Scielo RSS <![CDATA[Curationis]]> vol. 39 num. 1 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Level of job satisfaction amongst nurses in the North-West Province, South Africa: Post occupational specific dispensation</b>]]> BACKGROUND: Job satisfaction and burnout have been recurring problems amongst nurses in the Republic of South Africa (RSA). As a result, nurses are still leaving the rural public sector in search of lucrative work at the urban and private sectors and in developed countries. Accordingly, Occupational Specific Dispensation (OSD) was introduced as a strategy to circumvent the problem. However, since the implementation of OSD in 2007, there have been no studies conducted regarding the level of job satisfaction amongst nurses after the implementation of OSD in the North-West Province, especially because each province has its own challenges that are unique to the area OBJECTIVES: The study had two objectives: to describe the level of job satisfaction amongst professional and other category nurses (OCNs) at a public hospital in the North-West Province and describe the perceptions of nurses about OSD and their intention to continue working in the hospital METHOD: A quantitative descriptive cross-sectional design was used. Stratified random sampling was used to select a sample of 92 professional nurses (PNs), 90 enrolled nurses and enrolled nursing assistants (Nursing Act 2005), which made a total of 182 participants. For the purpose of the study, the enrolled nurses and enrolled nursing assistants were referred to as OCNs. Data were collected using the Minnesota Satisfaction Questionnaire short form and OSD statements and analysed with Statistical Package for Social Science (SPSS, version 18 RESULTS: The majority of PNs (79.3%, n = 73) and OCNs (86.7%, n = 77) were dissatisfied with the working conditions and salary: PNs (80.4%, n = 74) and OCNs (87.8%, n = 79). The nurses mostly discredited the current state of the OSD implementation. Majority of the PNs (84%, n = 77) and OCNs (91%, n = 82) disagreed with the statement that 'level of job satisfaction has improved after the implementation of OSD' CONCLUSIONS: The National Department of Health should consider a holistic approach to address all work-related conditions for nurses in order to curb the attrition rates. Policy makers and unions should urgently review OSD for all categories of nurses <![CDATA[<b>Navigating conflicting laws in sexual and reproductive health service provision for teenagers</b>]]> BACKGROUND: The South African legal and policy framework for sexual and reproductive healthcare provision for teenagers is complex OBJECTIVE: The article outlines the dilemmas emanating from the legal and policy framework, summarises issues with implementation of the legal and policy framework in practice, and summarises recent changes to the law METHODS: In-depth analysis of the legal and policy framework. Training workshops with a purposive sample of nurses and other healthcare providers in the Western Cape FINDINGS: Tensions between consent and confidentiality imposed by the Termination of Pregnancy Act, the Children's Act, the National Health Act and the Criminal Law (Sexual Offences and Related Matters) Amendment Act render conflicting obligations on healthcare providers. Healthcare providers' experiences with service provision in this context show that the conflicting roles they inhabit render their service provision to teenagers more challenging CONCLUSION: Healthcare providers need to learn about their legal obligations surrounding adolescent sexual and reproductive health services <![CDATA[<b>Assessment of activities performed by clinical nurse practitioners and implications for staffing and patient care at primary health care level in South Africa</b>]]> BACKGROUND: The shortage of nurses in public healthcare facilities in South Africa is well documented; finding creative solutions to this problem remains a priority OBJECTIVE: This study sought to establish the amount of time that clinical nurse practitioners (CNPs) in one district of the Western Cape spend on clinical services and the implications for staffing and skills mix in order to deliver quality patient care METHODS: A descriptive cross-sectional study was conducted across 15 purposively selected clinics providing primary health services in 5 sub-districts. The frequency of activities and time CNPs spent on each activity in fixed and mobile clinics were recorded. Time spent on activities and health facility staff profiles were correlated and predictors of the total time spent by CNPs with patients were identified RESULTS: The time spent on clinical activities was associated with the number of CNPs in the facilities. CNPs in fixed clinics spent a median time of about 13 minutes with each patient whereas CNPs in mobile clinics spent 3 minutes. Fixed-clinic CNPs also spent more time on their non-core functions than their core functions, more time with patients, and saw fewer patients compared to mobile-clinic CNPs CONCLUSIONS: The findings give insight into the time CNPs in rural fixed and mobile clinics spend with their patients, and how patient caseload may affect consultation times. Two promising strategies were identified - task shifting and adjustments in health worker deployment - as ways to address staffing and skills mix, which skills mix creates the potential for using healthcare workers fully whilst enhancing the long-term health of these rural communities <![CDATA[<b>Knowledge and uptake of occupational post-exposure prophylaxis amongst nurses caring for people living with HIV</b>]]> BACKGROUND: Nurses caring for people living with HIV (PLWH) are at higher risk