School of Nursing

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Open Access
Adapting to and implementing a problem- and community-based approach to nursing education
(AOSIS, 2000) Fichardt, A. E.; Viljoen, M. J.; Botma, Y.; Du Rand, P. P.
English: The process of change, implemented by the School of Nursing at the University of the Orange Free State so that a paradigm shift in approaches to nursing education at undergraduate level could be achieved, is outlined. The necessity to change, the identification of external and internal variables that impact on change, the founding of a support system, the process of overcoming resistance to change, the evaluation of the process of change and options for the future, are discussed. The rationale for the implementation of a problem-based teaching strategy and the phasing in of a community-based approach to teaching as the heart of the process of change are discussed.
Open Access
Adult learning: what nurse educators need to know about mature students
(AOSIS, 2015) Spies, Cynthia; Seale, Ielse; Botma, Yvonne
Background: Most nurse educators regard students who enter postgraduate studies as adult learners capable of self-direction and independent learner behaviour. Therefore, a mismatch between the nurse educator’s expectation of adult learners and actual adult learner conduct may result in disappointment and even frustration for both educator and learner. Purpose: This article is a report of a secondary analysis of data that were collected to explore the high-fidelity simulation learning experiences of a group of postgraduate nursing students. The secondary analysis was done to determine whether adult learners who bring professional knowledge and experience to a postgraduate learning environment displayed adult learner conduct as proposed by educational theorist Malcolm Knowles. Method: Using a qualitative descriptive research design, data were gathered from 18 postgraduate nursing students who participated in high-fidelity simulation in a nursing school at a higher education institution in South Africa. The nominal group technique was used to collect the students’ ideas about improving their simulation learning experiences. A secondary qualitative analysis of the primary nominal group data was done. Findings: Data either confirmed or belied adult learner behaviour. Although the findings suggested self-directed and independent learner behaviour, they also revealed behaviour evident of dependence on the educator. Conclusion: Mature students have well established ways of thinking and doing that may hinder learning. Educators have to support adult learners in developing effective learning techniques in order to maximise the benefits of their experience and knowledge by fostering independence and self-direction.
Open Access
Algemene voetversorging van die bejaarde
(AOSIS, 1985) Botma, Y.; Viljoen, M. J.
The role of the nurse in the prevention of problems of the feet in the elderly is discussed, and the common foot problems that could be caused by negligence and ignorance are referred to. Routine foot care including care of the skin, nails, choice of shoes and massaging of the feet is discussed, and exercises that the elderly can do to prevent foot problems are illustrated.
Open Access
An analysis of births outside health facilities in Maseru Health Service Area Lesotho
(University of the Free State, 2007-12) Seipobi, Esther M.; Myburgh, Reinette
English: According to the Ministry of Health/Social Welfare, 95% of all pregnant women attend ante-natal care at the health facility provided by skilled providers (MOH/SW, 2003:17). However, less than 50% of those pregnant women give birth at the health facility. The aim of the study was to describe births outside a health facility as a phenomenon. The objectives were to identify the place of birth outside a health facility, identify who the helper/attendant was during the birth, identify the reasons why the women gave birth at home, explore the mothers experiences regarding the birth, the outcomes of the health process, and describe cultural practices adhered to during birth. A non-experimental descriptive and exploratory design with a survey as a method was used. A semi-structured interview with an interview schedule with closed ended and open ended questions were used to gather data. A purpose sampling method was used to select 8 health facilities in the Maseru Health Service Area as well as 344 respondents for the study. Ethical principles relevant to conduct research involving human subjects was adhered to, such as obtaining the necessary permission to enter the field and complying with the human rights of the respondents. Semi-structured interviews were used to collect data from respondents of all ages, living in town, peri-urban and rural settings of Maseru Health Service Area. The methodology of the study was simply but thoroughly explained. The results of the study showed that women gave birth at home, assisted by their mother or family members. The reasons why they gave birth at home were either intentional (e.g. wanted to be amongst family members) or unintentional (e.g. baby came too fast). The mothers experience regarding the birth was generally good and the outcomes of the birth process were positive because there were no negative consequences for mother and baby. Mothers gave birth at home with the help of a family member or TBA who sometimes is the only help available in the community and that is why one of the recommendations is to train the community members (e.g. traditional birth attendant) to support safe motherhood as well as the mothers right to choose her own place of birth.
