Scielo RSS <![CDATA[Curationis]]> vol. 36 num. 1 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>School health and education: an interdisciplinary connection</b>]]> <![CDATA[<b>Minibus taxi drivers' sexual beliefs and practices associated with HIV infection and AIDS in KwaZulu-Natal, South Africa</b>]]> Risky sexual behaviours in South Africa are a major contributing factor to the spread of HIV infection and AIDS. HIV infection amongst minibus taxi drivers is a concern, because these people belong to an occupational group that exhibits risky behaviours due to the demands of their work. Given the high vulnerability of minibus taxi drivers, exploring the sexual beliefs and health-related sexual practices of this group will assist in planning targeted interventions. The objectives of this study were to assess the level of knowledge, beliefs and practices regarding HIV infection and AIDS amongst minibus taxi drivers. An exploratory descriptive study was conducted using a pre-tested questionnaire to explore and describe sexual beliefs and practices associated with HIV infection and AIDS in a convenience sample of 175 minibus taxi drivers. Permission to undertake the study was obtained from the KwaZulu-Natal Taxi Alliance and individuals who participated in the study. Data analysis were analysed using the Statistical Package for Social Sciences 13.0. The study revealed that minibus taxi drivers are one of the high- risk groups in the spread of HIV infection and AIDS; they lack necessary education and need attention in relation to control and prevention of the spread of HIV and AIDS. Multiple sexual partners are relatively common amongst the minibus taxi drivers. Violence against women and even forceful sexual intercourse in the belief that women should tolerate it to keep the family together was reported. There is a need for intervention programmes with a focus on minibus taxi drivers and similar high-risk groups. Prevention activities should incorporate the distribution of condoms amongst this group and HIV prevention educational programmes, as well as creating mechanisms for accessing circumcision by the minibus taxi drivers. <![CDATA[<b>The needs of health promoters on a health promotion programme for families with adolescents orphaned by HIV and AIDS</b>]]> The South African communities has shown to have a challenge in accessing health services especially in rural areas; hence the national strategic objective 1.7 aimed at strengthening community systems to expand access to services using the community-based care programmes (NSP 2012-2016). The programmes enhance access to health services whilst promoting health and educating the community to improve health knowledge and work towards attaining a healthy living (NSP 2012-2016). However, the health promoters from the rural Hammanskraal region in the North West Province of South Africa often found themselves rendering the health promotion services in their communities with limited resources. This study aimed at exploring and describing the challenges faced by health promoters in implementing health promotion programmes for families with adolescents orphaned by HIV and AIDS. The study followed a qualitative design. Data was collected using focus group interviews. Participants were purposely selected by the social worker and the health promotion coordinator working at Hammanskraal. The process of data analysis was adapted from the eight steps of Tesch method of data analysis where categories, sub-categories and themes were isolated. The following categories emerged as the needs of health promoters on health promotion programmes for families with adolescents orphaned by HIV and AIDS, (1) financial needs, (2) resources, (3) basic life needs, (4) educational needs and (5) health promoter's needs. It is therefore recommended that equal distribution of resources: including medicine, equipment and finances, should be maintained in order to ensure non-interrupted services. <![CDATA[<b>Factors contributing to sleep deprivation in a multi-disciplinary intensive care unit in South Africa</b>]]> Patients in intensive care units require rest and sleep to recuperate, but might suffer from sleep deprivation due to ongoing unit activities. The study aimed to identify and describe the factors contributing to sleep deprivation in one multi-disciplinary intensive care unit (MDICU) in a private hospital in South Africa. Quantitative, descriptive research was conducted to identify factors contributing to sleep deprivation in the research setting, and to make recommendations to enhance these patients' abilities to sleep. Structured interviews were conducted with 34 adult non-ventilated patients who had spent at least one night in the MDICU and who gave informed consent. Out of the 34 interviewed patients 70.6% (n = 24) indicated that they suffered from sleep deprivation in the MDICU. The five major factors contributing to sleep deprivation in a MDICU were, (1) not knowing nurses' names, noise caused by alarms, (2) stress, (3) inability to understand medical terms, and (3) blood pressure cuffs that restricted patients' movements and smelled badly. Patients' abilities to sleep were enhanced by reassuring nurses whose names they knew and with whom they could communicate. By attending to the identified five major factors, patients' abilities to sleep in a MDICU could be enhanced enabling patients to recuperate faster. The implementation of such measures need not incur financial costs for the MDICU concerned. <![CDATA[<b>Factors that guide nurse managers regarding the staffing of agency nurses in intensive care units at private hospitals in Pretoria</b>]]> Staffing needs affect the nursing department's budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse) perceive the staffing of agency nurses in intensive care units (ICUs). The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124). One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs. <![CDATA[<b>Online or not?