Theses and Dissertations (Nursing Science)

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Strategies for induction of novice midwives in labour wards in an academic hospital cluster in Gauteng province, South Africa
(University of Pretoria, 2022) Yazbek, Mariatha; Moagi, Mmamphamo Miriam; Ngunyulu, Roinah Nkhensani; fezmafisa@gmail.com; Mafisa, Florence Fezeka
Introduction: Globally, emphasis is placed on effective induction in the workplace to direct human capital in an appropriate manner. Induction of novice midwives might help forestalling unfavourable health effects that impact negatively on the health of mothers and babies. South African studies support that an effective induction programme for novice midwives can improve patient care outcomes in a labour ward. Aim: To develop induction strategies to guide novice midwives in a labour ward with the intention to empower them from novice to competent midwives. Objectives: Phase 1: (a) Explore and describe the experiences of novice midwives regarding their induction in a labour ward during the first six months of practice. (b) Explore and describe the views of the labour ward operational managers. (c) Explore and describe the support provided by maternity area managers regarding the induction of novice midwives in a labour ward. Phase 2: Develop the induction strategies with labour ward operational managers and maternity area managers through consensus method using Nominal Group Technique. Phase 3: Refine and validate the induction strategies with midwifery experts through consensus method using Delphi Technique. Research design: - A qualitative, exploratory, and descriptive design was used in three phases. Methods: The setting was in the labour wards of a designated central academic cluster of hospitals in Tshwane District, Gauteng. Population, Data collection and Data analysis: Phase 1: The population was novice midwives in a labour ward during the first six months of practice; labour ward operational managers and maternity area managers. Data were collected by means of individual interviews and scribing of the notes. The information received was interpreted by means of thematic analysis through an open coding system. Phase 2: Results of Phase 1 initially employed to formulate the first outline of induction strategies through Nominal Group Technique with operational and area managers. Phase 3: Midwifery experts refined and validated the developed induction strategies using an e-Delphi Technique. Significance of the study: Induction strategies will form part of the crucial knowledge base that will be used as a framework to capacitate novice midwives in improving patient care outcomes in a labour ward.
Measuring patient safety culture among nurses in adult critical care units in a private hospital group in Gauteng
(University of Pretoria, 2025-01) Coetzee, Isabel M.; Rasweswe, Melitah M; nanda.prinsloo@gmail.com; De Beer, Nanda
Background: Healthcare workers are taught the ethical principle of “do no harm” to maintain patient safety; however, this principle is recently facing challenges in the healthcare setting. A safety culture encompasses the values, attitudes, perceptions, competencies and behavioural patterns that shape health and safety management. Critical care units (CCUs) are high-risk nursing units that deliver advanced care to critically ill/injured patients. The Safety Attitude Questionnaire (SAQ) is a widely used tool to measure safety culture. The aim of the study was to assess the safety culture in adult critical care units in a specific private hospital group in Gauteng, South Africa. Objectives: To assess and describe the safety culture among critical care nurses and to propose recommendations to enhance patient safety culture in the critical care units. Methods: A quantitative descriptive design was used in this study. The safety attitude questionnaire was used to measure the safety culture of nurses, which could influence patient safety, in four critical care units of a specific private hospital group. Total population sampling was used in this study which included all registered and enrolled nurses working in the critical care units. Data collection was conducted using a questionnaire distributed to eligible participants, and data analysis was performed in collaboration with a university statistician. Results: This study used the safety attitude questionnaire to determine the safety culture in the critical care units. Six (6) domains were measured to determine the patient safety culture, three of which indicated areas of concern. The results showed that stress recognition, perception of management and working conditions have a significant impact on patient safety culture, which could contribute to an increase in patient safety incidents. Conclusion: The findings from the safety attitude questionnaire at the specific hospital group highlighted both strengths and areas for improvement in the critical care units related to patient safety culture. Teamwork, safety climate and job satisfaction reflected positive aspects of patient safety culture. However, a significant challenge was identified regarding stress recognition and working conditions, posing a risk to individual wellbeing and patient safety. The perception of the management domain was perceived as negative, which also indicated a challenge relating to patient safety.
Experiences of undergraduate university nurse lecturers on the online assessment of the affective domain during covid-19 pandemic in city of Tshwane
(University of Pretoria, 2025-01) Mashao, Kapari Constance; Mooa, Ramadimetja Shirley ; daureen.moepi@gmail.com; Moepi, Daureen
Introduction and background: Clinical assessment, which is an integral part of the affective domain, is usually conducted in a controlled environment where a nurse lecturer has close contact with a student nurse while performing the nursing skill or procedure. Due to COVID 19 pandemic in 2020, training institutions around the world came to a complete halt, and teaching and learning went completely online. In South Africa, Nursing Education Institutions (NEIs) introduced technology-based pedagogy to ensure that students have access to teaching, learning, and assessment while observing lockdown protocols. It was easy to deliver cognitive skills through online classes; however, due to its complexity, assessing the affective domain online became a challenge. Aim of the study: The overall aim of this study is to explore the experiences of undergraduate lecturers on assessing affective domain online during COVID-19 pandemic at universities. The findings will be used by stakeholders to better understand how nurse lecturers assessed the affective domain online during the COVID-19 pandemic and other future pandemics. Universities that require virtual assessment, due to decentralized training to reach students in rural areas. Method: A qualitative descriptive phenomenology design was used in this study. The study was conducted at a university offering an undergraduate nursing degree in the city of Tshwane. Participants who fit the inclusion criteria were selected. Data was collected through individual interviews, using a semistructured interview guide. The steps of content data analysis were followed to analyse the collected data. Trustworthiness was ensured basis of the criteria of credibility, transferability, dependability, confirmability, and authenticity. Significance: The study might contribute to the existing limited body of evidence on the assessment of the affective domain online. The South African Nursing Council might use the findings to develop teaching standards and policies. The findings of the study will support universities that offer decentralized training to reach students in rural areas.
