Scielo RSS <![CDATA[Health SA Gesondheid (Online)]]> vol. 24 num. lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Perceptions of patients regarding diabetes-related health communication strategies in the Free State, South Africa</b>]]> BACKGROUND: This study researched the perceptions of patients diagnosed with diabetes concerning diabetes-related health communication strategies in the Free State province in South Africa. The prolongation and quality of life of patients diagnosed with diabetes are affected by lifestyle choices. An enabler of risk reduction is health communication which informs, influences and motivates individuals to adopted health-focused lifestyles. AIM: This study sought to describe the perceptions of patients regarding diabetes-related health communication strategies in the Free State, South Africa. SETTING: This study was carried out in primary health care centres and community health care centres within the Free State province in South Africa. METHODS: A qualitative, descriptive and exploratory research design was used in this study. Thirty-four patients diagnosed with type two diabetes for at least a year were purposively included in this study. Semi-structured interviews in Afrikaans, English, Sotho and Xhosa were conducted. Data analysis was through inductive reasoning and thematic analysis. RESULTS: The majority of the respondents were older women having been diagnosed with diabetes for more than 5 years, with at least primary school education and of diverse South African ethnicities. The main prompting questions operationalised the term 'perception', probing their feelings, experiences and knowledge of health-related communication strategies as presented by a variety of information sources. After recording interviews, data were analysed according to themes, categories and sub-categories. CONCLUSIONS: The study highlights factors that encourage patients to seek help and foster attitudes of compliance. Practical problems regarding the management of diabetes are underlined. The role of family, as well as the patient-caregiver relationship, in the acceptance and management of the disease is revealed. Societal perception of male symptomology is shown. The study offers information to stakeholders and health care workers for continued successful management of diabetes in communities. <![CDATA[<b>A model to promote the uptake of male circumcision as an HIV-preventive measure in high HIV and low male circumcision prevalence settings</b>]]> BACKGROUND: Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) remain the leading global burden of disease, especially in Southern Africa. As such, efforts to develop innovative preventive and curative measures continue to be a global priority. Of late, the World Health Organization recognised and recommended mass male circumcision (MC) as an adjunct HIV-preventive measure in 14 selected sub-Sahara African countries. However, despite efforts to promote the uptake of MC in these countries, the uptake remains significantly below set targets. AIM: The purpose of this article is to describe the process that was followed in developing, describing and evaluating a model to promote the uptake of MC as an HIV-preventive measure in high HIV and low MC settings. SETTING: The model is designed for all settings of high HIV and low MC prevalence. METHOD: A theory-generative, qualitative, exploratory, descriptive and contextual research design was used. The process involved four distinct steps, namely concept analysis, description of relationship statements, and description and evaluation of the model using the criteria of clarity, simplicity, generality, accessibility and importance. RESULTS: The central concept was identified as 'promote the uptake of MC', and three integral constituents were identified for the process, such as transforming men's mindsets about MC, facilitating accessibility and utilisation of MC services, and maintaining a supportive social system. These formed the basis for the model. CONCLUSION: The model provides a framework of reference for healthcare providers in promoting the uptake of MC as an HIV-preventive measure in high HIV and low MC settings. <![CDATA[<b>Rooibos herbal tea: An optimal cup and its consumers</b>]]> BACKGROUND: Rooibos types and forms and how prepared and flavoured influence the total polyphenol content and total antioxidant capacity (TAC). AIM: To denote an optimal rooibos cup as having the highest total polyphenol content and TAC, considering the different types, forms, preparation methods and flavourings and amounts (Phase 1), and determine the demographic, lifestyle and rooibos consumption characteristics of adult rooibos consumers, and the association of these characteristics with drinking the optimal cup (Phase 2). SETTING: Assays: Oxidative Stress Research Centre, Cape Peninsula University of Technology; Consumer survey: George area, South Africa METHOD: Phase 1 entailed determining the total polyphenol content (Folin-Ciocalteau method) and TAC (Trolox equivalent antioxidant capacity and ferric-reducing antioxidant power assay) of the prepared rooibos samples. For Phase 2, a developed, pilot tested questionnaire was used to profile adult rooibos consumers. RESULTS: Phase 1: the following samples delivered higher total polyphenol content and TAC: green (type), green leaves and powdered extract (forms), and sample steeped for 10 min or longer (preparation method). The identified optimal cup was sample steeped for 10 min or longer. Phase 2: a total of 308 respondents completed the questionnaire. Few consumed more than one rooibos cup per day (25.3%; n = 