Curationis

Caesarean section deliveries: Experiences of mothers of midwifery care at a public hospital in Nelson Mandela Bay

BACKGROUND: The rate of caesarean section deliveries has increased globally and mothers are faced with challenges of postoperative recovery and caring thereof. Midwives have a duty to assist these mothers to self-care. OBJECTIVE: The objective was to explore and describe experiences of post-caesarean section delivered mothers of midwifery care at a public hospital in Nelson Mandela Bay. METHODS: A qualitative, descriptive and explorative research design was used in the study. Data were collected from 11 purposively criterion-selected mothers who had a caesarean section delivery. One-on-one semi-structured interviews were conducted in the post-natal wards. Research ethics, namely autonomy, beneficence, justice and informed consent, were adopted in the study. All participants were informed of their right to withdraw from the study at any stage without penalties. Interviews were analysed using Tesch's method of data analysis RESULTS: Three main themes were identified as experiences of: diverse pain, physical limitation and frustration and health care services as different. CONCLUSION: Experiences of mothers following a caesarean section delivery with midwifery services at a public hospital in Nelson Mandela Bay were explored and described as diverse. A need for adequate pain management as well as assistance and breastfeeding support to mothers following caesarean delivery was identified as crucial to promote a good mother-to-child relationship.

Conceptualisation of African primal health care within mental health care

BACKGROUND: It is believed by western education systems that the first contact should be with the nurse in primary health care. However, it is not the case. Therefore, the researcher attempts to correct this misconception by conceptualising the correct beginning of health seeking behaviour in an indigenous African community, namely African Primal Health Care (APHC). 'Primal' was coined during a colloquium by Dr Mbulawa and Seboka team members; however no formal conceptualisation took place, only operational definition. Due to the study scope, conceptualisation is narrowed to mental health, but this concept is applicable in the broader health context. The research purpose was to contribute to the body of indigenous knowledge systems to advocate towards co-existence of primal health care and mental health care. AIM: Formulate APHC within a mental health care context. OBJECTIVES: To explore philosophical grounding of APHC and describe epistemology of APHC. To analyse and crystallise the exploration to establish understanding within mental health and conceptualise APHC within mental health care to enhance co-existence. METHODOLOGY: Narrative synthesis, concept analysis (qualitative design). Lekgotla was used as a method of data collection and data were analysed using Leedy and Ormrod's five steps of data analysis. RESULTS: APHC is a health care system that existed in Africa prior to the introduction of the western health care system. It is based on the African belief system and practices. The practices come from the community, for the community and are authenticated by the community. APHC uses a holistic approach and the family and community are involved in the healing process.

A middle-range model for improving quality of nursing education in Malawi

BACKGROUND: Despite a global consensus that nurses and midwives constitute the majority and are a backbone of any country's health workforce system, productive capacity of training institutions remains low and still needs more guidance. This study aimed at developing a middle-range model to guide efforts in nursing education improvements. OBJECTIVE: To explore challenges facing nursing education in Malawi and to describe efforts that are being put in place to improve nursing education and the process of development of a model to improve nursing education in Malawi. METHOD: The study used a qualitative descriptive design. A panel discussion with eight nursing education and practice experts was conducted guided by core concepts derived from an analysis of research report from a national nursing education conference. Two focus group discussions during two quarterly review meetings engaged nurse educators, practitioners and clinical preceptors to fill gaps from data obtained from a panel discussion. A qualitative abductive analysis approach was used for the development of the model. RESULTS: Transforming and scaling up of nursing education emerged as the main concept of the model with nursing education context, academic practice partnership, regulation, competent graduate and nursing workforce as sub concepts. Key main strategies in the model included curriculum reforms, regulation, transformative learning, provision of infrastructure and resources and capacity building. CONCLUSION: The model can be used to prioritise nursing education intervention aimed at improving quality of nursing education in Malawi and other similar settings.

The roles, training and knowledge of community health workers about diabetes and hypertension in Khayelitsha, Cape Town

BACKGROUND: The current roles and capacity of community health workers (CHWs) in the management and control of non-communicable diseases (NCDs) remain poorly understood. OBJECTIVES: To assess CHWs' current roles, training and knowledge about diabetes and hypertension in Khayelitsha, Cape Town. METHODS: A cross-sectional study of 150 CHWs from two non-governmental organisations contracted to provide NCD care as part of a comprehensive package of services was conducted. An interviewer-administered closed-ended questionnaire was used to determine the roles, training, in-service support, knowledge and presence of NCDs. Descriptive analyses of these domains and multivariate analyses of the factors associated with CHWs' knowledge of hypertension and diabetes were conducted. RESULTS: The vast majority (96%) of CHWs were female, with a mean age of 35 years; 88% had some secondary schooling and 53% had been employed as CHWs for 4 years or more. Nearly half (47%) reported having an NCD. CHWs' roles in NCDs included the delivery of medication, providing advice and physical assessment. Only 52% of CHWs reported some formal NCD-related training, while less than half of the trained CHWs (n = 35; 44%) had received follow-up refresher training. CHWs' knowledge of diabetes and hypertension was poor. In the multivariate analyses, higher knowledge scores were associated with having an NCD and frequency of supervisory contact (≥1 per month). CONCLUSIONS: The roles performed by CHWs are broad, varied and essential for diabetes and hypertension management. However, basic knowledge about diabetes and hypertension remains poor while training is unstandardised and haphazard. These need to be improved if community-based NCD management is to be successful. The potential of peer education as a complementary mechanism to formal training needs as well as support and supervision in the workplace requires further exploration.

