female-dominated profession. Practical/managerial implications: Managerial structures should be required to invest in diversity training, create awareness of the noble intentions of the EEA and communicate the relevance of employment equity plans. Contribution/value-add: The findings provided evidence that reflected a need for diversity training and the creation of awareness about the longstanding influence of racial and gender hierarchies.
Patient satisfaction and treatment adherence of stable human immunodeficiency virus-positive patients in antiretroviral adherence clubs and clinics
(AOSIS, 2018) De Jager, Gabi A.; Crowley, Talitha; Esterhuizen, Tonya M.
Background: South Africa has experienced a substantial increase in access to antiretroviral treatment (ART) in recent years. Effective strategies to manage access to treatment need to be incorporated into and implemented in ART programmes. Antiretroviral treatment adherence clubs are a new strategy that is being implemented in various parts of South Africa. Aim: The aim of the study was to investigate treatment adherence and patient satisfaction of stable human immunodeficiency virus (HIV) patients on ART in ART adherence clubs and clinics. Setting: The study was conducted in the Eden district of the Western Cape, South Africa. Methods: A cross-sectional analytical study was conducted to examine the relationships between patient satisfaction and treatment adherence in ART adherence clubs and clinics in the Eden district, Western Cape province, South Africa. Validated questionnaires were used to measure patient satisfaction and self-reported treatment adherence. Results: The study included 320 participants (98 club and 222 clinic) from 13 primary health care clinics. The analyses showed that higher levels of satisfaction could be predicted with club participants compared to clinic participants (p = 0.05). There was no significant difference between clinic and club participants with regards to treatment adherence. However, being adherent was more likely in participants who were satisfied (odds ratio = 3.18, 95% confidence interval [1.14–7.11], p < 0.01). Conclusion: Antiretroviral treatment adherence clubs provide a service that patients are more satisfied with although they are not more adherent to treatment. This strategy may be effective for the delivery of long-term care for patients on ART.
Reorganisation of primary care services during COVID-19 in the Western Cape, South Africa : perspectives of primary care nurses
(AOSIS, 2021-11) Crowley, Talitha; Kitshoff, Danine; De Lange-Cloete, Frances; Baron, Justine; De Lange, Santel; Young, Cornelle; Esterhuizen, Tonya; Couper, Ian
Background: Primary care nurses play a pivotal role in the response to disasters and pandemics. The coronavirus diseases 2019 (COVID-19) pandemic required preventative, diagnostic, and curative measures for persons presenting with symptoms of COVID-19 by healthcare providers, whilst continuing other essential services. We aimed to investigate the reorganisation of primary care services during COVID-19 from the perspectives of primary care nurses in the Western Cape province of South Africa. Methods: We administered an online survey with closed and open-ended questions to professional nurses enrolled for a Postgraduate Diploma in Primary Care Nursing at Stellenbosch University (2020) and alumni (2017–2019) working in the Western Cape. Eighty-three participants completed the questionnaire. Results: The majority of the participants (74.4%) reported that they were reorganising services using a multitude of initiatives in response to the diverse infrastructure, logistics and services of the various healthcare facilities. Despite this, 48.2% of the participants expressed concerns, which mainly related to possible non-adherence of patients with chronic conditions, the lack of promotive and preventative services, challenges with facility infrastructure, and staff time devoted to triage and screening. More than half of the participants (57.8%) indicated that other services were affected by COVID-19, whilst 44.6% indicated that these services were worse than before. Conclusion: Our findings suggest that the very necessary reorganisation of services that took place at the start of the COVID-19 pandemic in South Africa enabled effective management of patients infected with COVID-19. However, the reorganisation of services may have longer-term consequences for primary care services in terms of lack of care for patients with other conditions, as well as preventive and promotive care.
The role of patient care workers in private hospitals in the Cape Metropole, South Africa
(AOSIS Publishing, 2017) Aylward, Louise A.; Crowley, Talitha; Stellenberg, Ethelwynn L.
