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.
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.
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, N V; 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.
Coping strategies for nurses when caring for mental health care users with violent and aggressive behaviour in mental health care institutions in North West province
(University of Pretoria, 2024-08-01) Van der Wath, Annatjie; Sepeng, Nombulelo Veronica; dsehularo3@gmail.com; Sehularo, Motlagomang Patience
Introduction: Violent and aggressive behaviour of mental health care users continues to be a serious global nursing problem. When nurses are confronted with violence and aggression in mental health care institutions, it affects them and their ability to perform as a team, as well as to perform their daily tasks and duties. The study aimed to explore and describe the coping strategies of nurses when caring for MHCUs displaying violent and aggressive behaviour in mental health care institutions in North West province. Methods and design: A qualitative-exploratory-descriptive and contextual research design was used. Th1e study population included 11 nurses who were caring for, treating and rehabilitating mental health care users with violent and aggressive behaviour in two mental health care institutions in North West province. A non-probability purposive sampling technique was used to select the nurses who met the inclusion criteria for participation from the study population. Face-to-face semi-structured individual interviews supplemented with field notes were used to collect data. A digital audio-recorder was used to record the interviews. Six steps of thematic analysis were used, namely: becoming familiar with the data, generating the initial codes, searching for themes and sub-themes, reviewing the themes, defining the themes, and writing up. Findings: Four themes emerged from the face-to-face semi-structured individual interviews and field notes, namely: factors contributing to violence and aggression, negative experiences in caring for mental health care users displaying violent and aggressive behaviour, coping strategies used by nurses and suggestions to enhance effective coping with violent and aggressive behaviour. Effective coping strategies mentioned by nurses include problem-focused coping strategies, appraisal-focused coping strategies and social-focused coping strategies. Conclusion: The findings of this study may benefit nurse practitioners, researchers and educators. Recommendations were made for the training of nurses and for nursing management to support nurses to cope more effectively with violence and aggression.
Experiences of nurses caring for mental health care users with intellectual disability in a selected hospital
(University of Pretoria, 2023-12) du Plessis, M A R; van der Wath, A E; talifhanimurovhi@gmail.com; Murovhi, Talifhani Princess
Introduction: The caring experiences of nurses has an effect on their attitudes towards mental health care users (MHCUs) with intellectual disability (ID). Negative experiences may result in ineffective treatment, affecting the self-esteem and treatment participation of MHCUs and their caregivers. The caring experiences of nurses working with MHCUs with ID in a selected hospital in Limpopo province were not known. Objectives: The aim of the study was to explore and describe the experiences of nurses caring for MHCUs with ID at a hospital in Limpopo province. The findings informed recommendations for nurses caring for MHCUs with ID with reference to nursing practice, education and research. Methods: A qualitative descriptive exploratory design was employed to conduct the study. Semi-structured interviews were conducted and the research sample consisted of eight participants guided by the principle of data saturation. In this research thematic analysis was employed as a primary method for data analysis. During the research process, information was gathered from nurses caring for MHCUs with ID. Qualitative data analysis was used to derive the findings. Trustworthiness was attained via credibility, dependability, confirmability, authenticity and transferability. Findings: Following an analysis of the data, four themes were identified: caring experiences, challenging experiences, coping experiences, and measures to improve caring for MHCUs with ID. The participants stated that more staff members should be employed and they must be trained in how to care for MHCUs with ID.