Barriers to tuberculosis and human immunodeficiency virus treatment guidelines adherence among nurses initiating and managing anti-retroviral therapy in KwaZulu-Natal and North West provinces

BACKGROUND: Nurses, as front-line care providers in the South Africa's health care system, are called upon to deliver integrated interventions for tuberculosis and human immunodeficiency virus (TB and HIV) including nurse-initiated management of anti-retroviral therapy (NIMART) and anti-TB treatment. Adherence to treatment guidelines and factors associated with non-adherence to treatment guidelines among nurses remain under explored. PURPOSE: To explore and describe barriers to treatment guidelines adherence among nurses initiating and managing anti-retroviral therapy and anti-TB treatment in KwaZulu-Natal and North West provinces. DESIGN: This study employed a qualitative exploratory descriptive design. METHODS: Four semi-structured focus group interviews were conducted during 2014 each consisting of four to eight NIMART trained nurses. Audiotaped interviews were transcribed verbatim and analysed using Atlas T.I. software. FINDINGS: During data analysis, two themes emerged: (1) NIMART trained nurses' distress about TB and HIV guidelines adherence that is inclusive of lack of agreement with guidelines, poor motivation to implement guidelines, poor clinical support and supervision, resistance to change, insufficient knowledge or lack of awareness and (2) exterior factors inhibiting nurses' adherence to treatment guidelines which incorporated organisational factors, guidelines-related factors and patient-related factors. CONCLUSION: This qualitative study identified that nurses have substantial concerns over guideline adherence. If NIMART trained nurses' barriers inhibiting adherence to treatment guidelines cannot be remedied, patient outcomes may suffer and South Africa will struggle to meet the 90-90-90 targets.

A model to facilitate the mental health of psychiatric nurses in a forensic unit to manage mental health care users' hostile behaviour constructively

BACKGROUND: Hostile behaviour by mental health care users (MHCUs) is prevalent in forensic units in South Africa, and this causes service providers distress and burnout. Psychiatric nurses (PNs) find it difficult to render quality care to MHCUs who are threatening them and also challenging their authority in a forensic unit. Forensic mental health care practitioners may be challenged to engage authentically with MHCUs who constitute a risk to their personal safety or who have committed acts the practitioner finds morally disturbing. There is a need to facilitate the mental health of PNs in a forensic unit to manage hostile behaviour constructively. OBJECTIVE: The objective of this article is to describe the process that was followed in developing, implementing and evaluating a model that could be used as a framework of reference to facilitate the mental health of PNs in a forensic unit to manage hostile behaviour constructively. METHOD: A theory-generative, qualitative, exploratory descriptive and contextual study design was used to develop the model. The steps of the process entailed the identification of the central concept, the definition of the central concept and other essential criteria and the classification of the central and related concepts. The model was then described and evaluated. RESULTS: The central concept was identified as the 'facilitation of empowerment of PNs to manage hostility in a constructive manner', defined, classified and then described and evaluated. CONCLUSION: The model as framework of reference could assist PNs in managing hostility in a forensic unit constructively.

Worker knowledge of occupational legislation and related health and safety benefits

BACKGROUND: Environmental hazards such as fumes, gases, poor ventilation and extreme temperatures might lead to occupational illnesses and injuries. To protect workers from potential occupational health and safety risks, the government has promulgated occupational legislation that must be implemented in work settings. OBJECTIVES: The objective of this study was to explore the knowledge of workers about occupational legislation and its benefits for their health and safety. The aim was to make recommendations that would be implemented to improve the knowledge and compliance with occupational legislation as advised by the occupational health nurse. METHODS: A quantitative approach was used for this study. One hundred and ten respondents were sampled from an accessible population of 1590 workers. A self-administered questionnaire was used for gathering data. Data were analysed through descriptive analysis using Statistical Package for Social Sciences. RESULTS: Research findings indicated that only 18 (16.36%) respondents were knowledgeable about occupational legislation. Eighty-two (75.54%) respondents were unable to mention even one occupational act by name. Respondents mentioned five benefits of occupational legislation for the health and safety of workers. These benefits were that legislation ensured safety, gave rights to workers, ensured compensation for occupational injuries and illnesses, and provided guidance in the prevention of occupational injuries and illnesses. CONCLUSION: Most respondents (75.54%) were found not to be knowledgeable about occupational legislation. The positive finding was that respondents knew the benefits of occupational legislation. To improve the respondents' knowledge about legislation, five recommendations are made by the researcher.