78) and the optimal cup (15.9%; n = 49). These latter respondents comprised those who steeped rooibos in a teapot (not a cup or mug) (p < 0.05). CONCLUSIONS: The optimal cup was identified as sample steeped for 10 min or longer. The rooibos consumers did not consume it sufficiently, nor steeped it long enough. <![CDATA[<b>Secondary school teachers' experiences related to learner teenage pregnancies and unexpected deliveries at school</b>]]> BACKGROUND: The incidence of learner teenage pregnancies can be reduced, provided that the major stakeholders, which include the Department of Education and the Department of Health, combine to address this issue. Despite the implementation of Life Orientation as a school subject, which focuses on sexual behaviour, health, decision-making, pregnancy risk, sexually transmitted infections and HIV and AIDS, the prevalence of learner teenage pregnancies at secondary schools remains alarmingly high. AIM: The purpose of this study was to explore and describe teachers' experiences of learner teenage pregnancies in secondary schools in a province in South Africa. SETTING: Secondary schools in KwaZulu-Natal. METHOD: A qualitative approach with exploratory, descriptive and contextual strategies was used in this research. Semi-structured interviews were conducted with teachers who had been selected through purposive sampling. Tesch's steps of systematic open coding were used to analyse all of the interviews. RESULTS: The results that emerged during the data analysis indicate that firstly, teachers' experiences of having pregnant learners in their classrooms are negative as these learners are frequently absent from school, perform badly and drop out of school. Secondly, teachers' experiences related to unexpected deliveries are coloured by their lack of the necessary skills and competencies to deal and their resultant insecurity. Thirdly, the teachers feel that they do not receive the assistance they need to deal with teenage pregnancies as well as unexpected deliveries. CONCLUSIONS: Collaboration between and continuous support from the Department of Health and the Department of Education are crucial if teenage pregnancies at secondary schools are to be handled with greater success. Support from health care personnel should include guidance on contraception and health campaigns should target both the teachers and secondary school learners. Furthermore, coping strategies for the teachers should form part of the preservice curriculum of teachers. <![CDATA[<b>The clinical environment</b><b>: </b><b>A facilitator of professional socialisation</b>]]> BACKGROUND: Competencies of health care workers, including nurses, often do not meet the health needs of populations. The clinical learning environment (CLE) is vital in socialising neophyte student nurses to display the desired competencies. Student nurses are however confronted with challenges, especially in the CLE, during this process. AIM: This article shares three validated guidelines to support professional nurses and nurse educators in facilitating appropriate professional socialisation of student nurses in the CLE. SETTING: The study was conducted in an 832-bed academic hospital and nine nursing education institutions (NEIs) that offered the nursing programme concerned in a province in South Africa. METHOD: A sequential, exploratory, mixed-methods study was conducted and qualitative data were collected from two purposive samples, consisting of seven focus group interviews and field notes. Five themes that emerged from the integrated data guided the instrument design to collect data quantitatively from 277 educators. Experts validated 10 guidelines to a set of criteria, which was developed combining all data. RESULTS: Qualitative and quantitative research evidenced that the CLE mostly did not support student nurses during professional socialisation. A few role models' behaviour was noteworthy, while student supervision was inadequate. The CLE was stressful, lacked in resources, marked by uncoordinated student placement, insufficient communication and inadequate preparation of student nurses. This evidence informed the development of the guidelines. CONCLUSIONS: The guidelines were (1) the empowerment of role models through reflective practice, (2) capacity building of professional nurses and nurse educators as clinical supervisors by means of intervention strategies and (3) adopting a multifaceted approach in the creation of a positive CLE. These guidelines could facilitate appropriate professional socialisation of student nurses. <![CDATA[<b>Perceived effectiveness of complementary medicine by mothers of infants with colic in Gauteng</b>]]> BACKGROUND: Infantile colic is a self-limiting condition, characterised by spasmodic, excessive and inconsolable crying without apparent cause. Although common, there is no widely accepted conventional treatment approach for colic. Complementary medicine is often promoted as an alternative therapeutic option for infantile colic; however, there is limited research available on its use, safety and effectiveness. AIM: The aim of this study was to determine the perceived effectiveness of complementary medicine by mothers of infants with colic by means of the Infantile Colic Questionnaire. SETTING: Mothers of infants who had colic were recruited from complementary medicine pharmacies, schools, baby clinics and various businesses in Gauteng, South Africa. METHODS: A quantitative-descriptive design was used whereby data was collected through a randomised, cross-sectional questionnaire. The research sample consisted of 152 participants (mothers), aged