Development of accreditation criteria for freestanding midwife-led birth centres in South Africa
(University of Pretoria, 2024-04-03) Yazbek, Mariatha; Maree, Carin; stellax01@gmail.com; Jordaan-Schlebusch, Christél
In recent years, privately owned, freestanding midwife-led birth centres have been established in South Africa, in addition to the existing hospital and obstetrician-led facilities. Midwife-led birth centres aim at individualised care and natural birth in a home-like setting. Still, in South Africa, there were no standardised criteria for the accreditation of privately owned, freestanding midwife-led birth centres by an independent midwife network at the time of this research. Accreditation of such centres has the potential to set a benchmark for high-quality, safe care that could lead to the expansion of birth-centre care and more equitable access to those centres for South African families. The aim of this study was to develop accreditation criteria through a three-phase multimethod study. Ménage’s model for evidence-based decision-making in midwifery served as a guidepost. The first phase consisted of a scoping review of research articles, guidelines, legislation and the scope of practice of midwives to explore factors that contribute to good outcomes and positive experiences for women and newborns at midwife-led birth centres. The results were collated, summarised, and used to contribute to the formulation and verification of accreditation criteria in Phase 3. Phase 2 began with input from couples or individuals who had experienced care at privately owned midwife-led birth centres. Through semi-structured focus groups and postpartum written narratives, clients from three distinct birth centres discussed their experiences and perceptions of safety and support at those facilities. Following this, a stakeholder analysis was conducted to identify experts in midwife-led birth centres and maternity care in South Africa and abroad. Fourteen stakeholders took part in a nominal group technique session to reach consensus on quality measures that should be incorporated into the accreditation criteria. In Phase 3, accreditation criteria were drafted based on the insights gathered from the preceding phases. Subsequently, consensus on the formulated accreditation criteria was obtained from the stakeholders involved in Phase 2 through the e-Delphi technique. Criteria deemed 'very important' or 'essential' by a minimum of 70% of participants were included in the final version. The final accreditation criteria include governance-, staff-, facility-, clinical care-, and quality control- aspects that prioritise the safety of women and newborns. Adopting these criteria on a national or provincial level might lead to more research on safety, client experiences and the economic viability of these birth centres.
Placental findings in term singleton stillbirths in a selected public hospital in Mpumalanga Province - descriptive study
(University of Pretoria, 2024-07-22) Yazbek, Mariatha; Musie, Maureen; oumavee@gmail.com; Vilane, Johannah Ouma
Background Stillbirth remains a global challenge and traumatic loss to women, families, communities, nurses and society at large despite all efforts made to reduce it. Globally 2.6 to 3 million stillbirths occur each year. Unexplained intrauterine deaths are the most common primary cause of perinatal deaths in South Africa. The placenta plays a key role in maintaining a healthy pregnancy. Malperfusion of the placenta may result in lesions associated with stillbirths. Placental lesions reflect various physical, social and environmental exposures which can be identified during an examination of the placenta. The researcher examined the placentas in singleton-term stillbirths in a single-site descriptive study to describe placental lesions of stillbirths in the selected hospital. Aim and objectives This study describes macroscopical and microscopical placental lesions of stillbirths in a selected public hospital in the eMalahleni sub-district in the Nkangala district in Mpumalanga Province with a perspective on the history of socioeconomic status, nutritional status, lifestyle, and others such as environment and season. Research design and methods A quantitative non-experimental observational descriptive study was conducted by examining the placentas of 89 term stillbirth babies in the labour ward for macroscopic lesions. A questionnaire was used to capture clinical data from patient files on variables of interest related to macroscopic and microscopic lesions for stillbirth cases. IBM SPSS Statistics version 28 package was used to analyse the data. Findings Statistical association and significance were found between the following variables: stillbirth and number of antenatal care visits (0.0035); birth weight and mid-upper arm circumference (0.013); birth weight and maternal vascular malperfusion (0.001); birth weight and birth attendant (0.034); type of stillbirth and birth attendant (0.033); type of stillbirth and previous obstetric history (0.038); cord insertion and smoking/substance abuse (0.012); cord insertion and haemoglobin (0.029); cord length and meconium histiocytes (0.031); cord diameter and syphilis (0.030); placental weight and onset of labour (0.012); placental weight and foetal vascular malperfusion (0.004); colour of membranes and maternal inflammatory response (0.002); colour of membranes and meconium histiocytes (0.000), and colour of membranes and syphilis (0.053). Significance and Conclusion Examination of the placenta may help to define the causes in more than 90% of stillbirth cases, inform the research and decrease stillbirth rates. Key terms/concepts: Placental findings, placental lesions, term singleton stillbirths, unexplained stillbirths, stillbirth.
