Scielo RSS <![CDATA[Health SA Gesondheid (Online)]]> http://www.scielo.org.za/rss.php?pid=2071-973620170001&lang=en vol. 22 num. lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Young families become mindful of their possibilities through the appreciation of their family life</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100001&lng=en&nrm=iso&tlng=en Young families, as viewed through a multi-generational lens, provide the environment in which children can be nurtured and socialised. The purpose of the research is to explore and describe how the parents and grandparents of young families appreciate their family life. A qualitative, exploratory, descriptive and contextual multiple case study design was used to conduct the study. Purposive sampling methods were applied to select families according to the sampling criteria, each family representing an individual case study. Appreciative inquiry interviews were conducted with the young parents and available grandparents, during which the participants were asked four open-ended questions. Data collection was enriched by means of reflective letters to participants, collages created by the young parents, and the researcher's field notes and journal inscriptions. The data collected from each individual case study was analysed and then synthesised by means of a cross-case analysis. A cross-case validation report was compiled. The themes and categories that emerged from the data were discussed. The research study concluded that when young families embarked on a journey of discovering their strengths and potential in the larger family system, they creatively envision and discovered the possibilities to transform their destiny in a purposeful and constructive way. <![CDATA[<b>Best practice during intrapartum care: A concept analysis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100002&lng=en&nrm=iso&tlng=en RATIONALE: Best practice is an abstract word open to different interpretations. The definition of best practice depends on the context. PURPOSE: The purpose is to explore the meaning of the concept of best practice within the context of intrapartum care. METHOD: The concept of best practice was analysed using Wilson's method of concept analysis. Dictionaries, a thesaurus, and an internet search were employed. References of journals were used to identify extra sources. Data saturation was reached at 117 definitions and uses of the concept of best practice. The definitions and uses of the concept of best practice listed in column one were read repeatedly. Common and similar patterns of words were highlighted. Grouping of common attributes and connotations occurred in column two and further deductive analysis and synthesis occurred in column three where derived essential attributes of the concept of best practice were categorised. RESULTS: Three broad categories emerged, namely (1) Values as antecedents of best practice; (2) A three-phased interactive integrative cyclic process of best practice; (phase one: awareness; phase two: need analysis and interactive process; phase three: consolidation); and (3) Desired outcomes of best practice, with resultant theoretical definition of the concept best practice during intra-partum care. Theoretical validity was attained through 117 sources used. RECOMMENDATION: The results of the concept analysis of best practice should be used to develop a model to facilitate best practice during intra-partum care <![CDATA[<b>The conceptualization of family care during critical illness in KwaZulu-Natal, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100003&lng=en&nrm=iso&tlng=en INTRODUCTION: In recent years there has been a movement to promote patients as partners in their care; however this may not always be possible as in the case of critically ill patients, who are often sedated and mechanically ventilated. This results in family members being involved in the care of the patient. To date, this type of care has been represented by three dominant theoretical conceptualizations and frameworks one of which is family centered care; however there is a lack of consensus on the definition of family centered care. Hence the objective of this study was to explore the meaning of family care within a South African context. METHODOLOGY: This study adopted a qualitative approach and a grounded theory research design by Strauss and Corbin (1990). Participants from two hospitals: one private and one public were selected to participate in the study. There was a total of 31 participants (family members, intensive care nurses and doctors) who volunteered to participate in the study. Data collection included in-depth individual interviews. Open, axial and selective coding was conducted to analyse data. Nvivo data analysis software was used to assist with the data analysis. FINDINGS: The findings of this study revealed that family care is conceptualized as togetherness, partnership, respect and dignity. CONCLUSION: During a critical illness, patients' families fulfil an additional essential role for patients who may be unconscious or unable to communicate or make decisions. FMs not only provide vital support to their loved one, but also become the "voice" of the patient. <![CDATA[<b>Strengths of families to limit relapse in mentally ill family members</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100004&lng=en&nrm=iso&tlng=en BACKGROUND: Relapse prevention in mental health care is important. Utilising the strengths of families can be a valuable approach in relapse prevention. Studies on family strengths have been conducted but little has been done on the strengths of family members to help limit relapse in mental health care users. The purpose of this research was to explore and describe the strengths of family members in assisting mental health care users to limit relapses. METHODS: A phenomenological design was followed. Purposive sampling was used and 15 family members of mental health care users who have not relapsed in the previous