Faculty of Health Sciences

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Clinical support to nursing community service practitioners in Ugu District, KwaZulu-Natal
(2018) Malunga, Ignatia Tandiwe; Basson, Petro Magdalena
Introduction: The shortage of skilled health professionals in public health care facilities is the main reason why compulsory community service was started by the South African government. The change in the disease pattern over the past two decades coupled with the mass exodus of health care professionals to overseas countries resulted in severe staff shortages especially in rural areas. Nursing community service practitioners (NCSPs) lack experience in dealing with complex clinical problems especially at primary health care level. They need experienced health professionals to offer clinical support to them. Aim of study: The aim of the study was to establish the degree of clinical support that is offered to NCSPs who are placed for compulsory community service within the Ugu district. Methodology: A qualitative study was conducted using an exploratory descriptive design. Purposive sampling was utilized to select eight NCSPs from a regional hospital and a community health centre. Semi-structured interviews were conducted and data was recorded verbatim for accurate analysis. Content analysis of data was employed where data was analyzed into meaningful themes. Results: The study revealed gaps in the clinical support offered to NCSPs. Lack of clinical support was reported more in the hospital than at the community health centre.·organizational problems such as lack of orientation, absence of in-service education and lack of proper rotation to different departments were some of the main concerns that were reported. Conclusion: Nursing community service practitioners need clinical support from experienced health professional to guide and teach them until they develop confidence.
A critical analysis of the implementation of obstetric management guidelines on common causes of maternal death, as applicable to midwives
(2021-05-27) Sewnunan, Asha; Puckree, T.; Basson, Petro Magdalena
Background Despite interventions by the United Nations which formulated the Sustainable Development Goals (SDGs), to replace the unmet targets of the Millennium Development Goals, the maternal mortality ratio (MMR) remains high in low-andmiddle income countries including South Africa (SA). The goal 3 of the SDG aims to achieve less than 70 maternal deaths per 100 000 live births by 2030, globally. The slow but steady decline in the number of maternal deaths in SA with 339 deaths over the last 2014-2016 triennium falls short of the SDG targets (National Department of Health, 2017). The institutional MMR for potentially preventable maternal deaths in South Africa was 83.3 over the last triennium. The management of obstetric emergencies in SA is based on the interventions laid out in the Essential Steps in Managing Obstetric Emergencies (ESMOE) which was adapted from internationally recognised obstetric management guidelines that have proven to reduce MMR’s if effectively implemented. The availability of a good clinical guideline is only part of the solution but ensuring effective implementation in the clinical environment is of greater significance to reduce preventable maternal deaths. Aim The aim of this study was to analyse the impact of the implementation of the ESMOE guidelines by midwives on the management of the common causes of maternal deaths. This included identifying gaps, challenges and successes of its implementation by the midwife at the different levels of health care facilities with the ultimate aim of developing a practice framework to implement the interventions into midwifery training, to improve relevant knowledge and skills in providing quality emergency obstetric care. Methodology A multi method data collection approach using quantitative and qualitative designs was implemented in four phases. This study was conducted in two of the eleven districts of KwaZulu-Natal. All level of hospitals and CHCs (eleven) in eThekwini (District A) and Ugu (District B) were chosen based on purposive sampling including the districts health system’s referral pattern. Data was collected by the researcher using self-designed data capturing sheets. Quantitative data was collected on resources and ESMOE training at all eleven selected facilities, as well as a retrospective chart review on a total of 17 maternal deaths that occurred over a specified period to assess the implementation of ESMOE interventions. Face to face interviews were conducted by the researcher with 14 ESMOE trained midwives to determine the barriers and challenges they experience that impedes successful implementation of the ESMOE interventions. To test for significant trends in the quantitative data, inferential statistics was applied, including Pearson’s correlation, ttests, Mann Whitney U test, Kruskal Wallis Test and Chi-square tests. Descriptive statistics included means and standard deviation as applicable. Relevant frequencies were represented in tables and graphs. Chi-square test of independence were used on cross-tabulations to see the significant relationships in resources at the various health facilities. The Kruskal Wallis test was used to compare specific variables across the different types of health facilities. The qualitative data was analysed using thematic content analysis. Finally, a Delphi Technique using ESMOE experts was employed to validate a practice framework to implement relevant ESMOE modules into midwifery training to enhance competencies of midwives and implementation of the guidelines. Results The findings of this study indicated that many barriers and challenges exist that prevent successful implementation of ESMOE interventions which would further reduce maternal mortality rates in SA. Of the 11 facilities chosen 45.5% (n= 5) were community health centres, whilst 54.5% (n=6) were hospitals. In phase two the results revealed that the CHCs and DH did not meet the criteria of being fully BEmONC compliant, which resulted in increased referrals to regional and tertiary hospitals. This was evident by the significant difference in normal vaginal deliveries at combination hospitals as compared to CHC (p=.037). An average of 2505 deliveries were conducted at combination/regional hospitals over a four- month period with averages of 1247 at a DH and 957 at a RH as compared to only 224 deliveries at a CHC. A