</b> <b>A comparison of students' experiences of an online and an on-campus class</b>]]> Educational discourse has long portrayed online, or e-based, learning and all non-campus-based learning options as second best to traditional face-to-face options. Critically much of the research and debate in this area of study has focused on evidence relating to student performance, attrition and retention with little consideration of the total learning experience, which values both the traditional learning outcome measures side-by-side with student-centered factors, such as students' satisfaction with their learning experience. The objective of this study was to present a synchronous head-to-head comparison between online and campus-based students' experiences of an undergraduate course. This paper reports on a qualitative comparative cross-sectional study, which used multiple data collection approaches to assess student learning and student satisfaction of 61 students who completed a semester of an undergraduate course. Of the 61 students, 34 were enrolled purely as online students, whilst the remaining 27 students studied the same material entirely through the traditional face-to-face medium. Methods included a standardised student satisfaction survey and an 'achievement of learning outcomes' measurement tool. Students on the online cohort performed better in areas where 'self-direction' in learning was indicated, for example self-directed problem-based tasks within the course. Online students gave less positive self-assessments of their perceived content mastery than their campus-based counterparts, despite performing just as well in both summative and formative assignments. A multi-factorial comparison shows online students to have comparable educational success and that, in terms of student satisfaction, online learners reported more satisfaction with their learning experience than their campus-based counterparts. <![CDATA[<b>Misoprostol for prevention and treatment of postpartum haemorrhage: A systematic review</b>]]> BACKGROUND: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality especially in the developing world. Misoprostol, a highly effective drug is highly effective in inducing uterine contractions and has been proposed as a low-cost, easy-to-use intervention for PPH. OBJECTIVE: This study assessed evidence of the effectiveness of misoprostol for the prevention and treatment of PPH. METHOD: Databases searched included MEDLINE, PUBMED, CINHAL, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE. Reference lists and conference proceedings were also searched for more studies. Three studies included in the meta-analysis were limited to randomised controlled trials (RCT). Two reviewers independently screened all articles for methodological quality using a standardised instrument adapted from the Cochrane Collaboration website. Data were entered in Review Manager 5.1 software for analysis. RESULTS: Three trials (n = 2346) compared misoprostol to a placebo. Misoprostol was shown not to be effective in reducing PPH (risk ratios [RR] 0.65; 95% confidence interval [CI] 0.40-1.06). Only one trial reported on the need for a blood transfusion (RR 0.14; 95% CI 0.02-1.15). Shivering (RR 2.75; 95% CI 2.26-3.34) and pyrexia (RR 5.34; 95% CI 2.86-9.96) were significantly more common with misoprostol than with a placebo. CONCLUSION: The use of misoprostol was not associated with any significant reduction in the incidence of PPH. Therefore, in order to verify the efficacious use of misoprostol in the treatment of PPH, specialised investigations of its dose and routes of administration for clinically significant effects and acceptable side effects are warranted. <![CDATA[<b>Factors affecting the performance of professional nurses in Namibia</b>]]> BACKGROUND: Professional nurses play a vital role in the provision of health care globally. The performance of health care workers, including professional nurses, link closely to the productivity and quality of care provision within health care organisations. It was important to identify factors influencing the performance of professional nurses if the quality of health care delivery was to improved. OBJECTIVES: The aim of the present study was to identify factors affecting the performance of professional nurses in Namibia. METHOD: A quantitative, descriptive survey was used to collect data by means of a questionnaire. A random sample of 180 professional nurses was selected from six hospitals in three regions of Namibia. RESULTS: Factors affecting the performance of nurses negatively were identified such as: lack of recognition of employees who are performing well, quality performance outcomes and an absence of a formal performance appraisal system and poor working conditions. Various factors contribute to both the positive and negative performance of professional nurses in Namibia. Strategies were developed for addressing the negative factors that could positively affect the performance of professional nurses in Namibia. CONCLUSIONS: This study emphasises the importance of developing strategies to promote the performance of nurses; build