Scielo RSS <![CDATA[Health SA Gesondheid (Online)]]> vol. 23 num. lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Challenges in implementing continuous support during childbirth in selected public hospitals in the North West Province of South Africa</b>]]> BACKGROUND: According to a Cochrane review, continuous support during childbirth increases the mother's chances of a vaginal birth without identified adverse effects. However, this evidence-based practice is not universally implemented. The objective of the study was to identify challenges encountered in implementing continuous support during childbirth in public hospitals in the North West Province of South Africa. METHOD: An explorative, descriptive and contextual qualitative approach was used. The data were collected during 2013 by conducting focus group interviews with 33 registered midwives who had worked in maternity units in three selected public hospitals in the North West Province for at least two years. RESULTS: Midwives identified challenges that negatively impacted the implementation of continuous support during childbirth at organisational and interpersonal levels. At the organisational level, challenges included human resources, policies and guidelines as well as the architectural outlay of the maternity units. The personal challenges related to communication and attitudes of nurses, patients and their families. CONCLUSIONS: Organisational and personal challenges had a negative impact on the provision of continuous care during childbirth. <![CDATA[<b>Neonatal chest image quality addressed through training to enhance radiographer awareness</b>]]> BACKGROUND: Diagnostic radiographers working in the neonatal intensive care unit primarily aim to produce an image of optimal quality using optimal exposure techniques without repeating exposures, to keep neonatal radiation dose to a minimum. OBJECTIVES: The aim of the study was to determine whether radiographers were producing optimal quality chest images and, if not, whether additional training could contribute to reaching this goal in the Free State Province of South Africa. METHODS: Neonatal chest image quality was determined in the Neonatal Intensive Care Unit by using a checklist based on and compiled from published guidelines to evaluate the quality of 450 randomly-selected images. Thereafter, a training programme was designed, based on the evaluation criteria of the checklist and image quality areas identified. The training also referred to positioning techniques that should be applied to ensure optimal image quality. After presentation of the training, 450 newly-produced neonatal chest images were evaluated. These images were selected through purposive sampling as this evaluation only included images of participating radiographers who completed the training. RESULTS: Image quality that showed significant improvement included a reduction in electrocardiogram lines superimposed on chest anatomy, a tendency to centre closer to thoracic vertebra four, and visible four-sided collimation on images. Image quality areas with no significant enhancement were the absence of lead markers and radiation shielding. CONCLUSION: The study has shown that a training programme has the potential to improve neonatal chest image quality. <![CDATA[<b>Challenges experienced by postgraduate nursing students at a South African university</b>]]> BACKGROUND: The increase in nurses enrolling in postgraduate programmes as well as the need to improve their completion requires academics to establish environments conducive for postgraduate studies. The challenges experienced during postgraduate studies have to be identified to establish conducive environments. OBJECTIVE: The objective of this study was to explore and describe the challenges experienced by postgraduate nursing students enrolled in postgraduate coursework and research programmes at a South African university. METHODS: An exploratory, descriptive and qualitative design was used. The study was contextual in nature. Purposive sampling was used. Fifteen honours, master's and doctoral students participated in the study. Data were analysed through qualitative content analysis and measures to ensure trustworthiness, and ethical implementation of the study were implemented. RESULTS: Three themes with categories were identified, namely personal challenges (i.e. finances, employment, family and accommodation), academic and institutional challenges (i.e. workload and time constraints, contact sessions, subject information and assessment) and research-related challenges (i.e. information literacy, supervisory relationship and supervisory structure and process. CONCLUSION: Institutional support addressing personal, academic and research-related challenges should be provided to enhance student experiences and completion. <![CDATA[<b>Prevalence and factors associated with low back pain among nurses at a regional hospital in KwaZulu-Natal, South Africa</b>]]> BACKGROUND: Low back pain (LBP) is a public health problem worldwide and is a common cause of work-related disorder among workers, especially in the nursing profession. Recruitment and retention of nurses is a challenge, and the nursing shortage has been exacerbated by the burden of occupational injuries such as LBP and related disabilities. The physiotherapy clinical records revealed that caseload of nurses presenting for the management of LBP was increasing. The prevalence and factors associated with LBP were unclear. METHODS: A cross-sectional study design with an analytic component was implemented. Data were collected utilising a self-administered questionnaire to determine the prevalence and factors associated with LBP among nurses at a regional hospital. Bivariate analyses were performed to determine the factors associated with LBP. RESULTS: The point prevalence of current LBP in nurses was 59%. The highest prevalence was recorded among enrolled nurses (54%), respondents aged 30-39 (46%), overweight respondents (58%) and those working in obstetrics and gynaecology (49%). Bending (p = 0.002), prolonged position (p = 0.03) and transferring patients (p = 0.004) were strongly associated with LBP. Nurses with more than 20 years in the profession reported a high prevalence of LBP. The prevalence of LBP was higher among the participants who were on six-month rotations (76%) compared with those on yearly rotation (16%). CONCLUSION: A high proportion of nurses reported to have LBP. Occupational factors are strongly associated with LBP. Education programmes on