two years participated. Individual unstructured interviews were conducted. Data were analysed using thematic analysis. RESULTS: Four main themes were identified, namely accepting the condition of the mental health care users, having faith, involving the mentally ill family members in daily activities and being aware of what aggravates the mentally ill family members. CONCLUSIONS: Family members go through a process of acceptance and receive educational information and assistance from health professionals. In this process families discover and apply their strengths to limit relapses of mentally ill family members. It is important that family members caring for mentally ill family members are involved in their treatment from the onset, and that they are guided through a process of acceptance. <![CDATA[<b>Nurses perceptions about their behavioural counselling for HIV/AIDS, STIs and TB in eThekwini Municipality clinics KwaZulu-Natal, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100005&lng=en&nrm=iso&tlng=en BACKGROUND: HIV and AIDS, sexually transmitted infections (STIs) and tuberculosis (TB) are common co-infections in South Africa, and constitute major public health problems. Nurses have frequent contact with HIV positive and TB co-infected patients, their counselling behaviour being influenced by knowledge about counselling as well as their beliefs, attitudes and perceptions about barriers to counselling. PURPOSE: The purpose of the survey was to assess the knowledge, attitude and beliefs of nurses about behavioural counselling for HIV and AIDS, STIs and TB (HAST) in three areas of the eThekwini Municipality. RESULTS: This was a quantitative descriptive cross sectional study, with stratified sampling being used to select 87 nurses from 24 PHC facilities who completed self-administered questionnaires. The most significant factors associated with the knowledge, attitude and beliefs of nurses about counselling behaviour were their age and level of education. Nurses were well informed about counselling behaviour (mean scores 4.1/5). However, the potential barriers to implementing effective counselling behaviour included their negative perceptions about counselling in HAST. CONCLUSION: There is an urgent need for further studies to explore barriers to counselling behaviour and how these can be addressed by the nurses and their managers. <![CDATA[<b>Is community-based electrocardiography education feasible in the early phase of an undergraduate medical curriculum?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100006&lng=en&nrm=iso&tlng=en Accreditation authorities expect medical schools to increase their teaching standards and civic engagement, despite limited resources. The aim of this study was to investigate the feasibility of community-based (CB) electrocardiography (ECG) instruction in semesters 4 and/or 5 of the undergraduate MBChB programme at the University of the Free State in Bloemfontein, South Africa. A literature review and 34 structured interviews were employed, using a mixed-methods QUAN (+qual) research design. Regarding the preclin-ical phase, 18 interviewees strongly supported community-based learning (CBL) and 21 strongly supported task-based (TB) CBL. Responses were more conservative regarding the practicability of TB CBL. Twenty-two interviewees supported preclinical phase ECG-specific CBL. There was more support for implementing CB ECG in the clinical phase than in the preclinical phase. Challenges identified included finances, transport, personnel availability, clinic space, curriculum time constraints, student and driver absenteeism, and ethical aspects. Solutions for the preclinical phase included combining electrocardiography with other CBL tasks. Many interviewees supported preclinical phase TB CBL, although several factors determine its feasibility. Availability of human and other resources and curriculum time significantly impact CB ECG learning. Solutions necessitate additional location-specific research. <![CDATA[<b>Adherence challenges encountered in an intervention programme to combat chronic non-communicable diseases in an urban black community, Cape Town</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100007&lng=en&nrm=iso&tlng=en BACKGROUND: Chronic non-communicable diseases (CNCD) have become the greatest contributor to the mortality rate worldwide. Despite attempts by Governments and various non-governmental organisations to prevent and control the epidemic with various intervention strategies, the number of people suffering from CNCD is increasing at an alarming rate in South Africa and worldwide. OBJECTIVES: Study's objectives were to explore perceived challenges with implementation of, and adherence to health messages disseminated as part of a CNCD intervention programme; to gain an understanding of participants' expectations of CNCD intervention programmes;, and to explore the acceptability and preference of health message dissemination methods. In addition, participants' awareness of, and willingness to participate in CNCDs intervention programmes in their community was explored. METHODS: Participants were recruited from the existing urban Prospective Urban Rural Epidemiology study site in Langa, Cape Town. Focus group discussions were conducted with 47 participants using a question guide. Summative content analysis was used to analyse the data RESULTS: Four themes emerged from the data analysis: practical aspects of implementation and adherence to intervention programmes; participants' expectations of intervention programmes; aspects influencing participants' acceptance of interventions; and their preferences for health message dissemination. The results of this study will be used to inform CNCDs intervention programmes. CONCLUSIONS: Our findings revealed that although participants found current methods of health message dissemination in CNCDs intervention acceptable, they faced real challenges with implementing and adhering to CNCDs to these messages. <![CDATA[<b>The