general shortage of essential equipment was found across facilities. The CHCs had significant shortages of CTG machines and intravenous regulators. Staff with ESMOE training were insufficient to staff all the maternity units across the facilities. District A, the bigger of the two districts with eight facilities had a significantly lower number of ESMOE trained advanced midwives (n=11) as compared to District B with three facilities (n=12). The number of maternal deaths that occurred over January 2016 to April 2016 at three combination hospital were 82% (n=14) as compared to 12% (n=2) at the regional hospitals and only 6% (n=1) that occurred at a District hospital and no deaths at a CHC. Deaths due directly to hypertension were 41% (n=7), HIV was 6% (n=1), whilst 53% (n=9) were from other causes not directly relevant to this study. A significant number of relevant maternal deaths 54.5% (n=6) were due to delays in seeking treatment and sub-standard care. Transport delays to the health facility contributed to 18.2% (n= 2) deaths, whilst non-compliance to treatment and poor record keeping were found in 27.3% (n=3) of the relevant maternal deaths. The interviews with the midwives in phase three yielded results that were suggestive of inadequate ESMOE training, lack of updates, lack of regular skills and drills exercises that contributed to lack of knowledge and skills in providing effective EmOC. Other challenges in effectively implementing emergency obstetric care included poor morale due to staff shortages, heavy burdens of workload, lack of motivation and support that contributes to sub-standard care. In the final phase the researcher took these findings and built on this by developing an algorithm that shows the need to improve midwifery clinical competencies. This algorithm was taken further to develop a practice framework that proposes to implement ESMOE interventions into the basic midwifery training to improve relevant knowledge and skills in managing obstetric emergencies effectively within a collaborative team approach. Conclusion This study has shown that gaps in the implementation of ESMOE guideline interventions in the selected facilities in KZN could have contributed to sustained high MMR in the province. The midwives expressed the need for regular training and updates to continuously improve and maintain their knowledge, skills and competencies in providing effective obstetric care. The data allowed the development of an algorithm for improved emergency obstetric patient care and a practice framework for training of midwives to ensure optimal implementation of the guidelines.
The effects of information technology on the delivery of nursing care : a comparative study
(2016) Smith, Ursula Antoinnette; Basson, Petro Magdalena
Background In response to the advances made in information technology (IT), many healthcare institutions worldwide have integrated IT into their healthcare systems. Some hospitals in South Africa have changed to a computer- based system for the delivery of nursing care and nursing documentation, whereas others still use a paper-based system. The main aim of introducing IT in nursing is to improve the quality of nursing care. Research has shown, however, that IT can negatively impact on the quality of nursing care rather than improve it. This study compared the delivery of nursing care in two public hospitals in the eThekwini district in KwaZulu-Natal: one hospital which uses a computer-based documentation system for patient care and one hospital which uses a paper-based documentation system. Aim of the study The aim of the study is to determine the effects of IT on the delivery of nursing care as experienced by registered and enrolled nurses working in the hospital setting. Methodology A quantitative comparative descriptive design was used in this study. The delivery of nursing care in a hospital which uses a computer-based documentation system for patient care was compared with a hospital which uses a paper-based documentation system. The participants in this study were registered and enrolled nurses working in the wards and units of the two selected hospitals. Data was collected through the administration of a questionnaire (Appendix G) directed at the registered and enrolled nurses in the two hospitals involved in the study. One hundred percent of registered and enrolled nurses in the two selected hospitals at the time of data collection were approached and invited to participate in the study. One hundred and four participants for the hospital which uses a computer-based documentation system and 104 participants for the hospital which uses a paper-based documentation system were willing to participate in the study. Data was summarised and described using descriptive statistics such as frequencies, measures of central tendency such as means and modes, as well as means of variability such as range, variance and standard deviation. Graphs and tables were used to graphically represent the data. Data analysis was done using the Statistical Package for the Social Sciences (SPSS), version 22. Findings The effects of IT on the delivery of nursing care was measured by the quality of nursing documentation, the amount of time nurses have available for hands-on patient care and the reduction of medication errors. This study revealed that IT positively affected the experiences of nurses with the delivery of nursing care, with only a few exceptions. Information technology did not decrease the use of unauthorised abbreviations. It also did not improve the time nursing care was rendered being reflected in nursing documentation. Errors being made when entering patient data from, for example, cardiac monitors, intravenous pumps or results to investigations into the patient’s record were not decreased by IT. Furthermore, IT failed to improve nurses being alerted to drug interactions and to contra-indications of prescribed medications. There were a few instances where IT had a negative effect on the delivery of nursing care. Information technology increased the need to copy the same data when creating and updating a nursing care plan as well as documenting nursing care. Although the need for taking telephonic orders was reduced through the use of IT, it was found that when nurses in the hospital with a computer-based documentation system took telephonic orders, errors were made more often than when nurses in the hospital with a paper-based documentation system took telephonic orders.
