Curationis

Factors contributing to low institutional deliveries in the Marondera District of Zimbabwe

The purpose of the study was to identify factors contributing to low institutional deliveries in the Marondera District, Zimbabwe, among women who attended antenatal clinics, in order to enhance the number of institutional deliveries. A quantitative descriptive survey, gathering data by conducting structured interviews with 80 women, was used in this study. All 80 women attended ante-natal clinics but 40 delivered at home and 40 delivered at an institution. The Health Belief Model (HBM) was used to contextualise the data. The research results indicated that factors that contributed to the low number of institutional deliveries included that women's minimal expectations of cleanliness and noninterference during labour and delivery could be met during home deliveries; institutional deliveries' costs included traveling expenses, losing family support and the inability to meet cultural expectations; women's lack of knowledge about danger signs of pregnancy; and women's negative perceptions of nurses working at the institution(s). The recommendations include reduced costs of institutional deliveries; allowing family members (especially the mother-in-law) to be present during institutional deliveries and to perform cultural rituals whenever possible. The nurses' attitudes and competence levels should be addressed through in-service education sessions and sustained follow-up evaluations, including evaluations by pregnant women.

Women's experiences of maternal and child health and family planning services in KwaZulu-Natal

The increasing recognition that millions of women and children die every year as a result of the poor health of the mother coupled with inadequate care before, during, and after delivery, has highlighted the importance of seeking women's views of health services in order to contribute to improving their health. The purpose of this paper is to shed more light on women's views of health services by exploring their experiences of maternal and child health and family planning services in Cato Manor in KwaZulu-Natal. The findings suggest that the majority of women were unclear about the purpose of antenatal care. Most women had little or no knowledge about the required number of antenatal care visits. In addition, few women reported that they were offered a comprehensive range of contraceptive services during their visit. In most cases, they were only given information on a limited number of family planning methods. However, the majority of women expressed overall satisfaction with the services. Discontent mainly rose from the long waiting period, duration of the consultation and limited contraceptive counselling. In order to ensure sustainable improvements in women's health increasing involvement of men is also important.

Knowledge, attitudes and practices related to healthy childbearing in the West Coast/Winelands

INTRODUCTION: Many of the known risk factors associated with low birth weight (LBW) infants, such as socio-economic status, ethnicity, genetic makeup, and obstetric history, are not within a woman's immediate control. However, there are many things that a woman can do to improve her chances of having a normal healthy child. Lifestyle behaviours, such as cigarette smoking, nutrition and the use of alcohol, play an important role in determining the growth of the foetus. There is a high rate of low birth weight infants born to women living and working on the farms in the Western Cape. Very little is known about the knowledge, attitudes and practices of the women living and working on the farms that may be influencing their pregnancy outcomes. The aim of this qualitative exploratory study was to establish the knowledge, attitudes and practices of reproductive age women related to lifestyle factors such as alcohol use, smoking and nutrition, and the perceptions of these factors by health care workers, in Stellenbosch and Vredendal areas (small towns in the Western Cape). METHODS: Four methods of data collection were employed: focus groups and individual interviews with women on farms, and focus groups and semi-structured interviews with health workers. All focus groups and interviews were recorded, transcribed, and then coded to form themes. Findings were then triangulated across data collection methods. RESULTS: Participants described high levels of use of alcohol and cigarettes by women living on the farms in general, and in pregnancy, despite reasonable levels of awareness of the dangers to the foetus. Regarding nutrition, women have a fairly good sense of eating in a balanced way during pregnancy, but affording this on very low wages is difficult. Many ideas regarding how to increase healthy lifestyles were offered, ranging from environmental improvements, such as access to recreational facilities and handwork classes, to more contact with health services, and improvement in conditions of employment. CONCLUSION: This study highlights the lifestyle factors related to LBW infants on farms, and proposes that these should be addressed collectively by all the relevant sectors in the community. Although some of these processes have been initiated, there are gaps in the health services, which should be addressed immediately to provide women with opportunities to ensure acceptable pregnancy outcomes.

Experiences of parents during the hospitalisation of their child in a private paediatric unit

A change in the health of a child is regarded as a major stressor for parents which further increases when the child is admitted to a hospital (Kaplan & Sadock, 1998:799). The role of the family in a child's illness is slowly being recognised (Kibel & Wagstaff, 2001:544), but the South African government per se has not yet issued any formal reports on parental participation in the hospitalisation process. The purpose of the study was to describe recommendations to support parents with the hospitalisation of their child in a private paediatric unit. An interpretive-phenomenological qualitative approach was followed through unstructured individual interviews, narrative diaries and field notes. Purposive sampling was used to achieve saturation of data. Seven parents were interviewed and 15 parents completed narrative diaries. Trustworthiness and ethical considerations were maintained throughout the study. The transcribed interviews, narrative diaries and field notes were analysed through open-coding. Recommendations focus on 1) empowering parents to participate in their child's care; 2) guiding nursing personnel to plan the discharge process; 3) including parents in the unit routine; 4) fostering a trusting relationship with parents; 5) promoting the communication of information; and 6) creating a therapeutic environment for parents.

Palliative care: A positive outcome for cancer patients?

