Scielo RSS <![CDATA[Health SA Gesondheid (Online)]]> vol. 21 num. 1 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Barriers and facilitators associated with HIV testing uptake in South African health facilities offering HIV Counselling and Testing</b>]]> BACKGROUND: The scale-up of HIV Counselling and Testing (HCT) in South Africa to 4500 public health facilities and the service's provision in mobile and non-medical sites was aimed at increasing HCT uptake. However, some people still have never had an HIV test OBJECTIVE: An HCT survey was carried out to ascertain barriers and facilitators for HIV testing in South Africa METHODS: A cross-sectional survey of 67 HCT-offering health facilities in 8 South African provinces was undertaken. Individuals (n = 489) who had not tested for HIV on the day of the site visit were interviewed on awareness of HCT services, HIV testing history and barriers to HIV testing. Frequencies were run to describe the sample characteristics, barriers and facilitators to HIV testing. Bivariate and multivariate logistic regression was used to identify the association between never tested for HIV with socio-demographics, awareness of HCT services and type of HCT facilities RESULTS: In all 18.1% participants never had an HIV test. Major barriers to HCT uptake comprise being scared of finding out one's HIV test result or what people may say, shyness or embarrassment, avoidance of divulging personal information to health workers and fear of death. In multivariate analysis the age group 55 years and older, and not being recommended to have an HIV test were associated with never had an HIV test. Potential facilitators for HIV testing include community or household HIV testing, providing incentives for those who test for HIV, mandatory HIV testing and disclosure of HIV status by those who test HIV positive CONCLUSION: The benefits of HCT which include the reduction of HIV transmission, the availability of HIV care and treatment needs to be emphasized to enhance HCT uptake <![CDATA[<b>Referral criteria for school-based hearing screening in South Africa: Considerations for resource-limited contexts</b>]]> BACKGROUND: School-based hearing screening is likely to be the first opportunity to identify childhood hearing loss in South Africa. Criteria for school-based hearing screening requires balancing the targeted degree of hearing loss while ensuring that referral rates are sufficiently low for a cost-effective and sustainable programme. The study aim was to investigate the effect of screening intensity (loudness) levels on the referral rate and to establish the effect of an immediate rescreen in reducing the referral rate METHODS: A within-subject study was conducted in two phases. Phase 1: compared the referral rate in a counterbalanced sequence at screening levels of 20 dB HL, 25 dB HL and 30 dB HL across 1, 2 and 4 kHz for 135 children. Phase 2: determined the effect of an immediate rescreen on referral rate for 337 children screened at 25 dB HL. If a further referral was obtained on rescreen, diagnostic audiometry was subsequently conducted RESULTS: Referral rate was reduced to 6.7% from 17% when using 25 dB HL as opposed to 20 dB HL as screening intensity. Referral rate was reduced to 4.4% when employing 30 dB HL as screening intensity. An immediate rescreen reduced the overall referral rate by more than one-third. Diagnostic audiometry confirmed that almost half (47%) of the referred children had a hearing loss CONCLUSION: A screening intensity of 25 dB HL and immediate rescreen reduces the referral rate significantly and will limit the burden of the screening programme on health care resources. <![CDATA[<b>Has the increase in the availability of generic drugs lowered the price of cardiovascular drugs in South Africa?</b>]]> BACKGROUND: This research focuses on pharmaceutical competition in South Africa where concurrent pricing legislation is being implemented without monitoring the consequences on generic drug competition and usage OBJECTIVE: To examine the relationship between originator drug prices and the number of generic brands within the cardiovascular class of drugs and to compare South African prices with international reference prices METHOD: Data on private sector drug prices was sourced from the South African Medicine Price Registry. The relationship between the median proportional price and the number of brands in the therapeutic class was analysed using correlation analysis. International reference prices were obtained from the Management Sciencesfor Health International Drug Price Indicator Guide (2012 edition RESULTS: A weak correlation between originator and generic drug prices and the number of available brands was observed, the exception being diuretic drugs. The median prices per strength of the originator generic were still higher than the most expensive generic version manufactured by any other company, the exception being telmisartan. Comparison of price ratios between the originator drug, lowest priced generic and international reference price values revealed that the originator drug prices had a median price ratio of 20.99 (interquartile range 7.31-53.46) and the lowest priced generics had a median price ratio of 4.28 (interquartile range 2.10-8.47 CONCLUSION: Increased generic competition is not a predictor of lower drug prices. The study also concludes that the current South African pharmaceutical policies have not yet achieved the lowest prices for drugs when compared internationally <![CDATA[<b>Nurses' experiences of inpatients suicide in a general hospital</b>]]> When suicide occurs, it is regarded as an adverse event. Often, little attention is given to the nurses who cared for the patients prior to the adverse event. Instead the affected nurses are expected to write statements and incident reports about the adverse event. The aim was to explore the experiences of nurses who cared for patients who successfully committed suicide whilst admitted at a specific general hospital in Gauteng Province, South Africa. A qualitative exploratory research was conducted. Data were collected through in-depth interviews with a purposive sample of six nurses and content analysis was done. Nurses experienced feelings of shock; blame and condemnation; inadequacy and feared reprisal. This study suggests a basis for development of support strategies to assist the nurses to deal with their emotions following experience of adverse events. <![CDATA[<b>Seven year overview (2007-2013) of ethical transgressions by registered healthcare professionals in South Africa</b>]]> A move has taken place internationally in the delivery and "consumption" of health care where if clients and patients (health care consumers) hold the opinion that the health care professionals/providers' behaviour has had a negative effect, impact or outcome on them, they may lodge a complaint with the relevant health professional regulatory body. Ethical transgressions of health care providers can generally be clustered into the following three categories: a) Competence and conduct with clients (e.g. abandonment, sexual intimacies, dishonesty, disclosure