knowledge and expertise; develop mechanisms for improving the performance of nurses; expand leadership and management capacity; and generate information and knowledge through research. <![CDATA[<b>Factors influencing successful implementation of the basic antenatal care approach in primary health care facilities in eThekwini district, KwaZulu-Natal</b>]]> BACKGROUND: In a move to alleviate the burden of consistently high maternal and perinatal mortality rates, the South African National Department of Health (DoH) introduced Basic Antenatal Care (BANC) in all Primary Health Care facilities that were providing antenatal care services. However, not all facilities in the eThekwini district have successfully implemented the approach. The aim of the study was to identify the factors that influence successful implementation of the BANC approach. OBJECTIVES: The objectives were to identify facilities that had successfully implemented the BANC approach and the factors that influenced successful implementation of the BANC approach, in order to make recommendations on these factors. METHOD: A descriptive quantitative design was used. Firstly, primary health care facilities that were successful in implementing the BANC approach were identified through a retrospective record auditing. A total of 27 facilities were identified, of which 18 facilities were included in the study. This was followed by data collection from 59 midwives in order to identify the factors that influenced successful implementation of the BANC approach. The data was analysed using version 19 of the Statistical Package for the Social Sciences. RESULTS: The positive factors that influenced successful implementation of the BANC approach included: the availability and accessibility of BANC services, policies, guidelines and protocol; various means of communication; a comprehensive package of and the integration of primary health care services; training and in-service education; human and material resources; the support and supervision offered to the midwives by the primary health care supervisors; supervisors' understanding of the approach and the levels of experience of midwives involved in implementation of the BANC approach. CONCLUSION: The success that the facilities had achieved in implementing BANC approach was attributed to these positive factors. <![CDATA[<b>A study of descriptive data for orphans and non-orphans on key criteria of economic vulnerability in two municipalities in South Africa</b>]]> BACKGROUND: It is generally assumed that orphan status increases the risk to children of a range of negative outcomes. In South Africa, death of parents due to HIV-related illness is contributing to a rapid increase in the prevalence of orphans. This paper presents descriptive data from two South African communities, namely Kopanong, in the Free State and Kanana in the North West province, characterising the differences between orphans (double, maternal and paternal) and non-orphans on key criteria of social vulnerability. OBJECTIVES: The objective was to obtain a better understanding of how different types of orphans and non-orphans may differ in these key areas as a crucial starting point for addressing the devastating consequences the AIDS epidemic has on these children's lives. While the study focuses on two specific areas these will provide insight into the general situation of orphans in South Africa. METHODS: A cross-sectional census survey was conducted in the two communities of Kopanong, comprising n =5254 households and Kanana, comprising n = 12 984 households. RESULTS: In Kopanong, 8.2% of children had lost both parents, 19.1% had lost their father and 6.5% their mother only, whilst in Kanana the results were 6.5%, 28.1% and 3.7% respectively. Loss of both parents appeared to have a consistent impact on material need, including access to food, clothing and essential services, whilst loss of a single parent seems to have a more variable impact. At present, there are very few child headed households, but this constitutes a risk in the longer term. CONCLUSIONS: Orphans appear to be more vulnerable in terms of material need. Children assessed in this study as being most in need were not accessing adequately many services directed at them. There is a need to extend understanding and measurement of emotional need and abuse. <![CDATA[<b>Perceptions of diabetes in rural areas of Eastern Uganda</b>]]> BACKGROUND: People diagnosed with diabetes mellitus are increasing in sub-Saharan Africa and prompt care seeking depends on perceptions of the illness. OBJECTIVE: The objective was to explore perceptions of diabetes in rural areas. METHOD: We conducted a qualitative, explorative and descriptive study in rural eastern Uganda. Eight focus group discussions with community members were conducted. Community members were presented with a story about a person with diabetes symptoms and their perceptions of the diagnosis and treatment elicited. Four focus group discussions with people with diabetes and seven key informant interviews with health workers were conducted. Respondents were asked how the community interpreted symptoms of diabetes, its causes and whether it was curable. Manifest content analysis was used. RESULTS: Some respondents thought people with diabetes symptoms had HIV or were bewitched. Causes of diabetes mentioned included consuming too much fatty food. Some respondents thought diabetes is transmitted through air, sharing utensils with or sitting close to people with diabetes. Some respondents thought that