Masters Degrees (Nursing and Midwifery)

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Absenteeism in district rural hospitals in the Eastern Cape : the experiences of nurses
(Stellenbosch : Stellenbosch University, 2022-12) Jonas, Lindill; Anthonie, Ramona; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY: Absenteeism is a global concern that has a negative impact on employees, patients and the organization. Whilst absenteeism is exacerbated by working conditions such as resources (human, equipment), rural communities have a higher prevalence of chronic conditions than their urban counterparts which increases the workload. The aim of the study was to explore the experiences of nurses in district rural hospitals in the Eastern Cape. The objectives of the study were to: - Gain understanding of nurses’ experience of absenteeism at the workplace. - Explore the influence of intrinsic factors on absenteeism as experienced by nurses. - Explore the influence if extrinsic factors on absenteeism as experienced by nurses. A descriptive qualitative design was applied. A sample size of 12 was drawn from a total population of 183 at three participating hospitals, using purposive sampling. A pilot interview was conducted using a semi-structured interview guide based on the study’s objectives. Credibility, confirmability, transferability and dependability was assured by using Lincoln and Cuba’s criteria of trustworthiness. All ethical principles were met. Seven themes emerged from data analysis, i.e., managing human resources, work planning and scheduling, job dissatisfaction and workload, diminished patient care, staff well-being, relationship building amid absenteeism and strategies for managing absenteeism. The findings support Hertzberg’s theory on motivation factors regarding what motivates workers to perform well and not be absent from work. Hygiene factors such as heavy workload, lack of equipment, benefits and support staff, poor co-worker relationships as well as inconsistent implementation of policies all contributed to job dissatisfaction and ultimately absenteeism. As a result, human resource policies and practices should be revised and implemented to provide a more supportive work environment to reduce absenteeism.
Academic factors affecting learning at a nursing college in the Western Cape
(Stellenbosch : University of Stellenbosch, 2011-03) Magerman, Yolande Nerissa; Stellenberg, E. L.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: Nursing education, including the individual nurse educator, has a responsibility to society and to students for providing quality education, for maintaining the highest academic standards, for the proficient use of teaching strategies and for ensuring adequate support to learners. These standards were threatened at a particular college in the Western Cape which instigated this study. This study aimed at investigating the academic factors that influenced learning at a particular nursing college in the Western Cape. The objectives included the following possible factors that may have contributed towards the unsatisfactory, academic performances of students: • Nursing as a career choice; • Selection criteria; • Approaches to learning; • Motivation and learning; • Language barrier to learning; and • Factors affecting the learning environment. A non-experimental, descriptive research design was applied with a quantitative approach. The target population (N = 963) consisted of nursing students following the course leading to registration as a professional nurse, according to the South African Nursing Council’s regulation 425, as promulgated by the Nursing Act 50 of 1978, as amended (Nursing Act 33 of 2005). Probability, stratified sampling was used to select the sample of participants (n = 174). A structured questionnaire, consisting of predominantly closed questions, was used for the collection of data. Ethical approval was obtained from Stellenbosch University to conduct this study. Permission to conduct the research was also obtained beforehand from the management of the nursing college being studied, whilst prior informed consent was obtained from each participant. Reliability and validity of the study were assured by means of a pilot study and through the use of experts in nursing research, methodology and statistics. Data was collected and captured by the researcher personally. The data was analysed with the support of a statistician and was expressed as frequencies and in tables and histograms. Descriptive statistics and post-hoc analyses, including tests for statistical associations, were performed. The outcomes from this study showed that third year students (n = 49/23%) spent the most time studying, whilst first years (n = 74/43%) and second years (n = 40/23%) only spent 2.3 hours studying per day. Academic support classes, when offered, were always attended by (n = 64/37%) and most times by (n = 72/42%). The majority of the participants were able to cope with the workload most of the time (n = 107/61%), whilst (n = 51/30%) and (n = 6/3%) of the participants indicated coping seldom and never, respectively. A significant relationship between the ages of participants and being able to cope with the workload (Spearman p-value = 0.02) existed. Results indicated that (n = 83/48%) of the participants received support with language problems, whilst (n = 75/43%) indicated that they did not receive support with language problems. The Afrikaans speaking participants coped the best with the workload (mean score = 1.72), followed by the English speaking students (mean score = 1.68), and lastly the Isi- Xhosa speaking learners (mean score = 1.65). Recommendations made by participants included the following: • Strict adherence to the selection criteria, which should help decrease the attrition rate. • English as a subject / module during the first year was proposed. • The promotion of the proficiency in English, through interaction between English speaking learners and students with English as second language, should be encouraged. • Regular updates of the contents of the curriculum. • The importance of identifying ‘at risk’ students and pro-actively introducing a mentorship programme. • Information technology needed to be improved in many aspects, such as accessibility of Web based communication. Results from the open ended questions showed that participants regarded the teaching strategies as boring. Large classrooms were also mentioned as a problem. Smaller classes were requested to enable more interaction in the class. In conclusion, this study showed that specific academic factors were influencing learning at the nursing college being investigated in the Western Cape. Therefore, recommendations were made in this study, which, if implemented, should result in an improvement in the overall academic performances of students.