The relationship between resilience and empowering leader behaviour of nurse managers in the mining healthcare sector

BACKGROUND: The South African mining healthcare sector faces injuries, illnesses including HIV and AIDS and high staff turnover rates. In this sector, nurse managers should create an optimal environment for providing nursing care by motivating, influencing and empowering nurses. OBJECTIVES: This study aimed to investigate the relationship between nurse managers' resilience and empowering leader behaviour in this sector. METHOD: The study employed a quantitative, descriptive and correlational design. The research population comprised 31 nurse managers, 101 professional nurses, 79 enrolled nurses and 79 enrolled nursing auxiliaries who participated in the study. Two questionnaires were used as data collection methods, namely Wagnild and Young's Resilience Scale Questionnaire to investigate the resilience of nurse managers and the Empowering Leadership Questionnaire to measure empowering leader behaviour of the nurses supervised by a particular nurse manager. RESULTS: Out of 31 nurse managers, 8 had a low level, 19 had a moderate level and 4 had a high level of resilience. According to Hoteling's t-test the nurse managers in the low resilience group displayed lower empowering leader behaviour as perceived by their team members than those in the high resilience group in terms of the five factors included in the Empowerment Leadership Questionnaire. CONCLUSION: Respondents with high resilience scores tended to have higher leader empowering behaviour. Recommendations include the strengthening of nurse managers' resilience through workshops and reflection practices, debriefing and performance feedback sessions.

Northern Ghana final-year nurses' attitudes towards nursing and remaining post qualification

BACKGROUND: Recruitment and retention concerns nursing globally, including Ghana, as the country attempts to meet health demands. A link exists between nursing students' attitudes towards nursing and decisions to enter, remain in or withdraw from the profession. OBJECTIVES: To describe northern Ghana final-year student nurses' current attitudes towards nursing and remaining in nursing post qualification. METHOD: Non-experimental quantitative descriptive design used convenient sampling targeting final third-year student nurses (n = 80) studying towards a Diploma in Registered General Nursing in a northern Ghana college (N = 220). Data were gathered using the attitude dimension of a self-administered questionnaire, developed by Al-Omar. RESULTS: The response rate was 87.5% (n = 70). Respondents were 20-30 years of age, more men and predominantly from urban areas. The mean attitude dimension score (range 10-50) was 35.41 (SD 4.03) with no skewness (0.37); mean of single-item question about intention to stay in nursing was 3.68 (SD 1.14) with negative skewness (-0.92). Male and urban respondents' attitudes were more positive than those of female respondents. No association was found between attitude score and demographics or intention to stay in nursing, but significant association was found between gender and habitation and attitude categories. Medium positive correlation existed between intent to stay in nursing and attitude score. Pay, travel opportunities and nursing being a challenging career attracted unfavourable attitudes. CONCLUSION: Ghanaian male student nurses' attitudes are non-typical of general stereotypes held of nurses and gender, suggesting increased recruitment of male nurses. Demographic variables hold a small amount of value in the development of attitudes in Ghanaian nurses.

Individual determinants associated with utilisation of sexual and reproductive health care services for HIV and AIDS prevention by male adolescents

BACKGROUND: Adolescent sexual and reproductive health is one of the essential health care programmes in the world. However, adolescents still face numerous challenges in the area of sexual and reproductive health, which hinder their utilisation of available Sexual and Reproductive HealthCare Services (SRHCS). Male adolescents face further obstacles in accessing and utilising sexual reproductive health services owing to the influence of social constructions of masculinity, which has a bearing on how they view sexual and reproductive health services and their use. OBJECTIVES: The aim of this study was to investigate individual determinants associated with utilisation of SRHCS for HIV and AIDS prevention by male adolescents. METHOD: An exploratory, descriptive and contextual qualitative design was used and semi-structured interviews with 20 purposively selected male adolescents aged 18-24 years living in the South African seat of government were conducted. Data were analysed using Tesch's approach of data analysis. RESULTS: Knowledge of existing services was described as a significant individual determinant of utilisation of SRHCS. This was linked to the quality of SRHCS and violation of human rights of male adolescents CONCLUSION: The study recommends the development of a strategy that will enhance and promote the utilisation of SRHCS by male adolescents.