between 18 and 45 years, with one or more children who suffered from symptoms of infantile colic, who had used complementary medicine as a form of treatment. RESULTS: Results indicated that most participants made use of both complementary and conventional medicines for their infant's colic; the most commonly used complementary medicine products were homeopathic remedies, probiotics and herbal medicines. Some participants were, however, unfamiliar with the term 'complementary medicine', indicating a need for further patient education. CONCLUSIONS: The participants perceived complementary medicines as safe and effective forms of treatment for infantile colic. However, further, larger scale studies should be conducted to validate this finding. <![CDATA[<b>Experiences of women enrolled in a prevention of mother to child transmission of human immunodeficiency virus infection programme in Zimbabwe</b>]]> BACKGROUND: Prevention of mother-to-child transmission (PMTCT) programmes have been reported to reduce the rate of transmission of human immunodeficiency virus (HIV) infection by 30% - 40% during pregnancy and childbirth. The PMTCT transmission is achieved by offering HIV prophylaxis or initiating antiretrovirals to pregnant women who test HIV positive. Being aware of the experiences of these women will assist in planning and implementing the relevant care and support. The study was conducted in three phases. AIM: This article will address phase 1 which is to explore and describe the experiences of pregnant women living with HIV. SETTING: The study setting was a PMTCT site in a Provincial Hospital, in Zimbabwe. METHODS: The study design was qualitative, exploratory, descriptive and contextual. In-depth face-to-face interviews were conducted from a purposive sample of 20 pregnant women. Thematic data analysis was performed. RESULTS: Six themes emerged: realities of disclosure, a need for quality of life, perceived stigmatisation, inadequate knowledge on infant feeding, continuity of care, empowerment and support CONCLUSIONS: The study concluded that pregnant women living with HIV require empowerment and support to live positively with HIV. <![CDATA[<b>Experiences of student nurses regarding the bursary system in KwaZulu-Natal province, South Africa</b>]]> BACKGROUND: During 2010, the South African nursing education system was restructured, changing student nurses from having supernumerary status to being bursary holders. Changes with the introduction of this new bursary system included institutional factors and benefits that could be removed from the students, potentially hampering students' sense of belonging. AIM: This study aimed to describe the experiences of students receiving bursaries in KwaZulu-Natal (KZN) province and to make recommendations for improving the system to bursary providers, educational institutions and practical settings based on these students' experiences of the bursary system. SETTING: The experiences of student nurses regarding the bursary system are described within a specified setting comprising two nursing campuses in KZN. METHOD: A qualitative study design was used and seven focus group interviews were conducted with purposively selected participants, representing the target population of first-, second- and third-year male and female nursing students registered for the Diploma in Nursing (General, Psychiatric, Community) and Midwifery. RESULTS: Two main themes and eight subthemes were identified. The findings indicated that some of the bursary system's experiences were negative as opposed to students having supernumerary status. These experiences had negative socio-economic, psychological, clinical, academic and family impacts. Many concerns related to staff members' attitudes, shortages of nurses and service demands during students' clinical practice assignments. CONCLUSIONS: The bursary system was not viewed as being beneficial to students as they did not receive all the benefits from being bursary holders. Support in clinical and academic areas was lacking as they were considered to be employees during their clinical assignments. There is an urgent need to review the bursary system. <![CDATA[<b>Community pharmacists' knowledge, attitude and practices towards the use of complementary and alternative medicines in Durban, South Africa</b>]]> BACKGROUND: Atopic eczema (AE) is a common skin disease with an increasing worldwide prevalence, which has almost doubled over the last decade in South Africa. Many patients commonly explore complementary and alternative medicines (CAM) for AE and often initially seek advice from their local pharmacists. AIM: To explore the knowledge, attitude and practices amongst community pharmacists regarding CAM. SETTING: The study was conducted amongst pharmacists working in community pharmacies in Durban, South Africa. METHODS: During 2016, a cross-sectional study was conducted amongst 158 randomly selected pharmacists, of which 82 responded. Respondents were sent an email with a link to the questionnaire. Where logistically possible, questionnaires were hand-delivered RESULTS: The majority of respondents were male (n = 46; 56%), aged between 31 and 40 years. Despite most pharmacists not being familiar with various CAMs for AE, many (43%) recommend them, and 50% were amenable to referring patients to CAM practitioners. Despite 51% reporting that patients do ask about CAM for AE, 54% are not confident discussing or initiating discussions with patients. More than half of the pharmacists (55%) had no CAM training but believed it is essential for inclusion in the undergraduate pharmacy curriculum. Most were