Accessibility and uptake of reproductive health education during earlier youth according to 18 and 19 year old college students in the Cape Town metropolitan area
(Stellenbosch : University of Stellenbosch, 2010-12) McMillan, Lauren; Marais, F.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: Reproductive health is the right of every person. The new Children’s Act (Act 38 of 2005) gives to children 12 years and older rights to reproductive health, which includes contraceptive access as well as information on sexuality and reproduction. They have the right to HIV/AIDS testing and treatment with only their own consent. The aim of the study was to investigate the personal and contextual factors which influence the accessibility and uptake of reproductive health education during early youth (13 to 18 years). The study also aimed to identify contextually appropriate recommendations toward improved reproductive health provision for these youths. A descriptive, non-experimental, research design was employed with a primarily quantitative approach. A sample of 270 participants, constituting 20% of the study population (N=1373) was randomly selected from Northlink FET Colleges, Cape Town. A self-completion structured questionnaire was used to collect the data. Ethical approval was obtained from the Health Research Ethics Committee of the Faculty of Health Sciences, Stellenbosch University. Permission to conduct the research was obtained from the management of Northlink FET College. A group of 30 participants, who met the inclusion criteria, constituting 11% of the sample, participated in a pilot study. Reliability and validity were assured by means of a pilot study and the use of experts in the field, nursing research and statistics. Data was collected personally by the Principal Investigator. The data analysis was primarily descriptive in nature and presented in frequency tables, proportions and measures of relationships, using where indicated Chi-square (x2) and Mann-Whitney U tests. A thematic approach was used to analyze the qualitative data yielded from the open-ended question. Subsequently, in order to strengthen the investigation, the qualitative data, within the identified themes, was quantified based on a validated analytical approach. The results show that 74.1% (n=195) of participants were sexually experienced by the time of the study. Of the participants who reported having already had sexual intercourse, 60.5% (n=115) indicated having made their sexual début by the age of 16. A third of participants (33.2%,n=77) received their first reproductive health education by age 13. Only half of the participants (50.4%,n=116) indicated that the reproductive health education they received always influenced them to make safer sex choices. Of the participants, 21.9% (n=59) stated that they felt that they were in some way hindered in accessing contraceptives during age 13 to 18 years. The vast majority of the participants (94.4%, n=255) indicated that they would prefer reproductive health education to be provided by a professional healthcare provider at a clinic (61.5%, n=166) or by a nurse at school (33%; n=89). Increased reproductive health education within the schooling systems was requested by 52 (19.3%) participants, with more than 30% (n=84) indicating their home as the preferred source of such education. Several recommendations, grounded in the study findings, were identified, including the provision of reproductive health care and accessibility to contraceptives for youths as young as 12 years within a school setting. This care should be provided by healthcare professionals, such as nurses, on a similar operating basis as that which is provided in primary health clinics. The findings reveal to the pressing need for the development, implementation and evaluation of an alternative model for reproductive health care provision in order to assure the complete deliverance of the rights and care to youths as stipulated in the new Child Act (Act 38 of 2005).
Accuracy of risk prediction tools for acute coronary syndrome : a systematic review
(Stellenbosch : Stellenbosch University, 2015-04) Van Zyl, Johet Engela; Khondowe, Oswell; Stellenbosch University. Faculty of Health Sciences. Interdisciplinary Health Sciences. Nursing.
ENGLISH ABSTRACT: Background: Coronary artery disease is a form of cardiovascular disease (CVD) which manifests itself in three ways: angina pectoris, acute coronary syndrome and cardiac death. Thirty-three people die daily of a myocardial infarction (cardiac death) and 7.5 million deaths annually are caused by CVD (51% from strokes and 45% from coronary artery disease) worldwide. Globally, the CVD death rate is a mere 4% compared to South Africa which has a 42% death rate. It is predicted that by the year 2030 there will be 25 million deaths annually from CVD, mainly in the form of strokes and heart disease. The WHO compared the death rates of high-income countries to those of low- and middle-income countries, like South Africa, and the results show that CVD deaths are declining in high-income countries but rapidly increasing in low- and middle-income countries. Although there are several risk prediction tools in use worldwide, to predict ischemic risk, South Africa does not use any of these tools. Current practice in South Africa to diagnose acute coronary syndrome is the use of a physical examination, ECG changes and positive serum cardiac maker levels. Internationally the same practice is used to diagnose acute coronary syndrome but risk assessment tools are used additionally to this practise because of limitations of the ECG and serum cardiac markers when it comes to NSTE-ACS. Objective: The aim of this study was to systematically appraise evidence on the accuracy of acute coronary syndrome risk prediction tools in adults. Methods: An extensive literature search of studies published in English was undertaken. Electronic databases searched were Cochrane Library, MEDLINE, Embase and CINAHL. Other sources were also searched, and cross-sectional studies, cohort studies and randomised controlled trials were reviewed. All articles were screened for methodological quality by two reviewers independently with the QUADAS-2 tool which is a standardised instrument. Data was extracted using an adapted Cochrane data extraction tool. Data was entered in Review Manager 5.2 software for analysis. Sensitivity and specificity was calculated for each risk score and an SROC curve was created. This curve was used to evaluate and compare the prediction accuracy of each test. Results: A total of five studies met the inclusion criteria of this review. Two HEART studies and three GRACE studies were included. In all, 9 092 patients participated in the selected studies. Estimates of sensitivity for the HEART risks score (two studies, 3268 participants) were 0,51 (95% CI 0,46 to 0,56) and 0,68 (95% CI 0,60 to 0,75); specificity for the HEART risks score was 0,90 (95% CI 0,88 to 0,91) and 0,92 (95% CI 0,90 to 0,94). Estimates of sensitivity for the GRACE risk score (three studies, 5824 participants) were 0,03 (95% CI0,01 to 0,05); 0,20 (95% CI 0,14 to 0,29) and 0,79 (95% CI 0,58 to 0,93). The specificity was 1,00 (95% CI 0,99 to 1,00); 0,97 (95% CI 0,95 to 0,98) and 0,78 (95% CI 0,73 to 0,82). On the SROC curve analysis, there was a trend for the GRACE risk score to perform better than the HEART risk score in predicting acute coronary syndrome in adults. Conclusion: Both risk scores showed that they had value in accurately predicting the presence of acute coronary syndrome in adults. The GRACE showed a positive trend towards better prediction ability than the HEART risk score.