of information); b) Business practices (e.g. billing, reports, documentation); and c) Professional practice (e.g. referral upon termination, obtaining appropriate potential employment opportunities, nonprofessional relationships). The primary objective of this study was to analyse the ethical transgressions of registered members of the twelve professional boards in the Health Professions Council of South Africa (HPCSA) in the period 2007 to 2013. A mixed methods approach was followed in this study which specifically focused on a historical research approach. The results indicate that the boards with the highest number of transgressions per the registered practitioners were firstly the Medical and Dental practitioners, closely followed by the Optometry and Dispensing Opticians Board. The predominantly complaint made against members of both these boards was for fraudulent conduct (collectively totalling to 85% of all fraudulent cases during the period) and included actions such as charging for non-rendered services, issuing false statements and submitting fraudulent medical aid claims. Cognisance needs to be taken that the South African public will increasingly demand better services and that since they are being better informed via the media of their rights and have access to a broader database of knowledge (rightly or wrongly so the internet) practitioners' opinions will not necessarily be accepted outright and that they (the public) will challenge it accordingly. This raises the concern that practitioners need to take on the responsibility to communicate with their patients/clients in order to educate them and keep them informed. <![CDATA[<b>Knowledge and psychosocial wellbeing of nurses caring for people living with HIV/AIDS (PLWH)</b>]]> The challenges of caring for people living with HIV (PLWH) in a low-resource setting has had a negative impact on the nursing profession, resulting in a shortage of skilled nurses. In response to this shortage and perceived negative impact, we conducted a descriptive, cross-sectional study to describe the level of knowledge and psychosocial wellbeing of nurses caring for PLWH at a regional hospital in Limpopo Province, South Africa. A total of 233 nurses, the majority being female, participated and were stratified into professional nurses (n = 108), enrolled nurses (n = 58) and enrolled nursing auxiliaries (n = 66). Data were collected using HIV/AIDS knowledge questionnaire, Maslach Burnout Inventory; AIDS Impact Scale and Beck's Depression Inventory. The total knowledge score obtained by all the participants ranged from 2 to 16, with an average of 12.93 (SD = 1.92) on HIV/AIDS knowledge. Depersonalization (D) (83.7%) and emotional exhaustion (EE) (53.2%) were reported among participating nurses caring for PLWH. Burnout was higher among professional nurses as compared to both enrolled nurses and enrolled nursing auxiliaries. There was a moderate negative significant correlation between HIV knowledge with the nurses' emotional exhaustion (r =-0.592), depression (r =-0.584) and stigma and discrimination (r =-0.637). A moderate to high level of burnout was evident among all levels of nurses. These findings lead to the recommendations for support of nurses caring for PLWH that include structured nursing educational support, organisational support with respect to employee wellness programmes that address depression and work burnout, as well as social support. The provision of these support mechanisms has the potential of creating a positive practice environment for nurses in the Vhembe District of the Limpopo Province in particular, and South Africa in general, and in improved care for PLWH. <![CDATA[<b>"Just live with it": Having to live with breast cancer related lymphedema</b>]]> An exploratory qualitative research approach was selected for this study aiming to explore how people living with breast cancer related lymphedema experience this complication. Unstructured interviews were conducted with nine purposively selected participants. Living with breast cancer related lymphedema was not easy. Participants were not informed of the possibility of developing lymphedema and felt let down by the medical professionals they consulted. They had to face the physical, psychological and practical consequences without the continuous support of a knowledgeable therapist. Managing the lymphedema was a challenge as they could not afford the necessary treatment and the self-care items. In addition, treatment failure resulted in them feeling exploited and using various treatment options. Nurses should maintain a high level of suspicion of breast cancer related lymphedema, assess patients for lymphedema and refer them to a therapist specifically trained in the management of this debilitating condition. Hierdie studie ondersoek die belewenis van mense met borskanker verwante limfe-deem. 'n Kwalitatiewe eksploratiewe navorsingsontwerp is gekies en ongestruktureerde onderhoude is met nege doelgerig gekose persone gevoer. Limfedeem kompliseer die lewe en die proefpersone het die nie maklik gevind om daarmee saam te leef nie. Hulle is nie ingelig oor die moonlikhied om limfedeem te ontwikkel nie en was van mening dat hulle deur die medici wat hulle behandel het in die steek gelaat is. Die proefpersone moes die fisiese, psigologiese en praktiese gevolge van limfedeem sonder die bystand van 'n kundige terapeut te bowe kom. Die hantering van die limfedeem was 'n uitdaging aangesien hulle nie die behandeling en self-sorg artikels kon bekostig nie. Die slegte resultate van behandeling het tot gevolg gehad dat die proefpersone uitgebuit gevoel het en ook verskillende behandelingsopsies gevolg het. Verpleegkundiges moet 'n hoë vlak van bewustheid ten opsigte van limfedeem handhaaf, pasiënte hiervoor beraam en na 'n terapeut wat in limfedeem spesialieer verwys. <![CDATA[<b>The experiences of clients and healthcare providers regarding the provision of reproductive health services including the prevention of HIV and AIDS in an informal settlement in Tshwane</b>]]> Globally challenges regarding healthcare provision are sometimes related to a failure to estimate client numbers in peri-urban areas due to rapid population growth. About one-sixth of the world's population live in informal settlements which are mostly characterised by poor healthcare service provision. Poor access to primary healthcare may expose residents of informal settlement more to the human immunodeficiency virus (HIV) and to acquired immunodeficiency syndrome (AIDS) than their rural and urban counterparts due to a lack of access to information on prevention, early diagnosis and treatment. The objective of this study was to explore and describe the experiences of both the reproductive health services' clients and the healthcare providers with regard to the provision of reproductive health services including the prevention of HIV and AIDS in a primary healthcare setting in Tshwane. A qualitative, exploratory and contextual design using a phenomenological approach to enquire about the participants' experiences was implemented. Purposive sampling resulted in the selection of 23 clients