A mixed methods study to develop a self-care management tool for both people living with diabetes and their families
(University of Pretoria, 2024-12) Bhana-Pema, Varshika; Legodi, Heather; jd-vdh@hotmail.com; Jumat, Jennifer Denise
Introduction and background: The progressive nature of Diabetes Mellitus requires lifelong selfcare, which refers to the deliberate decisions and practices of the people living with diabetes (PLWD) and supporting family. The essence of self-care is to prevent risks and complications, but health education programs are lacking, and support for care is weak. Aim and objective: To create a self-care tool that will support and improve self-care habits, it was necessary to investigate how PLWD perceive self-care and how the family is involved. Research design and methods: This Mixed methods study followed a qualitatively driven, descriptive and explanatory approach. In Phase 1, 104 individuals living with diabetes provided data using the DSSQ-Fv. Phase 1 reliability analysis revealed that the five constructs obtained high Cronbach Alpha values, ranging from 0.803 to 0.989, and had good discriminating power. Phase 2 Stage 1 data collection involved conducting fifteen telephone interviews after a focus group with four individuals. Phase 2 Stage 2 data collection involved four family members in a focus group, and eight telephone interviews were conducted afterwards. Coding, categorisation, and theming were used in the analysis process. Phase 3 involved the Delphi consensus-building process being used to collect information from ten experts. Results: The general self-care regimen was deemed inadequate. Most PLWD concentrate primarily on the diet, paying little attention to medication or exercise as a means of controlling blood sugar levels. An easy-to-use self-care tool was developed. Conclusion: The study revealed inadequate self-care behaviours and a weakness in DSME/S. Developing a daily self-care regimen is necessary to enhance self-care practices.
Exploring and describing the facilitators and barriers during shift handover between critical care nurses in a private hospital in Gauteng
(University of Pretoria, 2024-10) Coetzee-Prinsloo, Isabel M.; Leech, Ronell; marlini007@gmail.com; Naidoo, Marlini
Abstract Introduction: Nurses conduct shift handover to exchange vital patient care information at the beginning, during, and at the end of each shift. This can be done verbally, in writing, or via phone or video calls. Critical care nurses often prefer bedside handovers for better correlation with the patients’ clinical condition and records. Objective: To explore and describe the facilitators and barriers during shift handover between critical care nurses in a critical care unit. Method: The researcher used an exploratory descriptive qualitative design to study critical care nurses with more than six months of experience in direct nursing care of critically ill/injured patients at a private hospital in the Gauteng province. Nurses completed a self-reported narrative guide, which was collected on alternate days from a sealed container in the unit manager’s office. Participants: The participants were registered and enrolled nurses working in the adult critical care unit with a minimum of six months of critical care experience. Results: The study identified four facilitators and six barriers during the shift handover process between critical care nurses (CCN). The facilitators that enhanced and streamlined the shift handover (SHO) included effective teamwork, clear communication, detailed handover procedures, and comprehensive handover notes. Conversely, the barriers that hindered or obstructed the flow of information during the SHO process were identified as ineffective communication, lack of comprehensive handover, incomplete handover notes, negative attitudes, unrealistic workload and tardiness. Conclusion: The study aimed to explore facilitators and barriers that influence handover practices, with recommendations to address the barriers for the benefit of the organisation and patients. Additionally, optimal handover practices may lead to improved patient feedback and higher nursing staff satisfaction and provide valuable insights for management.
An exploration of the indigenous neonatal care practices of mothers and caregivers in Vhembe District, Limpopo Province
(University of Pretoria, 2020-07) Mulaudzi, Fhumulani Mavis; Rikhotso, Richard; mashtule@gmail.com; Tulelo, Patience Mashudu
Background South Africa is amongst countries with high neonatal mortality rates. The Department of Health has introduced strategies to promote good neonatal care practices within the healthcare institutions around the country. On the other hand, different communities throughout the country still adhere to their own indigenous neonatal care practices in caring for their neonates at home after discharge from clinics/hospitals. Some of these practices could prove to be beneficial to the neonates’ health, while others may pose a health risk to the very neonates. Purpose The study explores and describes indigenous neonatal care practices of mothers and caregivers in Vhembe District, Limpopo Province. Methodology A qualitative, explorative and descriptive research design approach was employed to collect data from 18 participants situated in three Makhado villages across Vhembe District in Limpopo Province, South Africa. Given the heterogeneity of both the participants and the research sites, the purposive and snowball sampling methods were used for their selection according to the researcher’s predetermined range of criteria. Semi-structured one-on-one interviews were made use of in collecting data over an interrupted period of two weeks (one week in August 2019 and another in February 2020) at Siloam District Hospital’s post-natal ward and at the participants’ homes in selected villages of Makhado district. Additional to the interview guide, an audio recorder and field notes were also utilised to maximise the data collection instruments, after which the same data was analysed according to its emerging patterns of themes and sub-themes. Findings The study found that indigenous health practices were the primary mechanism for caring for neonates in Vhembe District, and that not all such practices were harmful or unsafe. This study revealed further that women use indigenous neonatal care practices across age groups, social standing and level of education. Younger mothers receive guidance from the older women in their family or community, but also adopted biomedical options to some extent.