Adherence to standard precautions in clinical nursing practice : a comparative study
(Stellenbosch : Stellenbosch University, 2014-04) Nieuwoudt, Susandra; Marais, Frederick; Mehtar, Shaheen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing.
ENGLISH ABSTRACT: The aim of this study was to compare the impact of a four-day structured Basic Infection Prevention and Control course on the knowledge of, and adherence to, Standard Precautions in clinical nursing practice amongst nurses who had completed the course and those who did not. The specific precautionary measures of investigation included hand hygiene, personal protective equipment (PPE) and sharps management. The secondary aim of the study was to identify any personal and contextual factors that influenced the application of such Standard Precautions measures in public healthcare facilities within the Cape Winelands and Overberg District. Sixty eight students (those who had been trained) with a similar number of controls (who had not been trained) were enrolled in the study. Although both the participants and controls had the knowledge, their adherence to hand hygiene, PPE and sharps management in clinical nursing practice was poor. Staff attitude was found to be the main factor for non-adherence. The knowledge of the participants was good as they had answered most of the questions correctly. It seems as if there was retention of knowledge after the four-day Basic Infection Prevention and Control course. There were, however, no significant differences between the two groups. For both groups attitude and behavioural change must be addressed in order to improve adherence to hand hygiene, PPE and sharps management. The findings of the study will form recommendations towards improved infection prevention and control practices at public healthcare facility level in the Cape Winelands District.
The adolescent and sexual health
(Stellenbosch : University of Stellenbosch, 2004-04) Asia, Ida; Welmann, E. B.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: Research and in certain instances the lack of research as well as extensive experience of the researcher in this field of study convinced the researcher that a scientific study / exploration is critical on the different aspects of adolescent sexual health. A study, based on a combination of qualitative and quantitative methods (triangulation), was conducted to identify and describe the factors playing a role in adolescents’ experiencing problems in maintaining their sexual health. Adolescents are at risk of contracting Sexually Transmitted Diseases including HIV/AIDS because of their sexual behaviour. Initiation of early sexual relations contributing to possible multiple sexual partners and failure to consistently use condoms contribute to this risk. Failure to continuously use a reliable contraceptive method also enhances the risk of unintended pregnancies and consequent exposure to the risks involved in termination of pregnancy or the psychological effects of giving the baby up for adoption, the hardship of raising the baby as a single parent or being forced to marry at a young age. Thus the physical-, emotional-, and social well being of the adolescent is at risk when they are not equipped to maintain their sexual health.The study concludes that adolescents that are sexually active and have multiple sexual partners have a higher probability of not maintaining their sexual health. Based on the outcome of this study the researcher feels strongly that the following needs to be addressed in order to promote the maintenance of adolescent sexual health: • Professional nurses need to be trained and sensitized to guide and manage adolescents seeking sexual or reproductive advice; • Sexuality programmes need to be integrated into school curricula; • Positive use of the mass media to promote healthy lifestyles; and • Training programmes for parents and adolescents.
Adolescent sexual health in a selected region of Namibia
(Stellenbosch : Stellenbosch University, 2001-04) Lukolo, Linda Ndeshipandula; Welmann, E. B.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: Informal discussions and the work experience of the researcher in the field of health care raised concerns about the problems regarding the sexual health of adolescents. This demonstrated the need for an integrated health care system to promote adolescent sexual health. Against this background the study was undertaken to: • Identify the attitudes of adolescents towards sexual health. • Determine their knowledge of sexual health • Determine what the practice of sexual health by adolescents entail. • Provide recommendations where applicable. Triangulation, which is a combination of qualitative and quantitative research methods, was used. The findings reflected the following: • A positive attitude towards sexual health, but adolescents are involved in high risk sexual behaviour. • Sub-optimal knowledqë regarding sexual issues. • A need for sexual education by parents and health workers, especially nurses. The following recommendations, are proposed: • Sex education should start at an age as early as possible, at home, by parents. • Health workers should be trained to give proper information and advice to adolescents about their sexual health. • Condoms should be freely available and accessible to all the people of Namibia. • Adolescents should be actively involved in the promotion of their own sexual health. Keywords: Prevention of teenage pregnancy I Sexually transmitted diseases I HIV I AIDS and Sex education.
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.