of exposure to the human immunodeficiency virus (HIV) by needle sticks, cuts, getting body fluids in their eyes or mouth and skin when bruised or affected by dermatitis. OBJECTIVES: To determine knowledge, insight and uptake of occupational post-exposure prophylaxis (OPEP) amongst nurses caring for PLWH. METHOD: A cross-sectional descriptive design was used in this study. Stratified random sampling was used to sample 240 nurses. The study was conducted in a regional hospital in Limpopo province. Both parametric and non-parametric statistics were employed to analyse data. RESULTS: A total of 233 nurses participated in the study. Sixty per cent (n = 138) of all nurses had a situation at work when they thought that they were infected by HIV and 100 (43%) nurses had experienced the situation once or more in the past 12 month. Approximately 40% did not know what PEP (post-exposure prophylaxis) is, and 22% did not know or were not sure if it was available in the hospital. Only few participants (n = 68, 29%) had sought PEP and most (n = 37, 54%) of them did not receive PEP when they needed it. There was a significant association between the knowledge and availability of PEP (r = 0.622). CONCLUSION: The study recommend an urgent need for policy makers in the health sector to put in place policies, guidelines and programmes that will rapidly scale up PEP services in health care settings, so that preventable occupationally acquired HIV infection can be minimised amongst nurses. <![CDATA[<b>Students' views on the block evaluation process: A descriptive analysis</b>]]> BACKGROUND: Higher education institutions have executed policies and practices intended to determine and promote good teaching. Students' evaluation of the teaching and learning process is seen as one measure of evaluating quality and effectiveness of instruction and courses. Policies and procedures guiding this process are discernible in universities, but it is often not the case for nursing colleges. OBJECTIVE: To analyse and describe the views of nursing students on block evaluation, and how feedback obtained from this process was managed. METHOD: A quantitative descriptive study was conducted amongst nursing students (n = 177) in their second to fourth year of training from one nursing college in KwaZulu-Natal. A questionnaire was administered by the researcher and data were analysed using the Statistical Package of Social Sciences Version 19.0. RESULTS: The response rate was 145 (81.9%). The participants perceived the aim of block evaluation as improving the quality of teaching and enhancing their experiences as students. They questioned the significance of their input as stakeholders given that they had never been consulted about the development or review of the evaluation tool, or the administration process; and they often did not receive feedback from the evaluation they participated in. CONCLUSION: The college management should develop a clear organisational structure with supporting policies and operational guidelines for administering the evaluation process. The administration, implementation procedures, reporting of results and follow-up mechanisms should be made transparent and communicated to all concerned. Reports and actions related to these evaluations should provide feedback into relevant courses or programmes. <![CDATA[<b>A systematic review: Are herbal and homeopathic remedies used during pregnancy safe?</b>]]> BACKGROUND: Herbal and homeopathic remedies have been used to assist with childbearing and pregnancy for centuries. Allopathic ('Western') medicine is traditionally avoided during pregnancy because of limited drug trials and the suspected teratogenic effects of these medications. This has led to an increase in the use of herbal and homeopathic remedies, as they are viewed to have no teratogenic effect on the developing foetus. Health providers are faced with questions from their clients regarding the safety of these remedies, but much of the evidence about these herbal and homeopathic remedies is anecdotal and few remedies have been tested scientifically. OBJECTIVES: By conducting a systematic review, the primary objective was to evaluate maternal and neonatal outcomes of ingested herbal and homeopathic remedies during pregnancy. METHOD: A systematic review was conducted to synthesise all the evidence with the purpose of evaluating the safety of herbal and homeopathic remedies based on adverse maternal and neonatal outcomes. Only randomised and quasi-randomised controlled trials that met all inclusion criteria were included in the review. RESULTS: The ingestion of ginger for nausea and vomiting during pregnancy was shown to have no harmful maternal or neonatal effects. Ingestion of castor oil for induction of labour showed a tendency towards an increase in the incidence of caesarean section and meconium-stained liquor, warranting further research into its safety issues. CONCLUSION: Larger randomised controlled trials need to be conducted, especially in South Africa, to establish the safety and efficacy of commonly-used remedies. <![CDATA[<b>An assessment of the outcomes of prevention of mother-to-child transmission of HIV services in Addis Ababa, Ethiopia</b>]]> BACKGROUND: This article assessed maternal and neonatal outcomes amongst users of prevention of mother-to-child transmission (PMTCT) of HIV services in Addis Ababa, Ethiopia. OBJECTIVES: The study aimed to assess the health outcomes (antiretroviral prophylaxis versus antiretroviral treatment, CD4 counts, World Health Organization (WHO) stages of illness, other illnesses) of women who had used these services, as well as the HIV status of their babies and the infant