interested in broadening their knowledge on CAM and felt it would better prepare them in counselling their patients. CONCLUSIONS: The study demonstrated poor knowledge and communication about CAM for AE between pharmacists and patients, although pharmacists exhibited strong interests in learning more about CAM. There is a continuing need for education programmes and inclusion into undergraduate curricula that would assist pharmacists to advise patients on different types of CAMs. <![CDATA[<b>An assessment of infant medication administration and storage practices in selected communities in the Vhembe District of Limpopo Province, South Africa</b>]]> BACKGROUND: Effective infant medication administration and storage is a major public health challenge outlined by the World Health Organization. These challenges may be exacerbated in rural or limited-resource areas. AIM: The aim of this study was to investigate infant medication administration and storage practices. SETTING: This study took place in selected communities in the Vhembe District of Limpopo Province, South Africa. METHOD: Data was collected through 39 semi-structured interviews with infant caretakers and rural health workers. Interviews were recorded when permission was given by participants. Interviews were transcribed and coded using grounded theory and Tesch's model of data analysis. Themes were agreed upon through consensus discussions with the researchers and an independent coder. RESULTS: Six themes that affect current infant medication administration and storage practices in the Vhembe District were identified: access to infant healthcare, the role of health workers, the devices used in the administration of infant medication, reluctance of the infant to take the medication, storage and reuse of infant medication in the rural home and hygiene practices surrounding infant medication administration. CONCLUSIONS: Many factors were found to affect infant medication administration and storage practices in in the Vhembe District. Substantial evidence was found to suggest that the relationship between rural health workers and infant caretakers strongly influences these practices: a great amount of reliance and trust is placed in the health worker. Ensuring proper dosage of infant medication in the rural household arose as a main concern of participants. Reuse of medication in the home and home hygiene practices surrounding infant medication administration are areas of potential future research. This future research may further inform recommendations for infant medication administration and storage practices in the Vhembe District. <![CDATA[<b>Infection control recommendations for radiology departments in Malawi</b>]]> BACKGROUND: Guidelines for radiographers contain recommendations related to standard infection control precautions for healthcare-associated infections (HAIs) which are a major cause of mortality and morbidity in hospital settings. However, the implementation of these recommendations has proven to be a challenge in the Malawian radiology departments, as there are no national guidelines or radiology policies for infection control AIM: This article outlines the development of infection control recommendations that could facilitate sound knowledge and practices of radiographers regarding infection control. SETTING: Radiology departments in hospitals in Malawi. METHODS: The recommendations were developed based on data from a questionnaire that measured the knowledge and practices of 62 radiographers regarding infection control as well as data from the literature. The Florence Nightingale environmental theory was used as the conceptual framework for the recommendations, while its development was based on steps of the National Institute for Health and Care Excellence. For the format of the draft recommendations, an adapted version of the Appraisal of Guidelines for Research and Evaluation II tool was used. RESULTS: Issues identified from the responses to the questionnaire and literature resulted in seven sets of recommendations: hand hygiene, personal hygiene, personal protective gear and the use of appropriate equipment, safe handling of sharps and sharp containers, decontamination and cleaning, housekeeping and routine infection control practices.. CONCLUSIONS: The recommendations can be further reviewed and implemented to improve the implementation of infection control and to reduce HAIs in resource-constrained settings. <![CDATA[<b>The use of the Socratic inquiry to facilitate critical thinking in nursing education</b>]]> BACKGROUND: Critical thinking is a skill that nurse practitioners are required to have. Socratic inquiry can be used to facilitate critical thinking in nursing. Nurse educators seek methods to infuse into teaching content to facilitate students' critical thinking skills, and one of such methods is the use of Socratic inquiry as a teaching method. AIM: This article aims to explore and describe how Socratic inquiry can be used to facilitate critical thinking in nursing education. SETTING: This study took place in a nursing department at a university in Johannesburg. METHODS: A qualitative, exploratory, descriptive and contextual design was used. Purposive sampling was used to draw a sample of 15 nurse educators determined by data saturation. Miles, Huberman and SaldaƱa's methodology of qualitative data analysis was used. Lincoln and Guba's strategies for trustworthiness and Dhai and McQuoid-Mason's principles of ethical consideration were used. RESULTS: Three main themes emerged: the context necessary for Socratic inquiry, dispositions in Socratic inquiry and strategies