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Browsing School of Nursing by Advisor "Joubert, A."
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Item Open Access An assessment of the delivery of youth friendly health services in the Northern Cape(University of the Free State, 2011-05) Nogabe, Lingiwe Eldah; Joubert, A.English: Literature indicates that structural as well as functional accessibility and acceptability of Primary Health Care (PHC) services is a challenge facing the delivery of youth-friendly services in South Africa. Therefore, the aim of this study was to assess the delivery of youth-friendly services in the Northern Cape. A quantitative methodology using a descriptive design was selected for this purpose. Two hundred and fifty six (256) high school-going females and males aged 13-21 who were selected conveniently from six high schools in Kimberley, completed a self-report questionnaire. The results revealed conflicting perceptions about structural and functional accessibility and acceptability. The positive feedback focused on counselling and testing, communication, and attitude. With regard to the range of services offered to the youth, 51.9% (n=133) felt strongly about the provision of HIV counselling and testing, and acknowledged that the services were available to them. Although not conclusive, some respondents stated that the health care workers communicate well (n=18/12.5%), and that health care workers understand when they (the respondents) talk to them. The nurses were further described as good to very good listeners (55%), friendly (59.74%), competent (54.38%), respectful (50.87%), caring (46.53%) and lastly that they are helpful (61.20%). More than half of the respondents (64.3%) were of the opinion that the nursing staff at the clinic understand their needs. The negative feedback focused on operating hours, waiting time, treatment, and the attitude of health care workers. Eighty (34.2%) of the respondents said that they never find the clinics open, opposed to sixty-six (28.2%) that indicated that they seldom find the clinics open. Several respondents (n=24/19.5%) stated their dissatisfaction with the treatment offered to them. Nineteen respondents (15.4%) consulted a private practitioner for a second opinion after they have been treated at the clinic. Thirty-two (26%) described nurses as unfriendly, rude and judgemental. Respondents, 138 (55%) and 49 (19.5%) respectively, recommended longer operating times ranging from 13-24 hours. Some 141 (56.6%) requested services to be available from Monday to Saturday, while fifty-four (21.7%) suggested that services be rendered Sunday to Saturday. Twenty-two (20.5%) experienced problems with waiting areas. The structural and functional accessibility and acceptability of PHC services, especially with regard to the needs of the youth must be addressed. This conclusion is, for example, based on the fact that no positive responses obtained the support of more than 60% of the respondents, while problems with nurses was indicated by 69 (64.5%) of the respondents. High levels (>90%) of satisfaction on any issue addressed in the study, were not expressed. It is also recommended the school going youth be accommodated as a one-stop service, services be extended to public holidays and that health care workers include the youth when planning health care programmes. It is suggested that further research be done on the delivery of youth services, where the younger ages of 10-13 years are included, and the research be conducted in other areas within the Northern Cape. The training of health care workers on youth-friendly services should be included in the curricula and such training should be extended to other provinces.Item Open Access Comparison of clinical judgment of first year baccalaureate nursing students with and without cognitive support from a clinical preceptor during immersive simulation(University of the Free State, 2015-02) Bekker, Marilize; Joubert, A.English: Clinical judgment is a skill that all nurses need in order to deliver safe patient care. It is a complex process and nursing students should be taught how to apply clinical judgment in practice as soon as possible. The first year baccalaureate nursing students at a nursing school of a university in Central South Africa, are taught from the first semester of their training what clinical judgment entails. Tanner’s Clinical Judgment Model is used to support this process and was also used as conceptual framework in this study. However, students need to be assessed on clinical judgment in order to determine whether training is effective. Lasater’s Clinical Judgment Rubric, based on Tanner’s Clinical Judgment Model, was used to assess the application of clinical judgment in simulation by first year nursing students. A quantitative, experimental pre-test/post-test control group design was used to describe first year nursing students’ application of clinical judgment during an immersive simulation session and to compare it with those students that received cognitive support by a preceptor and those who did not. All first year nursing students participated in this study because it was part of their curriculum and would add to their knowledge in both theory and clinical practice. Students participated in a pre-test simulation scenario that was recorded on digital video cameras. Thereafter, students were allocated to the clinical setting for at least five weeks in order to gain clinical experience. During this period of the study, the participating students were randomly divided into two groups. The students from the experimental group received cognitive support and feedback on their performance in the simulation session via the preceptors trained specifically for this process. The post-test took place, again in simulation, and was digitally recorded. The control group also received cognitive support, and feedback from the preceptors, but only after the post-test took place. Sixty five first year nursing students gave consent for footage analysis for the purpose of this study. A biostatistician, who was consulted during the planning of the study, made use of Statistical Analyses Software (SAS) to analyse the collected data. Numerical and categorical variables were summarised by frequencies and percentiles