Challenges faced by nurses and parents to facilitate parent-infant bonding and attachment in a Neonatal Intensive Care Unit during COVID-19 pandemic
(University of Pretoria, 2024-03-18) Rossouw, Seugnette; Maree, Carin; Ntombijulia@icloud.com; Mokwayi, Ntombizodwa Julia
Background Infants who are admitted to the Neonatal Intensive Care Unit (NICU) are a medically vulnerable population who are at risk for developmental delays, behaviour difficulties and reduced parent-infant bonding and attachment. The bonding and attachment relationship that forms between parents and their infant is a sensitive process and should be initiated and maintained immediately after birth. The COVID-19 pandemic caused several pandemic-related adversities such as hospital restrictions to parental visits, limited parental contact time with their infants and physical distancing between parents and infants. These COVID-19 related risk mitigation strategies lead to a break in the bonding and attachment process resulting in poor weight gain, failure in exclusive breastfeeding and lack of parent-infant emotional and physiological connection. Aims and objective The aim and objective of this study is to explore and describe the challenges faced by nurses and parents to facilitate parent-infant bonding and attachment in a NICU as a result of the COVID-19 pandemic. Research design A qualitative, explorative and descriptive design was used. In the study, the researcher used face-to-face interviews and Microsoft Teams™ meetings with parents and face-to-face interviews with neonatal nurses to explore and describe the challenges of facilitating parent-infant bonding and attachment in the NICU during the COVID-19 pandemic. Methodology The study was conducted in a public hospital within the Gauteng province in the NICU of the hospital. The population was parents who had infants in the NICU and all the neonatal nurses who were working in the NICU the COVID-19 pandemic. Convenient sampling was used. Data was collected using face-to-face and Microsoft Teams™ semi-structured interviews. Data was analysed using Tesch’s eight steps of data analysis. Findings Four themes emerged which are parent-infant bonding and attachment in NICU; factors facilitating parent-infant bonding and attachment challenges related to the COVID-19 pandemic; and consequences of challenges to facilitate bonding and attachment. Conclusion This study illuminates the significant challenges confronted by nurses and parents in nurturing parent-infant bonding and attachment within the NICU amid the COVID-19 pandemic. The findings highlight the intensified emotional and communicative responsibilities placed on nurses, emphasizing the imperative for supportive protocols and resources. Moreover, the necessity to adapt practices to incorporate virtual communication and parental involvement is underscored. The study also underscores the dual impact on parents, who grapple with heightened stressors alongside diminished engagement opportunities. Key terms /concepts: Attachment and Bonding, Challenges, COVID-19 Pandemic, Facilitate, Infant, Neonatal Intensive Care Unit, Parents, Nurses.
Factors contributing to absenteeism among nursing staff in a public hospital in Dammam, Saudi Arabia
(University of Pretoria, 2024-03-07) Leech, Ronell; Filmalter, Celia; osangoboniface@yahoo.com; Olenga, Boniface Osango
Absenteeism is a big issue worldwide, and it costs businesses a great deal of money. Nurse shortages are a global problem, and absenteeism exacerbates the current hospital shortage. For hospitals to operate efficiently and effectively, daily attendance is expected to provide quality nursing care. Shortage of human resources, long and difficult working hours, stressful work, job uncertainty, and a lack of protection at work are all factors that contribute to nurse absenteeism. In healthcare institutions, absenteeism influences the quality of healthcare provided and such institutions further incur huge financial losses. Absenteeism further exposes nurses remaining on duty to increased workload, psychological distress, depression, inhospitable working conditions, and burnout. This study aimed to assess and identify the factors contributing to absenteeism among medical and surgical nurses of all categories in a public hospital in Dammam, Saudi Arabia. A descriptive, quantitative research design was used in this. Data was collected using a self-developed questionnaire among 310 nurses of all categories working in the medical and surgical wards at the designated hospital. A total population sampling method was used in this study. A total of 310 questionnaires were distributed, and 170 questionnaires were returned, achieving a response rate of 54.8%. Descriptive statistical analysis (including means, medians, and standard deviations) was used in this study for data analysis, and the results were presented in figures and tables. The responses addressed variables affecting nurses' absenteeism at Dammam Public Hospital in the Eastern Province of Saudi Arabia. Many of the nurses reported to be suffering from stress-related illness, and a relatively high percentage reported that there are insufficient staffing levels to handle the number of patients. The respondents also reported that the workplace is intolerable due to staff absenteeism. Other factors reported included a lack of recognition and rewards from the hospital, no overtime payment for the work done, and poor disciplinary procedures for nurses’ absenteeism by the hospital administration. The results further indicate a positive relationship between the characterises of the nurses and the work environment. Therefore, the results associate nurses’ absenteeism with dissatisfaction with their organisation characteristics and the working environment. Thus, to curb absenteeism and improve nursing care, it is imperative to address a shortage of human resources to enhance staff-to-patient ratios and prevent stress and burnout. Organisational policies and disciplinary procedures for absenteeism should be strengthened and implemented.