Frequency and reasons for missed appointments of outpatient mental health care users in the uMgungundlovu District

BACKGROUND: Over the years, there has been a rapid growth in the use of mobile technology which has been proven to increase treatment adherence. Short message services may improve service delivery through appointment reminders and improve communication between health care workers and patients. Missed appointments are becoming common amongst mental health care users, and this has a significant economic burden on mental health symptoms. OBJECTIVES: The aim of the study was to determine the frequency and reasons for missed appointments of outpatient mental health care users for their follow-up care in the uMgungundlovu District METHOD: This study used a quantitative survey. A non-probability convenient sampling method was used to select 182 participants at the psychiatric clinic.s RESULTS: Of the 182 participants, results of the study indicated that n = 84 (46.2%) respondents had missed their appointment at some stage. Of the n = 84 (46.2%) respondents who had missed appointments, n = 28 (33.3%) had missed their appointment once, and n = 45 (53.6%) had missed their appointment 2-3 times. Most common reasons for missed appointments included mental health care users forgetting (n = 58; 69%), work commitments (n = 14; 16.7%), no transportation (n = 4; 4.8%) and financial constraints (n = 5; 6%). CONCLUSION: The main reasons for missed appointments that were identified included forgetfulness, work commitments, lack of transportation and financial constraints. A significant number of participants (53.6%) had missed their appointments 2-3 times.

Integration experiences of student and qualified nurses with disabilities who graduated from selected KwaZulu-Natal nursing education institutions: An exploratory case study

BACKGROUND: Despite the introduction of the Disability Policy Guidelines in South Africa (SA), student nurses who have disabilities (SNWDs) are still habitually and effectively excluded from nurse training programmes, and hence from the nursing profession. Yet SNWD may be able to offer a unique perspective. OBJECTIVES: To explore and describe the integration experiences of both student and qualified nurses with disabilities who graduated from selected KwaZulu-Natal nursing education institutions (NEIs). METHOD: A concurrent mixed-method design based on multiple embedded case studies served as the primary data collection instrument in this paper. The researcher initially conducted a survey of all the private NEIs to determine which had experienced training SNWDs; 3 cases and 10 embedded cases were selected, using non-probability purposive sampling. Individual interviews were conducted with students and qualified nurses with who have a disability (n = 10) who had graduated from NEIs. RESULTS: The findings of the study indicated that, largely, private NEIs are paving the way for integrating SNWDs; however, there are still some gaps in meeting the needs of these students. Despite strong legislative policies, an inclusive and enabling teaching and learning environment for SNWDs in nurse training remains largely absent. CONCLUSION: The study recommends that NEIs develop policy guidelines for integrating SNWDs in nursing education programmes promoting an inclusive nursing education for SNWDs. The introduction of a disability liaison to assist SNWDs by liaising between key stakeholders and, perhaps, addressing many of the challenges that SNWDs experience in the clinical facilities where nursing personnel are unaware of their disability.

Factors influencing enrolled nursing students' academic performance at a selected private nursing education institution in KwaZulu-Natal

BACKGROUND: The success of any educational institution is measured by its academic performance or how well students meet the standards set out. Currently, nursing students' academic failure is a phenomenon of growing international interest because of its economic impact and its negative effects on the availability of future nurses in different health care systems. Factors identified as influencing the academic performance of students include the socio-economic background of parents or guardians, lecturer-student relationships, academic support services, demographic factors, quality of nurse educators, availability of facilities in the school, the language of instruction and level of entry qualifications of students. OBJECTIVES: The purpose of this study was to describe the perceptions of enrolled student nurses on factors influencing their academic performance in a private nursing school in KwaZulu-Natal, South Africa. METHOD: Data were collected from 100 respondents using an adapted instrument related to the factors believed to influence students' academic performance. RESULTS: The results showed that parental involvement in education, good and supportive relationships between nurse educators and students, classroom computer technological gadgets, internet connection and adequate learning facilities were perceived as fostering better academic performance of students. In contrast, poor family background, use of English language for classroom instruction as well as negative peer group influences were leading to poor academic performance. CONCLUSION: Nursing institutions should, therefore, select students with higher-level entry qualifications, early identify at-risk students, recruit more qualified nurse educators and upgrade their facilities.

Record-keeping: Challenges experienced by nurses in selected public hospitals

BACKGROUND: Patients' records provide a trace of care processes that have occurred and are further used as communication amongst nurses for continued management of patients. Nurses have the responsibility to ensure that records are accurate and complete in order to effectively manage their patients. In hospitals, nurses have to record a wide range of information in the patient's records and this leads to increased workload on the part of nurses that compromises accurate record-keeping. OBJECTIVES: The purpose of this study was to explore and describe the challenges experienced by nurses with regard to record-keeping at selected public hospitals in the Vhembe district, Limpopo Province, South Africa. METHOD: A qualitative, explorative and descriptive research design was used. Nurses working in selected public hospitals were purposively selected and semi-structured interviews were conducted until data saturation was reached. Data were analysed using the Tesch's open-coding method. RESULTS: Nurses working in public hospitals experience record-keeping as a challenging activity owing to a variety of challenges which include lack of time to complete the records, increased patients' admission and shortage of recording material. CONCLUSION: Record-keeping is not done properly which is problematic, and it is recommended that there should be continuous training, monitoring and evaluation of nurses on record-keeping issues, supply of adequate recording materials and proper time management amongst nurses to improve record-keeping challenges. The need for comprehensive record-keeping remains fundamental in public hospitals in order to improve patient care.