and differences between groups were assessed on a 95% confidence interval for unpaired data. The researcher made use of figures and tables to describe and present the data. Students in the experimental group gained higher marks in the upper developmental levels in the post-test than those in the control group. This indicates that students did benefit from receiving cognitive support and feedback on individual performance during simulation. Recommendations focused on the refinement of Lasater’s Clinical Judgment Rubric to be used in the School of Nursing for future studies on footage with other nursing student year groups. Cognitive support proved to be beneficial, although better results might be obtained if this kind of support could be extended over longer periods of time.Item Open Access A framework to improve postnatal care in Kenya(University of the Free State, 2015-01) Chelagat, Dinah; Roets, L.; Joubert, A.English: More than half a million women encounter complications during childbirth annually with a significant number of fatalities (UNFPA 2009: Online). It is estimated that 1,000 girls and women die in pregnancy or child birth each day (The White Ribbon Alliance 2010: Online; Ashford, Wong and Sternbach 2008:457-473). Ashford et al. (2008) further state that almost 40% of women experience complications after delivery with about 15% of these women developing potentially life-threatening complications. Maternal mortality can occur either during the antenatal, intrapartum or postnatal period. However, strategies to reduce maternal mortality have focused on the antenatal and the intrapartum periods (Ministry of Health, Kenya 2006: 52). Maternal mortality can be reduced with improved postnatal care by skilled health care professionals , the majority of whom are the midwives in many low and middle income countries (Senfuka 2012: Online; UNFPA 2011c: Online). Maternal mortality is greatest during the postnatal period which remains the most neglected stage of maternal care especially in the LMICs Kenya included (Safe motherhood 2011: Online). The aim of this study was to develop a Framework to improve postnatal care in Kenya. The study was accomplished in three phases whereby the first objective was to determine factors contributing to the current state of postnatal care services in Kenya which was undertaken in Phase 1.This objective was achieved through data collection where by 258 midwives completed a self-administered questionnaire plus a checklist used in 37 hospitals to assess the availability of physical resources required in the provision of postnatal care. Data analysis revealed that shortage of midwives exists in all the hospitals utilised for the study with a nurse midwife ratio of more than 10. It was further observed that midwives received incomplete orientation on being posted to the maternity units/postnatal wards hence their inability to provide quality postnatal care services. Policies and guidelines were reported to be inaccessible by a majority of the midwives and that cultural and religious beliefs of clients were deemed to have some influence on the provision of the postnatal care. The Nominal Group Technique was used among 13 Reproductive health coordinators in phase 2 to identify the strategies they deemed if employed would improve postnatal care in Kenyan hospitals.The six strategies identified in order of priority are capacity building, data management, quality assurance, human resource management, supportive supervision and coordination of postnatal care activities. The objective of this phase of study was achieved as the NGT process was followed scientifically and results obtained (the strategies) contributed to the development of the Framework as one of the important components of The Theory of Change Logic Model. The third objective and final phase of the study was to develop a Framework to aid in improving postnatal care in Kenya. Development of the framework was accomplished by triangulating the results obtained from Phases 1 and 2. The Framework development was guided by the Theory of Change Logic Model which describes the casual linkages that are assumed to occur from the start of the project to the goal attainment (Frechtling 2007: 5; Taylor-Powell and Henert 2008: 4). The components of the Theory of Change logic by Kellogg (2004: 28) are the problem or issue, community needs, desired results, influential factors, strategies and assumptions (Kellogg 2004: 28). The draft Framework was presented to the Reproductive Health coordinators for validation in a meeting held on 12th March 2014. The stakeholders who are the Reproductive Health coordinators added their expert input to the components of the Theory of Change Logic Model during the validation process leading to a complete Framework aimed at improving postnatal care in Kenya.Item Open Access Health sciences students’ perceptions of collaborative practice on a rural learning platform, Xhariep District(University of the Free State, 2020-07) Mona-Dinthe, Nompumelelo Lucy; Joubert, A.Item Open Access Levels and causes of stress amongst nurses in private hospitals: Gauteng Province(University of the Free State, 2007-01) Gibbens, Nadia; Joubert, A.; Van den Berg, H.The purpose of this study was to determine the levels and causes of stress amongst nurses in private hospitals within the Gauteng Province. Specific focus was drawn to three nursing categories: professional- and staff nurses as well as nursing auxiliaries. The specific objectives were to determine the perceived levels of stress in concurrence with diverse socio-demographic characteristics, influence of non-work-related causes of stress, work-related factors contributing to stress within the work environment as well as the methods of coping utilised. The levels and factors of stress amongst the different nursing categories, including suggestive recommendations, to the organisation involved, also formed part of the objectives for this study. The study design was an analytical, cross-sectional research design involving the three specified nursing categories. From these three categories 588 respondents were selected according to a convenience or availability sample from similar wards within four predetermined hospitals of the selected private hospital group: 370 professional nurses, 