Scielo RSS <![CDATA[Health SA Gesondheid (Online)]]> vol. 22 num. lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Young families become mindful of their possibilities through the appreciation of their family life</b>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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. <![CDATA[<b>The prevalence of osteoarthritic symptoms of the hands amongst female massage therapists</b>]]> BACKGROUND: Numerous occupations increase one's risk of developing osteoarthritis. Massage therapists rely heavily on their hands and cumulative hand strain injuries that occur whilst performing a massage may lead to the development of osteoarthritic symptoms. Females are at greater risk of developing osteoarthritis. Furthermore age weight, genetic predisposition; working years, working hours as well as body mass index all increase the risk of developing osteoarthritis. OBJECTIVE: This study sought to investigate the prevalence of osteoarthritic symptoms of the hands amongst female massage therapists, as well as to establish both an average age of symptomatic onset and whether their daily work productivity was influenced. Materials and methods: Since the massage industry is predominantly practiced by females, female massage therapists, irrespective of age and registered with a South African Regulating Body were included. Participants were required to complete a self-administered questionnaire which evaluated age, self-reported symptomatic presence of and family history of osteoarthritis, and body mass index. Participants also completed the AUSCAN™ Hand Osteoarthritis Index LK3.1 (Australian/Canadian Hand Osteoarthritis Index) which assesses pain, disability and joint stiffness of the hands. The sample was divided into two groups based on the presence or absence of self-reported symptoms. All gathered data was analysed by the University of Johannesburg's statistics department (Statkon) by use of IBM SPSS Statistics software version 21. RESULTS: The mean age of symptomatic presentation was 43 years. The AUSCAN™ Index found that more than half of the total sample reported osteoarthritic symptoms in their hands. Participants in the non-symptomatic group also indicated a positive response to symptoms on the AUSCAN™ Index although they did not self-report a symptomatic onset age. CONCLUSION: In this sample, massage therapists experienced osteoarthritic symptoms that cause pain and stiffness in their hands. It also seemed evident that the symptoms experienced were also responsible for placing strain on their ability to perform daily tasks. This study serves as a basis for further dialogue, research and professional awareness. <![CDATA[<b>Developing, implementing and evaluating a simulation learning package on post-partum haemorrhage for undergraduate midwifery students in KwaZulu-Natal</b>]]> BACKGROUND: The training of undergraduate midwifery students to identify and manage post-partum haemorrhage, is an essential skill in midwifery. AIM: The aim of this study was to develop, implement and evaluate a simulation learning package (SLP) on post-partum haemorrhage for undergraduate midwifery students using high fidelity simulation without risks to real-life patients. METHODS: An exploratory sequential mixed methodology was used in this study. The study was made up of three phases namely; the development, implementation and evaluation of the learning package. The research participants were fourth year baccalaureate of nursing midwifery students and midwifery experts involved in teaching midwifery. Data was collected using an evaluation checklist for experts, a student satisfaction survey and focus group sessions. Quantitative data were analysed using SPSS Version 23.0 and the qualitative data was analysed using content analysis as described by Graneheim and Lundman (2004). RESULTS: The evaluation checklist for experts revealed that the developed SLP was considered suitable for undergraduate students. It encouraged active learning, teamwork and accommodated diverse learning styles. The package was easy to use and offered opportunities for student feedback. The student satisfaction survey revealed that the pre-simulation support received was adequate and helpful, and the post simulation outcomes showed that using high fidelity simulation improved clinical skills, knowledge, critical thinking, self-confidence and satisfaction. The focus group sessions revealed that the SLP was an innovative and interactive method of learning; it improved the student's perception of their clinical competence, stimulated critical thinking and increased self-confidence. CONCLUSION: A simulation learning package, that uses high fidelity simulation, can be an innovative and interactive method to teach midwifery emergencies. <![CDATA[<b>Exploring the stigma related experiences of family members of persons with mental illness in a selected community in the iLembe district, KwaZulu-Natal</b>]]> BACKGROUND: Stigma in mental illness is a serious social problem which has a multitude of consequences on the individual concerned, as well as his or her family. Research has shown that families of persons living with mental illnesses are often subjected to stigma by virtue of their association with such a