motivational needs of primary health care nurses to acquire power as leaders in a mine clinic setting</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100008&lng=en&nrm=iso&tlng=en Motivation is a process that influences and directs behaviour in order to satisfy a need. It links with goal 3 of the sustainable development goals that focus on ensuring healthy lives and promoting well-being at all ages. Motivation of nurses is important in the primary health care environment of, for instance, mine settings; since low levels of motivation among Primary Health Care (PHC) nurses could have a negative effect on the achievement of high standards in health service delivery. The study was conducted within the theoretical framework of McClelland's Acquired Motivation Theory which consists of three basic needs, - the need for achievement, the need for power, and the need for affiliation. One of the research questions posed was "What are the motivational needs of PHC nurses to acquire power in the workplace at mine clinic settings?" A quantitative, explorative, descriptive design was followed. The accessible population in this study was PHC nurses (N = 30) working at 13 mine clinics, that also served as the total sample. A 7 point Likert scale was used in a self-administered structured questionnaire that was developed from a literature review. Ethical considerations were adhered to and respondents gave written informed consent. Data was analysed by using descriptive and inferential statistics. The Mann-Whitney test compared the mean ranks and a p-value of p < 0.05 was indicative of a significant difference between male and female groups. Validity and reliability principles were applied during the entire research process. The results indicated that PHC nurses needed acknowledgement, organisational responsibility, strategic planning and promotion, as well as support. Significant differences between gender were not found in relation to the need to acquire power. <![CDATA[<b>Experiences of South African multiparous labouring women using the birthing ball to encourage vaginal births</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100009&lng=en&nrm=iso&tlng=en The article explores the experiences of South African multiparous labouring women on their use of the birthing ball during the first stage of labour. The authors used a qualitative research approach using unstructured audiotaped interviews as the data collection method and data were collected over a period of one calendar month. The sample for the study were women who were six hours to six weeks post-delivery, had at least one child already, used the birthing ball, were on no medication, and had delivered a live infant. The sample consisted of twelve purposively selected participants, two of whom were used for the pilot study. The data analysis method was Data Analysis Spiral. The authors made use of an independent coder to assist with coding the data and three major themes were identified. The results revealed that the labouring women experienced the birthing ball as a useful labour tool, as shortening the labour process and as empowering them during labour. <![CDATA[<b>Perceptions of student nurses on the writing of reflective journals as a means for personal, professional and clinical learning development</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100010&lng=en&nrm=iso&tlng=en BACKGROUND: Reflective journals are used by the students to voice their views on the daily activities during clinical placement. Reflective journals are aimed at helping the student to observe and record as many facts about daily practice as the student finds relevant. Reflective journal writing can therefore be used as a tool to evaluate that clinical learning is actually taking place and what challenges students are experiencing which may influence their learning. Findings by Harris (2006:460-461) are encouraging that through journaling students will develop ability to identify and analyse their difficulties, make suggestions for solving problems and ask and pursue questions on their own. Some of the participants confirmed improved values clarification, self-valuing and personal growth. Bulman & Schutz (2008: 172) recommends journal writing for recording processes the student observe, copy and internalize in her journey towards professional development. OBJECTIVES: This study aimed to determine student nurses' perceptions of reflective journal writing as a means for personal, professional development and clinical learning development. METHOD: A quantitative and descriptive survey was conducted in September 2013. Forty participants were recruited from second year student nurses of a University of Technology in uMgungundlovu District of KwaZulu-Natal. Purposive convenience sampling strategy was used. A structured questionnaire was designed by the researcher from literature reviewed. The questionnaire was piloted and modified, then used after permission had been granted by the Ethics Committee of the university concerned. The Statistical Package for Social Sciences (SPSS 17) programme was used for data analysis. RESULTS: Results indicated that the participants generally experienced writing of reflective journals to be a valuable tool enhancing personal development, professional growth and clinical learning. A significant number (n = 24/60%) confirmed that they improved in making proactive decisions and taking on the spot corrective actions; 52% (n = 21) of the participants were empowered to examine their attitudes and perspectives to a given situation and 55% (n = 22) participants increased in active involvement and ownership of their learning. <![CDATA[<b>The quality of life of HIV-infected and non-infected women post-caesarean section delivery</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100011&lng=en&nrm=iso&tlng=en There is a dearth of literature on the postnatal quality of life (QoL) of women. This study aimed to determine to QoL of HIV-infected and non-infected