157 staff nurses and 61 nursing auxiliaries. The Experience of Work and Life Circumstances Questionnaire (WLQ) were used as measuring instrument and were preceded by a section regarding socio-demographic questions. The number of complete and unspoiled questionnaires received was calculated at 116 (59.18%) professional nurses, 45 (22.96%) staff nurses and 35 (17.86%) nursing auxiliaries. Skewed or asymmetrical data were obtained and thus lead to the use of only non-parametric methods. The only possible significant correlations with the level of stress, as revealed by the analysis, involved race, in particular Black/African nurses, non-work related causes of stress, causes of stress within the work environment with specific reference to organizational functioning, task characteristics, the physical working environment itself and social matters. These results were however not statistically significant for a specific nursing category. It is suggested that further research is conducted to facilitate the design of a comprehensive model and questionnaire specifically for nurses. Further research should also include nursing students into the nursing population and investigate the level of stress of Black nurses within South Africa. It is also suggested that the organisation, that were selected for the purpose of this study, should focus on all statistical significant areas as previous mentioned for the prevention, combating and management of all causes of work-related stress.Item Open Access Minimum competencies for the diploma in non-nursing operating department assistance in South Africa(University of the Free State, 2015-07) Botha, Margaretha Jansje; Joubert, A.English: A new era in the operating room science saw the light with the implementation of the diploma in non-nursing Operating Department Assistance in South Africa. This diploma is currently presented in a private hospital group in South Africa. The training was necessitated by the shortage of operating room nurses in South Africa. The Operating Department Assistants (ODAs) undergo a three year diploma course that is accredited by the South African Qualifications Authority (SAQA) on a National Qualifications Framework (NQF) level 6. The ODAs are not registered with any statuary body and the minimum competencies have not been set for this Allied Health category. In this research the minimum competencies for the diploma in non-nursing Operating Department Assistance in South Africa was agreed upon, by making use of the Delphi Technique to gain consensus on the competencies. A quantitative research design was used for this research. The study was conducted in three phases. In phase one, respondents were asked to list the competencies they expected from the ODAs after completion of their diploma in the clinical setting. At the same time competencies listed in literature were identified via a literature search. These two lists of competencies were combined into a data sheet compiled from those competencies that were agreed upon. A second data sheet was then compiled, with the agreed competencies listed in alphabetical order which the respondents had to rank according to importance. In the third and last data sheet, all competencies that were agreed upon that attained an average aggregate of 70% and higher, were listed alphabetically and respondents had to indicate their agreement of the competencies. Results were listed according to knowledge in the pre-, intra, and post-operative phases. These included knowledge regarding the preparation of the operating room, correct handling of instruments, and the correct handover of the patient to the post-anaesthesia care personnel. Some of the skills that were listed in the pre-, intra-, and post-operative phases include the checking for correct functioning of equipment used during surgery, application of aseptic and sterile technique, and the management of specimens. The peri-operative attitudes that were listed included honesty, respectfulness, positivity, professionalism, respect for patients and colleagues, and surgical conscience. The results of the study were finally compiled and recommendations were made to facilities responsible for the training of the Operating Department Assistants.Item Open Access A patient flow system for antenatal primary healthcare facilities in the Frances Baard District, Northern Cape Province(University of the Free State, 2016-02) Valla, Anna; MacKenzie, M. J.; Joubert, A.English: Long waiting times in primary healthcare (PHC) facilities is a major challenge for the National Department of Health. The aim of the study was therefore to develop a patient flow system which would reduce long waiting times for patients in antenatal PHC facilities in the Frances Baard District, Northern Cape Province. A quantitative, non-experimental design was used to collect data. A specifically compiled checklist was applied to audit 12 antenatal PHC facilities to identify aspects which should be included in a proposed patient flow system. Twenty-one (n=21) healthcare providers also participated in an “in-action” Delphi technique process to seek consensus with regard to the identified aspects. The consensus seeking target was ≥ 60%. Subsequently, a patient flow system was compiled, based on the “in-action” Delphi technique process. The results of the audit checklist were discussed according to the main headings in the checklist of which the first was the need for a patient flow system. The major challenges in this regard are determined by the fact that only 50% (n=6) of PHC facility assessed had any form of patient flow system or an appointment system in place. Eight of the facilities (66.6%) regularly experience bottlenecks at reception and in waiting areas, observation and consultation rooms, and toilets and at the pharmacy. Secondly, a lack of human resources was identified. Eleven healthcare facilities (91.6%) did not have queue marshals to direct healthcare users and organize patient flow. During the study, 11 of the healthcare facilities (91.6%) experienced a shortage of professional nurses to render PHC. Only three healthcare facilities (25%) had a pharmacist assistant to dispense medication and professional nurses fulfilled this role. In the last instance, physical resources were also a problem. Ten of the healthcare