Knowledge, perceptions and experiences of nurses towards family centred care in adult intensive care units
(2018) Ngcobo, Andile; Basson, Petro Magdalena
Aim and objectives: To explore and describe the knowledge, perceptions and experiences of nurses towards family centered care in adult ICUs. Background: Promoting quality patient care and family satisfaction is a current trend in health care systems. In addition, the identification of family needs has been used as a means to measure quality patient care in intensive care units (ICUs). Evidence shows that family centred care (FCC) is an essential approach to promote quality patient care through the recognition of family needs. Admission to an ICU creates increased stress levels for the patient and family members, thus nurses’ knowledge, skills and experiences are crucial during this time of a family crisis. Nurses in ICU are in the best position as critical bedside nurses to assess and evaluate strategies that can be used to minimise and prevent stressors that are caused by the critical illnesses and the ICU environment. Design: An exploratory descriptive qualitative design was used. Method: The study was conducted in a district and academic tertiary public hospital based in KwaZulu Natal. This hospital provides health care services to a diverse and cross cultural population. Two ICUs were used for data collection, namely, a surgical and a medical ICU. Nine nurses were purposively recruited from the two adult intensive care units. Data was collected using in-depth interviews with the assistance of an interview guide and audio recording. Qualitative content analysis was used to analyse the data. Results: Findings of this study indicated that nurses have an accurate and correct knowledge on the concept of FCC, thus identifying and recognising their roles and responsibilities with respect to the components that enhance FCC. However their perceptions towards facilitating family involvement in nursing care activities as part of FCC, revealed discrepancies due to mentioned factors that cause a hindrance in family involvement. Participants’ experiences has been shown to be positive in relation to family presence in ICUs, however findings indicated that participants restricted family visitation in adult ICUs is based on the existing policy pertaining to family visitation in ICUs. Consequently, nurses noted the great contribution a family makes towards patients’ well being in an ICU. Conclusion: The study findings showed that nurses in the selected ICUs require skills and training on the strategies that can be used to enhance and promote active family involvement in relation to nursing care activities in adult ICUs. Relevance to clinical practice: Training and further research for nurses has been proposed so as to better equip and encourage nurses with the necessary knowledge and skills required to improve family nursing in adult ICUs. In addition, the ICU environment including management, infrastructure and policy development can be adopted to allow such changes. Hence, nurses would need guidelines to be able to practice evidence based practices.