The development of palliative care in terms of recognizing the needs of the dying, palliative care becoming a nursing and medical speciality, the involvement of the World Health Organization in palliative care and the continuous development of treatment modalities available to cancer patients creates the expectation that the outcomes for the patient should also be positively influenced. The purpose of the study was to determine the most common symptoms of advanced cancer patients treated in a public and private hospital in Tshwane, and whether advances in palliative care improved the outcomes for these patients by decreasing the prevalence of symptoms experienced. The design of the study was a quantitative survey. The population consisted of patients with advanced cancer receiving palliative treatment as out patients in radiation and medical oncology clinics in a public and private hospital the Tshwane Metropolitan area. The sampling method was convenient and the sample size was 148 participants (n=148). Data was gathered by means of an interview and self report. Data analysis was done by means of descriptive statistics. The results of the study indicated that a high number of patients still experience problems that could have been prevented. Pain was found to be the biggest problem for patients (76.4%) followed by weakness and fatigue (65.5%), nausea and vomiting (65.5%) and a dry mouth (46.6%). Thirst was reported by 41.2% of the sample. The study provides evidence that the development of palliative care did not have a positive outcome for patients by reducing the prevalence of symptoms experienced.

Investigation into the relationship between the socio-economic and health status of the Coloured people of the Western Cape in an urban setting

A descriptive non-experimental approach was applied to investigate and describe the prevalence of factors influencing the health status of the Coloured people of the Western Cape in an urban setting as a dissertation for a doctorate degree. For the purpose of this article the relationship between the socio-economic and health status of the Coloured people of the Western Cape in an urban setting are described. The study only included economically active persons < 21 ^ 50 years. The objective was to determine the relationship between the health status and the socio-economic status of economically active Coloured people in an urban area as defined. The objectives set for the study were reached through a cross sectional study. The hypothesis, an association between the health status and the socio-economic status of the Coloured people of an urban area in the Western Cape was tested using the chi square statistical test. A purposeful stratified sample of 353 participants was drawn from the residential areas as defined for the purpose of the study. All social classes were well represented in the suburbs. Statistical associations on a 95% confidence interval were shown between the socio-economic status (i.e. educational level, income and occupation) social habits, diet, and money available for food, exercise and the health status of the respondents. Recommendations were made based on the scientific evidence obtained through the study.

Experiences of nurses working in a rural primary health-care setting in Mopani District, Limpopo Province

Professional nurses working in rural primary health-care settings are experiencing burnout due to serious shortages of personnel. This is exacerbated by the brain drain of nurses leaving the country. Rural settings are resource constrained in terms of personnel and equipment. This results in dissatisfaction among nurses due to the unbearable working conditions which result in stress and frustration. A qualitative, explorative, descriptive study was conducted to explore and describe the experiences of nurses working in a rural primary health-care setting in the greater Letaba sub-district in Limpopo Province. Purposive sampling was used to identify the participants. Data was collected in the form of in-depth interviews. The study revealed that nurses working in primary health-care settings were experiencing emotional and physical strain as a result of the shortage of human resources. It was recommended that policies that meet the health-care needs of rural communities be developed, and that strategies to retain professional nurses in primary health-care settings be formulated.

The impact of caring for persons living with HIV and AIDS on the mental health of nurses in the Limpopo Province

This study assessed the impact of caring for AIDS sufferers on the mental health of nurses. This assessment was measured against the level of burnout, stress and depression among 174 nurses caring for people living with HIV and AIDS in Limpopo Province, South Africa. A structured questionnaire was used for data collection. The questionnaire incorporated the AIDS Impact Scale (AIS), Maslach Burnout Inventory (MBI), Beck Depression Inventory (BDI) and the participants' demographic and professional profiles. Participants were conveniently selected from five selected hospitals in Limpopo Province. The study participants' valuation using the AIS showed that nurses tended to develop strong bonds and relationships with the patients; felt frustrated by their inability to help the terminally ill AIDS sufferers and were subsequently affected by the death of their patients. Personal accomplishments of the nurses remained high and the levels of emotional exhaustion and depersonalization levels were low. The BDI showed that over 3 out of 4 nurses were experiencing between mild mood disturbance and extreme depression. Higher average scores were noted for items of the depression scale like sadness, dissatisfaction, fatigue and low level of energy. The findings highlight the need to develop psychological support programmes for nurses caring for AIDS patients and promote the provision of social incentives and recognition of the role of nurses in AIDS care.

Critical care nurses' perceptions of stress and stress-related situations in the workplace

Critical care nurses (CCNs) experience stressful situations in their daily working environments. A qualitative research approach (exploratory, descriptive and contextual) was used to explore and describe the stressful situations experienced by critical care nurses in the Tshwane metropolitan are of South Africa. Focus group interviews were conducted with critical care nurses. Data was generated by means of focus group interviews. The results revealed CCNs' perceptions and experiences about stressful events, factors contributing to stress in the critical care environment, as well as their needs for support systems.Critical care nurses experience stressful situations in their daily working environments. The question arises for nurses: are there adequate support systems in the critical care environment and what are critical care nurses doing to maintain their own health and well-being? Facilitating conscious awareness among critical care nurses could enhance their resiliency and their hardiness, strengthening their coping capacities in stressful working situations. The contextual framework adopted for this research was the Neuman Systems Model. A qualitative research approach (exploratory, descriptive and contextual) was used to explore and describe the stress experienced by critical care nurses. Focus group interviews were conducted with critical care nurses and individual interviews with nurse managers. The results revealed their perceptions and experiences about the effects of stress in the critical care environment, as well as some of their coping strategies. The recommendations include that stress management programmes should be implemented and evaluated; debriefing services should be available to CCNs, in-service education programmes should address raising CCNs' consciousness awareness and enhance their resiliency skills. Effective communication systems should be established between managers and CCNs to address inconsistencies as they arise, including critical shortages of staff and equipment.