diabetes could heal fast whilst others thought it was incurable. CONCLUSION: Misdiagnosis may cause delay in seeking proper care. Preventive programmes could build on people's thinking that too much fatty food causes diabetes to promote diets with less fat. The perception of diabetes as a contagious disease leads to stigmatisation and affects treatment seeking. Seeing diabetes as curable could create patient expectations that may not be fulfilled in the management of diabetes. Rural communities would benefit from campaigns creating awareness of prevention, symptoms, diagnosis and management of diabetes. <![CDATA[<b>The role of social support in the relationship between mental health and posttraumatic stress disorder amongst orthopaedic patients</b>]]> BACKGROUND: Some life-event experiences such as injuries in car accidents, gun shots and the like, can be life changing and traumatic. OBJECTIVES: The article investigated the relationship between mental health and posttraumatic stress disorder (PTSD) symptoms after orthopaedic trauma, and attempted to understand whether social support moderates the relationship between mental health and PTSD. METHOD: A cross-sectional research model was used. Two hundred participants were selected using simple randomisation within a hospital complex in Gauteng, South Africa. The sample consisted of 110 men and 90 women ( x̄= 37.8 years, s.d. = 12.9 years). Data were collected using the Revised Civilian Mississippi Scale for PTSD, the Multidimensional Scale of Perceived Social Support (MSPSS), and the General Health Questionnaire version 28. RESULTS: The findings of the study indicated that there is a statistically significant relationship between mental health and PTSD after orthopaedic trauma, and a positive correlation between poor mental health and PTSD (r = 0.52, n = 200, p < 0.05). However, perceived social support did not moderate mental health or PTSD, indicating that perceived social support did not significantly influence mental health or PTSD, (MSPSS B = 0.07, p = 0.66). Those with high scores on social support had a lower regression coefficient (B = 0.19) for mental health and PTSD than those who reported low social support (B = 0.26). CONCLUSION: There is a significant relationship between mental health and PTSD of orthopaedic patients, and social support did not moderate the relationship between mental health and PTSD. <![CDATA[<b>Lived experiences of a community regarding its involvement in a university community-based education programme</b>]]> BACKGROUND: Community involvement is one of the crucial principles in the implementation of successful community-based education programmes. However, a gap continues to exist between the rhetoric of this principle and the reality of involving or engaging communities in the education of health professionals. OBJECTIVES: This study investigated the experiences of a community regarding its involvement in a community-based education programme offered by a university nursing school in Durban, South Africa. METHODS: An interpretive existentialist-phenomenological design was employed for its richness in extracting human experiences. Individual interviews were held with school teachers and coordinators from non-government organisations, whilst focus groups were used for school children and community health workers. Although focus group discussions are not well suited for phenomenological studies, they can promote active participation and reduce possible intimidation by providing support through group interaction. Analysis of data was guided by Schweitzer's model for analysing phenomenological data. RESULTS: Themes that emerged from the data include: (1) Community experience of unmet expectations; (2) Benefits to the community from its involvement in the University Nursing School community-based education programme; (3) Existing partnership between the community and the university; (4) Sharing in the case-based learning activities; (5) Awareness of available services, human rights and self-reliance. CONCLUSION: The researched community indeed benefited in its participation in the University Nursing School (UNS) CBE programme. However, there is a need to improve the communication between partners to make the partnership more sustainable through close relationships and interaction. There is also a need for further research on related aspects of the community's involvement. <![CDATA[<b>Woman-centred care in childbirth: A concept analysis (Part 1)</b>]]> 'Woman-centred care' in childbirth is a process in which a woman makes choices and is involved in and has control over her care and relationship with her midwife. The aim of this paper is to study the concept of woman-centred care through analysis in the context of childbirth. The attributes, antecedents and consequences of this concept are identified, and a model case, a borderline case and a contrary case constructed to achieve conceptual clarity. A concept analysis was undertaken as described by Walker and Avant (2011), with an extensive exploration of domain-specific literature and evidence from various disciplines. It was established from the concept analysis that 'woman-centred care' was complex and experienced individualistically. The analysis indicated that mothers' participation is supposed to be based on a more collaborative relationship and partnership. Participation is exhibited by open communication and the mother's involvement in decision-making, consultation and collaboration with the attending midwife, further characterised by mutual respect and