Co-creating a work-based interprofessional education programme for collaborative practice in maternity services in Botswana
(University of Pretoria, 2024-06-16) Heyns, Tanya; Filmalter, Celia J; mmadisa@staff.bou.ac.bw; Madisa, Montlenyane
Background: Interprofessional collaboration is the foundation for improved patient and provider satisfaction, as well as increased organisational efficiency. Poor collaborative practices and communication failures have been identified as major contributors to preventable adverse events, organisational inefficiency, patient and provider dissatisfaction, and increased health care costs. The Joint Commission on Root Causes and Percentages for Sentinel Events reported poor communication and teamwork for 60% to 70% of adverse events and medical mishaps in health care systems between 2004 and 2015. Root cause analysis of maternal deaths yielded similar results in low- and middle-income countries. Poor communication and teamwork contribute to the lack of capacity and support to engage in interprofessional collaborative practice. Therefore, health care professionals should receive context-based work-based training in inter-professional collaborative care. Interprofessional collaborative care promotes patient-centred care and self- management, which improves healthcare outcomes. It also strengthens healthcare systems, resulting in better service delivery and health outcomes. Aim: The aim of the study was to co-create a work-based interprofessional education programme to enhance collaborative patient care in the context of hospital-based maternal health services in Botswana. The objectives were divided into three phases, which aligned to the Design-Based Research (DBR), used as a methodological framework: Phase 1: Analysis of practical problems Phase 2: Development of solutions Phase 3: Iterative cycles of testing and refinement Methodology: The Design-Based Research (DBR) was used as a methodological framework. Multimethod research designs were used to assist in the development of the training programme, which included a scoping review and a qualitative, the Criteria for Describing and Evaluating Training Interventions in Healthcare Professionals and a consensus design. In Phase 1, a scoping review was conducted to explore the considerations for promoting the implementation of work-based interprofessional education programmes. A stakeholder analysis followed and then a workshop with seven stakeholders provided their perspectives on the development of an interprofessional collaborative programme for maternity care healthcare professionals. In addition, women’s and healthcare professionals' perceptions and experiences with interprofessional collaboration in a maternity care setting were explored. In Phase 2, the data collected in Phase 1 informed experts in research, clinical care and programme development to develop a work-based interprofessional education programme. In Phase 3, an online expert survey with qualitative (open-ended) and quantitative (Likert scale) questions was conducted to validate the co-created work-based interprofessional education programme. Findings: In Phase 1, data from the scoping review revealed limited articles (n=28) explicitly addressing interprofessional collaboration in maternity settings. Although some educational institutions offered interprofessional collaboration training as part of undergraduate curricula, including maternity care, qualified professionals were rarely given this training. Four themes emerged as issues to consider when developing and implementing interprofessional collaboration intervention: resource mobilisation, conducive learning environment, healthcare professional valuation, and barriers to interprofessional collaboration/education implementation. The findings of the stakeholder analysis and engagement revealed that the following key stakeholders should participate at various stages of the study, beginning with the design phase and ending with the evaluation of the implemented training programme: (1) Health care providers and beneficiaries; (2) Curriculum development and training specialists; (3) Interprofessional Collaboration and Education networks and champions; (4) Quality/assurance (Validation and Evaluation) groups, and (5) Strategist/policy developer/advocacy groups. Evidence from the workshop with stakeholders confirmed the lack of interprofessional collaboration in maternity settings and provided insight into the needs, implementation concerns, and competency gaps associated with interprofessional collaboration in the maternity care setting, as well as how the training programme should be structured to address interprofessional competency gaps. The stakeholders suggested that we name the programme ‘MabogoDinku a Thebana’, which loosely translates as 'together we can'. The programme was consequently renamed Mabogo-Dinku work-based interprofessional education programme for collaborative care in maternity care setting. In-depth interviews with women (n=13) and healthcare professionals (n=27) revealed that they perceived poor communication, disrespectful behaviour, ineffective teamwork practices, a lack of understanding of each other's roles and responsibilities, ineffective resource coordination, hierarchical power struggles, and weak collaborative leadership as interrelated factors that influenced the delivery of interprofessional collaborative care. Based on the findings from Phase 1, a five to seven-week self-paced online work-based interprofessional education programme was co-created. In phase 3, six IPC experts/champions and e-learning specialists were recruited and provided content validation for the developed programme via a Google survey. The expert validation survey results revealed that the training programme had good content validity, with a mean of 0.88 for section B of the validation tool and 0.94 for section C. Conclusion: This study describes the co-creation of the Mabogo-Dinku work-based interprofessional education programme, which is intended to improve and support interprofessional collaboration in maternity care settings in low- and middle-income countries. The training programme could support healthcare systems in reducing clinical errors, overcoming hospital-based maternal mortalities and morbidities, reducing healthcare costs and consequently improve quality of care and may be used to guide educators in integrating IPE into their curriculum to close education-practice gaps.