Support of students by academics in a nursing foundation programme at a university in the Western Cape

BACKGROUND: Owing to the inadequate schooling system and the under-preparedness of students in South African high schools, Higher Education Institutions are faced with students who do not meet the minimum criteria for acceptance into a mainstream programme and need support from an extended foundation programme. OBJECTIVES: The study described the support of students by lecturers in an extended 5-year nursing foundation programme. METHOD: A qualitative, exploratory and descriptive design was applied. Purposive sampling was conducted, and eight nursing students who completed the foundation year took part in semi-structured individual interviews. Each interview took around 30 min and was digitally recorded. Data were transcribed verbatim and analysed using open coding. Ethical principles and trustworthiness were maintained throughout the study. RESULTS: The findings of this study indicated that experiences varied on a foundation programme. Participants expressed support in a nurturing environment in which the lecturers were open and approachable with a positive attitude. Lecturers could support students by being caring and advising in learning methods around the programme. Lecturers could focus on the method of peer support which should be encouraged beyond the programme so as to provide a sense of camaraderie amongst students. CONCLUSION: Data revealed that support of lecturers in a foundation programme needs creative methods to make the learning environment nurturing for students. This provides for students from diverse backgrounds the opportunity to prepare for their studies at a university level. Insights gained from this study, which highlight the importance of supporting foundation students, could benefit all nurse educators offering foundation programmes.

Analysis of self-evaluated ethical competence of midwifery students at a selected nursing college in the Free State

BACKGROUND: It is imperative to know whether the students who have undergone a specific training perceive themselves as confident and competent in handling ethical dilemmas, in the face of contemporary ethical challenges. Such evaluation is significant especially for nursing and midwifery students who have undergone training that stipulates adherence to a code of ethics and professional norms. At present, such knowledge is limited, and this has an impact for ethics education. OBJECTIVES: The article aims to describe the self-evaluated ethical competence of midwifery students and to contrast the findings to the content of the ethics instruction received. Based on outcomes, the article aims to convey the claim to nursing institutions that current strategies that rely on teaching nursing ethics without appraising the context of a situation are ineffective in fostering ethical competence amongst students. METHOD: This study made use of a set of self-reflection reports in which the midwifery nursing students narrated their experiences in handling ethical issues. RESULTS: Analysis of the self-reflective reports revealed that one of the three dimensions of ethical competence was limited. There was evidence of moral perception, moral action and substandard moral reasoning. The principles that were mostly referred to within the narratives were autonomy and beneficence. CONCLUSION: The findings support the argument that teaching principlism and enforcing a code of ethics without contextualising it coerces the student to conform without questioning their beliefs. Thus, ethical competence amongst the midwifery students may be described in terms of compliance to principles with limited reflection on the situation as a whole.

Female condom acceptability and use amongst young women in Botswana

BACKGROUND: The female condoms are a barrier method of contraception. The FC1 female condom is made from soft thin plastic called polyurethane and has been replaced by FC2 female condom, which is made of synthetic latex. The female condom is worn inside the vagina and acts as a barrier to prevent semen getting to the womb. It is about 75% - 82% effective with normal use. When used correctly all of the time, female condoms are 95% effective. Despite evidence of its effectiveness, the use of the female condom has continued to face resistance from both women and men. OBJECTIVES: The objectives of this study were to determine clients' level of knowledge of female condom, identify predominant methods of contraception, examine young women's views regarding the female condom and identify barriers to the use of female condoms by young women. METHOD: A simple random sampling approach was used to recruit young women between 15 and 34 years in Jwaneng, Botswana. Data were collected using self-administered structured questionnaire from women accessing healthcare services in the three health facilities in 2015. Descriptive statistics, exploratory factor analysis and the chi-square test techniques were applied using the Statistical Package for the Social Sciences (SPSS) statistical programme version 23 for Windows to analyse data. RESULTS: The findings based on factor loadings show low utilisation of the female condom and highlights the significant challenges about the material, size, shape and timing of insertion. Respondents had stronger views on the structure of the condom. There was no significant relationship between attitude and method of contraception. CONCLUSION: Acceptability of the female condom involves complex factors such as women position and decision-making power in a relationship, attitude and knowledge. Attitude, knowledge and power relations play a role in the extent to which women would want to try or use it. Various strategies need to be developed to effectively promote the female condom amongst young women.