the midwife listening to the mother's views. There is also an exchange of complete and unbiased information, recognition and honouring of cultural diversity and making of informed choices. Through an inductive discovery approach and drawing on inferences, attributes were clustered in an attempt to identify the apparent essence of the concept. From the results of the concept analysis described in this study, the researchers recommend the formulation of criteria that could facilitate implementation and evaluation of woman-centred care and its empirical referents in the context of the Batho Pele principles (Part 2). <![CDATA[<b>Criteria to facilitate the implementation of woman-centred care in childbirth units of Limpopo Province, South Africa (Part 2)</b>]]> BACKGROUND: Facilitation of mutual participation, respectful and egalitarian relationship between the mother and the midwife during childbirth is a critical aspect. This article delineated the criteria that would facilitate the implementation of woman-centred care in childbirth units of the Limpopo Province in South Africa, following a concept analysis described in Part 1. Empirical referents or indicators were used to measure the concept woman-centred care and to validate its existence in reality. These empirical referents were referred to as measurable properties that further verified the concept. OBJECTIVE: The objective of this article was to formulate criteria that would facilitate implementation of woman-centred care in childbirth units of Limpopo Province in South Africa. METHOD: Criteria to facilitate the implementation of woman-centred care were formulated by the gathering of information about the topic under review and the use of resources to define the key elements of the criteria which were integrated into the Batho Pele principles. The criteria were then validated by selecting with a vested interest in the successful development and implementation of the criteria. RESULTS: Criteria were formulated to facilitate the implementation of woman-centred care that was integrated within the framework of Batho Pele principles. CONCLUSION: These formulated criteria for woman-centred care will be used as an institutional self-evaluation tool to enhance implementation of the Batho Pele principles in childbirth units. These criteria will give direction and provide guidelines for the performance of midwifery staff and will also help supervisors to guide staff to improve performance. <![CDATA[<b>A report on the development and implementation of a preceptorship training programme for registered nurses</b>]]> BACKGROUND: Clinical supervision represents an important aspect in the development of nursing students' clinical skills. At the School of Nursing (SoN) the clinical supervisors employed by the University of the Western Cape (UWC) have limited contact sessions with students in the clinical setting. However, with the increase in student numbers a need was identified to strengthen the support given to nursing students in the service setting. OBJECTIVE: A preceptorship training programme for nurses was developed in 2009, aimed at improving the clinical teaching expertise of professional nurses. The planning phase, based on a preceptorship model, represents a collaborative undertaking by the higher education institution and the nursing directorate of the Provincial Government Western Cape. METHOD: A two-week, eight credit, short course was approved by the university structures and presented by staff members of the school. The teaching and learning strategies included interactive lectures, small group activities and preceptor-student encounters in simulated and real service settings. Some of the course outcomes were: applying the principles of clinical teaching and learning within the context of adult education, understanding the preceptor role and managing RESULTS: To date, fifty-four participants have attended the course. Following an internal review of the pilot programme in 2010, relevant adjustments to the programme were made. CONCLUSION: It is recommended that all the stakeholders be involved in the development and implementation of a contextually relevant preceptorship training programme. It is further recommended that the school embarks on an extensive programme evaluation. <![CDATA[<b>Conceptualisation of knowledge construction in community service-learning programmes in nursing education</b>]]> BACKGROUND: Practices in higher education have been criticised for not developing and preparing students for the expertise required in real environments. Literature reports that educational programmes tend to favour knowledge conformation rather than knowledge construction; however, community service learning (CSL) is a powerful pedagogical strategy that encourages students to make meaningful connections between the content in the classroom and real-life experiences as manifested by the communities. Through CSL, learning is achieved by the active construction of knowledge supported by multiple perspectives within meaningful real contexts, and the social interactions amongst students are seen to play a critical role in the processes of learning and cognition. This article reflects facilitators' perspective of the knowledge construction process as used with students doing community service learning in basic nursing programmes. OBJECTIVES: The aim of this article was to conceptualise the phenomenon of knowledge construction and thereby provide educators with a shared meaning and common understanding, and to analyse the interaction strategies