Challenges midwives experience caring for mechanically ventilated women in a labour ward of a public tertiary hospital
(University of Pretoria, 2024-06-07) Yazbek, Mariatha; Vanderwath, Annatjie; ronewa.ronewa.alletta@gmail.com; Nwanamidwa, Ronewa Alletta
Introduction: In South Africa, especially in Gauteng Province, the healthcare system has been increasingly overcrowded by high-risk obstetrician women. These women are being cared for in the labour ward by a limited number of healthcare professionals. There are very few intensive care beds available, leading to women not being transferred to intensive care units after being mechanically ventilated in the labour ward. A standard labour ward must be able to provide short-term mechanical ventilation while awaiting the transfer of the women to a critical care unit. There seems to be a lack of skills among the midwives who take care of these critically ill women who are mechanically ventilated in the labour ward. Aim: The study explored the challenges midwives experience taking care of mechanically ventilated women in a standard labour ward in Gauteng Province, South Africa. Methodology: A qualitative research design was used to explore the challenges midwives experience caring for mechanically ventilated women in a standard labour ward at a public hospital in Gauteng province, South Africa. The method of non-probability purposive and convenience sampling aided in obtaining in-depth discussion from the midwives, who were chosen on the basis of their knowledge and experience with the research subject. Results: The research provided insight into the challenges midwives experience caring for high-risk women who need intensive care. The themes focused on midwives’ challenges in caring for mechanically ventilated women. Challenges included midwives' competency challenges, midwives' medical-legal challenges, inter- and intra-professional challenges, and healthcare system-related challenges. Recommendations: For midwives to render proper nursing care, all midwives who work with mechanically ventilated pregnant women should be trained. Early referrals should be made to higher levels of care, like the intensive care unit, where multidisciplinary levels of staff and treatment are available. Training recommended includes training the midwives about the mechanical ventilator machine settings and caring for pregnant women who are mechanically ventilated. Keywords: midwives, nursing, mechanically ventilated women, labour ward, and tertiary hospital
Factors contributing to attrition from a medication dispensing programme in the North West province amongst people living with HIV
(University of Pretoria, 2024-01-24) Musie, Maurine Rofhiwa; Coetzee, Isabel M.; olebogengmasemola9@gmail.com; Masemola, Olebogeng Mathabo
There is a huge number of people who require access to treatment for HIV and other chronic conditions. Such demand leads to overburdened health care providers and congested health facilities. This poses numerous challenges in the quality of care provided. South Africa has offered a programme known as Centralised Chronic Medicine Dispensing and Distribution (CCMDD) that works hand in hand with the Health Programmes Trust on behalf of the National Department of Health. This programme gives access to stable HIV clients to receive treatment outside of the clinic at pick up points with shorter queues in an area of convenience. The lack of awareness around the attrition rate issue and the contributing factors to the programme is worrisome. However, the programme remains misunderstood and unfamiliar to patients and health care providers.
Consensus on nursing guidelines to manage patients admitted to intensive care units with an open abdomen : e-Delphi method
(University of Pretoria, 2024-06) Heyns, Tanya; Coetzee-Prinsloo, Isabel; nicolemitropapas@gmail.com; Mitropapas, Nicole Barbara
Aim(s): To obtain a consensus on the use of nursing guidelines for managing patients with open abdomens admitted to intensive care units. Background: Critically ill patients who present with an open abdomen in the intensive care unit pose multiple challenges, especially for nurses, who play a pivotal role in the management of these patients. Updated evidence-based guidelines should be developed for nurses to alleviate nursing challenges when managing these patients. Design: A modified e-Delphi consensus design Methods: An expert panel, including nurses, surgeons, and intensivists with expertise in managing patients with open abdomens in intensive care units, was invited to participate. The data were collected using the Qualtrics survey platform. The expert panel was asked to rate the importance of each guideline statement as well as the importance and practicality of each nursing intervention using a 4-point Likert scale. Experts were allowed to suggest changes to refine the guidelines and interventions. Results: Thirty-one experts participated in Round 1, 22 participated in Round 2, and 18 participated in Round 3. Most of the experts were nurses (71%). The experts were informed of five nursing statements and their interventions. A consensus >80% was obtained on the content of the nursing statements and their interventions, but refined changes were made to the guideline statements and their interventions, which were presented to the experts in rounds two and three. A consensus >90% was obtained after Round 3. Conclusion: The panel of experts was able to reach a consensus on the nursing guidelines in Round 3, concluding that the 2020 guidelines have been updated. In the future, nursing guidelines should be introduced in practice and in training and a nursing protocol should be developed. Reporting method: The study adhered to the relevant EQUATOR reporting guidelines: Guidance on Conducting and Reporting Delphi Studies (CREDES) checklist.