Die afbakening van die rol en funksies van die forensiese psigiatriese verpleegpraktisyn in 'n geselekteerde forensiese psigiatriese eenheid in die Wes-Kaap
(Stellenbosch : Stellenbosch University, 2003) Engel, Alexander Adolf; Bester, M. E.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: No clear description exists in S.A. of the role and functions of a forensic psychiatric nurse. The researcher conducted a research project based on more than 20 years of practice experience to define and describe the role and functions of the forensic nurse practitioner. A non-experimental descriptive study was done. Questionnaires and checklists were compiled to determine the perceptions of forensic psychiatric patients/clients (n =24) and nursing staff (n = 15) .The nursing activities in a selected forensic psychiatric unit was evaluated through nonparticipative observation. Results indicated that: • Patients experienced their environment as isolated and has a need for better support by the nursing staff; • Nursing staff indicated their need for more specific training in forensic psychiatric nursing; and • A need exists for specific protocols and procedures to guide his/her practice. The recommendations are made that: • A special training program for forensic psychiatric nursing needs to be planned and implemented; and • Procedures and guidelines must be established to guide the practice of the nurse practitioner.
Agency nurses’ perceptions of job satisfaction within critical care units in private healthcare institutions
(Stellenbosch : University of Stellenbosch, 2011-03) Collier, Vasanthi; Van der Heever, Mariana M.; Stellenberg, E. R.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: Agency-nursing work refers to nursing services provided by agency nurses employed on a casual, contracted basis. Agency-nursing has become more common in nursing practice in South Africa. This group of nurses play a significant role within the health care industry for both public and private sector. Given the pivotal role that nurses play in caring for the health of others, it is important to understand what motivates agency nurses in terms of job satisfaction. The aim of the study was to explore the perceptions of agency nurses regarding job satisfaction within critical care units in private health care institutions in the Western Cape. A qualitative research design with a phenomenological approach was applied. A sample size of n=10 was drawn from a total population of N=553, using random sampling technique. A semi-structured interview guide was designed based on the objectives of the study and validated by experts in the field before data collection. 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 participating nursing agency and consent was given in writing. The presentation of the results was categorised into themes and sub-themes emerged from the data analysis. The five clusters of themes that emerged were reasons for doing agency work, experiences with hospital staff, allocation of agency nurses, communication of information and staff development. The findings support Herzberg’s theory on motivation factors in terms of what motivates workers to excel in their performance. Agency nurses experienced both positive and negative aspects with regards to job satisfaction. The results of the study suggest the need to include revision and implementation of human resource policies and practices to include the nurses’ “voice” in an effort to provide a more supportive work environment. Further research is recommended. Key Words: Agency nurse, nursing agency, job satisfaction.
Alcohol-based hand rub in the prevention of diarrhoea and respiratory-tract infection among children in community settings : a systematic review
(Stellenbosch : Stellenbosch University, 2015-04) Steyn, Joelynn Geraldine Rachelle; Khondowe, Oswell; Stellenberg, Ethelwynn L.; Stellenbosch University. Faculty of Health Sciences. Interdisciplinary Health Sciences. Nursing.
ENGLISH ABSTRACT: Annually more than 3.5 million children worldwide, less than five years of age die of diarrhoea and acute lower respiratory-tract infections. Over the last two decades, the care of pre-school children outside of their homes has become more common in most parts of the world and has contributed to an increased risk of respiratory-tract and gastrointestinal infections in children. Children attending day-care centres are at an increased risk for diarrhoea and respiratory-tract infections and hands are the primary vehicle for transmission of infectious diseases. Thus, hand hygiene is essential for preventing and controlling of infection in the health care and community settings. Waterless hand sanitizer as an alternative to hand washing was investigated. Rinse-free hand sanitizer programmes in the community may be effective, safe and feasible. The aim of the study was to systematically appraise evidence on the effect of alcohol-based hand rub in the prevention of diarrhoea and acute respiratory-tract infection among children aged five years and below in community settings. The primary outcome of the study was to assess the incidence of respiratory-tract infection and diarrhea. Diarrhoea is defined by the World Health Organization as the excretion of three or more loose or liquid stools per day (or more frequent excretion than is normal for the individual). The secondary outcome was to assess mortality, admission to hospital and duration of hospital stay. A comprehensive search for relevant studies was conducted on the following databases from 1990 to 2014: EMBASE, MEDLINE, CINAHL, Google Scholar and Cochrane Central Register of Controlled Trials (CENTRAL). We searched the reference lists of all relevant articles and textbooks for more studies. Unpublished data previously presented at international and scientific meetings have been included in the review. Proceedings of international conferences on diarrhoea and respiratory-tract infection among children were searched for relevant articles. Subject experts were contacted. Two reviewers, Joelynn Steyn (JS) and Oswell Khondowe (OK) selected studies following a two-step study selection process. This review considered all published randomized controlled trials and quasi-experimental designs published from January 1990 to July 2014. The first step was the selection of studies based on titles and abstracts. Both reviewers selected eligible studies which met the set criteria. During the second step, both reviewers retrieved the full-text articles of the studies and assessed the methodological quality of the studies. Four studies were included in this review. The included studies met most of the quality assessment criteria as stipulated in the Cochrane risk assessment tool. Two studies were clusterrandomized controlled trials, one was a block randomized controlled trial and one was a randomized controlled trial. Disagreements were resolved by discussion and where a lack of consensus existed, consultation with a third reviewer occurred. The use of alcohol hand rub as compared to control interventions significantly reduced the incidence of diarrhoea in children (RR 0.79, 95% CI 0.63 to 0.99). Statistical heterogeneity was observed among the included studies (I²=69, p=0.04). However this review found no significant difference in respiratory-tract infections between intervention groups versus control as observed from the confidence interval (RR 0.98, 95% CI 0.90 to 1.07, p=0.63). The results should be interpreted with caution due to the limited number of studies conducted in communities with alcoholbased hand rub used by caregivers. Due to limited studies in this review, it makes it difficult to make strong conclusions on findings and to provide sufficient evidence to guide future research. We therefore recommend that more studies with high quality methodologies, using randomized controlled trial designs be conducted especially in poor resourced communities.
