Theses and dissertations (Health Sciences)

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Exploring factors influencing patient safety incident reporting by nurses in primary health care facilities in King Sabata Dalindyebo sub-district, Eastern Cape
(2024) Tolobisa, Patiswa; Naranjee, N.; Moonsamy, S.
Patient incident reporting is a crucial activity for enhancing healthcare standards and ensuring patient safety. Reporting patient safety incidents offers a comprehensive overview of incidents, detailing what occurred and how it happened, thereby facilitating learning and improvement. The study identified several factors influencing patient safety incident reporting, including a lack of understanding of incident reporting, a blame culture, minimal support by managers, a lack of training, inadequate facilities, a lack of feedback and debriefing, and the absence of rewards and punishment system. A necessary positive activity to improve health care standards and patient safety is patient incident reporting. Patient safety incidents provides a broad picture of what has happened, how it happened and facilitates learning. AIMS AND OBJECTIVES OF THE STUDY The aim of the study was to explore and describe factors influencing the reporting of patient safety incidents in primary health care facilities from nurses’ viewpoints. The objectives were to explore factors influencing PSI reporting behaviours in primary health care facilities in King Sabata Dalindyebo sub-district, OR Tambo District, Eastern Cape, to explore nurses’ knowledge and understanding of PSI reporting, and to provide recommendations for improving PSI reporting. METHOD In this study, a qualitative, exploratory, descriptive design assisted the researcher in exploring the factors influencing reporting of patient safety incidents by nurses in primary health care facilities. The target population was all 48 nurses permanently employed in the primary health care facilities in Mqanduli cluster, King Sabata Dalindyebo. A non probability, purposive sampling method was used to select the participants for the study, where 10 nurses were interviewed as determined by data saturation. Individual interviews were conducted using semi-structured interviews in English based on an interview guide which lasted for 15-20 minutes for each participant. The data was analysed using the thematic data analysis method. FINDINGS Five themes emerged from the thematic analysis, with 19 subthemes. Themes were: (1) Experiences of patient safety incident reporting, (2) contributory factors to patient safety incidents, (3) importance of patient safety incident reporting (4) barriers to PSI reporting, and (5) recommendations by participants.The reporting process for patient safety is influenced by a number of factors, such as nurses' reluctance to report for fear of punishment, the emphasis placed on unclear reporting systems, management behaviour, lack of training and education, and fear of lawsuits. The experience of implementing patient safety incident reporting necessitates support from management in the form of training and provision of resources, creating a positive work environment and safety culture by not punishing those who make errors, and rewarding those who report patient safety incidents. CONCLUSION The nurses at Mqanduli cluster, King Sabata Dalindyebo Sub-District had challenges regarding the reporting of patient safety incidents due to a number of issues tabled by the participants that were influencing factors to patient safety incidents that should have been prevented such as negligence. The participants proposed recommendations such as development through training of the nursing staff regarding how to report patient safety incidents and provision of resources.