Development of an instrument to measure person-centred teamwork in hospital nursing units
(University of Pretoria, 2024-02-14) Heyns, Tanya; Leech, Ronell; alidavil5@gmail.com; Viljoen, Alida Hettie
Introduction and background Hospital units are dynamic, high-paced and challenging environments and effective teamwork is vital to high performance teams in hospital units. Teamwork and person-centredness are two strategies that improve patient outcomes and staff satisfaction and retention. Healthcare has become increasingly dynamic and demanding. Person-centredness as a strategy is supported by the World Health Organization (WHO) to assist the whole multi-disciplinary team with the patient and significant other, to reach the patient desired outcomes. Teamwork is recognised by the multi-disciplinary team as a way of ensuring holistic and achievable patient outcomes. The concept of person-centred teamwork has not been defined or explored in current literature. Only the measurement of either teamwork or person- centeredness has been explored. There are elaborate instruments available that measure the two concepts as separate entities. The concept of person-centred teamwork has not been explored and to date there is no instrument to measure the concept. Being able to measure person-centred teamwork will enable teams and management to give tangible feedback and revise improvement strategies on person-centred teamwork. Aim and objectives The development of an instrument to measure person-centred teamwork in hospital nursing units. To define person-centred teamwork and develop an instrument to measure person-centred teamwork in hospital units. In order to achieve the aim, the study wished to answer the following question: How can the concept “person-centred teamwork” be developed into an instrument to measure person-centred teamwork? In order to achieve the aim, the study was conducted in phases with the following objectives: • Phase 1: Concept clarification Objective 1: To conduct a concept analysis of person-centred teamwork. Objective 2: To reach consensus on the definition and attributes of person-centred teamwork. • Phase 2: Item development Objective 3: To reach consensus on items to be included in an instrument to measure personcentred teamwork in a hospital setting. Abstract vi Alida H. Viljoen 2024 o Sub-objective 3.1: To generate items for an instrument to measure person-centred teamwork. o Sub-objective 3.2: To reach consensus on items to measure person-centred teamwork. • Phase 3 and 4: Scale development and evaluation Objective 4: To validate an instrument to measure healthcare workers’ perceptions of personcentred teamwork in hospital units. Research design and methodology A multi-method multi-phased design, using both qualitative and quantitative approaches, was used to develop an instrument to measure person-centred teamwork in a hospital unit. The data collection included a concept analysis, methodological search for instrument items, two Delphi studies, pre-testing and sampling of the instrument. With the assistance of a statistician validation of the instrument was done. Results The concept analysis determined four attributes and a definition for person-centred teamwork. The attributes and definition was taken through a Delphi study with international experts, to obtain consensus on it. Consensus was obtained and this formed the basis of the methodological search on instrument items to measure person-centredness or teamwork. The items were analysed, refined and reduced to 43 items that were taken to a Delphi study with international experts to obtain consensus on the items to measure person-centred teamwork. Consensus was reached on 38 items, which were pre-tested and validated. The 38 items then underwent psychometric testing by 388 participants in two selected hospitals in South Africa. A statistician tested the findings of 38 items for validity and reliability and found to be valid and reliable to assess person-centred teamwork in the hospital setting. Conclusion This study was initiated from the need to be able to understand and measure person-centred teamwork. The instrument was found to be valid and reliable in measuring person-centred teamwork. The ability to measure person-centred teamwork will assist the implementation and ongoing improvement of person-centred teams. Person-centred teamwork will allow the outcomes set from a management perspective to be measurable and improved upon based on the results of the instrument. Abstract vii Alida H. Viljoen 2024 Keywords Concept analysis, Delphi technique instrument, measurement, person-centred teamwork, psychometric testing, validation
Development of clinical practice guidelines for person-centred handover practices in the emergency department
(University of Pretoria, 2024-05-02) Heyns, Tanya; Filmalter, Celia J; delangesantel@gmail.com; De Lange, Santel