person. The stigma of families is seen in the form of assignment of blame, social isolation and rejection. This stigma subsequently perpetuates a cycle of disability on the part of the patient and family. PURPOSE: To explore the stigma related experiences of family members of persons with mental illness in a selected community in the iLembe district of KwaZulu-Natal (KZN), in order to develop recommendations to help families cope with such stigma. METHODS: This was a descriptive qualitative study; data was collected from a purposive sample of six family members, which resulted in data saturation. Semi-structured interview questions were used during data collection and content analysis using Creswell's (2009) method was done to analyse the data; resulting in the formation of themes and sub-themes which were supported by the participants' responses and existing literature. RESULTS: Participants reported experiencing stigma from the community in the form of isolation, blame and exploitation, community neglect, as well as labelling and stereotyping. The majority of the participants reported using emotion-focused coping mechanisms to deal with the stigma they faced. Participants suggested that education of communities regarding the myths and facts about mental illness may help to curb the stigma faced by the family members of persons with mental illness. CONCLUSION: Based on the results of this study, it was recommended that a combination of coping strategies, together with the integration of public and private sector support, be used to holistically deal with family related stigma. It was found that ground level education and support to families is the key to curbing family related stigma of mental illness, local NGO's and the clinics would be instrumental in this area. <![CDATA[<b>A concept analysis of young adults; Perception of HIV Counselling and Testing</b>]]> AIM: The aim of the study was to investigate perceptions of young adults regarding HIV Counselling and Testing (HCT) and the factors contributing to either negative or positive perceptions towards the programme. This article is a report of a concept analysis of young adults' perceptions of HCT that were collected during the study. BACKGROUND: Perception forms the core of HIV Counselling and Testing (HCT) use by young adults, because it is from these perceptions that young adults will decide to follow an HCT programme or not, depending on how they perceive the programme. HCT as an entry point in HIV and AIDS services should be accessible and young adults' perceptions towards the programme be promoted in order to assist them to develop positive perceptions towards the programme, which will enhance its uptake. DATA SOURCES: A literature search was undertaken using internet search engines, different journals, websites and electronic literature indexes. A sample of 60 documents met the criteria. The inclusion criterion was any article addressing perceptions in psychology, social sciences, nursing and education were reviewed. REVIEW METHOD: A concept analysis was conducted according to the steps of Rodger and Knafl (2000); Walker and Avant (2005) and Wilson (1963). RESULTS: Perception has been defined as a constructive process that relies on a top-down processing. This entails that people make inferences about what they see and try to make a best guess as to what the object is all about. Attributes for perception were defined as intensity and physical dimension of stimulus, past experiences, and attention factors such as readiness to respond to the stimulus, motivation and emotional state of the subject. Consequences include increased HCT uptake by young adults, a positive lifestyle, a reduction in the spreading of HIV and AIDS and lowered HIV statistics amongst young adults. CONCLUSION: The study findings related to HCT and perceptions paved the way towards a further understanding of HCT as an entry programme in HIV/AIDS services or programmes in relation to young adults. The ability of young adults to use their auditory senses to hear the nurses talk about HCT and HIV, the ability to see the attitudes displayed by HCT counsellors, and their perceptions with regard to lack of privacy, together with a lack of treatment for HIV made young adults to perceive HCT programme as being of less importance to them. <![CDATA[<b>Ocular allergy</b>]]> AIM: To systematically review relevant literature investigating the classification and nomenclature, epidemiology and pathophysiological mechanisms, as well as diagnosis and treatment of ocular allergy. METHOD: The Medline, PubMed, Elsevier Science Direct, and Google Scholar databases were used to search for evidence-based literature on ocular allergy. Main outcome measures: Classification and nomenclature, epidemiology and pathophysio-logical mechanisms, diagnosis and management of ocular allergy. RESULTS: The search retrieved 5200 number of studies of which 6 met the criteria. CONCLUSIONS: While numerous studies regarding pharmacological and immunological research have identified new treatment options, there is a dearth of clinical studies to discover the biomarkers and immune therapeutic management to control sensitisation and effector phases of this condition. Given the complexity of this condition