utilised by nurse educators in the process of knowledge construction in community service-learning programmes in basic nursing education. METHOD: A qualitative research approach based on a grounded theory research design was used in this article. Two nursing education institutions were purposively selected. Structured interviews were conducted with 16 participants. RESULTS: The results revealed that the knowledge construction in community service-learning programmes is conceptualised as having specific determinants, including the use of authentic health-related problems, academic coaching through scaffolding, academic discourse-dialogue, interactive learning in communities of learners, active learning, continuous reflection as well as collaborative and inquiry-based learning. Upon completion of an experience, students create and test generated knowledge in different contextual health settings. CONCLUSION: It was concluded that knowledge is constructed by students as a result of their interaction with the communities in their socio-cultural context and is mediated by their prior concrete experiences. The implication of this is that students construct knowledge that can be applied in their future work places. <![CDATA[<b>Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa</b>]]> BACKGROUND: Comprehensive Primary Health Care (PHC), based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. OBJECTIVES: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients' experiences led to satisfaction or dissatisfaction with the Fast Queue service. METHOD: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed. RESULTS: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources. CONCLUSION: Effective health communication strategies contribute to positive experiences by health care users and these can be effected by: (1) involvement of health care providers in planning the construction of health facilities to give input about patient flow, infection prevention and control and provision of privacy, (2) effective complaints mechanisms for users to ensure that complaints are followed up and (3)encouraging users to arrive at the facility throughout the day, rather than the present practice where all users arrive at the clinic early in the morning. <![CDATA[<b>Mothers' expectations of midwives' care during labour in a public hospital in Gauteng</b>]]> BACKGROUND: Mothers develop expectations regarding midwives' care during labour and when these are not met mothers become dissatisfied and eventually have negative experiences of their labour. It is only when mothers' voices are heard by midwives in the labour ward that efficient and quality care will be provided. To ensure mothers have a positive experience of labour, midwives should include mothers' expectations when caring for them. OBJECTIVE: The purpose of the study on which this article is based was to determine mothers' expectations of midwives' care during labour. To achieve this purpose the researcher sought to explore and describe mothers' expectations of midwives' care during labour in a specific public hospital in Gauteng. METHOD: A qualitative, exploratory, descriptive and contextual study design was used. Face-to-face, in-depth individual interviews were conducted with mothers about their expectations of midwives' care during labour. Data were then analysed with an open descriptive method of coding (Tesch's eight steps) that is appropriate for qualitative research to identify categories. The data was also analysed by an independent coder. The categories were subsequently placed within a holistic health promotive nursing theory that encompasses body, mind and spirit. RESULTS: The findings revealed the provision of comfort and support as the two main aspects that the mothers expected from the midwives' care. The mothers expected midwives to improve their communication skills with them (mothers) as well as with fathers or partners if they were available. The mothers expected midwives to facilitate bonding between mother, father and baby, and also encouraged the midwives to improve their (midwives') knowledge, skills and morale. CONCLUSION: The results of this study should assist midwives in providing holistic quality care to mothers during labour, thus providing satisfaction and positive experiences of the mothers' labour. <![CDATA[<b>Do nursing students know and practise the Universal Precautions to prevent transmission of infectious agents?</b>]]> BACKGROUND: Nursing students, like other healthcare students, are at high risk of occupational exposure to blood and bodily fluids. Studies have shown that use of the Universal Precautions (UPs) lowers this risk, but do students know and practise these precautions? OBJECTIVES: This study investigated the knowledge and practice of undergraduate nursing students regarding the UPs, and whether there was a correlation between knowledge of the UPs and their practice. METHOD: This was a descriptive quantitative study amongst undergraduate nursing students in years 2-4 (n = 253), who were selected by means of stratified random sampling. A questionnaire was administered to the participants by the researcher. The data collected were analysed through use of the Statistical Package for Social Sciences (SPSS 16.0) and content analysis. RESULTS: It was established that there was indeed a lack of knowledge regarding the UPs, and that the students' self-reported practice of the UPs was poor. There was no statistically significant correlation between knowledge and practice of the UPs. CONCLUSION: More structured