Evidence-based support measures for simulation-based nursing: participatory action research from universities in South Africa
(University of Pretoria, 2025-10) Mooa, Ramadimetja Shirley; Moloko-Phiri, Seepaneng Salaminah ; Tabea.Motsilanyane@nwu.ac.za; Motsilanyane, Pelegamotse Tabea
Introduction: Clinical time in nursing education has been augmented with simulation to accommodate many nursing students who need clinical experience. Students are exposed to the simulation laboratory to facilitate learning and enhance their preparedness for patient care. Depending on the degree to which they match reality, several simulators range from low- fidelity to high-fidelity. Both medium-fidelity and high-fidelity simulators are underutilised, and the lack of support for clinical facilitators is viewed as the key aspect of this problem. Objectives of the study: The objectives of the study were achieved in different phases. Phase 1: To critically evaluate the available evidence regarding simulation-based nursing using an integrative literature review. Phase 2: To establish a working relationship with clinical facilitators participating in the study. Phase 3: To explore and describe the challenges of simulation-based nursing education in South African Universities; Phase 4: To identify the transformative values that contribute to the effective or ineffective simulation-based education in undergraduate nursing programmes; and Phase 5: To develop guidelines as evidence-based support for simulation-based guidelines for nursing education. Research design and methods: An integrative literature review was conducted. Co-operative inquiry and Metens’ transformative approach were used to conduct qualitative participatory action research with clinical facilitators from selected universities in South Africa. Transformative learning theory and transformative paradigm were used to ground the philosophical tenets of the study. The study was conducted at the selected Universities in South Africa. The researcher and the participants agreed on the data collection and analysis methods. Data were gathered through cooperative inquiry group meetings and analysed using thematic data analysis. The cooperative inquiry group decided on the outcome of the study. Ethical considerations were adhered to, and quality in the cooperative inquiry was achieved through eight proposed criteria. Findings: Three themes emerged from phase two of the integrative literature review structure, process, and outcome. Four themes emerged from phase three, barriers in simulation-based resources, feeling of inadequacy, questioning one’s assumption and perspective, and navigating shared experience through knowledge and practice. Five themes emerged from phase four as, exploring the relationships, simulation-based resources management, staff capacitation, development of policies and procedures and adjustment of simulation-based roles. Conclusion: The study findings and the transformative learning theory were used to develop the simulation-based guidelines. Qualtrics survey was used by experts to validate the guidelines.
Community health workers' perceptions of factors contributing to loss to follow-up of patients on antiretroviral therapy and residing in an informal settlement in the Tshwane district
(University of Pretoria, 2024-11) Bhana-Pema, Varshika; Nesengani, Tintswalo Victoria; mukwevhomulaloj@gmail.com; Mukwevho, Mulalo Julia
Introduction Antiretroviral therapy is a lifelong combination of at least three medications administered and taken by people living with the Human Immunodeficiency Virus to decrease the viral load and halt disease development. Antiretroviral therapy reduces the morbidity and mortality rates associated with Human Immunodeficiency Virus (HIV). Adherence to Antiretroviral therapy improves patients' quality of life, reduces drug resistance, lowers the occurrence of opportunistic infections, halts disease progression, and lowers hospital re-admissions and death. Community health workers play a key role in antiretroviral therapy care, bridging the gap between healthcare facilities and individuals living with human immunodeficiency virus. They provide support, education, and assistance to ensure medication adherence, disease management, and continuity of care. Through their dedication and empathy, they contribute significantly to improving health outcomes and reducing the impact of Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome in communities. Purpose of the study To explore and describe community health workers' perceptions of factors contributing to the loss of follow-up of patients on antiretroviral therapy living in an informal settlement in the Tshwane District. Research design and methodology The study was conducted in an informal settlement in Tshwane District. A qualitative, exploratory, descriptive, and contextual research design was adopted. Purposive sampling was utilised to sample study participants, and in-depth, face-to-face, individual interviews were conducted with 15 Community Health Workers. Data collection proceeded until saturation was attained. Tesch’s method of qualitative data analysis was utilised to analyse the data. The measures of trustworthiness were used to ensure quality throughout the study. Findings Five themes were articulated from the findings. The findings encapsulated a number of systemic and individual-related factors, which contributed to loss to follow up of patients on antiretroviral therapy. Theme one was ‘Individual-related factors’, theme two was ‘Negative consequences of being on ART’, theme three was ‘System-related factors’, the fourth theme was ‘Attitudes, behaviours and practices at the health facilities’, and lastly the fifth theme was ‘Recommendations to improve follow-up’. Numerous pieces of literature from all across the world, as well as from South Africa, backed up the study's conclusions. Based on the findings, we identified and advised actions for the community, health facilities, the Department of Health, and future studies.