due to the multifactorial nature of the possible aetiologies, rigorous well-designed scientific studies are needed to determine the exact classification, prevalence and underlying immune pathological processes of ocular allergy. <![CDATA[<b>Experiences of registered nurses caring for patients with an open abdomen in an intensive care unit in Gauteng</b>]]> The researcher observed that nurses prefer not to nurse patients with an open abdomen as they fear that the abdominal contents will protrude. The purpose of the study was to explore and describe the experiences of registered nurses taking care of patients with an open abdomen in intensive care in an academic hospital in Gauteng, and to provide recommendations for registered nurses when taking care of patients with an open abdomen. The research design used was a qualitative, exploratory, descriptive and contextual design. Focus group interviews were conducted with each group comprising six participants. The research question was: What are the experiences of registered nurses caring for patients with an open abdomen in an intensive care unit? What recommendations can be made to assist registered nurses in taking care of patients with an open abdomen in an intensive care unit? The data was analysed using Tesch's method. Three themes emerged: Difficulty in nursing care, complications such as fistula and infections, and poor hospital administration. Recommendations for assisting registered nurses in taking care of patients with an open abdomen were then made based on the findings of the four focus group interviews. Ethical principles and measures of trustworthiness were adhered to throughout the research study. <![CDATA[<b>Use of online interactive tools in an open distance learning context: Health studies students' perspective</b>]]> BACKGROUND: Open distance learning (ODL) institutions provide educational challenges with specific reference to the training of nurses. They have adopted online technologies to facilitate teaching and learning. However it is observed that most nurses do not use or minimally use tools such as a discussion forum for online interaction to facilitate teaching and learning. OBJECTIVE: The purpose of this study was to determine how the discussion forum as an online interactive tool be used in an ODL institution to enhance student-to-student and student-to-lecturer online interactions. DESIGN: Quantitative and descriptive in nature. METHOD: No sampling was done. An online questionnaire was sent to all 410 second and third years Health Services Management students around the world registered with a specific ODL institution during the second semester. Eighty seven students responded to the questionnaire. Data analysis was done quantitatively and descriptively in the form of diagrams. RESULTS: The findings indicated that 84.9% of students own computers, and 100% own cellular phones, but only 3.8% participated in online discussion forum. Some students indicated that they were technologically challenged. Some lecturers interact minimally online and are not supportive to them. The institution does not give them the support they need to acquire the necessary skills to utilise these technologies. CONCLUSION: The article suggests that lecturers, active interaction in an online discussion forum as a way of supporting students, are fundamental to effective teaching and learning. The university should consider providing intensive mentoring to students to enable them to utilise the available technologies optimally. <![CDATA[<b>Utilisation of mobile health by medical doctors in a Zimbabwean health care facility</b>]]> BACKGROUND: Mobile Health is the utilisation of mobile devices like cellphones and tablets for the delivery of health care. It is an up and coming intervention promising to benefit health services. Recent mobile health studies have tended to focus on mHealth for data collection and surveillance rather than on actual patient care. This paper highlights the potential and the challenges of mHealth use in the delivery of health care services. OBJECTIVES: This paper focused on determining the use of mHealth and identifying and describing the opportunities and the challenges faced by the medical doctors in using mHealth at a specific health care facility in Zimbabwe. METHODS: A quantitative, descriptive, cross-sectional and analytical design was used to determine the rate of utilisation of selected mHealth "patient identification and treatment activities" by medical doctors. A structured questionnaire was used for data collection form 104 respondents. The number of the returned complete and usable questionnaires was 42. No sampling technique was done because the whole population was of interest to the researcher, accessible and available during data collection. RESULTS: Fifty percent (50%) of the respondents indicated, lack of knowledge and un-awareness in using mHealth to support chronically ill patients. The majority of the respondents (83.3%) believed that mHealth presented opportunities to improve health care delivery. The majority of the respondents (95%) indicated the potential for its future use. CONCLUSION: Given the challenges that were encountered mHealth program to be officially launched for mHealth use and