women post-caesarean section delivery. This prospective, longitudinal and comparative study was conducted at four public hospitals in KwaZulu-Natal. The participants were followed for six-months post-delivery and the QoL was measured using the SF-36 and the pelvic floor impact questionnaire (PFIQ-7). The results showed that the QoL of women were negatively affected post-operatively with the HIV-infected group scoring lower over the six-months. Understanding postpartum QoL problems is essential in efforts to provide effective comprehensive care. <![CDATA[<b>Supply chain solutions to improve the distribution of antiretroviral drugs (ARVs) to clinics in rural areas: A case study of the QwaQwa district</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100012&lng=en&nrm=iso&tlng=en This article serves as a case study based on research that was performed in the QwaQwa district in the Free State Province where the distribution of ARVs to the regional Manapo hospital, as well as between the hospital and its peripheral clinics, was interrupted and inconsistent due to problems in the supply chain. An unreliable and interrupted ARV supply chain creates the risk of virus reactivation and eventual patient mortality. The objectives of the study were to explore the problems experienced with the ARV distribution practices at the Manapo hospital, and to recommend ways in which the distribution of ARVs can be improved so that patients can receive an uninterrupted supply. The nature of the topic researched dictated the use of mainly the quantitative research method. The main problems identified include: Wrong and no uniform practice of ordering stock by the hospital and the clinics; lack of reliable, structured transportation from the depot to the hospital; as well as poor inventory management and poor overall communication. Recommendations to address the problems include: Implementing a supply chain planning and design process; improving inventory management and warehousing practices; implementing more effective and reliable distribution and transportation processes; as well as improving supply chain coordination and overall communication. <![CDATA[<b>A creative analysis of the role of practice development facilitators in a critical care environment</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100013&lng=en&nrm=iso&tlng=en Practice development focuses on methods to address the quality of care and advance healthcare practices. The role of practice development facilitators to address challenges of delivering evidence-based person-centred care in the critical care environment was determined by using a nominal group technique. Eleven participants from public and private healthcare services reached consensus on seven clusters: theory-practice application, facilitation of learning, increasing collaboration, effective communication, facilitation of change, time management and role modelling. The clusters were visually represented as a hot air balloon. Competence as facilitators is of vital importance to ensure knowledge translation with the aim to improve quality. <![CDATA[<b>Change in patient nutritional knowledge following coronary artery bypass graft surgery</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100014&lng=en&nrm=iso&tlng=en INTRODUCTION: In order to reduce coronary artery disease (CAD) risk, moderate physical activity should be combined with other lifestyle modifications, such as proper nutrition, to have a dramatic impact. This necessitates educational and preventative measures, which should begin in childhood and continue throughout life. AIM: The aim of this study was to measure the change in nutrition knowledge of coronary artery bypass graft patients by implementation of a lifestyle intervention programme. METHODS: The Hawkes and Nowak Nutrition Knowledge Questionnaire (1998) was administered to 18 coronary artery bypass graft (CABG) patients to assess the change in nutrition knowledge. RESULTS: Significant improvements were noted in the nutrition knowledge score (18.9 ± 3.4 -23.2 ± 4.5; p = 0.000). Although all components measured exhibited improvements in knowledge, cholesterol reduction knowledge (5.3 ± 1.8-7.2 ± 1.8; p = 0.0066), low fat food knowledge (3.8 ± 2.3-5.1 ± 2.7; p = 0.011) and high fibre food knowledge (4.1 ± 1.4-4.7 ± 1.1; p = 0.022) exhibited the highest and most significant improvements. CONCLUSION: Notably, these significant improvements in nutrition knowledge points toward effective education being delivered during the intervention. Cardiac rehabilitation has proved to be effective in changing lifestyle habits in a holistic way and this study further shows an improvement in nutritional knowledge based on sound educational principles. <![CDATA[<b>The perceptions of professional nurses on student mentorship in clinical areas: A study in Polokwane municipality hospitals, Limpopo province</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100015&lng=en&nrm=iso&tlng=en The purpose of the study was to explore the perceptions of professional nurses on student mentorship in clinical areas. A qualitative hermeneutic phenomenological research was conducted to determine the meaning of mentoring as perceived by professional nurses and to identify the successes and challenges encountered by professional nurses with regard to student mentorship during clinical practice. Data was collected using in-depth individual interviews to collect data from sixteen operational managers who were managing all unit activities, including student mentoring. Each interview lasted for ±45 min. A hermeneutic data analysis (hermeneutic circle) was used to analyse data. Four (4) themes and fourteen (14) sub-themes emerged from data collected from operational managers. The findings revealed that mentoring was perceived as a valuable tool to apply in the preparation of student nurses for future professional role. In the process of mentoring, the caring attitude is important. Factors that facilitated the mentoring process