who used the reproductive healthcare services and ten healthcare providers who were interviewed during individual and focus group interviews respectively. Tesch's method for qualitative data analysis was used. Ethical principles guided the study, and certain strategies were followed to ensure trustworthiness. The findings revealed that females who lived in informal settlements were aware of the inability of the PHC setting to provide adequate reproductive healthcare to meet their needs. The HCPs acknowledged that healthcare provision was negatively affected by policies. It was found that the community members could be taught how to coach teenagers and support each other in order to bridge staff shortages and increase health outcomes including HIV/AIDS prevention. <![CDATA[<b>Keep pushing! Limiting interruptions to CPR: bag-valve mask versus i-gel® airway ventilation</b>]]> BACKGROUND: Recent recommendations made by ILCOR have de-emphasised the role of advanced airway management such as "endotracheal intubation" (ETI) during cardiac arrest in favour of maximising the number of chest compressions performed by rescuers. Maximising time available for compressions is achieved by minimising hands-off time (HOT). This has led to first responders and paramedics performing single rescuer CPR using a bag-valve-mask (BVM) device as opposed to the historical practice of intubating and ventilating via an endotracheal tube. Bag-valve-mask ventilations, especially during single rescuer CPR, are however associated with complications potentially resulting in increased ventilation times. More time spent on ventilations in the single rescuer scenario naturally leads to an increase in HOT and less time being available for compressions. It is postulated that the use of an appropriate supraglottic airway device (SAD) may decrease the time spent on the ventilation component of CPR and result in a decrease in HOT OBJECTIVES: This pilot study evaluated how interruptions to chest compressions or hands-off time (HOT) are affected by the placement of an i-gel® airway vs. simple BVM ventilation during single rescuer CPR METHOD: 16 participants performed two, ten-minute single rescuer CPR simulations, firstly using the BVM and later the i-gel® airway for ventilation. Data pertaining to ventilations and HOT in each scenario was statistically analysed and compared RESULTS: The i-gel® airway demonstrated a superior ease of ventilation compared to BVM alone and resulted in a reduction of time spent on ventilations overall. The i-gel® however took a mean of 29 s, ± 10 s, to secure which contributes considerably to HOT CONCLUSION: The use of the i-gel® airway resulted in a considerable decrease in the amount of time spent on ventilations and in more compressions being performed. The overall reduction in HOT was, however, offset by the time it took to secure the device. Further investigation into the use and securing of the i-gel® airway in single rescuer CPR is recommended. <![CDATA[<b>The GAMMA® nursing measure: Its calibration for construct validity with Rasch analyses</b>]]> BACKGROUND: The GAMMA nursing measure was developed to routinely score a person's ability to independently perform activities of daily living. The nursing utility of the scale has been established as being satisfactory and it has been recommended that its use be extended to home-based care where restorative nursing is required for rehabilitation and elderly care PURPOSE: To subject the GAMMA nursing measure to the Rasch Measurement Model and to report if the measure can function as an interval scale to provide metric measurements of patients' ability to perform instrumental activities of daily living METHOD: A quantitative design was followed whereby GAMMA raw scores were collected from persons (n = 428) living in seven retirement villages and patients (n = 334) receiving home-based care after an acute or sub-acute nursing episode. In most of the retirement villages only cross-sectional data were collected; however, in the home-based care patients both admission and discharge data were collected. The data were prepared for Rasch analyses and imported into WINSTEP® Software version (2010). Persons with extreme scores were eliminated, resulting in a final sample of 570 persons. The calibration and analyses of the final reports are illustrated with figures and graphs RESULTS: The Rasch analyses revealed that the GAMMA functions optimally as an interval scale with a four-category structure across all eight items, rather than a seven-category structure as originally intended. Overall, the GAMMA satisfies the Rasch Model with a good to excellent fit. <![CDATA[<b>Clinical judgement within the South African clinical nursing environment: A concept analysis</b>]]> Reform in the South African healthcare and educational system were characterized by the ideals that the country needs to produce independent, critical thinkers. Nurses need to cope with diversity in a more creative way, defining their role in a complex, uncertain, rapidly changing health care environment. Quality clinical judgement is therefore imperative as an identified characteristic of newly qualified professional nurses. The objective of this study was to explore and describe clinical judgement through various data sources and review of literature to clarify the meaning and promote a common understanding through formulating the characteristics and developing a connotative (theoretical) definition of the concept. An explorative, descriptive qualitative design was used to discover the complexity and meaning of the phenomenon. Multiple data sources and search strategies were used, for the time frame 1982-2013. A concept analysis was used to arrive at a theoretical definition of the concept of 'clinical judgement' as a complex cognitive skill to evaluate patient needs, adaption of current treatment protocols as well as new treatment strategies, prevention of adverse side effects through being proactive rather than reactive within the clinical nursing environment. The findings emphasized clinical judgement as skill within the clinical nursing environment, thereby improving autonomous and accountable nursing care. These findings will assist nurse leaders and clinical nurse educators in developing a teaching-learning strategy to promote clinical judgement in undergraduate nursing students, thereby contributing to the quality of nursing care. <![CDATA[<b>Relation of socio-economic status to the independent application of self-care in older persons of South Africa</b>]]> BACKGROUND: Many older persons in South Africa (SA) are affected by a poor socio-economic status, leading to an increase in the use of the public healthcare sector. However, the public healthcare sector is burdened by high volumes of patients and long waiting periods. As a result, professional nurses in primary healthcare (PHC) facilities are not able to spend enough time on proper physical examinations and assessment of needs, including health education and support to older persons to help them apply independent self-care. : To determine if the socio-economic status of older persons affects