to use in Socratic inquiry to facilitate critical thinking skills of students CONCLUSIONS: Socratic inquiry can be used both in education and practice settings to facilitate the use of critical thinking skills to solve problems. <![CDATA[<b>Health and educational achievement of school-aged children: The impact of anaemia and iron status on learning</b>]]> BACKGROUND: Anaemia is a common blood disorder in children and is known to cause complications such as lethargy and stress on bodily organs. Children from disadvantaged communities often fail to achieve their age-related potential with iron deficiency anaemia stated as a risk factor through causing inattentiveness and learning problems. Limited evidence exists for the adverse effects of iron deficiency anaemia on the developing child's brain from South African studies. AIM: The objective of this study was to determine the local prevalence of anaemia and iron deficiency and to examine their association with psychomotor development and school performance in school-aged children. SETTING: This study was conducted in a peri-urban disadvantaged community from KwaZulu-Natal, South Africa. METHODS: Children aged 6 to 8 years from KwaZulu-Natal were enrolled (n = 184). Three parameters of assessment were used: clinical data, biochemical data (haemoglobin levels and iron studies) and school performance (interviews with caregivers, teachers and the children). Anaemia presence and iron deficiency were the hypothesised mediating variables through which growth, development and school performance were influenced. RESULTS: A high point prevalence of anaemia (23.4%), iron deficiency anaemia (4.9%) and helminth infection (27.1%) was identified. Impaired cognitive assessment scores (20.7%) were prevalent in the children sampled. Behavioural problems (4.3%), poor memory function (4.3%) and impaired attention (1.1%) were of low prevalence. Anaemia and iron deficiency were both associated with impaired fine motor skills (p < 0.05). Anaemia was significantly associated with low cognitive scores (p = 0.01). Neither anaemia, iron status nor helminth infection significantly predicted school performance in the children sampled. CONCLUSIONS: The point prevalence of anaemia and iron deficiency among the sampled children was higher than the national prevalence. The sample size was however inadequate for drawing statistical conclusions about psychomotor development and school performance because of the low prevalence of the different outcomes that were examined. Practical challenges faced in conducting this investigation in rural South African schools were discussed. <![CDATA[<b>Self-managing individual wellness for the health professional: A somatology perspective</b>]]> BACKGROUND: Health professionals play a vital role in the stability and sustainability of any healthcare system. However, the well-documented long working hours, lack of wellness support structures, regular occurrence of burnout and low retention rates are concerning. AIM: The aim of this research study was to understand how a group of therapists self-manage their own individual wellness, to provide insight on how other health professionals, working in a demanding environment, could potentially address their individual wellness more effectively. SETTING: The research was conducted in a private room at the place of participant employment, in two metropolitans in Gauteng, South Africa. METHOD: Qualitative, explorative, descriptive and contextual designs were used within the paradigm of constructivism. Purposive sampling was used to select participants. Data were collected through in-depth interviews, field notes and reflective practices, and analysed through open coding. RESULTS: This study revealed disequilibrium between the theoretical knowledge and practical realities of therapists, and indicated that these therapists experience various personal obstacles that hinder the self-management of their individual wellness. CONCLUSIONS: Somatology therapists use various personal strategies that allow them to better self-manage their individual wellness. Individual wellness seems to be a personal phenomenon, indicating the need to self-reflect on personal perceptions of wellness, individual wellness obstacles and individual wellness strategies to effectively self-manage individual wellness. <![CDATA[<b>Traumatic incident reduction: A suitable technique for South African social work practice settings</b>]]> It is part of South African social workers' responsibilities to attend promptly and appropriately to victims of trauma. Overstrained and limited resources in communities influence the availability of debriefing services to traumatised community members. The purpose of this article was to elaborate on the traumatic incident reduction (TIR) technique as a suitable, short-term intervention technique for social work practice settings to address the impact of trauma effectively and timely. A discussion on TIR is presented by contextualising and defining mental health and post-traumatic stress disorder (PTSD) and elaborating on other practice approaches, therapies, techniques and models for addressing trauma and PTSD in social work practice. Given the excessive exposure to trauma experienced by the South African population, it is clear that further trauma counselling services are required and more effective ways must be found to empower communities to deal with trauma. Most approaches for the treatment of trauma in South Africa are specialised and resources are limited; therefore, many communities are excluded from these specialised services. The TIR technique fits appropriately