educational programmes are needed to improve both knowledge and practice of the UPs. These programmes should be offered across all nursing student study years as continuous professional development. <![CDATA[<b>Compliance or non-compliance of hypertensive adults to hypertension management at three primary healthcare day clinics in Tshwane</b>]]> The objective of this article was to report on the rate of compliance to medication, sodium use and appointment keeping of hypertensive adults who are attending primary healthcare clinics in Tshwane. Despite the availability of effective management of hypertension globally, non-compliance to management still exists. This article reports on the hypertensive adult's compliance to medication, sodium use and appointment keeping. The design was a cross-sectional descriptive study. The sample was n = 101 hypertensive patients from three primary healthcare clinics. Structured interviews were used to gather the data. The results indicated a variation in compliance rate depending on the question asked. When investigating whether the participants received enough medication on their last visit to the clinic, 98% said that they received enough medication to last them a month (Nkosi 2008:130). However, the appointment-keeping scale revealed that 23% of the participants reported that they left the clinic without prescribed medication or missed an appointment. When, using the Hill-Bone Compliance Scale, individuals were asked a question using the verb forgetting, 9 out of 10 would answer 'no', but when the verb decide was used to determine compliance, 6 out of 10 would admit to deciding not to take their medication sometimes. In terms of sodium use, 33% showed good compliance and 44% low compliance (Nkosi 2008:138). Compliance with regard to taking hypertension medication was 70%, which is good. This study recommends that compliance to hypertension management be assessed by asking questions specifically for sodium use, medication and appointment keeping as it was clear from the findings of this study that a person would comply with appointment keeping but not take medication daily as prescribed or not use sodium as recommended. <![CDATA[<b>Health maintenance and low socio-economic status: A family perspective</b>]]> The socio-economic status of people has a profound influence on health, as higher rates of morbidity and mortality are reported for individuals with lower socio-economic status. Due to the increased burden of disease, research exploring how families maintain their health in a low socio-economic situation is an urgent priority. The objective of the study was to gain an understanding of the reality families are confronted with in terms of their health due to their socio-economic status. The study was contextual, qualitative and exploratory using purposive sampling methods. The sample size was governed by data saturation and realised as 17 families (n = 17). The participants for the study were families residing in Soshanguve Extension 12 and 13, South Africa. The data collection method was self-report using a semi-structured interview. Content analysis was done according to Tesch's approach using open coding. Five themes based on the theoretical basis of the study, including age, sex and genetic constitution, individual lifestyle factors, social and community networks, living and working conditions and general socio-economic status were used. Maintaining the health of people living in a physically and psychosocially disadvantaged position requires a different approach from registered professional nurses. No community-specific intervention can be planned and implemented to reduce the burden of communicable and non-communicable disease in the community without evidence based on a family perspective. <![CDATA[<b>Airway and feeding problems in infants with Fairbairn-Robin triad deformities</b>]]> BACKGROUND: The majority of patients with Pierre Robin sequence in the subdivision Fairbairn-Robin triad (FRT), are born with glossoptosis, retro-/micrognathia and cleft or agenesis of the palate leading to feeding difficulties and airway obstruction. There is limited literature on these problems, and on methods used to address them. OBJECTIVES: Community nurses in the Facial Cleft Deformity Clinic evaluate associated airway obstruction and feeding problems and devise nursing interactions to address these. This retrospective study examined the incidence of airway and feeding difficulties in the neonatal, pre-surgical period, as well as the surgical and nutritional management of these infants. METHOD: Retrospective records of 215 infants with FRT were examined and data on incidence, airway and feeding difficulties and surgical and nutritional management was collected. Descriptive statistics, including average and percentage values, were compiled. RESULTS: The incidence of FRT amongst the cleft palate patients was 6.0%, with 37.7% of these having feeding difficulties. However, surgical interventions such as glossopexy (5.6%), distraction osteogenesis (0.9%) and tracheotomy (2.3%) for airway management were seldom required. Most of the infants who had upper airway obstruction and feeding problems were handled by means of suction and drinking plates, along with additional specific feeding aids. This reduced airway obstruction in 70.6%, and feeding problems in 62.4% of these infants. CONCLUSION: Based on this study's finding the introduction of the suction and drinking plate and the use of specific types of feeding devices and surgical management can improve