their ability to apply self-care independently without support from professional nurses in the PHC facility. : Quantitative, descriptive research design. METHODS: Older persons (N = 198; n = 192 respondents) were asked to complete the Appraisal of Self-care Agency (ASA-A) and Exercise of Self-care Agency (ESCA) questionnaires. Seven self-care deficits were identified through deductive logic after analysis of the two questionnaires. These seven self-care deficits were compared to the socio economic status of the same sample. RESULTS: Seven self-care deficits were identified after analysis of the ASA-A and ESCA questionnaires. One self-care deficit was found to have a relationship with the socioeconomic status of the older persons. CONCLUSIONS: Low literacy levels of older persons with a low socio-economic status affect their ability to apply self-care independently without the support from a professional nurse in the PHC facility. Data analysis of the ASA-A and ESCA revealed that these older persons suffer from a "lack of knowledge and ability to acquire knowledge with regard to self-care" which had a relationship with the socio-economic status of older persons with specific reference to low literacy levels and poverty. IMPLICATIONS FOR PRACTICE: More attention should be given to older persons with a low socioeconomic status as their ability to apply self-care independently without the support from a professional nurse is limited. This would lead to less frequent visits to PHC facilities by older persons for minor ailments, decrease healthcare costs, relieve overcrowding in PHC facilities and prevent possible unintentional self-neglect. <![CDATA[<b>Systematic review as a research method in post-graduate nursing education</b>]]> In South Africa, there appears to be poor understanding about using a systematic review as an acceptable research method in post-graduate nursing education. The lack of understanding may result in research supervisors being unable to guide post-graduate students, such as masters and doctoral students, in using the systematic review methodology in the completion of an academic qualification. Furthermore, they might not be able to assist post-graduate students in completing their studies, or conducting studies, in particular systematic reviews, which are of high quality. Valuable opportunities can thus be missed that might add to the body of knowledge to inform and improve research, education, and clinical practice. This article may set the field for an informed debate on systematic reviews as a useful and acceptable research method to be used by post-graduate nursing students in South Africa. We conclude that a systematic review could be a useful and acceptable method for research in post-graduate nursing education. However, the method's benefits and disadvantages should be considered before a post-graduate student embarks on such a journey. <![CDATA[<b>"Consider our plight": A cry for help from nyaope users</b>]]> Nyaope is a relatively new drug which until recently was not classified as illegal. It is widely used by many young and poor people in predominantly Black townships and users can be easily identified as they usually assemble in open spaces such as parks and taxi ranks and have formed a community through which they support one another in the habit. In addition to this, users often display poor personal hygiene and often resort to stealing and selling stolen goods in order to sustain their habit. There is a paucity of literature on nyaope and its use and impact, and the present study is a qualitative exploration of the experiences of nyaope users in three provinces, namely Gauteng, Mpumalanga and North West. The findings highlight the strong addictive nature of the drug, the ease of access, and the unfavourable social environment which promotes initial use and difficulty in quitting. Nyaope users typically express a desire to find and utilise help in order to overcome their current circumstances.<hr/>Nyaope is 'n relatiewe nuwe dwelmmiddel wat algemeen gebruik word deur die meerderheid jong, hoofsaaklik arm mense wat in swart buurte woon. Dit is eers onlangs dat die dwelmmiddel as onwettig geklassifiseer is. Gemeenskappe wat mekaar ondersteun in die gewoonte van die dwelm misbruik kom gewoonlik saam in oop areas in dorps gebiede soos parke en huurmotor staan plekke. Gebruikers kan maklik uitgeken word aan swak per-soonlike higiene en die neiging om enigiets te steel om geld te kry om hulle gewoonte te ondersteun. Literatuur oor nyaope, die gebruik daarvan en die impak op die verbruiker is relatief skaars. Hierdie studie was 'n kwalitatiewe eksploratiewe ondersoek oor die ondervindinge van nyaope gebruikers wat uitgevoer is in drie provinsies naamlik Gauteng, Mpumalanga en Noord Wes. Die bevindinge beklemtoon dat nyaope hoogs verslawend en makilik bekombaar is en 'n ongunstige sosiale omgewing dra by tot die gebruik. . Nyaope gebruikers is ongelukkig met die toestand waarin hulle hulle bevind en vra vir hulp aan-gesien hulle dit moelik vind om die gewoonte op te gee. <![CDATA[<b>Mothers' perceptions of their premature infant's communication: A description of two cases</b>]]> BACKGROUND: Survival rates of premature infants have increased due to advances in medicine. Premature infants however, remain at risk for developmental delays including communication difficulties. The bonding and attachment experiences of premature infants and their parents are often challenged, further placing these infants at risk for communication difficulties. This study firstly aimed to explore mothers' perceptions of their premature infants' communication. The second aim was to explore the mothers' perceptions of their own role in the communication development of their infants. METHODS: A descriptive, longitudinal study was conducted with two mother-infant dyads. Three visits took place in the first year of life. Subjective maternal reports were obtained through semi-structured interviews. RESULTS: Differences in the two mothers' perceptions were noted. The mothers described helping their infants to communicate through physical contact and talking. Risk and protective factors for early communication development are discussed in relation to the findings. CONCLUSION: The findings support the need for a healthy mother-infant relationship in the first few months of life. Health professionals should support premature infants and their families after discharge in order to help them interact with their infants and encourage attachment and bonding. <![CDATA[<b>Knowledge, opinions and practices of healthcare workers related to infant feeding in the context of HIV</b>]]> BACKGROUND: The importance of healthcare workers' guidance for women infected with human immunodeficiency virus (HIV) regarding infant feeding practices cannot be overemphasised. OBJECTIVE: To determine the knowledge, opinions and practices of healthcare workers in maternity wards in a regional hospital in Bloemfontein, Free State Province, South Africa, regarding infant feeding in the context of HIV. METHODS: For this descriptive cross-sectional study, all the healthcare workers in the maternity wards of Pelonomi Regional Hospital who voluntarily gave their consent during the scheduled meetings (n = 64), were enrolled and handed over the self-administered questionnaires. RESULTS: Only 14% of the respondents considered themselves to be experts in HIV and infant feeding. Approximately 97% felt that breastfeeding was an excellent feeding choice provided proper guidelines were followed. However, 10% indicated that formula feeding is the safest feeding option. 