Assessing the knowledge and opinions of registered nurses with reference to quality indicators in clinincal nursing within a tertiary health institution in Saudi Arabia
(Stellenbosch : Stellenbosch University, 2011-12) Pelser, Anya; Damons, Anneleen; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: The quality of care nurses provide to patients is done with the expectation that skills and knowledge of each registered nurse will result in quality patient care. Compliance statistics for quality indicators (level of service indicators) or (LSI’s) in the tertiary health care institution in Saudi Arabia varies, raising the following questions: “Do nurses understand the importance of quality indicators in clinical nursing and do they know how to use them to improve patient care?” No studies done on registered nurses’ knowledge and opinions of quality indicators could be found thus indicate the necessity of a research study to determinine the knowledge and opinions of registered nurses on quality indicators in clinical nursing in the tertiary healthcare system in Saudi Arabia. This is the focus of this research. The objectives of the study were: - To determine the current knowledge and opinions of the professional nurses regarding quality indicators in a tertiary hospital in Saudi Arabia - To identify the factors that influence identification of quality indicators in clinical nursing - To identify the need for a training program regarding nurse sensitive quality indicators Data was collected through a questionnaire handed to more than 200 nurses working in general wards and intensive care areas in a single Saudi Arabian hospital. Participants were selected through a randomised list. The registered nurses who have participated in the pilot study’s responses were excluded from the final data analysis. No patients were included or involved in the study. A descriptive design with a quantitative approach was applied to investigate the professional nurses’ knowledge and opinions on quality indicators (level of service indicators) or (LSI’s) in clinical nursing in Saudi Arabia. Research data suggests that the knowledge and opinions of registered nurses in the tertiary health care institution in Saudi Arabia are not supporting the expectations of quality assurance in clinical nursing. Registered nurses have strong opinions of quality indicators in clinical nursing but do not have the knowledge to support those opinions. Improving initial and recurring training on quality indicators provided to nursing staff with diverse backgrounds and high turnover was recommended as an essential component in using quality indicators to drive improvements in patient care.
Assessing the nurse's knowledge and opinions regarding the management of persons with physical disabilities in two healthcare settings in Kimberley
(Stellenbosch : University of Stellenbosch, 2011-03) Snyman, Johanna Hendrina; Damons, Anneleen; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: It generally is a problem for persons with disabilities to have barrier free access to buildings, which is their constitutional right. It is however, not only the physical facility that causes barriers for persons with disabilities but also the attitudes of the able-bodied persons. The aim of the study was to explore what opinions the nurses and persons with disabilities held in two healthcare settings in Kimberley with reference to the nursing care provided to persons with disabilities. To the researcher, it was important to gather the opinions of the nursing staff on how they saw persons with disabilities, but also to hear what they thought the problem areas in caring for persons with disabilities were. On the other hand, it was equally important to understand the persons with disabilities’ perceptions of the hospitals, nursing and what they saw as solutions to the problems. The objectives of the study were: • To determine what the opinions and knowledge of nurses working in two healthcare services in Kimberley are regarding the nursing management of persons with disabilities. • To determine what the opinions of persons with disabilities are in healthcare settings in Kimberley, with reference to the nursing care provided for persons with disabilities. Data was collected in two phases namely Phase 1 amongst the nursing staff in the private and state hospital in Kimberley and Phase 2 amongst the persons with disabilities. A list of staff members which was obtained from the Human Resource office in both the private and state hospitals were sent to the statistician Prof Kidd and who prepared a randomised list which was used for the participants in the study. The same process was followed when a list of all the people who are members of the Association for Persons with Disabilities (APD) and with the help of the statistician a randomised list was compiled from which the participants in the study were chosen. The design of this research is an explorative, descriptive non-experimental study with a quantitative approach, utilizing a structured questionnaire with closed and open ended questions. In this study it was found that the nursing staff was aware of the problems and barriers persons with disabilities encounter. The nurses, however, were aware of their own shortcomings. For example, the nurses identified the lack of training to equip them to assist the persons with disabilities during nursing care, while persons with disabilities also saw this as a problem. By addressing this shortcoming, nurses would be able to provide more holistic care. Recommendations were made based on the findings regarding the facility, perceptions, caregivers, procedures, doctors and the training of the nurses.