Background: Nursing managers have to meet expectations of patients despite economic pressures, an increasing burden of disease and nursing shortages. Shifting health care-related tasks to lower categories of staff, including non-nursing support staff, has become one solution to address this dilemma. Patient care workers are a specific group of non-nursing support staff working in South African hospitals. Although patient care workers have been used for several years and their numbers are increasing, there are controversial opinions about the role of patient care workers, ranging from praise for their contribution towards patient care to serious concerns about the impact of their role on patient safety. Objective: The study objective was to explore and describe the role of patient care workers in private hospitals. Methods: A qualitative, descriptive design was applied to explore the role of patient care workers. Purposive sampling was used to select unit managers, nurses and patient care workers from medical and surgical wards of three private hospitals. Fifteen semi-structured interviews were conducted and transcribed verbatim. The researcher applied interpretative data analysis to move from the participants’ descriptions of their experiences to a synthesis of all participants’ descriptions. Results: Patient care workers are involved in direct patient care and spend much time with patients, often not working under direct supervision of registered nurses despite limited training and lack of regulation. Their contribution, however, is valued by nurses. Conclusion: Patient care workers are 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 and the lack of direct supervision. Regulating the work of patient care workers is recommended.
Self-management interventions for adolescents living with HIV : a systematic review
(BMC (part of Springer Nature), 2021-05-07) Crowley, Talitha; Rohwer, Anke
Background: Self-management interventions aim to enable people living with chronic conditions to increase control over their condition in order to achieve optimal health and may be pertinent for young people with chronic illnesses such as HIV. Our aim was to evaluate the effectiveness of self-management interventions for improving health-related outcomes of adolescents living with HIV (ALHIV) and identify the components that are most effective, particularly in low-resource settings with a high HIV burden. Methods: We considered randomised controlled trials (RCTs), cluster RCTs, non-randomised controlled trials (non- RCTs) and controlled before-after (CBA) studies. We did a comprehensive search up to 1 August 2019. Two authors independently screened titles, abstracts and full texts, extracted data and assessed the risk of bias. We synthesised results in a meta-analysis where studies were sufficiently homogenous. In case of substantial heterogeneity, we synthesised results narratively. We assessed the certainty of evidence using GRADE and presented our findings as summaries in tabulated form. Results: We included 14 studies, comprising 12 RCTs and two non-RCTs. Most studies were conducted in the United States, one in Thailand and four in Africa. Interventions were diverse, addressing a variety of selfmanagement domains and including a combination of individual, group, face-to-face, cell phone or information communication technology mediated approaches. Delivery agents varied from trained counsellors to healthcare workers and peers. Self-management interventions compared to usual care for ALHIV made little to no difference to most health-related outcomes, but the evidence is very uncertain. Self-management interventions may increase adherence and decrease HIV viral load, but the evidence is very uncertain. We could not identify any particular components of interventions that were more effective for improving certain outcomes. Conclusion: Existing evidence on the effectiveness of self-management interventions for improving health-related outcomes of ALHIV is very uncertain. Self-management interventions for ALHIV should take into account the individual, social and health system contexts. Intervention components need to be aligned to the desired outcomes.
Trends in task shifting in HIV treatment in Africa : effectiveness, challenges and acceptability to the health professions
(AOSIS Publishing, 2015-07) Crowley, Talitha; Mayers, Pat
Background: Task shifting has been suggested to meet the demand for initiating and managing more patients on antiretroviral therapy. Although the idea of task shifting is not new, it acquires new relevance in the context of current healthcare delivery. Aim: To appraise current trends in task shifting related to HIV treatment programmes in order to evaluate evidence related to the effectiveness of this strategy in addressing human resource constraints and improving patient outcomes, challenges identified in practice and the acceptability of this strategy to the health professions. Method: Electronic databases were searched for studies published in English between January 2009 and December 2014. Keywords such as ‘task shifting’, ‘HIV treatment’, ‘human resources’ and ‘health professions’ were used. Results: Evidence suggests that task shifting is an effective strategy for addressing human resource constraints in healthcare systems in many countries and provides a cost-effective approach without compromising patient outcomes. Challenges include inadequate supervision support and mentoring, absent regulatory frameworks, a lack of general health system strengthening and the need for monitoring and evaluation. The strategy generally seems to be accepted by the health professions although several arguments against task shifting as a long-term approach have been raised. Conclusion: Task shifting occurs in many settings other than HIV treatment programmes and is viewed as a key strategy for governing human resources for healthcare. It may be an opportune time to review current task shifting recommendations to include a wider range of programmes and incorporate initiatives to address current challenges.

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