prevention and workplace interventions are required in order to reduce occupational injuries. <![CDATA[<b>Recognition of prior learning candidates' experiences in a nurse training programme</b>]]> Recognition of prior learning (RPL) in South Africa is critical to the development of an equitable education and training system. Historically, nursing has been known as one of the professions that provides access to the training and education of marginalised groups who have minimal access to formal education. The advent of implementing RPL in nursing has, however, not been without challenges. The purpose of this study was to explore and describe the experiences of RPL nursing candidates related to a 4-year comprehensive nursing training programme at a nursing education institution in Gauteng. An exploratory, descriptive and contextual qualitative research design was undertaken. The research sample comprised 13 purposefully selected participants. Face-to-face individual interviews, using open-ended questions, were used to collect data, which were analysed using Tesch's approach. Recognition of prior learning candidates experienced a number of realities as adult learners. On a positive note, their prior knowledge and experience supported them in their learning endeavours. Participants, however, experienced a number of challenges on personal, interpersonal and socialisation, and educational levels. It is important that opportunities are created to support and assist RPL candidates to complete their nursing training. This support structure, among others, should include the provision of RPL-related information, giving appropriate advice, coaching and mentoring, effective administration services, integrated curriculum design, and a variety of formative and summative assessment practices. <![CDATA[<b>Psychiatric nurses' experience of aggression amongst colleagues</b>]]> Psychiatric nurses run a high risk of being exposed to aggression. They experience aggression from clients as well as fellow colleagues. Aggression in the work environment has an overt negative psychological effect on the nurse. The purpose of this research was to explore and describe how psychiatric nurses experienced aggression amongst colleagues in the work environment. The study used a qualitative, exploratory and descriptive research design. Eight psychiatric nurses exposed to aggression by their colleagues in an academic psychiatric hospital in Johannesburg were purposively sampled to participate in this study. Data were collected by means of in-depth phenomenological interviews, observations and field notes until data saturation was achieved. The following question was asked: 'What is your experience of aggression amongst colleagues in the work environment?'. The findings indicated that the psychiatric nurses experienced aggression in a passive but harmful manner. The nurses experienced a suspicious and distrustful team environment. Limited support was experienced when colleagues and management did not acknowledge aggression and the nurses applied various coping and defence mechanisms when emotional stress and aggression were experienced. The aggression psychiatric nurses experienced had an effect on their experience on self, team work and providing services to patients. <![CDATA[<b>Cultural factors that influence the treatment of osteosarcoma in Zulu patients: Healthcare professionals' perspectives and strategies</b>]]> PURPOSE: International and national research regarding the discussion of cancer treatment across cultural boundaries is sparse. This study was conducted in the province of KwaZulu-Natal, South Africa, where healthcare encounters are largely culturally discordant; and this study focused on adult Zulu patients diagnosed with osteosarcoma. The purpose of this research study was to identify the cultural factors associated with discussing the different treatment options - and to explore healthcare professionals' responses to these cultural factors - from the healthcare professionals' perspective. METHODS: A qualitative, exploratory, descriptive and contextual research design was used. We conducted focus group interviews with professional nurses, allied health professionals and orthopaedic physicians. These three focus groups comprised a total of 23 participants, and interviews were conducted with each of these groups. We thematically analysed the interview transcripts, using Guba's model of trustworthiness to ensure rigour. RESULTS: We found that the factors, influencing treatment discussions in this cross-cultural clinical setting, included the meaning and the disclosure of cultural health beliefs. We identified strategies for responding to the cultural factors associated with amputation, namely timing treatment discussions, using support services, patient models and DVDs or videos. Strategies for responding to cultural and health beliefs that affect the treatment included initiating the cultural discussion, demonstrating an understanding of patients' cultural beliefs and liaising with family and cultural decision-makers wherever possible. CONCLUSION: Our findings emphasised healthcare professionals' reports of how patients can experience the discussion of culturally discordant treatment options as bad news. We recommend that the treatment discussion form an integral part of the guidelines for culturally competent communication with such cancer patients. <![CDATA[<b>Early childhood caries and dental treatment need in low socio-economic communities in Cape Town, South Africa</b>]]> BACKGROUND: Early childhood caries (ECC) is a particularly severe problem in low socio-economic communities which impacts the overall health and well-being of children. The extensive waiting lists for general anaesthesia and sedation services at the only tertiary dental care centre in the study area for the treatment of children with ECC were an indication of the extent of the problem. The true extent of the problem in this area was, however, not known. This information is crucial in order to plan and execute remedial measures. AIM: To assess the prevalence of oral and dental problems, especially ECC, in children under six years of age in the study population, and ascertain their need for dental treatment. METHODS: A cross-sectional survey of 659 children from selected schools and clinics in the study area was carried out between 2010 and 2013. RESULTS: A caries prevalence of 71.6% (472/659) was recorded. Of these, 67.5% (445/659) of children were in need of dental treatment. CONCLUSION: Over the last decade, there