Assessment of attitudes related to the management of aggression and violence in four psychiatric hospitals
(Stellenbosch : University of Stellenbosch, 2011-03) Bock, Theresa Melodie; Pienaar, Abel J.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: The aim of this descriptive survey was to investigate the attitudes of mental health care providers with regards to the management of aggression and violence. The absence of scientific data describing the attitudes of nurses towards the management of aggression and violence motivated the researcher to conduct this study. The researcher undertook a descriptive survey to describe the attitudes of nurses towards the management of aggression and violence. The management of aggression and violence attitude scale (MAVAS) was administered to N92 nurses with different qualifications these nurses are employed in the acute admission units of four psychiatric hospitals in a province in South Africa. The results showed no significant differences in attitudes between the different categories of nurses in most of the questions. Enough evidence was gathered that indicated, compared to trained staff, staff without a qualification in psychiatric nursing science had found it difficult to calm patients down, had not understood the effect of the environment on a patient, had felt that patients should control their feelings and had lacked the perception of trained nurses, with regards to the effect of negotiation and poor communication on violent and aggressive mental healthcare users. These findings can make significant contributions towards the implementation of training programmes and policies to assist staff to deal with patient related aggression and violence. Furthermore the data generated can contribute towards future research in this field with subsequent expansion of skills programmes.
Assessment of bridging students’ access to and utilisation of resources to ensure safe medication administration in a private hospital group in Southern Africa.
(Stellenbosch : Stellenbosch University, 2018-03) Blanckenberg, Martha Magdalena; Eygelaar, Elsa; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY: Medication-related errors are a global concern, leading to unnecessary and avoidable harm to patients, families, healthcare workers and healthcare facilities. Errors can occur during the prescription, dispensing, preparation and administration of medication as well as during observation after administration of medication. The nurse responsible for administration of medication is the last person in this chain of events (prescription, dispensing and administration) to prevent any medication errors from reaching the patient, and the first person to detect any unwanted effects of administered medications. The purpose of this study was to determine 2nd year bridging students’ access to and utilisation of available information sources to ensure safe medication administration in a private hospital group in Southern Africa. Knowles’ assumptions of adult learners being self-directed and motivated to learn new information relevant to their personal lives or jobs were utilised in the conceptual framework for this study. A quantitative approach with a descriptive design in the format of a survey was applied to this study. The target population was initially (N=190) second year students. However, (n=87) participants were excluded as they were not available at the time of data collection. Therefore, an all-inclusive sample of (n=103) participants was included for this study. A self-administered questionnaire with Likert items and one open-ended question were utilised. This instrument was tested during a pilot test involving (n=15) participants. The results of the pilot test was excluded from the main study Data was entered into a Statistical Package for Social Sciences (SPSS) spreadsheet and was analysed by an experienced biostatistician from the University of Stellenbosch. Descriptive and inferential tests were applied for the data analysis. Results revealed that medication information resources are available in all selected settings. However, these resources were under-utilised in the clinical settings and also during training on pharmacology and medication. Some participants acknowledged that they had never consulted the pharmacist n=19 (18.4%), Monthly Index of Medical Specialities (MIMS) or South African Medicines Formulary (SAMF) n=5 (4.9%), other sources e.g. articles n=18 (17.8%), prescribing physician n=19 (18.6%) and medication package inserts n=8 (8%). Due to a growing number of medications available under different brand names, pharmacists frequently dispense a more economic generic equivalent of the prescribed medication. Nurses therefore need to consult medication information sources on a regular basis, to ensure that medication dispensed is the generic equivalent of medication prescribed. Results regarding the utilisation of different study methods and information sources for studies on pharmacology and medications also revealed that the majority n=65 (63.1%) of participants were not self-directed and preferred lectures for studies on these subjects. To conclude, the results of the final section referring to the knowledge of frequently administered medications showed that the majority of participants n=30 (88.24%), n=30 (88.24%) and n=32 (91.42%) respectively, had adequate knowledge of the classification of the following medications: Enoxaparin sodium (Clexane), Paracetamol intravenous infusion, (Perfalgen) and Tramadol (Tramazac). The researcher recommends that further studies with a qualitative design to explore the reasons behind the under-utilisation of available resources, should be conducted.
Attitudes and barriers to the use of the World Health Organisation’s surgical safety checklist at a specialized academic hospital in the Western Cape, South Africa
(Stellenbosch : Stellenbosch University, 2023-03) Davids, Vanessa Berenice; Cohen, Mary A.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
The Surgical Safety Checklist (SSC) of the World Health Organization (WHO) has been developed and adopted by the surgical fraternity worldwide to reduce patient mortality and morbidity in surgical operating rooms (ORs). Further to this, the SSC has been implemented in ORs to enhance communication and teamwork among the OR team members. The aim of this study was to investigate the attitudes and barriers to the WHO’s SSC in a specialised tertiary academic hospital in the Western Cape, South Africa. The degree of impact of the SCC on teamwork and safety, the support rendered by all categories of OR personnel in compliance with the SSC, the initiation of the SSC by all the OR personnel, and the barriers to the use of the SSC where investigated. The Donabedian Structure-, Process- and Outcome models underpinned the study. A self-administered online survey published by O’Connor et al (2013:2) was used to collect data with a six-point Likert scale. English, Afrikaans, and Xhosa versions were provided. The respondents’ demographics were included. The OR personnel employed in all the ORs of the hospital were requested to participate, namely the surgeons, the anaesthetists, the professional registered nurses, the OR trainee professional nurses, the registered enrolled nurses, the registered enrolled nurse assistants, the radiographers, and the cardiac-bypass technicians (N=111). Data was collected over four weeks. The response rate was (N=61). Ethical approval was obtained from the Health Research Ethics Committee of the University of Stellenbosch (Ref: S21/08/150) and the ethical research departments of the Western Cape Department of Health (Ref: WC_202110_034) and the hospital in which the study was conducted. Prof T. Esterhuizen (Stellenbosch University’s Department of Epidemiology and Biostatistics) was consulted for guidance on the analysis using IBM Statistical Product and Services Solutions (SPSS28©). Descriptive and inferential statistics were computed from the raw data and are presented in tables. The research findings found that compliance with the phases of the SSC is inconsistently implemented. It is recommended that this be remedied to enhance patient safety and to promote OR team cohesion.