45% stated that heat-treated breast milk is a good infant feeding option; however, 29% considered it a good infant feeding option but it requires too much work. Only 6% could comprehensively explain the term "exclusive breastfeeding" as per World Health Organisation (WHO) definition. Confusion existed regarding the period for which an infant could be breastfed according to the newest WHO guidelines, with only 26% providing the correct answer. Twenty per cent reported that no risk exists for HIV transmission via breastfeeding if all the necessary guidelines are followed. CONCLUSION: Healthcare workers' knowledge did not conform favourably with the current WHO guidelines. These healthcare workers were actively involved in the care of patients in the maternity wards where HIV-infected mothers regularly seek counselling on infant feeding matters.<hr/>AGTERGROND: Die waarde van die leiding wat gesondheidsorgwerkers aan vroue wat met menslike immuniteitsgebrekvirus (MIV) gemfekteer is, ten opsigte van babavoeding prak-tyke verskaf, kan nie oorbeklemtoon word nie. DOEL: Om die kennis, opinies en praktyke van gesondheidsorgwerkers in kraamsale in 'n plaaslike hospitaal in Bloemfontein, Vrystaat Provinsie, Suid-Afrika, ten opsigte van babavoeding in die konteks van MIV te bepaal. METODES: Vir hierdie beskrywende dwarssnit studie was alle gesondheidsorgwerkers in die kraamsale van Pelonomi Streekshospitaal wat vrywillig gedurende afgespreekte verga-derings ingeligte toestemming verskaf het (n = 64), in die studie ingesluit en het die self-toegediende vraelyste oorhandig. RESULTATE: Slegs 14% van die respondente het hulself as kundiges in MIV en babavoeding geag. Bykans 97% het gevoel dat borsvoeding 'n uitstekende voedingsopsie is indien gepaste riglyne gevolg word. Tog het 10% aangedui dat formule voeding die veiligste voedingsopsie is. 45% het verklaar dat die gebruik van hitte-behandelde borsmelk 'n goeie opsie is; terwyl 29% aangedui het dat dit 'n goeie opsie is maar dat dit te veel werk vereis. Slegs 6% kon die term "eksklusiewe borsvoeding" soos deur die Wereld Gesondheidsor-ganisasie (WGO) gedefinieer, omvattend beskryf. Verwarring het bestaan rakende die periode wat 'n baba geborsvoed kan word volgens die nuutste WGO riglyne, met slegs 26% wat die korrekte antwoord verskaf het. Twintig persent het aangedui dat daar geen risiko van MIV oordrag via borsvoeding bestaan indien die nodige riglyne gevolg word nie. GEVOLGTREKKING: Gesondheidsorgwerkers se kennis het nie gunstig met die huidige WGO riglyne vergelyk nie, inaggenome dat hierdie gesondheidsorgwerkers in kraamsale werk waar MIV-geïnfekteerde vroue op 'n gereelde basis advies rakende babavoeding soek <![CDATA[<b>Perception and attitude of healthcare workers towards the use of a female condom in Gaborone, Botswana</b>]]> BACKGROUND: Although the female condom (FC) is viewed as an effective female controlled barrier contraceptive device that can be used by women to prevent them from contracting the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS), other sexually transmitted infections (STIs) and unwanted or unintended pregnancy, the perception and attitude of healthcare workers (HCW) plays a key role in its effective use and distribution amongst women. OBJECTIVES: To identify and examine factors that influences the perception and attitude of HCWs towards the use and distribution FCs. METHOD: A quantitative, explorative and descriptive design was used to conduct the study based on the Health Belief Model (HBM) as a conceptual framework. A pre-tested questionnaire was utilised in June 2013 to collect data from a convenience sample of 164 HCWs with a 100% return rate. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 13.0 and Statistical Analysis Systems (SAS) version 9.2. RESULTS: The results showed that 64.0% (n = 105) of the respondents perceived unavailability of FCs as contributing to lack of adequate use. Only 31.7% (n = 52) [95% CI: 24.7-39.4] of them reported to be using the FC. There was an association with increasing use of a FC with age (Fischer's exact = 0.05), marital status [Fischer's exact = 0.037] and training [χ2= 53.3; p < 0.05]. The results revealed that lack of knowledge and training on the use of a FC might prevent its effective use and distribution. CONCLUSION: The results showed evidence that the FC was a safe method of contraception and protection against STIs and that it empowers women to make decisions related to sexuality. However, awareness campaigns, increased availability of FCs and training of HCWs are essential to enhance positive perception and attitudinal change to reduce sexual risks related infections and poor quality of life for women. <![CDATA[<b>Paramedics' experiences of financial medicine practices in the pre-hospital environment: A pilot study</b>]]> BACKGROUND: The term "financial medicine" refers to the delivery of health-related services where the generation of financial gain or "profit" takes precedence over the provision of care that is reflective of evidence-based best practice. The practicing of financial medicine includes over-servicing and overbilling, both of which have led to a sharp rise in the cost of health care and medical insurance in South Africa. For this reason, the practicing of financial medicine has been widely condemned both internationally and locally by the Health Professions Council of South Africa (HPCSA) and allied Professional bodies. OBJECTIVES: This qualitative pilot study explored and described the experiences of South African Paramedics with regard to the practicing of financial medicine in the local pre-hospital emergency care environment. METHOD: A sample of South African Paramedics were interviewed either face-to-face or telephonically. The interviews were audio recorded and transcripts produced. Content analysis was conducted to explore, document and describe the participants' experiences with regard to financial medicine practices in the local pre-hospital environment. RESULTS: It emerged that all of the participants had experienced a number of financial medicine practices and associated unethical conduct. Examples included Over-servicing, Selective Patient Treatment, Fraudulent Billing Practices, Eliciting of kickbacks, incentives or benefits and Deliberate Time Wasting. CONCLUSION: The results of this study are concerning as the actions of service providers described by the participants constitute gross violations of the ethical and professional guidelines for health care professionals. The authors recommend additional studies be conducted to further explore these findings and to establish the reasons for, and ways of, limiting financial medicine practices in the South African emergency care environment.