Knowledge, practices, and barriers of surgical items counting among perioperative team in public hospitals, Tshwane district Gauteng province
(University of Pretoria, 2024-04) Rasweswe, Melitah M.; Mooa, Ramadimetja Shirley; dikeledingobeni19v@gmail.com; Ngobeni, Dikeledi Elizabeth
INTRODUCTION: Counting surgical items is an important process in the operating room and is defined as the manual process of counting surgical items during a surgical procedure. Standardised methods for counting surgical items and miscellaneous materials can prevent foreign bodies from being left at the surgical site. The perioperative team is required to count surgical items during surgery to prevent errors and harm to prevent complications such as prolonged hospital stays, repeated open surgical procedures, high rates of medical expenses, morbidity and death in patients who underwent surgery due to a retained surgical items. AIM: The aim of this study was to determine the knowledge, practices and barriers of surgical item counting among the perioperative team in public hospitals, Tshwane District, Gauteng Province. RESEARCH DESIGN AND METHODS: A non - experimental, quantitative, descriptive design was used. The setting was the operating theatres of three hospitals in the Tshwane District of Gauteng Province South Africa. The total population sampling method, which is the type of purposive sampling where the whole population of interest is studied, was used. The data were collected through the use of a standardised validated questionnaire. Statistical Package for the Social Sciences (SPSS) statistics version 28 software was used to perform the analysis with the assistance of a biostatistician. The data are presented as descriptive statistics. RESULTS: The perioperative team in three selected hospitals in the Tshwane District of Gauteng Province working in operating theatres displayed different knowledge, practices and barriers regarding the counting of surgical items. A total of 87.7% (n=193) of the respondents conducted surgery according to hospital policy and WHO guidelines; however, they noted that there was a significant difference in surgical team implementation (p=0.028) of surgical item counting. Sixty-six-point five percent 66.5% (n=147) of the respondents disagreed that surgical item counting is conducted for certain surgical procedures, and 33.5% (n=74) agreed. A total of 30.8% (n=68) reported different styles of surgical item counting, and 69.2% (n=153) reported that they counted the same. Furthermore, 89.1% (n=197) of the respondents noted that they performed surgical item counting when additional items were added to the surgical field, however 10.0% (n=22) indicated that they sometimes counted, while 0.9% (n=02) did not count. Additionally, 63.8% (n=141) of the respondents indicated that multiple mentors with different methods demonstrated how to conduct surgical counts, and only 36.2%(n=80) reported that they demonstrated the same.
Exploring the understanding of followership amongst nursing staff in the emergency department of a private hospital in Gauteng : an appreciative inquiry
(University of Pretoria, 2024-12) Leech, Ronell; Rossouw, Seugnette; Suneldp@gmail.com; Du Plessis, Sunel
Introduction: Followership can be defined as the moment when followers regard themselves as followers and allow for the influence of leaders. With each passing decade, followers are becoming increasingly influential and powerful – hence the gravity of a thorough understanding of their role. Aim: This study aimed to understand followership amongst emergency department nursing staff in a private hospital in Gauteng. Methodology: An appreciative inquiry model with five cycles was utilised. The five appreciative inquiry model cycles were launched by crafting defining, discovery, dream, design and destiny-oriented questions for the interview guide. Ethics approval was obtained from the university’s research ethics committee (No:168/2023). All the nursing staff in a level two trauma-accredited emergency department in a designated private hospital were invited to participate in this study. Purposive sampling was used, and nine semi-structured interviews were conducted to collect data. Braun and Clarke’s six-step thematic method was used to analyse the data. Trustworthiness was ensured by utilising the criteria of credibility, confirmability, dependability and transferability. Findings: The study's findings revealed a limited understanding of followership among the participants, the commendatory attributes needed for proactive followership within the emergency department, and implementation actions expressed by participants that they believe are necessary to create proactive followership in the emergency department. Lastly, the participants communicated what they believed would be essential to nurture followership within the emergency department. Recommendations were formulated based on the findings. Recommendations were made for nursing education institutions, hospital management, nursing staff and further research. Conclusion: The study aimed to explore the understanding of followership amongst emergency department nurses in a private hospital in Gauteng. Based on the findings, a definitive conclusion was reached. Participants revealed that they had a limited understanding of followership and that their limited understanding did not encompass the true definition of followership as guided by the literature. There is a need to deepen the understanding of followership amongst emergency department nurses, which could improve organisational- and patient outcomes and patient experiences.
Psychological experiences of nurses caring for patients living with cancer in a public hospital in Gauteng Province, South Africa
(University of Pretoria, 2024-11) Van der Wath, Anna Elizabeth; Lavhelani, Ndivhaleni Robert; maphumu97@gmail.com; Mthethwa, Phumzile
The psychological issues in oncology units may affect nurses’ well-being and the quality of care rendered resulting in adverse events, poor therapeutic outcomes and decreased patient safety. Oncology is demanding and stressful, especially on a psychological level. Understanding and considering the situation will improve nurses’ psychological state, enhance the quality of care, and prevent staff turnover. Therefore this study explored and described the psychological experiences of oncology nurses caring for patients living with cancer in a public hospital Gauteng Province, SA.
An exploration of support needed by nursing students to develop their professional dignity
(University of Pretoria, 2024-09) Van Wyk, Neltjie C.; Van der Wath, Anna Elizabeth; shilengei@yahoo.com; Shilenge, Isabel Hlupheka
Introduction: Nursing students develop their professional dignity during training with the support of their lecturers and professional nurses who supervise them during work-integrated learning. If left unguided and unsupported, such development will not be attained. To find their voice in the nursing profession, support and guidance are needed. Aim: The aim of the study was to explore and describe the support that nursing students need from their lecturers and professional nurses who supervise them during work-integrated learning to develop their professional dignity. Research design and methods: A qualitative, exploratory-descriptive research design was followed. A non-probability sampling method was applied in the selection of participants. Fourteen participants were interviewed. Face-to-face semi-structured individual interviews were conducted. Recording of the interviews and the writing of field notes were carried out with the permission of the participants. A thematic analysis was performed to analyse the data. Findings: The findings yielded four categories: a) improve work-integrated learning experiences, b) value students’ professional development, c) cooperate to benefit students’ professional growth and d) manage resources optimally. The categories were discussed with literature integration. Recommendations were formulated based on the study findings.