the users to be developed on its utilisation. <![CDATA[<b>Reported exposure to trauma among adult patients referred for psychological services at the Free State Psychiatric Complex, Bloemfontein</b>]]> BACKGROUND: Information regarding lifetime exposure to potentially traumatic events is critical in the management of various psychiatric disorders. Recent South African research suggests high levels of trauma exposure in the general population, however, the prevalence and type of potentially traumatic events among tertiary psychiatric patients are unknown OBJECTIVE: The study aimed to explore and describe the extent and nature of reported potentially traumatic events and associated variables in adult patients referred for psychological services at the Free State Psychiatric Complex (FSPC), Bloemfontein. METHODS: In this cross-sectional study, demographic information, diagnostic morbidity and co-morbidity, and presence and type of reported trauma exposure reported by patients during the initial assessment were obtained from files of adult patients seen during a one-year period (2010) at the out-patient unit and the in-patient affective ward at the FSPC. Data were captured on data record forms by the researchers and analysed by means of descriptive statistics, univariate analysis and logistic regression (SAS version 9.1) RESULTS: Of the 192 adults (71.9% White and 67.2% female) referred for psychological services, 75.5% were diagnosed with mood disorders, 17.2% with anxiety disorders, 22.4% with substance-related disorders and 20.9% with cluster B personality disorders or traits. A total of 145 (75.5%) reported past trauma exposure. The most frequently reported types of trauma exposure were traumatic death/injury of a loved one (37.0%), physical assault (24.5%), witnessed/threatened violence (19.3%), and sexual assault (17.7%). Women were more likely to have been exposed to trauma than men (OR 4.02, 95% CI 1.87-8.62), in particular to traumatic death of a loved one (OR 3.13), physical assault (OR 4.08), or sexual assault (OR 5.43). CONCLUSIONS: The findings of this study contribute to current data regarding the prevalence of exposure to trauma and its possible association with mental illness. The importance of comprehensive trauma exposure screening in routine psychiatric interviewing practices is highlighted. <![CDATA[<b>An elderly, urban population: Their experiences and expectations of pharmaceutical services in community pharmacies</b>]]> OBJECTIVE: The aim of this study was to determine the pharmaceutical services experiences of an elderly, urban population in relation to their expectations in community pharmacy. DESIGN: and setting: The study was a cross-sectional descriptive empirical study and was conducted by means of a structured questionnaire, designed and administered by the researcher, in face-to-face interviews at an old age residence in the participants' own dwellings (N = 242). The management of this specific village approached the researcher about healthcare concerns for their residents and granted permission for this study to be conducted. Main outcome and results: The sample population of elderly patients (n = 67) had a higher expectation of community pharmacists, in terms of pharmaceutical services, than what they had experienced. Significant differences were found in all aspects examined. Effect size, amongst others, revealed that expectations were not met in discussions about the effect of other medicines on their chronic medicine (d = 1.94); whether they had any medicines left from previous issues (d = 1.77) and questions regarding existing chronic conditions (d = 1.69). There was an association between questions, regarding the use of chronic medicines at pharmacies and at other healthcare professionals (d = 0.26), as well as the supply of written information at pharmacies and other healthcare professionals (d = 0.42). The study reveals that this population has expectations of their community pharmacists that are not met. CONCLUSIONS: Pharmacists can be active members of the healthcare team and restore their professional image in the eyes of the community, if they renew their attitudes, have confidence in their abilities and understand their role in patient care. The community pharmacist should focus on the health-related quality of life of the individual patient and identify the immediate healthcare needs of their unique community, with specific reference to vulnerable populations like the elderly. Pharmacists should establish themselves as the go-to healthcare professional. <![CDATA[<b>Effect of personal and work stress on burnout, job satisfaction and general health of hospital nurses in South Africa</b>]]> The majority of studies to date have focused on the effects of work stress in the nursing environment, with the effect of personal stress in nursing being less explored. This study sought to determine whether personal stress is a more significant predictor of burnout, job satisfaction and general health than work stress. Of the 1200 nurses randomly selected to participate in the study, 895 agreed to complete six questionnaires over 3 weeks. Data was analysed using hierarchical multiple linear regression. Findings revealed that personal stress is a better predictor