Experiences of facilitators regarding the extended curriculum programme offered at a higher education institution in the province of KwaZulu-Natal in South Africa

BACKGROUND: Much like the rest of the world, student access and success are primary concerns of the South African higher education institutions, especially in the face of data that suggest that up to 50% of students do not successfully complete their course of study. Despite compulsory and free basic education for all South Africans, and increased government funding for education, there has been little impact on learner performance and the majority of primary schools remain poor. To improve access and success and in keeping with international practice, the Department of Nursing at the selected university of technology in 2013 offered for the first time the extended curriculum programme (ECP). To date, the impact of the programme has never been evaluated. OBJECTIVES: The aim of the study was to explore the experiences of the facilitators regarding ECP in the undergraduate nursing programme. METHOD: Guided by this, the current article describes a qualitative exploration of the experiences of six purposively selected facilitators regarding ECP in the Department of Nursing. In-depth interviews were conducted with the ECP facilitators. Tesch's method was used to analyse the data. RESULTS: Four main themes emerged from the data: stigmatisation and lack of confidence, lack of self-will, additional workload of facilitators and gradual improvement of students' performance. The participants reported that although students displayed and verbalised negative attitude towards the ECP, the performance of students showed gradual improvement and thus a need to continue to offer the programme to increase access and success in higher education institutions. CONCLUSION: It was concluded that ECP should continue to increase access and success in higher education institutions; however, there is a need for additional resources to support ECP students.

Experiences of family members who have a relative diagnosed with borderline personality disorder

BACKGROUND: While working in a psychiatric hospital, the researcher observed the beneficial effects of the mindfulness programme offered to patients diagnosed with borderline personality disorder (BPD). Little support was offered to family members who attempted to manage their relatives diagnosed with BPD. The family members often experienced stress, depression, grief and isolation. OBJECTIVES: The purpose of this research was to explore and describe the experiences of family members who have a relative diagnosed with BPD. METHOD: A qualitative, exploratory, descriptive and contextual study design was used. A purposive sample of family members aged between 24 and 74 years was made. Data were collected by conducting eight in-depth, phenomenological interviews, and field notes were taken. The interviews focused on the central question, 'Tell me your experience of having a relative diagnosed with BPD'. Tesch's method for data analysis was used, and an independent coder analysed the data and met with the researcher for a consensus discussion of the results. Measures to ensure trustworthiness were applied and ethical principles were adhered to. RESULTS: Four themes were identified. In theme one, family members described their relative diagnosed with BPD as experiencing emotional, behavioural, interpersonal and self-dysregulation. As a result, family members expressed negative feelings towards their relatives and experienced social humiliation, financial strain and marital discord. In theme two, they experienced a desire to move forward and improve their mental health. In theme three, family members experienced a challenging process of adaptation and coping. In theme four, family members experienced a quest for harmony and integration. CONCLUSION: The results indicated that family members experienced disempowerment because they lacked knowledge about their relative's BPD. More knowledge about BPD, the understanding and implication of the diagnosis, treatment and care are needed from mental health care professionals and service providers.

Community-based maternal and newborn care: A concept analysis

BACKGROUND: Community-based care can serve as a valuable programme in the provision of essential maternal and newborn care, specifically in communities in low-income countries. However, its application in maternal and newborn care is not clearly documented in relation to the rendering of services by skilled birth attendants. OBJECTIVES: The purpose of the analysis was to clarify the meaning of the concept 'community-based maternal and newborn care and its relationship to maternal and newborn health'. METHOD: Walker and Avant's and Rodgers and Knafl's as well as Chin and Kramer's approaches to concept analysis were followed to analyse community-based maternal and newborn care. RESULTS: The attributes of community-based care in maternal and newborn health include (1) the provision of home- and/or community-level skilled care, (2) linkages of health services and (3) community participation and mobilisation. These attributes are influenced by antecedents as well as consequences. CONCLUSION: The provision of good maternal and newborn care to all clients is a crucial aspect in provision of maternal and newborn services. In order for low-income countries to promote maternal and newborn health, community-based care services are the best option to follow.

Four-year diploma male students' experiences in a profession traditionally perceived as a female domain at a selected public college of nursing in Limpopo, South Africa