Nursing students' appreciation of clinical supervision during work-integrated learning
(University of Pretoria, 2024-11) Van Wyk, Neltjie C.; Lavhelani, Ndivhaleni Robert; mphambanyenimugwari@gmail.com; Mugwari, Mphambanyeni Julia
INTRODUCTION AND BACKGROUND : Clinical supervision is a critical support factor in the success of nursing students’ development during work-integrated learning. Quality clinical supervision and good relationships among all involved facilitate students’ clinical performance. A poor fit between the expectations of the supervisors and those of the students may jeopardise the outcome of clinical supervision. However, the nursing students of the designated nursing education institution often complained of receiving little or no supervision during work-integrated learning. AIMS : To explore and describe the aspects of clinical supervision during work-integrated learning that nursing students of designated nursing education institution appreciate. METHODS : Qualitative research with an appreciative inquiry approach was used to explore and describe the aspects of clinical supervision that undergraduate nursing students of a designated nursing education institution appreciated. The sample comprised of purposively selected students enrolled for a Diploma in Nursing on level 2 and 3, for the academic year 2021/2022. Four focus group interviews were done with a semi-structured interview guide and 45 student participants were involved. A thematic data analysis was done and ethical considerations were maintained throughout the study. RESULTS/FINDINGS : Thirteen categories and sub-categories related to nursing students’ appreciation of clinical supervision during work-integrated learning emerged, based on the findings of the study. Conclusion and Recommendation: A conducive clinical learning environment should be established to enable proper guidance of nursing students to acquire professional knowledge and skills. Collaboration between nursing education institution and clinical facilities should be well established to facilitate effective communication.
A multifaceted educational intervention to reduce moral distress among critical care nurses in Abu Dhabi
(University of Pretoria, 2024-12) Coetzee-Prinsloo, Isabel; Van der Wath, Annatjie; m_algapry1980@yahoo.com; Aljabery, Mohannad
Background: In the profession of nursing, moral distress becomes a recurrent unavoidable problem with a high prevalence. Moral distress is described as a psychological disequilibrium and painful feeling that results when the individual is constrained from doing the right moral action. The complex nature of moral distress requires continuous development and improvement for the currently utilized interventions. Despite the availability of research that addressed moral distress among nurses in the literature, there is a debate about the effectiveness of the applied interventions in reducing moral distress. Aim of the study: to measure the outcome of the development and implementation of a multifaceted educational intervention on the impact of moral distress among critical nurses in Abu Dhabi. The objectives were divided into three phases: Phase 1: Measured the magnitude of moral distress among nurses working in critical care units in two tertiary hospitals in Abu Dhabi. Phase 2: Implemented the developed multifaceted educational intervention to reduce moral distress among nurses working in critical care units in one tertiary hospital in Abu Dhabi. Phase 3: Evaluated the outcomes of the implemented multifaceted educational intervention in reducing moral distress among nurses working in critical care units in one tertiary hospital in Abu Dhabi. Methodology: The study followed a quantitative quasi-experimental pretest-posttest control group design in three consecutive phases. Phase one administered the pre-test of the quasi-experimental design. Phase two implemented the developed multifaceted educational interventions that combined four educational sessions and three booster sessions for the experimental group with no intervention implemented in the control group. Phase three administered the post-test of the quasi-experimental design. The pre-test and post-test data were collected using the socio-demographic questionnaire, the Measure of Moral Distress for Health Care Professionals, and the Moral Distress Thermometer. A convenient sampling approach was used to recruit participants who volunteered for the study. The study was implemented in two tertiary hospitals located in the Emirate of Abu Dhabi. The study had a potential population of 124 critical care nurses. In phase one, a total of 218 nurses (108 control group, and 110 experimental group) responded to the pre-test. In phase two, 80 participants attended the four educational sessions and three booster sessions. In phase three, 76 participants from the experimental group and 82 from the control group (total=158) responded to the post-test and constituted the total sample of the study. Results: Pre-intervention, the critical care nurses reported a composite moral distress score of 146.4 ± 82.62, a frequency score was 51.02 ± 22.2, and an intensity score was 59.71 ± 22.1. The top-ranked cause contributing to moral distress was “following the family's insistence to continue aggressive treatment.” The independent t-test revealed a significant difference concerning participants’ gender, marital status, educational level, receiving ethics education, and intention to leave their position. Approximately 57% of the CCNs considered leaving their position due to moral distress. A moderate positive correlation was found between participants’ experience in critical care and moral distress composite, frequency, and intensity scores. Post-intervention, the multifaceted educational intervention exhibited statistically significant reductions in the experimental group frequency, intensity, and composite moral distress scores. Conversely, moral distress scores were increased among the control group. Moreover, the intervention significantly reduced the number of nurses who intended to leave their positions from 58 to 47 in the experimental group. Conclusion: Compared with other international studies, critical care nurses had higher moral distress scores in this study. The participant’s gender, marital status, educational level, ethics education, intention to leave, age, and years of experience were associated with moral distress. The multifaceted educational intervention exerts positive outcomes in reducing moral distress across all the dimensions and improving the nurses' retention.