of burnout and general health than job satisfaction, which is better predicted by work stress. The findings of this study could inform potential solutions to reduce the impact of personal and work stress on burnout, job satisfaction and general health. Coping strategies and staffing strategies need to be evaluated within developing contexts such as South Africa to ascertain their effectiveness. <![CDATA[<b>Lived experience of patients on tuberculosis treatment in Tshwane, Gauteng province</b>]]> Tuberculosis is one of the communicable diseases that still contributes substantially to the worldwide disease burden and is still a major health threat worldwide. In order to gain a better understanding of being a patient taking tuberculosis treatment and to improve adherence to treatment, this phenomenological study was conducted to explore the lived experience of patients on tuberculosis treatment. The population comprised patients in an identified tuberculosis clinic in Tshwane who had been on treatment for at least four months and who were able to communicate in English. The data gathering instrument was self-report by in-depth interview. Some of the main themes that emerged include influence of personal social situation, influence of good social support and disclosure, experience of taking medication daily and knowledge about tuberculosis treatment. Findings revealed that the personal social situations of the participants which include accommodation, unemployment and nutritional requirements influenced the adherence of the participants to treatment. It was discovered that good social support had an influence on adherence which could only be enjoyed when the treatment and diagnosis of tuberculosis is disclosed to the family members and friends. Some of the participants, who had been non-adherent in the past, attributed the reasons for their non-adherence to the side effects that they experienced. Lastly, participants also reported knowledge about tuberculosis, that is, knowledge about its causes, treatment and prevention, as crucial for adherence to treatment. <![CDATA[<b>A review of the transportability of cognitive therapy for the treatment of PTSD among South African rape survivors</b>]]> This study aimed to evaluate the transportability of cognitive therapy (CT) for rape survivors with PTSD to South African conditions. Ten local treatment outcome studies investigating the transportability of CT were identified and appraised. The common elements of CT for PTSD including psychoeducation, exposure therapy and cognitive restructuring of trauma-related appraisals were found to be transportable to local contexts. Contextual factors that can complicate treatment delivery were also identified namely exposure to multiple traumatic events, HIV, absence of safety and support in the external environment and language barriers. The augmentations made to an existing evidence-based treatment protocol to address these contextual factors are described. <![CDATA[<b>A conceptual framework to facilitate clinical judgement in nursing: A methodological perspective</b>]]> The South African health care and education systems are challenged to provide independent, critical thinking nurses who can cope with diversity in a creative way and define their role in a complex, uncertain, rapidly changing health care environment. Quality clinical judgement is an imperative characteristic that newly qualified professional nurses should possess. To accommodate these needs, SANC in line with the SAQA Act, advocated the development of teaching and learning strategies to balance theory and practice opportunities together with an outcome-based, studentcentred approach and appropriate clinical supervision. This resulted in a positive outcome to facilitate the integration/fusion of theory and practice. The purpose of this study was to synthesise a teaching-learning strategy for creating an enabling learning environment to facilitate clinical judgement in South African undergraduate nursing students. The proposed teaching-learning strategy is grounded in modern-day constructivist approach of learning. The conceptual or theoretical framework of this study aimed to link the central concepts that were identified from the conclusions of four (4) strategic objectives of the two preceding phases of the study into a new structure of meaning that served as a basis for the proposed strategy. The implementation of the proposed action plan to achieve the stated strategic objectives should empower the relevant role players to facilitate clinical judgement in undergraduate nursing students and thereby promote autonomous and accountable nursing care. <![CDATA[<b>Evidence-based recommendations to facilitate professional collaboration between allopathic and traditional health practitioners</b>]]> BACKGROUND: Globally, and in South Africa, there is an increased demand for consulting both traditional and allopathic health practitioners. As both health practitioners are working within the same communities, their respective practices could complement or undermine the health of consumers using both health services. Professional collaboration between traditional and allopathic health practitioners is therefore desirable and requires collaboration between