BACKGROUND: Over the last 20 years, more men have been choosing to pursue a career in nursing. Despite this, men remain a minority in the nursing workforce around the world, including South Africa. Even though there is an increase in the number of male students entering the profession, male students remain a minority. Comparatively speaking, there is no balance between the number of female and male students taken in each intake. This is even reflected in the South African Nursing Council statistics. Nursing is traditionally perceived as a distinctly feminine career and the use of the terms 'angel in a white dress, sister or nurse' perpetuates this stereotype. This perception may deter some men from choosing a career in nursing and presents challenges for others who are currently in the profession. OBJECTIVES: To explore and describe 4-year diploma male students' experiences in a profession traditionally perceived as a female domain. METHOD: This qualitative study used an explorative and descriptive design. The population comprised African male students in their third and fourth years of study who were registered for the 4-year diploma course at a selected public college of nursing in Limpopo, South Africa. Participants were purposively sampled. Five focus group discussions were conducted, and each comprised six to eight participants. The data were analysed using the Tesch's open code method. RESULTS: Two themes emerged during data analysis: discrimination in the clinical setting and lack of role models and mentors. CONCLUSION: Unless these challenging experiences are attended to, discrimination on the basis of gender in the clinical settings and lack of mentors may deter some men from choosing and remaining in the nursing profession. The selected public college of nursing and the nursing services need to work towards creating a welcoming environment to all students regardless of gender because some participants indicated that the clinical environment is sometimes not welcoming to them as men.

Using e-Delphi to formulate and appraise the guidelines for women's health concerns at a coal mine: A case study

BACKGROUND: E-Delphi is an online method widely used in health and social research to strengthen decision-making processes and reach consensus on developing guidelines for health services. OBJECTIVES: The e-Delphi technique was designed to formulate and appraise a set of criterion-referenced guidelines for women's health concerns of mineworkers at a selected coal mine in Mpumalanga, South Africa. METHOD: The University Learning Management System's discussion forum was customised to suit the characteristics of e-Delphi as the second phase of a primary study on the formulation of guidelines for women's health concerns. Six purposively sampled experts with extensive experience in Occupational Health and in Women's Health participated. Online engagements on the formulation and appraisal of the guidelines for women's health concerns took 7 weeks, divided into four phases as preparatory, exploratory, consensus and refinement. From the experts' inputs, guidelines were drafted. Experts were invited to evaluate the guidelines by using a 7-point Likert scale with AGREE II criteria. Consensus was reached in two e-rounds. RESULTS: Eight guidelines were formulated, appraised and adopted as: change management, control of hazardous environments, suitable psychosocial working environment, provision of health care service, uphold human dignity and adherence to human rights, effective measures for safety participation compliance, accessible, available and relevant on-site health care services and hope and resilience. Each guideline has rationale, operational strategies and anticipated outcomes. CONCLUSION: E-Delphi platform used various tools to deliberate on the process of guidelines formulation and appraisal. The platform was convenient for the experts' participation in the discussion at any time and anywhere.

Stigma and chronic illness: A comparative study of people living with HIV and/or AIDS and people living with hypertension in Limpopo Province, South Africa

BACKGROUND: Stigma among people with chronic illnesses exists, preventing many sufferers from presenting for treatment especially in South Africa OBJECTIVES: This study compared stigma experiences of people living with human immunodeficiency virus and/or acquired immunodeficiency syndrome (HIV and/or AIDS) (PLWHA) and people living with hypertension (PLWHPT) in Limpopo Province of South Africa. METHOD: Using a cross-sectional design, 600 participants (300 PLWHA with mean age of 31 years, standard deviation of 8.2; and 300 PLWHPT with age of 55 years, standard deviation of 8.1) were purposefully sampled at HIV and/or AIDS and hypertension outpatient clinics. The perceived stigma of AIDS scale was used to assess stigma in the HIV and/or AIDS sample while the adapted version was used to assess stigma in PLWHPT. Data were analysed using independent t-test. RESULTS: Results indicated that PLWHA experienced significantly higher enacted stigma (t(598) = −11.79, p < 0.001) as compared to PLWHPT. However, PLWHPT experienced significantly higher internalised stigma (t(598) = 37.56, p < 0.001) and perceived stigma (t(598) = 41.71, p < 0.001) than PLWHA. CONCLUSION: Stigma among people with chronic illnesses is existent. The stigma type is, however, dependent on the nature of the illness. Stigma reduction interventions among these populations are indicated.

Undergraduate nursing students' experience of clinical supervision

BACKGROUND: Clinical supervision plays a major role in the undergraduate nursing programme. There have been some local studies addressing clinical supervision; however, there still remains a lack of knowledge and understanding how to improve quality supervision of undergraduate nursing students. This article is based on the authors' original thesis. OBJECTIVES: The objective of the study was to explore the experiences of undergraduate nursing students on clinical supervision. METHOD: A descriptive design with a qualitative approach using focus group interviews was used to explore the experiences of undergraduate nursing students regarding clinical supervision. Purposive sampling was used for selection of 36 participants. The participants needed to be enrolled at the institution under study, at the time of the study, as undergraduate nursing students in order to meet the inclusion criteria. The participants also needed to have worked at clinical facilities where they received clinical supervision. Nine (n = 9) students were purposively selected from each year level to participate in focus group interviews. The interviews were analysed using content analysis. RESULTS: The findings indicated both positive and negative experiences regarding clinical supervision. The results were tabulated in which the positive experiences were grouped together and were separated from the negative experiences of the undergraduate students. Positive experiences included the support that was received from supervisors. These were, however, overshadowed by many comments on negative experiences concerning the behaviour and competencies of the supervisors. The findings also confirmed that the students experienced differences in the clinical procedures demonstrated by various supervisors. Negative experiences that relate to abusive behaviour such as misuse of power were also found, as well the incongruence amongst clinical supervisors regarding clinical procedures. Recommendations were proposed to enhance clinical supervision and the learning experiences of student nurses. CONCLUSION: The study findings suggest a need for continuous professional development for clinical supervisors by means of in-service training as well as to maintain congruence by clinical supervisors when demonstrating clinical procedures.