Knowledge, understanding and perception of parents towards the utilization of chiropractic treatment for paediatric patients in the Durban Metropolitan area
(2016) Cawood, Hughnique; Basson, Petro Magdalena; Maharaj, Praveena
INTRODUCTION: The utilization of complementary and alternative medicine (CAM) in the treatment of paediatric patients is increasing, especially the utilization of chiropractic treatment for children. However controversy exists regarding the reasons why parents may or may not choose to utilize chiropractic treatment for children. Parents are the gatekeepers to care as they consent to all treatment that is given to their children. Parents that have a lack of knowledge and understanding regarding chiropractic, as well as a negative perception regarding chiropractic treatment for children may be reluctant to choose chiropractic treatment as a treatment option. Both positive and negative opinions regarding chiropractic treatment have been identified in other populations in South Africa which emphasizes the need to explore the way parents feel about chiropractic treatment for children. A lack of knowledge and understanding of CAM has been identified as a reason for underutilization. Insight into the status of knowledge, understanding and perception of parents regarding chiropractic treatment for paediatric patients in the Durban Metropolitan Area equips the profession to better understand how parents view chiropractic treatment for children. AIMS AND OBJECTIVES: The main aim of this research was to explore and describe the knowledge, understanding and perception of parents regarding chiropractic treatment for paediatric patients. The outcomes of such a study can provide useful information which can serve as a baseline from which education and chiropractic treatment awareness can be built, as well as dispelling any misconceptions and myths regarding chiropractic treatment for children. RESEARCH DESIGN: An explorative, descriptive, qualitative research design was followed in this research. This research design was chosen in order to evaluate the knowledge, understanding and perception of parents regarding the utilization of chiropractic treatment for paediatric patients, within the Durban Metropolitan area. RESEARCH METHODOLOGY: Semi-structured interviews were conducted with participants of the Durban Metropolitan Area in order to determine the current knowledge, understanding and perception of parents regarding chiropractic treatment for paediatric patients within this area. Interviews were conducted with the participants until saturation was met, after which an additional five interviews were conducted. A total of 13 interviews were analyzed. The data was transcribed and coded by the researcher as well as a co-coder. NVivo software was utilized for the coding process. RESULTS: It was found that the participants had a lack of knowledge and understanding regarding chiropractic treatment for children. The participants felt that this lack of knowledge and understanding of chiropractic treatment for children left them unsure, resulting in the non-use of this form of treatment for their children. The participants were however not opposed to the utilization of chiropractic treatment for children; they felt fear and concern regarding chiropractic treatment as they felt they were uneducated regarding the outcome of the treatment, what the treatment would involve and the reasons why chiropractic treatment should be utilized for children. The participants mentioned that if they had increased knowledge and understanding they would feel more comfortable in utilizing chiropractic treatment for their children. The participants felt that they did not have the resources to learn more about chiropractic treatment and they showed interest in learning more about chiropractic treatment for children. Recommendations were made for further research and for the chiropractic profession regarding increasing the knowledge and understanding of parents regarding chiropractic treatment.
The knowledge, understanding and perceptions of professional nurses, working in primary health care clinics, about autism spectrum disorder
(2018) Williams, Neil Arnold; Sokhela, Dudu Gloria; Basson, Petro Magdalena
Background Abstract The Centers for Disease Control and Prevention (CDC) in the United States has found that more children than ever before are being classified as having autism spectrum disorders (ASDs) (Chiri and Warfield 2011: 1081). According to Matenge (2014: 1), ASD is a pervasive developmental disorder characterised by two essential features: a combination of impairments in social interaction and social communication, and restricted, repetitive, and stereotyped patterns of behaviour, interests and activities. Malcolm-Smith et al. (2013: 4) report that data on the incidence, prevalence, and impact of ASD in South Africa are almost entirely lacking. No epidemiological studies of ASD have been conducted in the country (Malcolm- Smith et al. 2013: 4). Diagnostic and intervention services, particularly at state level, are scarce (Malcolm-Smith et al. 2013: 4). Hence, those that are in place are heavily overburdened. Of particular concern for South Africa are research findings indicating that ASD is under-identified in low socioeconomic status communities, so in these contexts ASD often goes undiagnosed, or is diagnosed late (Malcolm-Smith et al. 2013: 4). Matenge (2014: 19) argues that there is, therefore, a need to assess the level of knowledge, understanding and the experiences of South African nurses regarding autism, as they are usually the first professionals that families of children with autism contact. Research purpose The purpose of this research was to determine the knowledge, understanding and perceptions of professional nurses who work in primary health clinics in eThekwini Health District, KwaZulu-Natal, regarding ASD. Research design A quantitative, non-experimental, descriptive research survey design was utilised. A self-reporting questionnaire was used to collect data. Sampling and sample size Simple random sampling was used to determine which clinics in the eThekwini health district would be part of the study. The sample size for the clinics was thirty four, of those thirty were eThekwini municipality clinics and four KwaZulu-Natal Department of Health clinics. These clinics were utilised and provided the 275 professional nurses needed. The sample was calculated with a margin of error and an alpha value of 0.05; the researcher needed a minimum of 275 respondents. The researcher selected the respondents utilising non-probability, convenience sampling. Data analysis Data was analysed with the assistance of the statistician, using SPSS version 22. Descriptive statistics were used to explore differences