the systems, which is currently legislated by the Traditional Health Practitioners Act 22 of 2007. However, in the Eastern Cape, no evidence-based recommendations were found that facilitated the collaborative relationship between the two health practitioner groups. Purpose of the research: To develop evidence-based recommendations aimed at facilitating professional collaboration between allopathic and traditional health practitioners for the benefit of patients. METHODOLOGY: Descriptive evidence-based recommendations to enhance professional collaboration between both groups of health practitioners were developed based on focus group interviews with allopathic practitioners (n = 10) and individual interviews with traditional health practitioners (n = 18) (traditional health practitioners (n = 14) and traditional healers who are also allopathic health practitioners (n = 4)) practising in the Amathole District in the Eastern Cape, South Africa. Dickoff et al.'s (1968) Survey List was used as a conceptual framework. RESULTS: Collaboration was hampered by allopathic practitioners demonstrating negative attitudes by not referring patients to traditional practitioners based on lack of knowledge and mutual understanding of each other's practices. Suggestions for collaboration made by both groups resulted in the development of two distinct sets of evidence-based recommendations. The first set of recommendations aims to enhance professional collaboration between both groups of health practitioners. This is done through facilitating mutual understanding based on respect and acceptance between the different practitioners. The second set of recommendations aims to enhance professional collaboration through facilitating open communication between different practitioners. CONCLUSION: These evidence-based recommendations can be used to facilitate professional collaboration between allopathic and traditional health practitioners resulting in mutual understanding and open communication, enhancing team work in a multi-professional environment, and ultimately leading to improved patient care. <![CDATA[<b>e-Learning readiness amongst nursing students at the Durban University of Technology</b>]]> e-Learning and other innovative open learning multimedia modalities of delivering education are being introduced to enhance learning opportunities and facilitate student access to and success in education. This article reports on a study that assessed students' readiness to make the shift from traditional learning to the technological culture of e-Learning at a university in Durban. A quasi-experimental study design was employed to assess such readiness in first year nursing students before and after an appropriate educational intervention. A modified Chapnick Readiness Score was used to measure their psychological, equipment and technological readiness for the change in learning method. It was found that, while students' psychological readiness for e-Learning was high, they lacked technological and equipment readiness. Although e-Learning could be used in nursing education, technological and equipment readiness require attention before it can be implemented effectively in this institution. Fortunately, these technical aspects are easier to resolve than improving psychological readiness. <![CDATA[<b>A student-facilitated community-based support group initiative for Mental Health Care users in a Primary Health Care setting</b>]]> BACKGROUND: South African Mental Health Care (MHC) legislation advocates for supportive rehabilitative services in Primary Health Care (PHC) settings. PHC settings are often understaffed and MHC nurses in these settings overburdened with high patient loads. Alternative cost-effective psycho-social intervention strategies must be explored to supplement the overstrained MHC sector to meet the rehabilitative and supportive needs of service users in community settings. Using a social constructionist epistemology, this study aimed to highlight the value of a community-based support group for MHC users at a Tshwane District Community Health Centre. This was done by exploring the meaning group members attached to the group. The intervention was a collaborative partnership between a local University Psychology Department and the Department of Health, Tshwane District, utilising post-graduate psychology students as group facilitators. METHODS: Qualitative research methods were applied. Data were collected using semi-structured interviews and a collage-making and storytelling method. Thematic analysis highlighted the main themes representing the meaning the five participants ascribed to the group. RESULTS: The findings suggest that the group offered the participants a sense of belonging and a means of social and emotional support. The group also created opportunity for learning, encouraged mental and physical mobilisation and stimulation, and served as an additional link to professional services. CONCLUSION: The findings suggest that student-facilitated support groups could offer a viable supplement for offering support to service users in PHC settings. The group assisted MHC users to cope with symptoms, social integration, and participating in meaningful activities as part of rehabilitation services.