<hr/>AGTERGROND: Die term "finansiële medisyne" verwys na die lewering van gesondheids-verwante dienste waar die skep van finansiële gewin voorkeur geniet bo die lewering van sorg soos vereis word deur bewys gebaseerde praktyk. Die be-oefening van finansiële medisyne sluit oor-verskaffing van dienste en oor-fakturering in, wat beide lei tot 'n skerp styging in gesondheidsorg kostes en mediese versekering in Suid Afrika. As gevolg van hierdie rede word die be-oefening van finansiele medisyne wyd gekritiseer, beide inter-nasionaal en nasionaal deur die "Health Professions Council of South Africa (HPCSA)" en verwante professionele rade. DOEL: Hierdie ondersoekende studie poog om die ondervindinge van Suid Afrikaanse Par-amedisie te verken en te beskryf met betrekking tot die gebruik van finansiële medisyne in die plaaslike pre hospitalisasie noodgeval omgewing. METODE: Ses Suid Afrikaanse Paramedisie is ondervra om hul ondervindings te ondersoek, te dokumenteer en te beskryf met betrekking tot die praktyk van finansiële medisyne in die plaaslike voor-hospitaal omgewing. RESULT: ate: Dit blyk dat al die deelnemers 'n aantal finansiële medisyne praktyke ervaar het asook geassosieërde onetiese gedrag. Voorbeelde sluit in: oor-dienslewering; selektiewe pasiëent behandeling, bedrog ten opsigte van eise, aanduiding van onwettige winsbetaling of winsdeling, aansporing of voordele en doelbewuste mors van tyd GEVOLGTREKKING: Die uitslag van hierdie studie is kommerwekkend omdat die aksies van die diensverskaffers soos beskryf is deur die deelnemers dui op growwe oortredings van die etiese en professionele riglyne vir die professie. Die outeur beveel verdere addisionele studies aan vir uitbreiding van hierdie bevindinge en om die redes vir en maniere van finansiële medisyne praktyke in die plaaslike noodsorg professie te beperk. <![CDATA[<b>Experiences of women living with borderline personality disorder</b>]]> There is limited understanding of the experiences of women living with borderline personality disorder. It was therefore decided to discover how women living with this disorder would tell their life story. For the researcher, who worked in a psychotherapy ward where most women were living with borderline personality disorder, the care of these women was of vital importance, as they were less understood by mental health care providers. The research aimed to explore and describe the experiences of women living with borderline personality disorder. A qualitative, explorative, descriptive and contextual study design was used. Data was collected through in-depth phenomenological interviews that focused on the central question, "Tell me your life story". Eight participants living with borderline personality disorder were interviewed. Tesch's method for data analysis was used (Creswell, 2009:186), along with an independent coder. Measures to ensure trustworthiness and ethical principles were applied throughout the research. From the findings obtained by means of the interviews of women living with borderline personality disorder, it was evident that there were childhood experiences of living in an unsafe space, related to unhealthy family dynamics, boundary violations and educational challenges. They experienced chronic feelings of emptiness in their relationships with the self. They also presented with a pattern of unstable interpersonal relationships and compromised mental health, which was apparent through the early onset of mental problems, emotional upheaval, looking for emotional escape and having different trigger factors. Lastly, all these women yearned for facilitated mental health. <![CDATA[<b>The prevalence of risky sexual behaviours amongst undergraduate students in Jigjiga University, Ethiopia</b>]]> Young adults including university students are at high risk of acquiring HIV due to their risky sexual practices. The aim of this study was to determine the prevalence of risky sexual behaviours amongst regular undergraduate students in Jigjiga University. The researcher used a quantitative, univariate cross-sectional descriptive study. Two hundred and thirty six (236) students were selected using a simple random sampling technique. Data were collected using a standardised structured questionnaire. The study revealed that 70.53% of respondents were sexually experienced. Majority (54.8%) of the sexually experienced respondents were sexually active within 3 months of the study. Up to 30.14% of sexually experienced respondents have had sex with a person other than their current partner in the past 12 months. Only 59.6% of the sexually experienced respondents used condom in their most recent sexual engagement. The findings of this study showed that university students are involved in sexual behaviours that may increase their risk of contracting HIV infection. Based on the above results, researchers recommended the designing of interventions which are contextually relevant to Jigjiga University to mitigate risky sexual practices amongst university students. <![CDATA[<b>A HIV stigma reduction intervention for people living with HIV and their families</b>]]> BACKGROUND: The diagnosis of HIV is life-changing that requires people not only to deal with the disease but also to cope with the stigma attached to HIV. People living with HIV (PLWH) as well as their close family members (CFM) are stigmatised; however, CFM also stigmatise PLWH. This interaction affects the relationship between PLWH and their CFM. : To explore and describe the experiences of PLWH and CFM during and after a community-based HIV stigma reduction intervention in both an urban and rural setting in the North-West METHOD: A qualitative description approach through in-depth interviews was used in both settings. Purposive sampling was used for the PLWH and snowball sampling for the CFM. Data was analysed using open coding RESULTS: Both urban and rural groups gained a richer understanding of HIV stigma and how to cope with it. The relationships were enriched by PLWH feeling more supported and CFM realising how they stigmatised PLWH and that they should be more supportive. Leadership was activated in PLWH and CFM through the stigma reduction project that they participated in CONCLUSION: No significant differences were found between rural and urban communities, thus the intervention can be implemented with similar results in both settings. The intervention showed positive outcomes for both PLWH and CFM. Bringing PLWH and CFM together during an intervention in an equalised relationship proved to be useful as PLWH felt more supported and CFM showed much more compassion towards PLWH after the intervention <![CDATA[<b>Knowledge and attitudes about HIV infection and prevention of mother to child transmission of HIV in an urban, low income community in Durban, South Africa: Perspectives of residents and health care volunteers</b>]]> BACKGROUND: HIV prevalence is high among South African women of reproductive age and transmission of HIV from mothers to children is a concern. This study ascertained the level of knowledge about HIV infection and