feeding method adopted. METHODS: A quantitative, cross sectional, retrospective cohort design was used. Document reviews were conducted with a sample of 384 mother-infant pairs (out of a population of 796) who had used PMTCT services. RESULTS: All respondents were using prophylactic antiretrovirals or antiretroviral therapy, but some were on the wrong treatment based on their CD4 counts. The CD4 counts increased four times more for women on antiretroviral treatment than for those on prophylactic antiretrovirals. The WHO's stages of HIV illness did not improve but deteriorated in some cases, and 52 other illnesses were recorded. Out of the 384 infants, 6.0% (n = 23) were HIV-positive. Most respondents opted for exclusive breast feeding but some used mixed feeding during the first six months of their infants' lives, despite having received health education related to infant feeding options. CONCLUSION: The respondents' improved CD4 counts were inadequate to improve their World Health Organization stages of HIV illness. Some babies received mixed feeding during the first six months of their lives and 6% of the babies were HIV-positive despite their mothers' utilisation of PMTCT services. <![CDATA[<b>Effects of increased nurses' workload on quality documentation of patient information at selected Primary Health Care facilities in Vhembe District, Limpopo Province</b>]]> BACKGROUND: Recording of information on multiple documents increases professional nurses' responsibilities and workload during working hours. There are multiple registers and books at Primary Health Care (PHC) facilities in which a patient's information is to be recorded for different services during a visit to a health professional. Antenatal patients coming for the first visit must be recorded in the following documents: tick register; Prevention of Mother-To-Child Transmission (PMTCT) register; consent form for HIV and AIDS testing; HIV Counselling and Testing (HCT) register (if tested positive for HIV and AIDS then this must be recorded in the Antiretroviral Therapy (ART) wellness register); ART file with an accompanying single file, completion of which is time-consuming; tuberculosis (TB) suspects register; blood specimen register; maternity case record book and Basic Antenatal Care (BANC) checklist. Nurses forget to record information in some documents which leads to the omission of important data. Omitting information might lead to mismanagement of patients. Some of the documents have incomplete and inaccurate information. As PHC facilities in Vhembe District render twenty four hour services through a call system, the same nurses are expected to resume duty at 07:00 the following morning. They are expected to work effectively and when tired a nurse may record illegible information which may cause problems when the document is retrieved by the next person for continuity of care. OBJECTIVES: The objective of this study was to investigate and describe the effects of increased nurses' workload on quality documentation of patient information at PHC facilities in Vhembe District, Limpopo Province. METHODS: The study was conducted in Vhembe District, Limpopo Province, where the effects of increased nurses' workload on quality documentation of information is currently experienced. The research design was explorative, descriptive and contextual in nature. The population consisted of all nurses who work at PHC facilities in Vhembe District. Purposive sampling was used to select nurses and three professional nurses were sampled from each PHC facility. An in-depth face-to-face interview was used to collect data using an interview guide. RESULTS: PHC facilities encountered several effects due to increased nurses' workload where incomplete patient information is documented. Unavailability of patient information was observed, whilst some documented information was found to be illegible, inaccurate and incomplete. CONCLUSION: Documentation of information at PHC facilities is an evidence of effective communication amongst professional nurses. There should always be active follow-up and mentoring of the nurses' documentation to ensure that information is accurately and fully documented in their respective facilities. Nurses find it difficult to cope with the increased workload associated with documenting patient information on the multiple records that are utilized at PHC facilities, leading to incomplete information. The number of nurses at facilities should be increased to reduce the increased workload. <![CDATA[<b>Effective educator-student relationships in nursing education to strengthen nursing students' resilience</b>]]> BACKGROUND: Little research has been conducted in private nursing schools with regard to the educator-student relationship to strengthen the resilience of nursing students and to improve the educator-student relationship. An effective educator-student relationship is a key factor to ensure a positive learning climate where learning can take place and resilience can be strengthened. PURPOSE: The purpose was to explore and describe nursing students' view on the basic elements required for an effective educator-student relationship to strengthen their resilience and the educator-student relationship. METHOD: This study followed an explorative, descriptive and contextual qualitative design in a private nursing education institution in the North West Province. Purposive sampling was used. The sample consisted of 40 enrolled nursing auxiliary students. The World Café Method was used to collect data, which were analysed by means of content analysis. RESULTS: The following five main themes were identified and included: (1) teaching-learning