between or among groups (Grove, Burns and Gray 2013: 217). Inferential statistics are used to draw conclusions regarding the differences between groups in the population from which the samples are drawn and the relationship between the variables in the population (Morgan et al. 2015: 84). Both descriptive and inferential statistics were used to analyse data in this study. Conclusion and findings It was found that the average professional nurse working in a primary healthcare clinic has 65.8% knowledge and understanding of ASD. Of particular concern is that the majority of respondents 51% (n=141) did not know or understand that the child with autism loves routine which is a key symptom in making a diagnosis of ASD, which may lead to late, or missed diagnosis. Eighty eight percent (n = 242) of respondents felt that they would benefit from further training on the identification and diagnosis of ASD. It was also found that respondents that have completed the Psychiatric Nursing Science course were more knowledgeable about ASD and confident in diagnosing ASD and counselling parents on ASD and available ASD services in the community. Recommendations The researcher recommended that: Autism spectrum disorder to be included in the curriculum for nurses training and that regular in-service training be done to keep the professional nurses up to date with on new information related to ASD. It was also recommended that all children should be screened for ASD at 18 and 24 months at all PHCs in eThekwini district and that posters on the signs and symptoms of ASD should be displayed at primary healthcare clinics in full view of patients, parents and staff
A model for managing psychological distress in undergraduate nursing students in South Africa
(2018) Radana, Nolundi (Jevu); Basson, Petro Magdalena
This study has its origins in the researcher’s own observations and experiences as a lecturer in mental health nursing. Specifically, it concerns the challenges associated with providing support and enabling environment for students presenting with psychological distress whilst on training. There is a dearth of literature in the Sub-Saharan Africa region regarding the prevalence of psychological distress amongst undergraduate nursing students, and there are no clear measures in place regarding how to deal with the situation, due to the lack of empirical evidence, leading to delayed referrals of students presenting with psychological distress, further compounds the psychiatric morbidity and ultimately the burden of disease in the country including institutions of higher education, which led to the formulation of the research rationale. The aim of this research study was to develop a model for management of psychological distress in undergraduate nursing students. A quantitative, descriptive, contextual and theory-generating research design was used. A 120-item questionnaire, consisting of four scales, was utilised to collect data from 848 undergraduate nursing students in the sampled universities in three provinces. SPSS-23 was employed in data analysis and descriptive, inferential statistics were generated using regression analysis, exploratory and confirmatory factor analysis-tests, analysis of variance (ANOVA) and Pearson’s correlation tests. Results showed significant evidence of psychological distress mainly related to social dysfunction and anxiety. Some of the identified factors contributing to more stress whilst on training were financial and time constraints (M=3.2432, SD= .97390); and level of education (M=3.2230, SD=.82644). Female students seemed to be experiencing more stress (M= 2.8199, SD=.99374) related to interpersonal conflict than do males (M=2.6131, SD=.90309), t (833) =2.617, p=.009). Analysis showed that older age is associated with more stress due to interpersonal conflict (r=.096, p=.005), while younger students experienced more stress from education (r=-.104, p=.003). Results showed a significant positive relationship based on personality traits, with neurotic personality traits contributing to all four areas of psychological distress, as well as an emotion- based coping styles. An intervention guideline in the form of a model for Managing Psychological Distress was developed.
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 use of traditional medicine by caregivers for children under the age of five years as health seeking behaviour
(2017) Pillay, Shanitha; Basson, Petro Magdalena
Child health has always been a global priority for decades; however, despite efforts to reduce the child mortality statistics, 5.9 million children under the age of five years have deceased in 2015. IMCI guidelines are used to assess, classify and treat sick children under the age of five years, however, despite the prevalent use of traditional medicine for this age group of children, the guidelines excludes the use of traditional medicine, hence the tendency exists to ignore such questions being asked. It is this gap in the history taking pertaining to sick children seeking health care at clinics that the researcher has identified, therefore, this study is intended to highlight the use of traditional medicine in children under the age of five years. The researcher’s methodology is a quantitative descriptive study by means of a self- developed structured questionnaire which was handed out to 183 caregivers attending a Gateway Clinic and 324 caregivers at Paediatric Out – Patient Department. The total sample size was 507 caregivers of children under the age of five years. Data was analysed using SPSS version 17. The data derived from this study indicated that although most caregivers would take their sick children to the clinic for first line treatment, there are a significant number who would rather use home remedies or seek care from traditional healers. The study reveals that 28.5% of caregivers were found to be administering traditional medicine with conventional medicine and 17.4% would do so concurrently. Evidence also revealed that 75.7% of the caregivers would disclose the use of traditional medicine for their children only if nurses enquired about it. Recommendations arising from the study findings are that the IMCI guidelines should incorporate a classification chart for use by health care professionals in order to identify children who were treated by traditional medicine preferably as “RED” - requiring urgent attention and possible admission to hospital, in view of the potential threat to life. Since the IMCI guidelines are also a teaching tool in nursing curricula, the assessment of sick children using traditional medicine will be incorporated into the formal teaching of nurses. Key words used were Integrated Management of Childhood Illnesses, effects and use of traditional medicine on children.