prevention, particularly prevention of mother to child transmission (PMTCT) amongst South African women from a low income community. It also established the challenges in delivering HIV education from the perspectives of health care volunteers METHOD: Female residents (n = 67) from Kenneth Gardens, a low income community in Durban, South Africa were interviewed. In-depth semi-structured interviews were conducted with 12 health care volunteers who were either health care workers or residents who provided some form of social support in the community RESULTS: The majority of respondents indicated that a mother could transmit HIV to her child but were unable to specify how. Many women had general HIV/AIDS knowledge but were unable to identify essential prevention behaviours and were not very receptive to more information on HIV/AIDS. They were supportive of routine testing procedures and child bearing amongst HIV positive women. Health care volunteers indicated a need for a community clinic in the area. They also had limited knowledge of PMTCT and indicated that there was a need for more education on HIV, particularly to encourage the youth and men to use preventative measures CONCLUSION: Innovative ways to impart knowledge particularly of PMTCT and updated standards of practice are essential. It is important that the community understands how transmission occurs so that prevention can follow. <![CDATA[<b>HIV stigma experiences and stigmatisation before and after an intervention</b>]]> This study focuses on one aspect of a more extensive SANPAD-funded HIV stigma reduction research project. The study addresses not only the continuous burden of HIV stigma, but more specifically on the low rate of participation in healthcare opportunities and HIV stigma reduction interventions by people living with HIV (PLWH) This study tested both change-over-time in HIV stigma experiences of PLWH and change-over-time in the HIV stigmatisation behaviour of people living close to them (PLC) in an urban and rural setting in the North-West in South Africa. These aspects were measured before and after the comprehensive community-based HIV stigma reduction intervention. A quantitative single system research design, with a pre-test and four repetitive post-tests, and purposive voluntary and snowball sampling were used. Findings did not indicate significant differences between urban and rural settings, but demonstrated some significance in changeover-time in the HIV stigma experiences of PLWH as well as the HIV stigmatisation behaviour of PLC after the intervention. Recommendations include the continuation of this intervention, following the same guidelines that were implemented during the study. <![CDATA[<b>Selection criteria for a radiography programme in South Africa: Predictors for academic success in the first year of study</b>]]> BACKGROUND: Selection criteria used to admit students to a radiography programme at the Central University of Technology (CUT) included academic criteria, as well as the General Scholastic Aptitude Test (GSAT) and Self-directed Search (SDS) Questionnaire. Aims and objectives: The aim of the study was to identify which selection criteria were predictors of academic success in the first year of study. As a four year Bachelor's degree in Radiography (480 credits) was to replace the three year National Diploma (NDip) in Radiography (360 credits), selection criteria would come under review. RESULTS: Design and method: Data from 130 students were gathered in a retrospective quantitative study. Data were edited, categorised and summarised. A statistical analysis was undertaken to identify which selection criteria predicted academic success in the first year of study. : Statistics showed that the matriculation Admission Points Score (National Senior Certificate/NCS APS) and core matriculation subject results in Mathematics, Physical Sciences and English were adequate predictors for first-year academic success, and the subjects Life Sciences for the NSC and Biology for the Senior Certificate (SC), showed strong predictive values for first-year academic success. According to the statistical analysis, the GSAT and SDS Questionnaire did not contribute any significant information which could predict academic success. CONCLUSION: Matriculation marks and NSC APS were adequate predictors for academic success, with a focus on Life Sciences or Biology marks as the strongest predictor. The usefulness of the GSAT and SDS Questionnaire could be questioned, and a recommendation was made to replace these tests with alternative student selection methods. <![CDATA[<b>Health care professionals' perspectives on the requirements facilitating the roll-out of kangaroo mother care in South Africa</b>]]> BACKGROUND: Using best evidence to inform practice is the cornerstone of quality patient care, and requires spread, uptake, implementation and roll-out of best practices. Kangaroo mother care (KMC) was used as a best practice which has been partly rolled-out in South Africa. In order for successful roll-out of best practices, it is important to understand what health professionals perceive as requirements for the rolling-out process. However, no published research was found on requirements for rolling-out a best practice in the South African context. PURPOSE: of the research: To explore and describe the perspectives of health professionals on the requirements for the rolling-out process of KMC as a best practice in South Africa. METHODOLOGY: Twelve semi-structured individual interviews were conducted in 2012 with health professionals from various South African healthcare levels, involved in the implementation and the rolling-out process of kangaroo mother care. Content analysis were guided in terms of the four requirements for roll-out of best practices, identified in Edwards and Grinspun's Evidence Informed Model of Care. RESULTS: The requirements for the successful rollout of best practices mentioned by the participants in this study concur with the requirements of Edwards and Grinspun: personal alignment and protocol/policy alignment with the best practice; a roll-out plan; leadership; and supporting and reinforcing structures such as: resources, communicating, education and development regarding the best practice, and the organisational structure. The requirements were identified at four different levels: individual level (e.g. the nurse and medical specialists), management level (of the hospital), provincial level and national level CONCLUSION: Although certain requirements, such as personal alignment and reinforcing structures can be used in the roll-out of best practices, further research is desirable to promote fuller understanding of how to devise and apply the requirements in the wider adoption of best practices in South African health care settings. <![CDATA[<b>Community care worker perceptions of their roles in tuberculosis care and their information needs</b>]]> BACKGROUND: Community care workers (CCWs) inhabit a central role in the management of tuberculosis (TB) patients in South Africa. CCWs attend training courses, but training is not standardised at either the national