environment, (2) educator-student interaction, (3) educator qualities, (4) staying resilient and (5) strategies to strengthen resilience. CONCLUSION: Students need a caring and supportive environment; interaction that is constructive, acknowledges human rights and makes use of appropriate non-verbal communication. The educator must display qualities such as love and care, respect, responsibility, morality, patience, being open to new ideas, motivation, willingness to 'go the extra mile' and punctuality. Students reported on various ways how they manage to stay resilient. It thus seems that basic elements required in an effective educator-student relationship to strengthen the resilience of students include the environment, interaction, educator and student's qualities and resilience. <![CDATA[<b>Social factors determining maternal and neonatal mortality in South Africa: A qualitative study</b>]]> BACKGROUND: South Africa's maternal mortality ratio has increased from 150/100 000 in 1990 to 269/100 000 live births in 2015 against the Millennium Development Goals 5 (MDG5) target of 38/100 000, indicating slow progress in improving maternal health. The neonatal mortality rate was 14/1000 live births against the MDG4 target of 7/1000. The purpose of the article was to outline the socio-economic factors that determine maternal and neonatal mortality in South African communities. OBJECTIVES: To identify and describe the social determinants of maternal and neonatal mortality in South Africa. METHOD: A qualitative study using audio-taped individual interviews was conducted. The interviews included 10 pregnant women who were purposefully recruited from the antenatal clinic attendees in a public hospital. The interviews were conducted in isiZulu and later translated into English by the researcher who is fluent in both. Data were analysed using the World Health Organization's (WHO) Commission on Social Determinants of Health framework. RESULTS: Findings revealed that poverty was an underlying factor to the vulnerability to illness and death of the mothers and their neonates. Other determinants were found to be the nutritional inadequacies, neglect and abuse by male partners, HIV or AIDS, inattention to reproductive health and violation of reproductive rights, and powerlessness of women and health system issues such as poor quality and incompetent health care. CONCLUSION: It is apparent that poverty plays a major role in determining the health of mothers and neonates. This requires more coordinated multi-sectorial interventions to address both the social determinants and direct causes of maternal and neonatal deaths. <![CDATA[<b>The needs of families accompanying injured patients into the emergency department in a tertiary hospital in Gauteng</b>]]> BACKGROUND: Families are not prepared for traumatic injuries of loved ones. Emergency nurses have the important role of caring for patients and families in this time of crisis. Family needs in the critical care setting have been explored using the Critical Care Family Needs Inventory (CCFNI), however little is known about family needs in the emergency department. OBJECTIVES: This study sought to determine the needs of family members accompanying injured patients into the emergency department, and if these needs were met. METHODS: A quantitative, descriptive, study was conducted in a level 1 trauma facility in Johannesburg, South Africa. The population included families of patients admitted to the emergency department, sampling 100 participants. The instrument, based on the CCFNI, was validated in a pilot study in Melbourne, Australia and re-evaluated using the Cronbach Alpha validity test to ensure internal consistency Five themes were explored: 'meaning', 'proximity', 'communication', 'comfort' and 'support' and data were analysed using descriptive statistics. Responses to open-ended questions were analysed using content analysis. Permission from the Human Research Ethics Committee was granted and participants were ensured confidentiality and the option for counselling if required. RESULTS: Themes ranked highly important were 'meaning' and 'communication'. Satisfaction was highest for 'meaning'. Low satisfaction levels for 'communication' were found. Issues regarding prolonged time spent in the emergency department and discrimination were raised. CONCLUSION: These findings have a negative impact on the family's satisfaction with care and it is recommended that the nurse's role in family care be further explored and emphasised. <![CDATA[<b>Palliative care needs in Malawi: Care received by people living with HIV</b>]]> BACKGROUND: Infection with human immunodeficiency virus (HIV) has changed from an acute to a chronic illness in the past decade, because of highly active antiretroviral therapy (ART). Malawi's response to the HIV challenge included provision of ART for people living with HIV or AIDS (PLWHA), which significantly reduced HIV- and AIDS-related mortality. In addition, palliative care for PLWHA was introduced as a strategy that improves the success of ART. OBJECTIVE: The purpose of the study was to explore the needs of PLWHA concerning care received from primary caregivers and palliative care nurses in Malawi. METHODS: A qualitative, explorative design was used and 18 participants were selected purposefully and interviewed individually using a semi-structured interview guide. Data were analysed using NVivo software package version 10. RESULTS: Results revealed that PLWHA needed physical care from the primary caregivers due to severity of illness, integration of healthcare services, and continuity of care and proper care from nurses. They also needed knowledge from