Operationalisation and implementation experiences of the coronavirus disease 2019 (COVID-2019) response guidelines by nurse managers at selected private hospitals in KwaZulu-Natal, South Africa
(2023-05) Raghunath, Shamintha; Naidoo, Vasanthrie
ackground The Coronavirus 2019 (COVID-19) pandemic is a complex global public health crisis presenting clinical, organisational and system challenges. In any healthcare organisation, management and leadership are key components and enablers of change for the delivery of health services. The uncertainty of the pandemic, emotional turmoil in the face of death and dying together with unfamiliar directives and the adoption of unaccustomed work practices has posed challenges in the work environment. The challenges of responding to COVID-19 national imperatives, such as response guideline adherence and preparation of vaccination rollouts has demanded meticulous coordination and control by all Nurse Managers. Furthermore, the role and functioning of the Nurse Manager as a change agent, during the pandemic, has undoubtedly determined the effectiveness of the COVID19 risk mitigation strategies at an operational level. Aim of the study The aim of the study was to explore the experiences of Nurse Managers regarding the operationalisation and implementation of the COVID-19 Response Guidelines. Methodology The study was guided by a qualitative research design, using an exploratory, descriptive approach. This approach enabled the researcher to explore the experiences of Nurse Managers regarding the operationalisation and implementation of the COVID-19 Response Guidelines. Data was gathered through individual interviews from the study population based at two hospitals of different private hospital groups in KwaZulu-Natal, South Africa. Data saturation was achieved after interviewing 13 participants. The study was guided by Carl May’s Normalisation Process Theory and Creswell’s six steps of data analysis was utilised for content analysis and themes in this study. Findings Findings revealed three (3) major themes and associated sub-themes. Whilst management and leadership of Nurse Managers were constantly challenged, they appeared to lead by example, often placing themselves at the frontline. This study has revealed that leadership, during the pandemic in the health care sector, moved beyond just the recognition of the leader as a change agent. Their behaviors and approaches led these nurse leaders to effectively improvise and respond to the crises in the field of health care service delivery during disaster management. Furthermore, their shared vision, commitment and resilience ensured effective navigation during the COVID-19 pandemic.
Guidelines for pedagogical practices to ensure research preparedness of undergraduate nursing students : a case study of institutional perspectives and practices
(2023-05) Padayachee, Poovanesthree; Naidoo, V.; Sibiya, Maureen Nokuthula
Background Rigorous, reliable and credible research has proven to be the success of policy and decision - making amongst world leaders and policy- makers in the provision of healthcare. In science, research is known to be a diligent and systematic inquiry into nature and society and both these exist to validate and refine the existing body of knowledge and generate new knowledge. Progress in meeting students' educational needs with available resources requires institutional commitment to ensuring greater associations between teaching and research activity. Reputations for teaching and research are also becoming interwoven as globally, universities position themselves competitively and define their particular and distinctive approaches to knowledge transfer and knowledge acquisition. Since teaching and research are widely regarded as the two core activities of academics, it is vital to understand that the relationship between them should be enhanced by policy and pedagogical practices under respective institutional circumstances. Aim The aim of this study was to explore the perspectives, practices, and experiences of lecturers involved in research teaching, facilitation and supervision of research projects and proposals in the undergraduate (UG) nursing programme. Ultimately, the aim was to develop a set of guidelines, based on the findings of the study, that may assist to inform and advise all parties of the multiple dimensions and constraints of research methods and pedagogy. It is envisaged that this would be offered in a constructive and meaningful way. Methodology This study utilised a qualitative, exploratory, descriptive design to collect data and to understand and explore pedagogical practices as well as institutional perspectives and practices of teaching and supervising of the research module in the relevant nursing programmes. This method of inquiry assisted the researcher to gain insight and in - depth understanding of the phenomena of the study. The findings of the study, in the form of the themes that emerged, aided in the development of guidelines for pedagogical practices that would serve to ensure research preparedness of UG Nursing students and to enrich the knowledge capacity of postgraduate (PG) students in nursing research. Findings The findings of this study revealed a gap in the facilitation and teaching of research in UG Nursing education. While there has been a shift towards a research and inquiry-based learning environment across the global higher-education sector, international and local institutions are trying very hard to increase UG students’ exposure to research and inquiry, both inside and outside of the classroom, through various individual, departmental or institutional initiatives. However, the success of these initiatives is still highly dependent upon individual academics’ perceptions of the teaching and research relationship and the development of their own academic identity. The participants indicated that there was a lack of structured guidelines to inform the relevant stakeholders on the delivery of the research module in UG Nursing. The findings also revealed that the timeframes for teaching and facilitation of the research module were insufficient. The researcher developed a set of guidelines that would serve to inform and guide lecturers and facilitators of research education in UG Nursing to ensure optimum retention of knowledge capacity of research in PG Nursing and aid post–graduate students to embark on research studies with greater ease