within the ambit of the developmental approach, as embraced by the South African Department of Social Development. It will be beneficial if social workers, auxiliary social workers, community leaders, community volunteers, health care workers and lay counsellors are trained in the TIR technique. Concerted efforts are necessary to empower communities in supporting themselves and developing the necessary skills to address trauma. This initiative will be consistent with the developmental approach sanctioned by the Department of Social Development. <![CDATA[<b>Therapeutic play as a qualitative data generation method: A critical reflection</b>]]> BACKGROUND: Child-centred research requires researchers to develop research designs that will enable children to express their views in an ethical, appropriate and child-friendly manner and generate rigorous findings. These requirements challenge researchers to develop new methods to generate data with children, and the 'younger the child, the more intense the challenge'. AIM: The aim of this article was to describe and reflect on the use of therapeutic play as a data generation method by nurse researchers with young children in a child-centred qualitative, explorative, descriptive and contextual study using a multiple case study strategy SETTING: The study was conducted with young children attending an outpatient department at a public hospital in Gauteng. METHODS: Four young children, purposively sampled, participated in six sessions, each based on therapeutic play grounded in the work of Oaklander's Gestalt play therapeutic approach, facilitated by a nurse researcher. Critical reflection was made about the play therapeutic approach as a data generation method, based on its ability to generate useful data, its implications for data analysis and its ability to be child-enabling and child-centred. RESULTS: The play therapeutic approach, as a data generation method, is capable of generating useful data and amplifying children's voices in the process. CONCLUSIONS: The nurse researcher needs to be highly skilled in this approach as it requires the ability to implement the specific play therapeutic approach in a safe and skilful manner. <![CDATA[<b>Sense of coherence in Chinese and German students</b>]]> BACKGROUND: Mental health and salutogenesis are important topics at universities in China and Germany where heightening stress levels in students can be observed AIM: The aim of this article is to determine the profile of the salutogenic concept, sense of coherence (SOC), in Chinese and German students to provide new insights into SOC and mental health in Chinese and German students in higher education institutions (HEIs SETTING: The study was carried out at universities in China and Germany METHOD: A non-experimental, cross-sectional, survey-based research design and convenience sampling was utilised to obtain the sample (n = 356). The sample was derived at a selected Chinese (n = 255) and a selected German university (n = 101). Data were gathered using the 7-point Likert SOC dimension scales based on the Life-Orientation Questionnaire (LOQ) research instrument. The internal consistency levels of the SOC sub-scales were of acceptable levels. Descriptive and inferential statistics were used to analyse the data. Cronbach's alpha coefficients were calculated to determine the reliability of the LOQ research instrument. General linear modelling techniques RESULTS: The results showed the Chinese students scored significantly lower in all three SOC scales than the German students, with the largest practical significant difference in the sub-score of meaningfulness. In general, female Chinese and German students scored higher than their male counterparts. No significant differences could be found between German female and male, and Chinese female and male students CONCLUSION: Conclusions and recommendations for future research and HEI practice are provided <![CDATA[<b>Nurses' perspectives about communication with patients in an intensive care setting using a communication board: A pilot study</b>]]> BACKGROUND: Communication in the intensive care setting (ICS) is critical for both the patient and the medical staff to provide efficient care and thus alleviate possible patient adverse effects. Persons with complex communication needs are particularly vulnerable in ICSs and therefore require additional communication support AIM: This study focused on the perspectives of nurses about communication with patients with communication needs in ICSs using paper-based communication boards, namely the translated Vidatak EZ Board, before and after a training session SETTING: A 1650-bed public hospital with a 26-bed ICS in a semi-urban, low socio-economic area in South Africa served as the research setting METHODS: A quasi-experimental pre-test post-test group design with withdrawal and a control group was used. Data were gathered using a custom-designed questionnaire completed by ICS nurse participants recruited from a public hospital RESULTS: Responses of some nurses did not change in post-test 1, but their responses did change in post-test 2. Some of the nurses' perspectives changed, as expected from the pre-test to post-test 1. Nurses recommended specific adaptations to the communication board CONCLUSIONS: Most nurses agreed that communication is crucial in ICSs and that a communication board can be implemented; however, limited success was observed implementing the board following a short training. The inter-professional collaboration between nurses and speech-language therapists to provide optimal health care to patients in ICS is