Background: Handover practices are an integral part of an emergency department’s activities and ensures continuity of patient care and patient safety. Handover practices between emergency care practitioners and healthcare professionals in the emergency department are a crucial point of information transfer and should involve the patient and/or significant others. This handover should be done in a structured, yet context-specific manner, and directed towards person-centredness. The gold standard for a structured, context-specific manner has not been determined. Determining this gold standard is important to improve person-centred handover practices. Aim of the study: The aim of the study was to establish the elements underpinning a person-centred approach to handover practices between emergency care practitioners and healthcare professionals in the emergency department. Methodology: The study followed a sequential multimethod approach in phases. For phase 1, objective 1, the researcher conducted a concept analysis using Walker and Avant’s (2014) 8-step method followed by an online modified Delphi study to achieve objective 2, reach consensus on the concept definition of person-centred handover and related attributes. Phase 2, objective 3 involved a scoping review using the Johanna Briggs Institute guidelines (2021) for conducting scoping reviews, to inform clinical practice guidelines. For objectives 4 and 5 in phase three guideline development method was used. Sampling for the Delphi study involved purposive and snowball sampling. The context of the study involved emergency departments, and experts in person-centred care, handover practices and guideline development were involved in the various phases. In phase 3, objective 4 was to develop preliminary clinical practice guidelines for person- centred handover practices in the emergency department and objective 5 was to achieve consensus on clinical practice guidelines for person-centred handover practices in the emergency department. A Delphi study, involving experts in person-centred care practices, emergency care practitioners involved in handover practices in the emergency department, was conducted. Results: The concept of person-centred handover practices was defined with its related attributes. The scoping review produced one clinical practice guideline together with information on current national and international handover practices. Preliminary guidelines were developed, and an expert Delphi panel achieved consensus on the final definition and the clinical practice guidelines. The external panel’s comments were integrated into the final clinical practice guidelines. Conclusion: This study contributes to the body of knowledge on person-centred care and handover practices. The study developed an agreed upon concept definition for person- centred handover practices to identify and guide structured person-centred handover practices. Furthermore, the developed clinical practice guidelines for person-centred handover practices in the emergency department should provide the gold standard to perform person-centred handover practices in future.
Exploring support for newly appointed unit managers in a public academic hospital in Tshwane district in Gauteng Province
(University of Pretoria, 2024-01-30) Leech, Ronell; Heyns, Tanya; tfmazibuko@yahoo.com; Mazibuko, Thembisile Felicty
Transition to a new position frequently results in anxiety and feelings of inadequacy. Newly appointed unit managers often experience a lack of organisational support in their leadership roles, leaving them feeling inefficient in their positions. There is a need for organisations to provide support through sustainable support strategies. A sustainable, ongoing support programme for newly appointed unit managers would improve job satisfaction and reduce staff turnover. Newly appointed unit managers who are confident in their work influence junior nurses’ confidence, which enhances quality patient care provision. The study aimed to explore the support needs of newly appointed unit managers, what the support should entail, and develop a support practice guideline for newly appointed unit managers in a designated public hospital. A descriptive qualitative research design was used. The population included inexperienced unit managers who have been in the position for less than one year and experienced unit managers who have been in the position for more than one year in the designated public academic hospital in Gauteng province. Purposive sampling was used to select participants. Data was collected using focus group discussions and analysed through content analysis. The study could enhance support for newly appointed unit managers in their leadership roles, which could ultimately improve staff retention. Organisational support for newly appointed unit managers should enhance job satisfaction and create a productive environment for those with whom the managers work. The results showed that there is a lack of awareness towards strategic initiatives of employee support, and this includes orientation, induction and mentoring. Finally, the researcher made some recommendations to assist in the support of newly appointed unit managers. These include the creation of a therapeutic environment and, the implementation of support systems (peer, social and managerial support), with a continuous professional development programme to acquire competencies to support these newly appointed unit managers. KEYWORDS: Newly appointed, Nursing, Public academic hospital, Support, Unit manager

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