Experiences of nurses regarding the implementation of an ideal clinic project in eThekwini district, KwaZulu-Natal
(2022-09-29) Zulu, Mthokozisi; Ngxongo, Thembelihle Sylvia Patience
Introduction and background: The key outcome of the vision of the government of South Africa is the attainment of a long and healthy life for all of its citizens. In view of this, the government of South Africa has embarked on a phased implementation of the National Health Insurance (NHI) scheme in order to achieve universal health coverage so that there is access to appropriate, affordable efficient quality health care services for all. The South African National Department of Health introduced the ideal clinic realisation and maintenance programme in response to the current shortages of primary health care (PHC) services and to lay a strong foundation for the implementation of NHI. The programme includes an algorithmic approach to change all the PHC clinics to adhere to the NHI standards. An ideal clinic is defined as a clinic with good infrastructure, adequate staff, adequate medicine and supplies, good administrative processes, and sufficient adequate bulk supplies. Nevertheless, reports indicated that the target of achieving the 50% mark in selected vital areas such as staffing, resource allocation and utilisation, by 2019, has not been achieved. Aim and objectives of the study: The aim of the study was to explore and describe the experiences of nurses regarding the implementation of an ideal clinic project in eThekwini district, KwaZulu-Natal. The objectives of the study were to: explore and describe the experiences of nurses regarding the implementation of an ideal clinic project; determine the perception of nurses regarding the implementation of an ideal clinic project, describe the support, if any, received by the nurses during the implementation of the ideal clinic project; determine the challenges if any experienced by nurses during the implementation of an ideal clinic, and to determine the strategies that can be instituted to facilitate successful implementation of an ideal clinic project. Method: A qualitative research design which using an explorative and descriptive approaches was employed with Donabedian’s structure, process and outcome model used as a theoretical framework to guide the study. Data were collected through one-on-one semi-structured interviews with the nurses who were involved in the implementation of ideal clinic projects in the 18 PHC clinics under Prince Mshiyeni Memorial Hospital between the 16th September 2020 and the 26th October 2020. Findings: The six major themes that emerged from the interviews included structural limitations, processes involved in the running of the clinic, support offered to the PHC clinics, communications and staff involvements, staff training and administration of an ideal clinic project all of which interfered with successful implementation of this project. Conclusion: The findings of the study confirmed that the nurses who are the drivers of this ideal clinic project have many negative experiences and perceptions which make it difficult to fulfil the ideal clinic project standards. It was evident from the study that there was little support offered to them when it came to ideal clinic implementation. However, the study also revealed that there are a number of actions that could be instituted in order to bring the ideal clinic status to fruition such as improvement of infrastructure, training of staff and addition of more staff and instituting staff involvement in the ideal clinic project as a whole. Recommendations: Recommendations are made in relation to policy formulation and implementation, service delivery, nursing education and research. The recommendations made from this study were based on the strategies that can be instituted to improve the ideal clinic implementation. The recommendations were made with special reference to the employment of more trained staff, improvement of infrastructure of the facilities, staff involvement in the implementation of any programmes and adequate support of staff members regarding the implementation of the ideal clinic project.
Transcultural self-efficacy among student nurses in a private nursing school
(2022-05-13) Somoloo, Premalena; Razak, Ayisha; Pillay, Padmini
Introduction Transcultural nursing is a formal area of study and practice focused on comparative holistic culture, care, health, and illness patterns of people with respect to differences and similarities in their cultural values, beliefs, and ways of life with the goal of providing culture-congruent, competent, and compassionate care (Leininger 1991:29). Nurses are in a unique position to embrace transcultural nursing as it impacts on health care practices and their ability to communicate effectively with patients. An increase in cultural competency usually leads to culturally congruent customary care to accommodate patients’ beliefs, cultural values, lifestyles, practices, and traditions (Schmidt 2015:3). Aim of the study The aim of the study was to explore the level of transcultural self-efficacy among student nurses at a private nursing school in Durban, Kwa Zulu-Natal. Methodology A qualitative research design with an ethnographic, descriptive narrative was used in this study. Ethnography is a qualitative paradigm which involves the description of cultural behaviour, cultural patterns and experiences and shared meanings that shape behaviour (Polit and Beck 2018:220). Data collection comprised of four stages, participant observations, focus group interviews, diaries, and reflections. Focus group interviews were analyzed using Leininger and McFarland’s (2002: 97) four phase data analysis. Findings The research questions were answered regarding the competence, skills, self-efficacy, and confidence of student nurses in their experience of nursing patients from diverse cultures. Three major themes, sub-themes and categories emerged, and these were awareness and self-awareness of culture, respect, caring and self-efficacy. The results showed that nurses believed that the more knowledge and experience they were exposed to, the more skilled and competent they would become, and this would enable them to be confident and efficient in delivering transcultural nursing care.