The use of evidence provided by healthcare professionals as expert witness in sexual violence trials in Gauteng province, South Africa
(University of Pretoria, 2024-07) Mooa, Ramadimetja Shirley; Rasweswe, Melitah Molatelo; maggyshabangu8@gmail.com; Shabangu, Maggy
Introduction: In South Africa, healthcare professionals provide care to sexual violence victims across health care settings. One of such settings are Thuthuzela Care Centres. Thuthuzela Care Centres are non-stop facilities that have been introduced as a critical part in South Africa’s anti- rape strategy aiming to reduce secondary victimization. Healthcare professionals working for this Centres are usually asked to appear in court to provide expert evidence and testimony about sexual violence cases. Aim: The overall aim of the study was to explore “the use of evidence provided by healthcare professionals as expert witness in sexual violence trials in Gauteng province, South Africa”. Methodology: A qualitative case study methodology was followed in this study. Data were collected through eight semi-structured interviews with nurses and medical doctors working in different Thuthuzela Care Centres around Gauteng. Data was using Braun and Clarke (2006) thematic analysis framework Three main themes emerged as: (1) commanded to appear in court, (2) being on the stand and the (3) aftermaths of expert witnessing. Each theme has three sub- themes. Results: The findings indicate that expert witness experiences are related to each other. They are being served with a subpoena before appearing in court to give expert testimony, they all received a subpoena that informs them that they are needed in court. They consult with the attorney for preparation prior to their court appearance. It was also found that the defence lawyers distress the expert witnesses by cross-questioning and grilling them during the trial. Implications: The issue of using nurses and medical doctors as expert witnesses in sexual violence trials is a problem worth researching in South Africa because there is scanty literature and their use in prosecution of perpetrators is not clear. Conclusion: This study explored expert witnessing in cases of sexual violence trials. Due to their knowledge and skills nurses and doctors are considered to be expert during trials of sexual violence. Therefore, expert witnesses’ role calls for the continuous various forms of relevant training that can uplift their competencies and knowledge base in cases of sexual violence. Attorneys, police officers and healthcare professionals need to work together as a team like the way Thuthuzela Centres are structured. This approach is very helpful collection of evidence from the victims that will help in building strong cases. Additionally, the approach is expected from expediting the cases that are taken to court. Victims will be able to attend not cancelling cases and victim will gain more trust with justice system. The high rate of sexual violence in South Africa has shown in this study that there is a gap in the training of healthcare professionals in providing expert testimony in sexual violence trials in courtrooms. It is evident by the cases that drag long and some cases do not qualify to go to court.
Knowledge, attitudes and practices of men and women regarding infertility in the City of Tshwane, Pretoria, South Africa
(University of Pretoria, 2024-06-15) Sepeng, Nombulelo Veronica Jr; Musie, Maurine Rofhiwa Jr; vangile.seroto@gmail.com; Mabitsela, Vangile Naney
Background: Infertility affects millions of couples and individuals around the world. Despite this, there is minimal evidence of the knowledge, attitudes and practices among men and women regarding infertility in South Africa, particularly in the City of Tshwane, Pretoria. Aim: The aim of this study was to determine the level of knowledge, attitudes, and practices among men and women regarding infertility in the City of Tshwane, Pretoria, South Africa. Research design and methods: The descriptive quantitative research design was adopted for this study. A self-administered questionnaire was used to collect data from men and women in primary health care settings in the Tshwane District of the Gauteng Province. Stratified sampling was utilised to sample men and women who met the inclusion criteria. The sample size was 377. The researcher captured raw data on an Excel spreadsheet and sent it to a statistician for data analysis. Statistical Package for Social Sciences Statistics (IBM SPSS) version 28 software was used to analyse the data. Findings: The study found that most respondents had a good understanding and knowledge regarding the causes of infertility. About (67.4%) of respondents indicated that the menstrual cycle is likely to cause infertility among females, and 64.4% indicated that semen abnormalities are likely to cause infertility among males. However, several misconceptions were noted, such as infertility is a disability (69.2%) and that females (30.5%) are to blame for infertility than men (7.4%). Both men and women had a positive attitude toward infertility. About (79.5%) regarded infertility as a medical condition. Furthermore, most of respondents were open to modifying their lifestyles and utilising cutting-edge techniques like invitro fertilisation (90.7%) to increase fertility. When confronted with infertility, (90%) of women showed a strong Abstract vi Vangile Naney Mabitsela preference for using spiritual or religious wellbeing as a coping mechanism. Additionally, (79.2%) of men supported the use of traditional medicine if they became infertile. Conclusion: The results of this study revealed that most women and men who participated in the study had knowledge and positive attitudes regarding infertility. Despite this, there were still misconceptions about how past contraceptive use and lifestyle decisions affect fertility. These findings highlight the need to educate the general population about infertility, its causes, and available treatments. Education is crucial for addressing the myths and misconceptions related to infertility. In addition, men and women had differing approaches to coping with infertility. Women tended to rely on spiritual or religious practices for their well-being, whereas men preferred traditional medicine.