or provincial level. OBJECTIVE: To explore perceptions of CCWs of their role in TB care and TB information needs. METHODS: CCWs working with TB patients were recruited from Grahamstown Hospice and local primary healthcare clinics in Grahamstown. Focus group discussions and semi-structured interviews were conducted with 14 CCWs using a question guide. Data were thematically analysed. RESULTS: Three themes emerged from data analysis. Firstly, altruism was identified as the major motivational factor, with a desire to help others often stimulated by previously caring for sick relatives. Some CCWs had experienced being patients needing care, which motivated them to become involved in offering patient care. Secondly, CCWs reported great fulfilment and pride in their work as they believed they made a meaningful impact on patients' lives and in the surrounding community, and were respected for this contribution. Thirdly, most identified a need for further training and access to additional information about TB, particularly MDR- and XDR-TB, in order to reinforce both their own knowledge and to educate patients about drug-resistant TB. CONCLUSION: CCWs were motivated and proud of their contribution to TB patient management and the education they provided to patients and to lay community members. Ongoing training was identified as a need, along with access to quality information materials to improve their knowledge and facilitate patient counselling. <![CDATA[<b>The use of observation on patients who self-harm: Lessons from a learning disability service</b>]]> BACKGROUND: Observation is an important approach to care that is commonly used in in-patient learning disability services to prevent self-harming behaviours. It is often implemented when there is a perceived increase risk of self-harm. Most nurses who implement observation have little or no training in the use of this practice. The literature on this subject is also biased towards mental health settings with learning disability services much neglected. AIM: To explore nurses' knowledge and understanding of the use of observation on patients who self-harm in a learning disability service in the United Kingdom. DESIGN: and methods: This study adopted a qualitative approach, and utilised interpretative phenomenological analysis as a design and as a tool of analysis. The study was conducted in a secure learning disability service in the United Kingdom. Data were obtained from registered nurses using individual interviews (n = 20) and focus groups (n = 3 χ 5 = 15). Data were analysed thematically using the principles of interpretative phenomeno-logical analysis. RESULTS: Three superordinate themes emerged from data analysis: 1) observation: its meaning, 2) observation: does it prevent self-harm? 3) Observation: making it work. CONCLUSION: Observation is a useful practice in in-patient learning disability services, which can be used to prevent or reduce the incidence of self-harm in these settings. This approach should therefore be an integral part of nurses' daily therapeutic activities in in-patient learning disability services. <![CDATA[<b>Strategies to facilitate professional development of the occupational health nurse in the occupational health setting</b>]]> BACKGROUND: Education and experience are important components in the ability of occupational health nurses (OHNs) to promote high-quality care and competence. OHNs will increasingly require the skills and knowledge to base care on best evidence, to use critical thinking and demonstrate advanced leadership and decision-making skills to develop and enhance services in a more complex and diverse occupational healthcare environment. OBJECTIVE: The purpose of this study was to identify the needs for professional development of the OHN in the occupational health setting. METHOD: An explorative, descriptive, contextual generic and qualitative research method was used in this study. The purposive sampling method was used as the OHNs surveyed described their personal need for professional development in the occupational health setting. Data was collected by means of semi-structured individual interviews. Eight interviews were done by an interviewer who held a doctoral degree in community health nursing and a qualification in occupational health and was affiliated with a private occupational health institution at the time of the study. The interviews were conducted during August 2012. RESULTS: The OHNs reported that professional development needs have to be identified by the OHNs. Short courses need to be designed by training institutions and should be attended by the OHNs to improve their operational functioning on a day-to-day basis in the occupational health setting. The OHNs experienced that their role and function in the workplace were not valued by their managers. The results of this study revealed four major themes, namely constraints hindering the OHN in developing professionally, positive aspects identified by the OHNs regarding the need for professional development, professional development needs of the OHN and suggestions of how to meet the OHNs' professional development needs. CONCLUSION: There is a need for OHNs to identify their professional development needs and recommendations were made to meet these needs. <![CDATA[<b>An integrative review of Albertina Sisulu and ubuntu: Relevance to caring and nursing</b>]]> BACKGROUND: Caring forms the core component of nursing. The history of the nature of caring in South Africa is non-specific and is unknown. The impact of nurse and activist Albertina Sisulu - known as the Mother of the Nation - has the potential to offer unique insights into what could be the context of caring for nurses. AIMS: The study aimed at 1) critically synthesising the available evidence of caring as portrayed by Albertina Sisulu within the South African context, and 2) interpreting Sisulu's work within the Ubuntu philosophy as a framework for nursing and caring METHOD: An integrative review was completed using Whittemore and Knafl's framework. Key electronic databases, selected references and web-based search engines were scoured for articles meeting the inclusion criteria. This systematic and iterative approach yielded 18 non-research reports related to Sisulu; eight reports (three research, five non-research) related to ubuntu and nursing. Data was extracted that related to relevant and conclusive new and innovative practices in caring. RESULTS: The findings provided a context for practice guidelines of caring concerning knowledge and critical thinking about caring by nurses. Two primary factors emerged that demonstrated a culture of caring as seen through the prism of Sisulu's life: devoted dancer and creation of a healing environment. These factors also reflect African ubuntu principles, where the focus is on the relationships between people and how these relationships could be conducted CONCLUSIONS: Ubuntu and Sisulu's approach to caring have much to offer for the nursing profession in terms of developing of new directions for nursing pedagogy, curriculum, practice patterns, and policies that emphasise caring constructs.