nurses in several areas which affected decision-making and needed financial and nutritional support. CONCLUSION: More could be done in meeting needs of PLWHA to improve their health and survival and assist them to achieve a better quality of life. <![CDATA[<b>Lived experiences of student nurses caring for intellectually disabled people in a public psychiatric institution</b>]]> BACKGROUND: Caring for intellectually disabled people can be demanding for student nurses who are novices in the nursing profession. To ensure that quality nursing care is provided, student nurses should have an understanding of and a positive attitude towards intellectually disabled people. Nursing intellectually disabled people can be a challenge for the student nurses. Therefore, student nurses need to be able to deal with challenges of caring for intellectually disabled people. OBJECTIVE: This article aims to explore and describe experiences of student nurses caring for intellectually disabled people in a public psychiatric institution. Design and method: A qualitative, exploratory, descriptive and contextual research design was used. Data were collected through individual in-depth phenomenological interviews, naive sketches and field notes. Thematic analysis was utilised to analyse the collected data. Results were contextualised within the literature and measures to ensure trustworthiness were adhered to. Ethical principals were also applied throughout the research process. RESULTS: Five themes emerged from the data. Student nurses experienced a profoundly unsettling impact on their whole being when caring for intellectually disabled people; they developed a sense of compassion and a new way of looking at life, and experienced a need for certain physical, mental and spiritual needs to be met. CONCLUSION: From the results, it is evident that student nurses were challenged in caring for intellectually disabled people. However, they developed a sense of awareness that intellectually disabled people have a need to be cared for like any other person. <![CDATA[<b>Leadership, job satisfaction and intention to leave among registered nurses in the North West and Free State provinces of South Africa</b>]]> BACKGROUND: The nurse leadership of a hospital is identified as the single most important aspect of the practice environment that impacts nurse outcomes. When nurses are satisfied with their jobs, they tend to remain with their employers and become more productive in their workplaces. OBJECTIVES: This study aimed to investigate the relationship between leadership, job satisfaction and intentions to leave among registered nurses (RNs) working in hospitals in the North West and Free State provinces of South Africa. METHODS: A cross-sectional survey design was adopted. The population (N = 680) with the sample (n = 204) included RNs in medical-surgical units in both private and public hospitals in the two provinces. Data were collected using the RN4CAST questionnaire. RESULTS: RNs were satisfied with the items pertaining to leadership except for praise and recognition (55.7%). They also indicated high levels of overall job satisfaction (70.5%) but were dissatisfied with wages (50%), study leave (40.9%) and opportunities for advancement (40.1%). Furthermore, 46.1% of the RNs intended to leave their current hospitals. The results indicated a relationship between leadership and job satisfaction (r = 0.47; p = 0.00) and between intention to leave and job satisfaction (d = 0.50). CONCLUSION: The nurse managers played a significant role influencing RN's level of job satisfaction, while job satisfaction was highly correlated with intention to leave. The nurse leadership can improve job satisfaction by giving praise and recognition to the RNs for jobs well done, and RNs should be afforded the opportunity to advance their careers through further studies. <![CDATA[<b>Lived experiences of nurse educators on teaching in a large class at a nursing college in Gauteng</b>]]> BACKGROUND: The gradual increase in the number of learners admitted into a nursing college in Gauteng resulted in an increase in class size without a proportional increase in the number of nurse educators. OBJECTIVES: To explore and describe the experiences of nurse educators teaching in large classes at a nursing college in Gauteng in order to present recommendations to facilitate teaching and learning. METHOD: A qualitative, exploratory, descriptive, and phenomenological research design which is contextual in nature was used. A total of 20 nurse educators were selected through purposive sampling, and in-depth phenomenological semi-structured individual interviews were conducted between January and February 2013. Data were analysed together with the field notes, using Tesch's open coding protocol of qualitative data analysis. Lincoln and Guba's four principles were used to ensure trustworthiness. RESULTS: The themes that emerged from this study were that nurse educators experienced difficulty in recognising learners as individuals in a large class, using innovative pedagogical strategies, and managing a large class. These findings had a negative impact on meaningful teaching and learning as they interfered with an enabling learning environment. RECOMMENDATIONS: Nurse educators should be empowered with facilitative skills in order to effectively manage a large class and hence to achieve teaching and learning abilities. CONCLUSION: There is a need for nurse educators to finding alternative ways to overcome challenges associated with teaching in large classes and prepare learners to render individualised, caring and holistic nursing care to each unique patient in the healthcare setting.