The relationship between occupational coping self- efficacy of nurses and patient satisfaction scores in a private hospital in KwaZulu-Natal
(2022-05-09) Ghirdhari, Sewak; Orton, Penelope Margaret; Naidoo, Vasanthrie; Orton, Penelope; Naidoo, Va
Brief background of the Study The nursing profession is faced with high levels of work stress such as staff shortages, poor working conditions, lack of resources, job dissatisfaction and burnout, which tends to compromise quality of care rendered to patients. The research was to establish whether nurses’ occupational coping self- efficacy had any association with patient satisfaction scores. Aim of the study The aim of this research was to describe any relationship between occupational coping self- efficacy of nurses and patient satisfaction scores in a selection of wards in a private hospital in KwaZulu-Natal. Methodology A quantitative, cross-sectional, descriptive survey design was used to conduct the study. Data was collected using questionnaires. The quantitative data was analysed statistically. The statistics used included descriptive statistics such as frequencies, measures of central tendency and measures of dispersion. Factor analysis was used to explore the structure of the data and in order to test for significant trends in the data, inferential statistics were applied. Results The results revealed that although the recording was done objectively, the outcome was not positively achieved due to the unforeseen covid-19 pandemic. Results were skewed due to all wards unable to participate in research. The nurses completed their tool but unable to meet the expected patient ratio. Sample realization of 100% was achieved.
Achievement of clinical learning objectives by midwifery nursing students : an appreciative inquiry
(2020-06-19) Ngcobo, Ntombifuthi Pearl; Sokhela, Dudu Gloria
INTRODUCTION ABSTRACT Clinical practice in nursing education is vital as it provides a platform for nursing students to correlate what they have been taught in the classroom during a theory session and apply it in the real-life situation. There are specific objectives which midwifery nursing students must achieve in order to meet the required competency levels as prescribed by the South African nursing education regulating body the South African Nursing Council (SANC) (South Africa 2005: 5). Some of the learning objectives that have to be achieved by midwifery students are: demonstrate competency in the assessment, planning and implementation and evaluation of nursing care for a woman with an uncomplicated and complicated pregnancy, labour puerperium and normal new born baby. The country has embarked on an endeavour to improve maternal and child health as expressed in the Sustainable Development Goals (SDGs) (United Nations 2015: 3). Goal number 3 of the 17 SDGs is to ensure healthy lives and promote well-being for all at all ages. This goal is relevant to this study as competent midwives are the foundation for maintaining mother and child well- being during pregnancy, labour, delivery and post-delivery, yielding healthy families, communities and the nation. AIM OF THE STUDY The purpose of the study was to describe how an Appreciative inquiry (AI) was used to determine strategies used towards achievement of the midwifery clinical learning objectives. METHODOLOGY An AI approach with a qualitative descriptive research design was used to determine the strategies used by the lecturer and midwifery clinical instructors and students in the University of Technology (UoT) selected for this study and students towards achievement of their clinical learning outcomes. Purposive sampling was used to select the lecturer, midwifery clinical instructors in the UoT, hospital midwifery clinical instructors and students. Six professional nurses from the clinical facilities, one lecturer from the UoT, seven clinical instructors from the UoT and eleven midwifery nursing students were purposively sampled and interviewed. RESULTS The results of the study revealed that there were several factors that assisted students to achieve their midwifery clinical learning objectives. These included supervision by clinical instructors who modelled good behaviour, had no favouritism and were always willing to teach students. Collegiality and co-operation between lecturers, clinical instructors in the UoT and facility clinical instructors assisted in bridging the gap between theory and practice resulting in students achieving their midwifery clinical learning objectives. Staff development was cited as a key factor in ensuring that students are taught relevant and up-to-date knowledge. CONCLUSION Collaboration of all stakeholders in coordinating and planning student training is essential for the production of well-rounded, competent and confident students. In this collaboration, it is imperative to acknowledge that everyone’s contribution is equally important for good outcomes of students.