Attrition of under-graduate male nursing students at a private nursing education institution in Gauteng
(Stellenbosch : Stellenbosch University, 2016-12) Hutchinson, Frances; Klopper, Ceridwyn; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH SUMMARY ENGLISH SUMMARY : The nursing profession forms the mainstay of the healthcare system in South Africa (SA). The profession needs a consistent supply of qualified nurses to deliver continuous safe quality care, as well as to replace those that leave the profession or retire from it. However, the nursing profession is losing nurses and prospective nurses during and after completion of a nursing course for a variety of reasons. Globally, the attrition rate of under-graduate male nursing students far exceeds the attrition rate of female nursing students. Despite men always having been in nursing, attrition of under-graduate male nursing students is poorly understood. No specific data is available regarding this phenomenon in SA. Therefore, understanding and exploring reasons for attrition among these male nursing students could potentially assist educators and nursing education institutions to generate and formulate strategies towards a higher throughput rate. The aim of the study was to explore and understand the reasons for the attrition of under-graduate male nursing students at a private nursing education institution. The objectives of this study were to: • Explore and understand the reasons for attrition of under-graduate male nursing students at a private nursing education institution in Gauteng. • Understand the challenges that male under-graduate nursing students encounter. • Identify the demographic factors that contribute to the attrition of male under-graduate nursing students at a private nursing education institution in Gauteng. A descriptive, phenomenological qualitative study design was applied. Eight semi-structured interviews were conducted by a trained interviewer in which participants shared their experiences of having been under-graduate male nursing students. An exploratory interview was completed with one of the participants. The data collected was evaluated for trustworthiness by measuring and assessing the data for credibility, conformability, dependability and transferability (Lincoln & Guba, 1985:290; Polit & Beck, 2012:175). Ethical approval was obtained from the Health Research Ethics Committee at the Faculty of Medicine and Health Sciences, Stellenbosch University. Institutional permission was also obtained from the management of the private nursing education institution in Gauteng. Informed consent was obtained from the former male nursing students. The data was analysed according to the five-step process as explained by Terre Blanche, Durrheim and Painter (2006:322-325). These five steps are: Step 1: Familiarisation and immersion; Step 2: Inducing themes; Step 3: Coding; Step 4: Elaboration; and Step 5: Interpreting and checking of data. Findings demonstrated that attrition of male under-graduate nursing students is a complex and multifactorial phenomenon that is poorly understood. Factors that contributed to their decision not to complete their studies were: academic inadequacies; attitude of students towards their studies; family (social) responsibilities; feelings of failure and regret; ill health or poor wellness; inadequate support (clinical and educational); inadequate knowledge of the programme; isolation in the workplace; long working hours and wrong career choice The recommendations to ensure higher throughput rate were given as follows: Current selection criteria to be re-evaluated; nursing as a career for males to be promoted; academic, remedial and emotional support systems to be improved; attrition rates to be monitored annually; and exit interviews to be conducted with students so that they can verbalise their intent to discontinue their training. The conclusion that was reached during this study was that attrition of under-graduate male nursing students is very complex and that it requires concrete systems in place to identify and assist at-risk male nursing students from discontinuing their studies.
An audit of discharged patient files at hospitals specialising in the management of tuberculosis
(Stellenbosch : University of Stellenbosch, 2011-03) Werely, Volene Joy; Stellenberg, Ethelwynn L.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: Background: In her clinical practice as nursing manager the researcher was concerned about incomplete and inaccurate documentation of patients diagnosed with tuberculosis (TB) which were compromising the management of these patients. The primary care nurses endorsed these concerns. Goals and Objective: The goal of this study was to audit nursing documentation according to the phases of the nursing process and the discharge planning of patients diagnosed with TB discharged from TB hospitals in the Western Cape. The objectives for the study were to determine whether the patients were adequately assessed and diagnosed, whether nursing care plans were formulated based on the assessment and whether they were implemented and evaluated according to the nursing process - including the discharged planning. Ethics approval was obtained from the Committee of Human Research Science at Stellenbosch University and permission was also obtained from the respective institutions. Methodology: A descriptive design with a quantitative approach was applied for the purpose of this study. The total population for the study was N=1768. A systematic random sample of 12% from each hospital was drawn: n=214, hospital A (n=142) and hospital B (n=72). Criteria included:  all adult patients older than 18 years  patients who were discharged between 01 January 2007 and 31st December 2007  all discharged patients from the two hospitals specializing in patients diagnosed with TB. Instrumentation: An audit instrument based on the objectives of the study was approved as the data collection tool. Guided by the proposed study a 10% (n=21) of the number of discharged patient files were drawn for the purpose of a pilot study. Reliability and validity was ensured through the use of experts in the field of nursing, research methodology and statistics. A pilot study was also conducted to support the reliability and validity of the study. Data collection: The researcher collected the data personally with the support of five trained field workers who only assisted at hospital B and was reluctant to assist at the second hospital. Data analysis: Data was analysed with the support of a statistician and expressed in frequencies and tables. Results: All phases of the nursing process showed a low compliance. Results showed that only n=90(42%) of the registered professional nurses checked and signed the initial assessment, furthermore only n=53(34%) showed that a recording was made of all referral documentation to the patient’s follow-up clinic. Recommendations: Recommendations based on the scientific evidence obtained from the study include the implementation of a quality assurance programme namely standardisation, auditing, case management of patients, education and training, rewarding of staff and further research. Conclusion: In conclusion guided by the research question “Are the audited discharged patient files at hospitals specialising in the management of patients with TB in the WCDoH compliant?” The researcher concludes that the discharged patient files are not compliant.