were good communication, time and available resources. <![CDATA[<b>Exploring resilience in nurses caring for older persons</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100016&lng=en&nrm=iso&tlng=en BACKGROUND: A shortage of nurses caring for older persons is experienced due to adverse working conditions. Resilience might empower nurses to persevere while caring for older persons. Research regarding the resilience of nurses caring for older persons is scarce. OBJECTIVES: The objectives were to explore and describe the strengths and coping abilities of nurses caring for older persons and to formulate recommendations to strengthen their resilience. METHODOLOGY: An explorative, descriptive qualitative research design was used. An all-inclusive sample of nurses caring for older persons in an urban setting in the North West Province, South Africa, participated in the study. During phase one, demographic information was obtained, and narratives were written (n = 43). Four focus group interviews were conducted in phase two (n = 17) and recommendations were formulated in phase three. Content analysis was used. PRINCIPAL RESULTS: Participants experienced adverse working circumstances while caring for older persons and they needed resilience to balance the emotional nature of the work, work ethics, staff shortages, physical demands of the work and the dependency of the older persons. These nurses used personal, professional, contextual and spiritual strengths to handle adverse working conditions. CONCLUSIONS: By applying their personal, professional, contextual and spiritual strengths, nurses could further enhance these strengths and possibly their resilience. The participants' identified strengths were used to formulate recommendations to strengthen resilience of nurses caring for older persons. <![CDATA[<b>Cost-savings accruable to removing value added tax from antiretrovirals in the South African private health sector</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100017&lng=en&nrm=iso&tlng=en BACKGROUND: Despite the important and essential role that medicines play in any society, all medicines, including those identified as essential, are uniformly subjected to 14% value added tax (VAT), regardless of their therapeutic value in the private healthcare sector of South Africa. The aim of this article is to demonstrate the potential cost-saving attained from the removal of VAT from the private sector pricing of essential medicines, using antiretroviral treatment as an example. METHODS: An empirical analysis was undertaken to illustrate the potential cost-saving achieved by removing VAT from the Single Exit Price and the dispensing fee of essential medicines. This outcome was demonstrated by applying the methodology to an adult fixed dose combination 1st line antiretroviral regimen as well as to a group of 3rd line antire-troviral medicines. RESULTS: The potential saving for the lowest priced generic and originator 1st line antiviral regimen accrued to ZAR 693.84 and ZAR 1085.04 over a year respectively. Regarding the 3rd line antiretroviral drugs, results yielded an annual saving of ZAR 1678.68 (darunavir), ZAR 5741.04 (maraviroc) and ZAR 159.48 (rilpivirine). CONCLUSIONS: Lobbying for the removal of VAT from the supply chain of medicines should be intensified. Policy development to monitor and recover lost government revenue through the removal of taxes should be explored. <![CDATA[<b>Movement as a critical concept in model generation to attain wholeness</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100018&lng=en&nrm=iso&tlng=en Movement is an integral aspect of daily living. Movement allows the human being to express, find meaning and reflect a part or the whole of the unfolding of the stories of their lives. The essence of the dialogue is the movement towards caring and healing between the professional nurse and the individual. The purpose of this research is to develop, describe, evaluate and provide guidelines for the operationalisation of a model as a framework of reference for nursing to facilitate the individual faced with mental health challenges as an integral part of wholeness. A model was generated to facilitate the engagement of self through movement, which contributes to and manifests in a mindful way of living to promote mental health as an integral part of wholeness. The findings of the study are applicable to the world of nursing practice, nursing education and research. <![CDATA[<b>Factors influencing recruitment and retention of professional nurses, doctors and allied health professionals in rural hospitals in KwaZulu Natal</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362017000100019&lng=en&nrm=iso&tlng=en INTRODUCTION: In South Africa fewer health professionals (HPs) work in rural areas compared to urban areas, despite rural communities having greater health needs. This study explores factors influencing recruitment and retention of three categories of HPs in KwaZulu-Natal and has implications about how to retain them in rural areas. METHODS: A cross-sectional, descriptive survey was conducted in 8 hospitals, 5 rural and 3 urban, in one district in KZN in 2011. Data were collected on single day in each hospital and all HPs on duty were requested to participate. We compared responses from rural and urban based HP as well as professional nurses (PNs), doctors, and allied HPs. : 417 questionnaires were completed: 150 from HPs in rural and 267 from HPs in urban hospitals. Perceptions of living/working in rural areas is negative and the quality of health care provided in rural areas is perceived as poor by all categories of HP. Rural-based HPs were more likely to report living apart from spouse/partner (72.1% vs 37.0%, p < 0.001) and children (76.7% vs 36.9%, p < 0.001), and living in hospital accommodation (50.8% vs 28.9%; p < 0.001. CONCLUSIONS: Decisions made by HP about where to work are complex, multifactorial and should be tailored to each category of health professional.