Pre-Exposure Prophylaxis (PrEP) therapy in KwaZulu-Natal : an implementation guideline
(2020-04) Moodley, Roxann; Orton, Penelope Margaret; Basson, Petro Magdalena
Why is pre-exposure prophylaxis (PrEP) therapy not implemented as a preventative treatment against human immunodeficiency virus (HIV) in primary health care (PHC) clinics in the KwaZulu Natal province? PrEP therapy has proven to be an effective preventative strategy against HIV (Bekker et al. 2016) which could be used to decrease the number of individuals becoming infected with the Human Immunodeficiency virus. This study explores the perceptions of PHC nurses, PHC doctors, PHC support staff and individuals at high risk of contracting HIV regarding PrEP therapy in KwaZulu Natal public clinics. The Department of Health (DoH) has published guidelines for the implementation of PrEP therapy; however, the guidelines have not been adopted and used by the primary health care staff in the clinics and has resulted in pre-exposure prophylaxis therapy not being implemented in the clinics to individuals at high risk of contracting Human Immunodeficiency Virus. This research employed a qualitative framework using the grounded theory approach of Charmaz (2014). There are ten districts in KwaZulu Natal with a total of 588 primary health clinics that are accessible to the public. Five primary health care clinics were used in this research study with fourteen participants that were interviewed. Using semi-structured interviews with research participants across primary health care clinics that were purposefully selected, the researcher was able to develop an implementation guide for the department of health (DoH) pre-exposure prophylaxis therapy guidelines. The implementation guide that has been developed can be used by health care providers to assist with the implementation of the department of health pre-exposure prophylaxis therapy guideline in the primary health care clinics. The results of the study showed that educating the public and the individuals at high risk of contracting HIV can create awareness and demand for pre-exposure prophylaxis therapy. Participants expressed their concern regarding the implementation of pre- exposure prophylaxis in the primary health care clinics as there may not be enough resources to successfully implement and monitor individuals that want to take pre- exposure prophylaxis therapy.
The relationship between work stress and years of experience amongst male mental health care practitioners within tertiary psychiatric hospitals in the uMgungundlovu Health District
(2020-11-30) Smith, Mark Albert; Orton, Penelope; Adams, Carol
Psychiatric nursing is a speciality within the nursing profession in which the nurse directs his or her efforts to the early identification of and intervention in emotional problems and work towards the promotion of mental health. In addition, effort is placed on the prevention of mental disturbances, and follow - up care to minimize long - term effects of mental disturbance (Uys and Middleton, 2014:18-20). According to the South African Depression and Anxiety Group (SADAG) (2015), 16.5% of South Africans suffer from common mental disorders like depression and anxiety. Even more concerning is the fact that 17% of children and adolescents suffer from mental disorders. Mental illness adversely affects the person’s brain and at times requires long-term treatment. In this study a total of 158 male mental health care nurse practitioners’ were questioned and a quantitative non- experimental cross sectional descriptive survey was conducted to describe male mental health care nurse’s practitioners’ years of experience in psychiatric nursing and the levels of stress of these nurses was identified. The researcher also determined whether there was any relationship between the stress reported and the years of experience amongst male mental health care nursing practitioners in tertiary psychiatric hospitals in Pietermaritzburg.

Theses and dissertations (Health Sciences)

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