Awareness, knowledge and experiences of women regarding cervical cancer in rural KwaZulu-Natal, South Africa
(Stellenbosch : University of Stellenbosch, 2011-03) Ndlovu, Beauty Hlengiwe; Boshoff, E. L. D.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
ENGLISH ABSTRACT: Title: Awareness, knowledge and experiences of women regarding cervical cancer in rural Kwa- Zulu-Natal, South Africa. Background: Cervical cancer has been identified as the second most common cancer in women and contributes to the high mortality rate in women. Among all cancers in women, cervical cancer is rated the second most common cancer in women worldwide. In poorly resourced settings, access to services offering cervical screening is still a challenge and it is estimated that more than 50% of women in developing countries have never had a single screening test for cervical abnormalities. Purpose: The purpose of this study was to assess women’s awareness, attitudes and experiences regarding cervical smear testing and for cervical cancer in rural KwaZulu-Natal and to better understand factors influencing access to and utilization of cervical cancer screening services by rural women. Methods: The method employed was a descriptive study using a questionnaire to collect quantitative data. The sample consisted of 69 women aged 30 years and above, was taken from women who were enrolled in the on-going Microbicide Clinical Trial and attending follow-up clinic visits between July and August 2009. The primary outcome measure for the analyses was who has been screened for cervical cancer and this was assessed from the previous history reports of the women. The secondary outcome measure was to investigate knowledge and perceptions regarding cervical cancer and screening. Socio-demographic factors associated with having been screened were also explored. Results: Out of 69 women, only N=13 (18.8%) reported ever screening for cervical cancer. More than half of women who had never screened reported lack of information as a barrier to screening N=50 (71.4%). Older women aged 35-45, 45 and above were less likely to screen compared to women aged 30 to 34 years of age (OR: 0.06). Having an educational background seemed to increase the likelihood to screen, twice if a woman had primary education (OR 2.0) and almost three times (OR 2.67) if a woman had a secondary or a higher education. More than half of the respondents considered themselves at risk for cervical cancer N=42 (60.8%) and almost all showed a willingness to screen in the future N=64 (93%). Conclusion: Most of the women in this study had never been screened for cervical cancer in their lifetime as reflected by n=55 (82%) while only n=14 (18%) ever screened for cervical cancer. The results of this study cannot be generalised to the population due to the small sample size. However, there is need to facilitate comprehensive health education and the implementation of cervical screening programmes to target women in rural communities to contribute to the success of the cervical screening programme. The results of this study showed that 60% of respondents were informed by health care professionals on cervical cancer screening. Health care workers also should play a vital role in educating communities on cervical cancer and on the benefits for cervical cancer screening, through reaching all patients who utilise health care services with cervical cancer information and also communities through outreach programmes.
Barriers affecting the implementation of the World Health Organization Surgical Safety Checklist by staff in a private hospital in the Cape Metropole
(Stellenbosch : Stellenbosch University, 2019-04) Sauls, Peter Jonathan; Cohen, M. A.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
ENGLISH SUMMARY : Adverse events or near misses in the operating room (OR) is the result of negligence, medical malpractice and management that compromise patient safety which may result in wrong patient, wrong procedure and wrong site/side surgery. The World Health Organisation developed the Safe Surgical Checklist in 2008 as a systematic approach towards the improvement of peri-operative patient safety and reduces the risk of harm. The reliability of this process when implemented correctly has been widely published as invaluable. However, the researcher of this study, observed in clinical practice that adherence to the protocol is frequently inconsistent and may obstruct its efficacy. Thus, the aim of this study was to explore the OR staff’s perception of the implementation and efficacy of the checklist used in one private hospital in the Cape Metropolitan district of South Africa. A non-experimental, descriptive, cross-sectional quantitative approach using a case study design was applied. A self-administered structured questionnaire was used to collect data. Validity and reliability of the tool was assured by means of published research (Chronbach 0.70), a pilot study and consultation with nursing experts and a statistician. The total population was N=125 and included surgeons, anaesthetists and OR staff specifically involved in the surgical procedure. A response rate of 53% was achieved. Ethical approval was obtained from the Health Research Ethics Committee of the University of Stellenbosch and the institution’s ethical review board. Informed written consent was acquired from the participants. Data was analysed descriptively by the statistician and is presented in frequencies and tables. No inferential statistic calculations were performed as advised by the statistician. The analysis highlighted revealed that improper use of the SSC, a lack of training and a lack of management involvement may limit the benefits of the surgical safety checklist. In summary it is recommended to encourage continuous staff awareness campaigns to enhance the effective implementation of the SSC and promote a culture of safety among the surgical team.

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