Implementation of maternal guidelines to reduce preventable intra-partum death at a selected public hospital in Gauteng
(University of Pretoria, 2023-11-01) Isabel, Coetzee-Prinsloo; Mariatha, Yazbek; mokonemeldah@yahoo.co.za; Mokone, Meldah Makhoba
INTRODUCTION Maternal death during pregnancy, childbirth, and the postpartum period is a tragedy with a catastrophic impact on families and serves as an important indicator of a health care system. More than one-third of maternal deaths occur during the intrapartum period and the majority of these deaths are largely preventable. Women continue to die from largely preventable causes despite global and national maternal care guidelines in place to reduce preventable maternal deaths. A preventable intrapartum death is a possible and probable potentially avoidable maternal death due to substandard care and missed opportunity. Reducing preventable intrapartum maternal deaths requires effective implementation of essential intrapartum guidelines such as monitoring of labour and childbirth, early identification of abnormalities, timely intervention, and treatment of complications. AIM The study aimed to determine the causes of preventable intrapartum maternal deaths, implement selected intrapartum maternal care guidelines, and evaluate the outcomes of the implemented guidelines at a selected public hospital in Gauteng province. RESEARCH DESIGN AND METHODOLOGY The researcher selected a sequential mixed methods research design and conducted the study in three phases. Using multiple approaches allowed the researcher to generate quality data and to gain an insight into the phenomenon under investigation. Phase 1 involved the collection of quantitative data with the use of a PPIP tool to retrospectively audit the preventable intrapartum maternal deaths between January 2018 and December 2021 in the labour unit at the selected public hospital. In Phase 2, the researcher in collaboration with the midwives implemented specific intrapartum guidelines based on the findings from Phase 1. Implementation research is a scientific investigation into the processes and factors that influence the implementation of evidence-based programmes and policies in real-world situations. Implementation research prompts researchers to describe both the implementation strategy techniques used to promote implementation of the evidence-based intervention and the effectiveness of the intervention that was being implemented. The objective of implementation research is to improve the quality of care and health outcomes of patients by implementing guidelines or health care programmes. In Phase 3, a focus group interview was used to evaluate the outcomes of the implemented intrapartum guidelines to reduce preventable intrapartum maternal deaths. Qualitative content analysis of transcripts, interviews and reflective dairies was used during data analysis. FINDINGS Phase 1 found that a total of forty-eight intrapartum maternal deaths were potentially preventable. Obstetric haemorrhage (37.5% n=18) and hypertensive disorders (31.2% n=15) in pregnancy were shown to be the most common causes of preventable intrapartum maternal deaths. Using a bottom-up approach in Phase 2, the researcher and the midwives selected specific intrapartum maternal guidelines at a consensus workshop. The three specific maternal guidelines to be implemented throughout the intrapartum period were: use of the partogram, management of hypertensive diseases, and management of obstetric haemorrhage from retained placenta. The implementation phase lasted from February 2023 until June 2023. Phase 3 had three sections for evaluation of the outcomes of the implemented maternal guidelines, the individual narrative interviews and the focus group interviews. Using the PIPP audit tool, four (4) intrapartum maternal deaths that had happened during the implementation phase were audited. Two (2) intrapartum maternal deaths were preventable. A content data analysis was conducted on the 20 individual narrative interviews. The interviews yielded four interrelated themes: (1) Adherence to selected intrapartum maternal care guidelines; (2) Improved decision-making, (3) Effective intrapartum maternal care guidelines, and (4) Barriers to effective implementation of the intrapartum maternal care guidelines. Using content data analysis, eleven themes emerged from the focus group interviews, namely (1) Available and accessible intrapartum maternal guidelines, (2) Value the multidisciplinary approach. (3) Support clinical evidence-based practice, (4) Relevant intrapartum maternal care guidelines, (5) Awareness of the use of evidence-based midwifery practice, (6) Dissemination of results from implemented intrapartum maternal care guidelines, (7) Engaging relevant stakeholders, (8) Adequate infrastructure, (9) Adequate staffing, (10) Availability of medical equipment and consumables, and (11) Clinical audits. CONCLUSION This study was conducted at a selected public hospital in Gauteng Province in South Africa. To improve clinical practice and intrapartum maternal care to achieve the best intrapartum patient outcomes, the researcher believes and hopes that this study will provide policymakers, clinical governance, midwives, nursing service managers, clinicians and other health care providers an insight into the significance of incorporating research into clinical practice. Keywords: Implementation, guidelines, intrapartum, preventable maternal death, midwife, labour unit
Assessment of knowledge, attitudes, and practices of undergraduate students regarding family planning methods in a selected institution of higher learning
(University of Pretoria, 2024-06-14) Sepeng, Nombulelo Veronica; alidah.kekana@up.ac.za; Kekana, Mmaphuthi Alidah
ABSTRACT Introduction and background: The number of unwanted pregnancies among students in institutions of higher learning around the world continues to increase each year despite the awareness and accessibility of family planning methods. As a result, there is minimal evidence from studies done to assess the level of knowledge and determine the attitudes and practices of undergraduate students regarding family planning, particularly at the selected institution of higher learning in Gauteng Province. Aim: The aim of the study was to assess the level of knowledge and determine the attitudes and practices of undergraduate students regarding family planning in a selected institution of higher learning. The objectives of this study were to: • To assess the knowledge of undergraduate students regarding family planning in a selected institution of higher learning. • To determine the attitudes of undergraduate students regarding family planning in a selected institution of higher learning. • To determine the practices of undergraduate students regarding family planning in a selected institution of higher learning. Research design and methods: The study used a quantitative descriptive design. The population was undergraduate students, and the sample size was 400 students. A questionnaire was used to collect data, and descriptive statistics was used to analyse the data. The researcher adhered to ethical considerations and rigor. Results of the study: The results of this study revealed that about (n=98.2%) of the respondents had higher knowledge regarding family planning. About (n=82%) of the respondents indicated that they have good access to the services and family planning method that is offered for free. About (n=26.2%) of respondents indicated that healthcare professionals were the largest source of knowledge and advised students to use the method. However, the majority of the respondents, (n=65%), indicated that they are afraid of family planning side effects. About (n=7.8%) reported that they are not using the methods of family planning because they do not know enough about them. About (n=82.8%) of the respondents indicated that birth control/family planning should be available at schools. About (n=44%) of the respondents indicated that they are using family planning methods to prevent pregnancies, and (n=18%) were using the methods to prevent Sexually Transmitted Infections (STIs) and Human Immunodeficiency Virus (HIV). About (n=94.8%) of the respondents indicated that it is important to know the methods of birth control/family planning before starting sexual relationships. About (n=0.25%) of the respondents indicated that they fell pregnant at the ages of 15 and 17 years. Conclusion: The findings showed that there was a good level of knowledge about family planning methods. Positive attitudes were identified related to ease of access, methods being easy to use, and prevention of pregnancies and STIs, including HIV. However, the fear of side effects was a hindrance to the use of family planning methods. Early pregnancies among undergraduates’ students indicated an early sexual debut, which was due to a lack of awareness and proper knowledge regarding family planning methods. Key terms/concepts: attitudes; family planning; institution of higher learning; undergraduate students.