facilities (83.3%) did not have computers, printers or Internet access. Nine of the facilities (75%) did not have the minimum equipment required to render proper basic antenatal care services. None of the healthcare facilities had a separate change room additional to the antenatal consultation rooms (n=12 100%). vii The level of consensus with regard to the list of identified aspects to be included in patient flow system gained from the audit results was 67%. Although these respondents agreed on the required proposed aspects to be included, they were also given an opportunity to add additional aspects. The original list of aspects was extended by adding the additional aspects agreed upon. No consensus was reached in the ranking of the aspects in the proposed patient flow system (< 60%). Consensus was reached on 25 of final list of 27 aspects to be included in the patient flow system. As indicated, a final patient flow system was developed based on the research results. The following recommendations would require further consideration as well: All healthcare facilities need dedicated, trained queue marshals to direct and organized the varied healthcare users. If this is not possible, administrative personnel, nursing staff or volunteers must be trained to execute this task. More healthcare providers need to be scheduled during clinic peak times. Healthcare users need to be booked according to appointment dates and times, to prevent overcrowded facilities and bottlenecks in the morning. A separate changing room where the next patient can undress while the present patient is being attended to would be ideal to save time. Finally, all healthcare facilities should have the necessary equipment and material resources to render proper healthcare services. It is extremely time consuming to move between consultation rooms sharing equipment, and is frustrating for both the healthcare provider and the healthcare user. Each antenatal consultation room should have a telephone to arrange referrals immediately and to swiftly obtain laboratory results on which treatment can be selected.Item Open Access The views of different categories of nurses on clinical supervision in the South African Military Health Services (SAMHS)(University of the Free State, 2013-01) Coetzee, Aleshia; Joubert, A.In the South African Military Health Service (SAMHS) clinical supervision is the responsibility of both the nurse educator and the professional nurse. However, the insufficiency of clinical departments in the military service triggered the researcher’s interest in how clinical supervision is experienced by the different nursing categories. The objectives of the study were to determine the views of nurse educators, professional nurses, nursing students and pupil enrolled nurses with regard to clinical supervision in the SAMHS and to formulate recommendations for improving clinical supervision based on the results. The following research question was evaluated: How do the different categories of nurses view clinical supervision in the South African Military Health Services? The research methodology constituted a non-experimental descriptive exploratory design with a quantitative approach. Self-administered questionnaires were used for data collection. The population comprised of nurse educators, professional nurses, nursing students and pupil enrolled nurses employed in the SAMHS. A random sampling technique was used and all students available at the time of data collection were included in the study. The final sample of nursing students and pupil enrolled nurses was n=148 (56%:264) of a total population of 264 students and the sample size of nurse educators and professional nurses was n=136 (20%:691). Prior to commencement of the research, approval for conducting the study was obtained from the Ethics Committee of the Faculty of Health Sciences at the University of the Free State (UFS), the Military Health Ethics Committee, the Chief Executive Officers of the various military hospitals, the Commanding Officer of the SAMHS nursing colleges, the Officers in Charge of each nursing college as well as the respondents who participated in the study. Data for the study was collected in a four-week period, the first of which took place at 3 Military Hospital. The second week saw data collection at 2 Military Hospital and the nursing college in Cape Town. The last two weeks were spent at 1 Military Hospital and the nursing college in Thaba Tshwane. The ethical principles stated in the proposal were strictly adhered to as the research involved human respondents. The respondents were asked to complete questionnaires voluntarily and they were assured that their participation and the information they provided would not be used against them. They were also assured of their right to confidentiality and anonymity. Anonymity was preserved by not revealing any of the names of the respondents who took part in the research study. Confidentiality was ensured by denying unauthorised access to data. Respondents were informed of their right to withdraw from the study at any stage. Each complete questionnaire was coded, before a biostatistician of the UFS’s Department of Biostatistics assisted with the data analysis. Descriptive statistics measures such as frequency and percentage distributions were obtained. A conceptual framework of three dimensions, namely the clinical supervision prerequisites, the core of clinical supervision and the outcomes of clinical supervision were used to guide the discussion in Chapter 2 on clinical supervision. Certain recommendations were made. Some of these included that clinical supervision should be given priority and that the appointment of clinical mentors and preceptors and the establishment of clinical departments in the SAMHS should be investigated. Nurse educators and professional nurses should be jointly responsible for clinical teaching and support of students in the clinical learning environment. Furthermore, it is recommended that nurse educators should provide professional nurses with a structured clinical supervision programme and that formal written contracts between nurse educators and students be drawn up. The supernumerary status of students needs to be maintained, and, lastly, the nurse-educator student ratio needs to be adjusted.