The knowledge, perceptions and relationship behaviour of rugby and football players towards HIV infection at the University of Limpopo

BACKGROUND: Sport has the capability to unite a country. To achieve winning teams, athletes have to rely on each other and often have close physical contact. Disclosure of a positive human immunodeficiency virus (HIV) status may be problematic for athletes in contact sports as they may suffer discrimination and stigmatisation which may impact their relationship behaviours. This may impact frontline nursing and medical staff dealing with on-field 'blood' injuries. OBJECTIVES: The purpose of this study was to determine if individuals who participate in football and rugby are aware of the risk of HIV infection in contact sports and their perceptions and reported behaviour towards HIV-positive athletes. METHOD: A cross-sectional survey design with a qualitative element. Quantitative data were analysed using descriptive statistics, while thematic content analysis was used to analyse qualitative data. Non-proportional quota sampling was used for male rugby (n = 23) and football (30) players registered at the University of Limpopo (Turfloop campus). RESULTS: The results supported previous research in that there are gaps in HIV knowledge. For instance, not knowing that anal sex may cause HIV infection and believing that saliva can transmit HIV and that blood transfusions are unsafe. CONCLUSION: Problematic findings were that a portion of the sample believed that having sex with a virgin could cure HIV and the majority of the sample believed that being 'bewitched' could cause HIV and acquired immunodeficiency syndrome (AIDS)

The effects of absenteeism on nurses remaining on duty at a tertiary hospital of Limpopo province

BACKGROUND: Absenteeism is a global problem in the working force and this is no exception in the nursing profession. Much attention has been drawn to factors that contribute to absenteeism; however, little attention has been placed on the effects of absenteeism on nurses remaining on duty by their colleagues. Nurses absent themselves leaving behind their colleagues to execute their part of work OBJECTIVES: To investigate the effects of absenteeism on nurses who remained on duty at a tertiary hospital in Limpopo province METHOD: A quantitative descriptive research approach was chosen to enable the researchers to achieve the research aim. Data collected using structured questionnaires were analysed by descriptive statistics RESULTS: The findings indicated that absenteeism has an effect on both the nurses' psychological and professional well-being, as well as the quality of patient care provided as a result of psychological stress, low morale of nurses and increased workload. The study further revealed the provision of substandard care to patients by those nurses who are remaining on duty, resulting in risk of medical errors that could jeopardise their professional credibility. Therefore, absenteeism creates an unhealthy working environment for nurses remaining on duty CONCLUSION: Nurse managers should provide platforms to address psychological and professional problems experienced by nurses remaining on duty. The study further recommends the introduction of policies that would address absenteeism in the workplace and how nurses who remain on duty could be assisted with the workload of colleagues who continuously absent themselves

Academic monitoring and support of undergraduate nursing education programme: A middle-range theory

BACKGROUND: Globally, there is consensus on the need for student support to address high student attrition and low throughputs, especially in nursing and midwifery programmes. OBJECTIVES: This study analysed the implementation of academic monitoring and support (AMS) in an undergraduate nursing programme to generate a context-informed academic monitoring and support middle-range theory. METHOD: An ethnographic design and grounded theory approach were adopted in this study. Data sources included individual and focus group interviews, observations, reflective conversations and document analysis. Ethical clearance was obtained from the University Research Ethics Board, and ethical principles were maintained throughout the study. RESULTS: The country's contextual conditions emerged as conditions that necessitated a comprehensive approach to student support to increase throughput in a nursing programme that attracted students from diverse backgrounds. A shared common vision, supportive leadership, collaboration and investing resources in a student support programme that uses a comprehensive and holistic approach emerged as key to an AMS model that will yield the desired outcomes. Major concepts in an AMS middle-ranged theory generated included education for social justice, visionary leadership, comprehensive, holistic and intentional student support, AMS pillars, AMS threats and process and goal-oriented consequences. CONCLUSION: Academic monitoring and support is a tool used to facilitate access of all deserving students to an undergraduate nursing programme and to ensure that they all have an equal chance to succeed academically, resulting in improved throughput rates. Strengthening support in clinical settings is recommended and further research to improve effectiveness of AMS programmes is suggested.

Acknowledgement to reviewers