Assessing knowledge of the professional nurses in primary health care regarding climate change in Nkangala District of Mpumalanga Province
(University of Pretoria, 2024-03-15) Mooa, R.S.; Sepeng, Nombulelo Veronica; marriotmabena@gmail.com; Mabena, Marriot Mmama
Introduction: Climate change has been described as a health issue and the United Nations has endorsed this concept as the ‘Sustainable Development Goals number 13’. Given its associated burden of diseases, climate change could be reframed as a predominant health issue, one necessitating an urgent health sector response. Despite its magnitude to human health, literature review revealed that majority of nurses struggled to understand how climate change would affect public health. Additionally, some nurses did not have knowledge of the relationship between health and climate change particularly in limited resource constrained countries like South Africa in Nkangala district of Mpumalanga province. Aims and Objectives: This study aimed to assess the knowledge of professional nurses in Primary Health Care (PHC) regarding climate change in Nkangala District, Mpumalanga Province. Research design: The researcher employed, a non-experimental descriptive research design to assess the knowledge of the professional nurses in PHC regarding climate change. Method: The study population was the total number of professional nurses working at the PHC facilities in Nkangala District of Mpumalanga province. The sample size of this study was 177 professional nurses working in different PHC facilities. Data were collected using questionnaires. Data was captured in an Excel sheet, and sent to statistician for analysis. Data of this study were analysed through Statistical Package for the Social Sciences. Descriptive statistics was used to analysed data. Results: Primary Health Care (PHC) nurses in Nkangala district of Mpumalanga province, displayed varying knowledge regarding climate change. Most of the respondents acknowledged that health related illnesses other climate change related health impacts are already occurring due to climate change. On the other hand, few respondents mentioned the association of malnutrition and disruption of services during extreme weather events with climate change. The majority of the respondents also acknowledged that the nursing iv Marriot Mmama Mabena Abstract profession has a role to play in curbing climate change and its effects. Hence the need to learn about climate change in the classroom and re-enforce it in the clinical setting. Conclusion: Most respondents indicated varying degrees of knowledge regarding climate change and its health impacts and acknowledged that they have a role to play in curbing climate change and its impacts. Therefore, it is necessary to include environmental health into the nursing curriculum to ensure uniformed knowledge and skills. Significant of the study: The study results will be used to inform the curriculum for Primary health care professional nurses based on study findings of their knowledge in climate change. Policy makers may adopt the findings of this to integrate climate change in the training of nurses.
Development of guidelines for feeding practices for children aged 2-5 years in Bulawayo province in Zimbabwe
(University of Pretoria, 2024-03) Coetzee, Isabel M.; Leech, Ronell; ychauraya@gmail.com; Chauraya, Yevonnie
Introduction and background Feeding practices are parental-feeding interactions which determine how, when and why children are fed. Poor feeding practices are more significant determinants of malnutrition in children than lack of food. Globally, 20 million children under 5 are malnourished, resulting in morbidity and mortality. Despite food supply strategies and programmes, 92% of all deaths in children under 5 in Zimbabwe are attributed to malnutrition. At the designated hospital, 35% of children aged 2-5 years have malnutrition, and 10% die from malnutrition-related illnesses. Global guidelines for feeding practices in children, such as the ten steps to successful breastfeeding and the baby-friendly hospital initiatives, focus on 0-2 years with scanty information on 2-5 years when it is the age range for rapid growth and development. Aim Develop guidelines for feeding practices for children aged 2- 5 years in Bulawayo province in Zimbabwe. Objectives were to Determine caregiver health literacy regarding current feeding practices for children aged 2-5 years in Bulawayo province in Zimbabwe. Explore stakeholder views regarding feeding practices for children aged 2-5 years. Obtain stakeholder suggestions for guidelines for feeding practices for children aged 2-5 years. Develop guidelines for feeding practices for children aged 2-5 years in Bulawayo province in Zimbabwe. Study design Mixed methods sequential explanatory design. Abstract iv Yevonnie Chauraya 2023 Methods The study was conducted in three phases. Quantitative, a questionnaire was used to collect data on feeding practices used by approximately 260 caregivers of children aged 2-5 years. The statistician assisted with data analysis. Qualitative, consensus meeting to obtain views of 12 stakeholders about current feeding practices and obtain suggestions for the content of a guideline for feeding practices. Integration of the results of the two phases led to the drafting of guideline statements in phase 3. Three experts participated in a Delphi technique to reach a consensus on the final guidelines. Significance of the study. The body of knowledge on feeding practices for children aged 2-5 and research may be improved, reducing morbidity and mortality from malnutrition. Nurses’ care and clinical practice may also be improved.

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