emphasised <![CDATA[<b>Comparison of patient satisfaction with pharmaceutical services of postal pharmacy and community pharmacy</b>]]> BACKGROUND: The growing drive in South Africa to contain medicine cost has seen the emergence of postal pharmacy as an alternative mechanism to dispense chronic medicines. Patient satisfaction with pharmaceutical services has received limited attention in South Africa AIM: The aim of this study was to compare the level of patient satisfaction with pharmaceutical services between postal and community pharmacies. SETTING: The research was conducted in the eThekwini Municipality, KwaZulu- Natal Province, South Africa in July and August 2014. METHODS: A cross-sectional quantitative study using a randomised, telephonic questionnaire survey was conducted. Selected land telephone numbers were called until a sample size of 250 community pharmacy participants and 125 postal pharmacy participants was obtained RESULTS: Nine hundred and five telephone calls were made to obtain a sampling frame of 375 (41.44%) respondents, 250 for community and 125 for postal. After adjusting overall satisfaction by removing financial satisfaction, there was no significant difference between satisfaction in the two groups (p = 0.471). Postal pharmacy participants reported a higher level of financial satisfaction (p = 0.001). Community pharmacy participants reported a higher level of satisfaction with counselling or explanation (p = 0.028) and less medicine wastage (p < 0.001. CONCLUSIONS: Patient satisfaction with pharmaceutical services provided by either community or postal pharmacy was not significantly different. However, community pharmacies tend to address patients' specific concerns more effectively. With the move to National Health Insurance, policymakers need to ensure that they provide high-quality pharmaceutical services and are more inclusive of community pharmacies to deliver quality care. <![CDATA[<b>Challenges of women refugees in utilising reproductive health services in public health institutions in Durban, KwaZulu-Natal, South Africa</b>]]> BACKGROUND: Reproductive health services are essential for everyone worldwide. In South Africa, the available literature does not address reproductive health as a full package for women refugees and their experiences. This study addressed women refugees in relation to reproductive healthcare services they receive from public healthcare facilities. AIM: The aim of the study was to document the day-to-day experiences of women refugees and uncover their challenges regarding utilisation of reproductive health services in public institutions of Durban, KwaZulu-Natal. SETTING: The study was conducted in eThekwini district, Durban, KwaZulu-Natal, and did not consider participants who are located beyond the above-mentioned city's borders. METHODS: A qualitative, descriptive design was used. A semi-structured interview guide was used to collect data through face-to-face in-depth interviews with eight women refugees. Thematic content analysis guided the study. RESULTS: Two major themes emerged: negative experiences or challenges, and positive experiences. The most dominant negative experiences included medical xenophobia and discrimination, language barrier, unprofessionalism, failure to obtain consent and lack of confidentiality, ill-treatment, financial challenges, internalised fear, religious and cultural hegemony, and the shortage of health personnel and overcrowding of public hospitals. The positive experiences included positive treatment and care and social support. CONCLUSION: The findings revealed that women refugees in Durban, KwaZulu-Natal, face many challenges such as medical xenophobia and discrimination in their attempt to seek reproductive health services in public healthcare facilities, making them even more vulnerable. Assisting women refugees with their reproductive health needs will remediate the challenges they face. <![CDATA[<b>A radiographic criteria checklist to determine reasons for errors, resulting in sub-optimal routine shoulder projections</b>]]> BACKGROUND: Optimal shoulder images must adhere to specific radiographic criteria before they are sent to the radiologist for reporting. Repeat x-rays of the shoulder may increase radiation exposure to the patient. AIM: The aims of this study were to determine whether images adhered to the required radiographic criteria for routine shoulder imaging and to identify possible reasons for non-adherence. SETTING: The study was conducted at an imaging department at a tertiary academic hospital in Bloemfontein, South Africa. METHODS: A criteria checklist compiled from literature was used to evaluate 578 routine shoulder images including anteroposterior (AP) with external rotation and lateral-Y (LAT-Y) projections. The checklist determined whether the shoulder images adhered to the criteria with regard to the anatomy included, positioning and technical factors, such as inclusion of the correct anatomical lead marker. Data were analysed using SAS Version 9.2 statistical software. RESULTS: More than 80% of the AP external rotation images included unnecessary anatomical structures owing to incorrect centring. In four out of seven criteria pertaining to positioning for AP external rotation imaging, at least 70% of images were performed incorrectly. Four-sided collimation was not present in more than 50% of both AP external rotation and LAT-Y images because of incorrect centring, while more than 30% of shoulder images presented with anatomical digital markers. CONCLUSION: The application of criteria required for shoulder imaging must be addressed at the