growth and development in infants with FRT. <![CDATA[<b>Descriptive survey of the contextual support for nursing research in 15 countries</b>]]> BACKGROUND: Global research productivity depends on the presence of contextual factors, such as a doctorally prepared faculty, graduate programmes, publication options, that enable the conduct and publication of studies to generate knowledge to inform nursing practice. OBJECTIVES: The current study aimed to develop and test an instrument that measures the level of contextual support for nursing research within a specific country, allowing comparisons between countries. METHOD: After development of a 20-item survey with seven factors and 11 criteria based on a literature review, a quantitative descriptive e-mail survey design was used. RESULTS: Nurse researchers (N = 100) from 22 countries were invited to participate. The response rate was 39% from 15 countries. Ethics approval was obtained by investigators in their country of origin. Results showed wide variation in the level of contextual support. The average total level of support across all countries was 26.8% (standard deviation [SD] = 14.97). The greatest variability was in the area of availability of publishing opportunities (ranging between no suitable journals in a country to over 100). The least variability was in the area of availability of local enabling support (SD = 7.22). This research showed wide differences in the level of contextual support for nursing research. CONCLUSION: The survey instrument can be utilised as a country assessment that can be used to strategically plan the building of infrastructure needed to support nursing research. Contextual support for nursing research is an antecedent of strong science. Building infrastructure for nursing science is a priority for global health. <![CDATA[<b>Caring during clinical practice: Midwives' perspective</b>]]> BACKGROUND: Caring forms the core of nursing and midwifery. Despite caring being an important emotional aspect of midwifery and nursing, there are general public complaints about uncaring behaviour in midwifery. Therefore, there is a need to explore caring from midwives' point of view with the hope of identifying solutions and recommendations for midwifery practice. Furthermore, the study aimed to stimulate debate and discussion about the caring behaviour of midwives. OBJECTIVE: To explore caring during clinical practice as perceived and experienced by midwives. METHOD: The study was contextual, exploratory and qualitative. The participants were midwives working in state and private hospitals in Tshwane, South Africa where BTech II and III midwifery learners were allocated for work integrated learning (WIL). Data collection was carried out through self-report using a questionnaire and focus group. Questionnaires were distributed to 40 midwives at private and state hospitals in Tshwane. This was followed by two focus group sessions to ensure that data is enriched. The hermeneutic interpretive approach was used to analyse data, and analysis continued until saturation. RESULTS: Themes of caring and uncaring related to patient care and midwives emerged. The findings illustrated that the midwives had excellent theoretical knowledge of caring, but some of them did not display caring behaviour during clinical practice. CONCLUSION: Some of the midwives did not display caring behaviour. Implication for practice was provided based on the research findings. Recommendations included measures of improving caring behaviours during midwifery practice. <![CDATA[<b>Implementing case-based teaching strategies in a decentralised nursing management programme in South Africa</b>]]> BACKGROUND: Case-based education has a long history in the disciplines of education, business, law and the health professions. Research suggests that students who learn via a case-based method have advanced critical thinking skills and a greater ability for application of knowledge in practice. In medical education, case-based methodology is widely used to facilitate knowledge transfer from theoretical knowledge to application in patient care. Nursing education has also adopted case-based methodology to enhance learner outcomes and critical thinking. OBJECTIVES: The objectives of the study was to describe a decentralised nursing management education programme located in Durban, South Africa and describe the perceptions of nursing faculty facilitators regarding implementation of this teaching method. METHOD: Data was collected through the use of one-on-one interviews and also focus groups amongst the fifteen facilitators who were using a case-based curriculum to teach the programme content. The average facilitator was female, between 41 and 50 years of age, working part-time, educated with a baccalaureate degree, working as a professional nurse for between 11 and 20 years; slightly more than half had worked as a facilitator for three or more years. RESULTS: The facilitators identified themes related to the student learners, the learning environment, and strengths and challenges of using facilitation to teach the content through cases. Decentralised nursing management educational programmes can meet the needs of nurses who are located in remote areas which are characterised by poor transportation patterns and limited resources and have great need for quality healthcare services. CONCLUSION: Nursing faculty facilitators need knowledgeable and accessible contact with centrally based full-time nursing faculty in order to promote high quality educational programmes.