has been no improvement in the caries status of children in the study population, and no organised measures have been put in place to address this problem. Awareness needs to be raised so that governments, especially in developing countries, can take appropriate measures to alleviate this public health problem. Time and resources have to be invested in the education of all health professionals dealing with children, by raising their awareness of the early stages of the disease so that timeous referrals can be made. <![CDATA[<b>Increasing coping and strengthening resilience in nurses providing mental health care: Empirical qualitative research</b>]]> BACKGROUND: Research on coping and resilience is on the rise. However, there is a paucity of information addressing strengths, assets, competence or resilience that enable nurses to remain committed and cope in their profession despite the adversities they face in their working environment. OBJECTIVE: The purpose of this research was to explore and describe how to strengthen the resilience of nurses in a work environment with involuntary mental health care users. METHOD: An exploratory and descriptive research design, which is contextual in nature, was used. RESULTS: Narrative responses to two open-ended questions (How do you cope with providing mental health care to involuntary admitted mental health care users? and; How can your resilience be strengthened to provide mental health care to involuntary mental health care users?) yielded coping mechanisms and resilience strengthening strategies. CONCLUSION: Nurses caring for involuntary mental health care users are faced with challenging situations while they themselves experience internal conflict and have limited choices available to be assertive. To strengthen their resilience, the following factors should be taken into account: support, trained staff, security measures and safety, teamwork and in-service training and education. <![CDATA[<b>Process of development of a contemporary curriculum in advanced midwifery</b>]]> BACKGROUND: We identified the need for a contemporary curriculum to enhance education in advanced midwifery. Midwifery education needs to address the changing health needs, meet the requirements of the educational framework in South Africa and align with international trends. AIM: The aim was to describe the development of a contemporary curriculum for advanced midwifery. SETTING: The curriculum development took place at a South African university. METHOD: We used a situational analysis to create a contemporary curriculum based on the Research Development and Diffusion Model. RESULTS: We described the process followed for the situation analysis towards the development of a contemporary curriculum in advanced midwifery which is aligned with global trends. CONCLUSION: A situation analysis of the existing curriculum, the community and country's maternal and neonatal needs, educational framework and global trends should be used to develop the intended contemporary curriculum. <![CDATA[<b>An overview of the history and development of naturopathy in South Africa</b>]]> BACKGROUND: A huge growth in complementary and alternative medicine (CAM) took place in South Africa in the 1960s which paralleled what was happening in other parts of the western world. Naturopathy has been practised in South Africa for over 60 years, and the history of naturopathy is entwined with the broader history of CAM. No laws existed at that stage to regulate the curriculum, education and training of CAM practitioners. With the passage of time, various statutes were introduced which eventually led to changes in legislation and the establishment of a recognised training programme. Naturopathy became a legally regulated profession, the full history of which has never been documented. OBJECTIVE: This article explores the history of naturopathy in South Africa. METHOD: A two-phase qualitative research design was used, consisting of a document search and semi-structured interviews with key informants who were identified through a process of snowballing. Information collected from the naturopaths who participated in the interviews was triangulated with documentation uncovered in the archives of the Allied Health Professions Council of South Africa (AHPCSA) and other literature available. RESULTS: The result is a history of events which took place and reveals the effect of various legislations on the profession. CONCLUSION: Changes in the political system paved the way for changes in legislation which allowed for the registration and training of naturopathic practitioners. However, the lack of a functioning association and the small number of naturopathic graduates have hampered the growth of the profession, preventing it from becoming a significant contributor to the health care system. <![CDATA[<b>Methylphenidate and atomoxetine prescribing trends in children in the Western Cape Province of South Africa, 2005-2013</b>]]> BACKGROUND: There is paucity of data on methylphenidate and atomoxetine prescribing patterns in South African children. AIM: To describe the prescribing trends of these agents in children residing in the Western Cape Province. SETTING: South African private health secto.r METHODS: Longitudinal drug utilisation study on medicine claims data from 2005-2013, focussing on the number of patients and prescriptions per patient. RESULTS: The total number of patients increased by 29.5% from 2005 to 2013. The majority were boys (male:female ratio, 3.5:1), and between the ages of &gt; 6 and ≤12 years in 2005 and &gt;12 and ≤18 years in 2013. More than 75% of patients received methylphenidate or atomoxetine in the City of Cape Town Metropolitan municipality. Prescriptions for methylphenidate and atomoxetine increased by 45.5% overall from 2005 to 2013 (p < 0.001), with that for methylphenidate and atomoxetine increasing by 36.0% and 314.5%, respectively. The average number of annual methylphenidate prescriptions per patient increased from 3.96 ± 2.92 (95% CI, 3.69-4.23) in 2005 to 4.38 ± 2.85 (95% CI, 4.14-4.61) in 2013 (Cohen's d = 0.14) and for atomoxetine from 2.58 ± 1.86 (95% CI, 1.80-3.37) in 2005 to 4.85 ± 3.66 (95% CI, 3.84-5.86) in 2013 (Cohen's d = 0.62). CONCLUSION: Although the total number of patients and prescribing of methylphenidate and atomoxetine increased significantly from 2005 to 2013, a slight downward trend was observed in the mean number of prescriptions per patient per year from 2008 onwards. These prescribing patterns warrant further research.