participating imaging department to improve overall patient care. An in-service training session is recommended to enhance the radiographic technique with regard to routine shoulder projections. <![CDATA[<b>The use of clickers to evaluate radiographer's knowledge of shoulder images</b>]]> BACKGROUND: Conducting research can be daunting, although applicable methods can facilitate the process. A study was performed at an imaging department pertaining to the routine shoulder projections, namely the anteroposterior (AP) external rotation and lateral-Y (LAT-Y) projections. AIM: The aim of the study was to determine if radiographers (qualified, supplementary, community service) and student radiographers (second-year diploma, third-year diploma, second-year bachelor) use the radiographic evaluation criteria to evaluate the routine shoulder projections. SETTING: The study was conducted at an imaging department in the Free State province, South Africa. METHODS: Participants had to complete a survey by means of a questionnaire that was compiled in Microsoft Excel and converted to an audience response system known as clickers. The questions addressed aspects of shoulder imaging with regard to positioning, exposure factors and the evaluation of routine shoulder projections. The data were analysed separately using statistics software SAS Version 9.2. Fisher's exact test was used to determine statistically significant differences between students and radiographers RESULTS: More than 80% of students selected the AP (external rotation) X-ray image demonstrating optimal milliamperage per second whereas 43% of radiographers selected the correct image. More than 50% of radiographers and students indicated that a breathing technique and a short exposure time reduce motion during shoulder imaging. CONCLUSION: Using clickers eased the process of testing the participants' knowledge, and the results were available immediately after completion of the test. Clickers can contribute to and expedite the process of data analysis. <![CDATA[<b>The influence of language of instruction in the facilitation of academic activities: Nurse educators' experiences</b>]]> BACKGROUND: Learners in most South African higher education institutions are taught mainly through English for most of their academic lives, yet many of them enter these institutions with poor proficiency in this language of instruction (LOI). AIMS: The purpose of this article was to describe the experiences of nurse educators teaching in a 4-year comprehensive nursing diploma programme regarding the use of English as the LOI during academic activities. SETTING: The nursing college under study offers a 4-year comprehensive nursing diploma programme as well as post-basic diploma qualifications such as Primary Health and Midwifery Nursing Science and is situated in Gauteng, South Africa. METHODS: Twenty nurse educators were purposively sampled for in-depth individual interviews until data saturation and were requested to participate in the study. Tesch's protocol of qualitative data analysis was used and the themes that emerged were confirmed by an independent coder. Trustworthiness was ensured, and ethical considerations were adhered to. RESULTS: It emerged that English language incompetence (1) undermines learners' self-esteem; (2) hinders critical, reflective and creative thinking; (3) renders understanding difficult and that (4) nurse educators' incompetence in LOI hinders meaningful teaching. CONCLUSIONS: Recommendations were made to improve the use of the LOI because through language interdisciplinary knowledge and understanding are integrated, thus ultimately providing patients with comprehensive, holistic and transcultural healthcare. <![CDATA[<b>Group-based intervention in a primary healthcare setting was more effective for weight loss than usual care</b>]]> BACKGROUND: Literature and practice recommendations for lifestyle interventions to treat the increasing number of obese patients with non-communicable diseases (NCDs) or risk factors for NCDs attending resource-constrained public healthcare facilities in South Africa are scarce. AIM: To compare the impact of a facility-based therapeutic group (FBTG) intervention with usual care on weight in obese participants, with NCDs or risk factors for NCDs SETTING: Public healthcare facility providing primary healthcare services in Cape Town, South Africa. METHODS: A quasi-experimental study design was used where participants chose to receive weight loss treatment with either the FBTG or usual care interventions. Both interventions involved a one-on-one medical and dietetic consultation, while FBTG participants had six additional group sessions. Follow-up assessments took place 6 months after baseline. Socio-demographic variables, blood pressure, smoking status, weight, height, waist circumference, dietary intake, physical activity and stage of change were measured. RESULTS: Of the 193 obese adults enrolled, 96 selected the FBTG and 97 selected usual care. There were no significant differences at baseline between the two groups. Weight loss over 6 months was greater (p < 0.001) in FBTG (median [IQR] of −2.9 [−5.1; −0.3] kg) than usual care (−0.9 [−0.9; 0.6] kg) participants. At 6 months, more FBTG completers reached the weekly target of 150 min (p = 0.009), while both groups showed improvements in dietary intake. More FBTG (74%) than usual care (49%) participants were in the action stage of change by 6 months (p = 0.010). CONCLUSIONS: The group-based intervention was more effective than usual care in weight reduction as well as improvements in physical activity and stage of change.