Open Access
An assessment approach for competency-based nursing education in a low-income country
(University of the Free State, 2023) Mukurunge, Eva; Nyoni, C. N.; Hugo-Van Dyk, L.
𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Nursing education institutions in Lesotho were directed by the government to adopt a competency-based curriculum, which required a paradigm shift in assessment methods from traditional to programmatic assessment. However, the implementation of the new assessment approach faced several challenges. Firstly, most nurse educators were unfamiliar with programmatic assessment since it was not included in their formal nursing training. Secondly, during the preparatory stages of programmatic assessment implementation, nursing training institutions could financially afford the initial training opportunity for nurse educators by the assessment experts, which, unfortunately had no follow up trainings. Lastly, unclear programmatic assessment implementation guidelines and a lack of support posed challenges to most of the institutions. 𝗣𝘂𝗿𝗽𝗼𝘀𝗲: The study sought to develop a contextually relevant assessment approach for competency-based nursing education in a low-income country. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀: The development of the assessment approach was guided by multiple methods, which were informed by the Design Science Research methodology. The approach was developed through a multi-phased process. In the first phase, a mapping review was conducted to synthesise literature on the various assessment approaches that have been used in health professions education since the year 2000. The second phase involved engaging with nurse educators to describe the contexts of the nursing education institutions in Lesotho where programmatic assessment was implemented. In the final phase, the findings from the first two phases were used to develop a contextually relevant assessment approach, which was then validated by a panel of assessment experts. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: The outcome of this study was a contextually relevant assessment approach for competency-based nursing education in a low-resource countries. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: To successfully implement educational innovations, it is important to have a clear understanding of the context of nursing education institutions. This enables the development of relevant implementation strategies that take into account the specific needs and challenges of the institution. Moreover, the development of educational innovations should be based on scientific methodology and should incorporate strategies that have been proven to work. Nursing education institutions in low-income countries need to take an active role in developing contextually relevant educational innovations, rather than relying solely on innovations developed in high-income countries.
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.
Open Access
Attrition of undergraduate nursing students at South African Universities
(University of the Free State, 2014-07) Roos, Erna; Fichardt, A. E.; MacKenzie, M. J.
English: The aim of the study was to determine and describe the attrition rate and the factors influencing undergraduate nursing students to discontinue the nursing programme at selected South African universities. Knowing the current attrition rate and understanding why nursing students do not complete an undergraduate programme can be a possible means to decrease the poor production rate of degree qualified registered nurses. These comprehensively trained registered nurses are needed to assist in implementing the healthcare plans made by the current South African Government. They are the frontline practitioners in providing healthcare to the South African population. A quantitative descriptive design was used to gather the required information, with a specifically designed questionnaire and structured interview guide. Two populations were selected, namely Study Population One: Universities, which are grantees of the Atlantic Philanthropies and ELMA Group of Foundations under the University-based nursing education of South Africa (UNEDSA) project. The second study population is identified as former nursing students, who were enrolled at the nursing educational institutions within the selected universities. No intervention or treatments were used therefore, no harm was anticipated for the participants of this study. The expected outcome was to determine, calculate and compare attrition rates at the selected universities and to identify and trend the factors influencing former nursing students to discontinue their undergraduate nursing studies. This information could be valuable in making recommendations to existing selection criteria used to select candidates for an undergraduate nursing programme. Furthermore, recommendations can be made to establish and maintain a data base to gather information of the completion and attrition rates of nursing students per intake. The information received from the data base is needed for strategic planning for the following year. Lastly, recommendations can be made to implement strategies to assist at-risk nursing students, who consider discontinuing the undergraduate programme. The study revealed that attrition of undergraduate nursing students does occur at the participating universities. Attrition furthermore occurs at a higher rate than prescribed by the South African Department of Higher Education. A further discovery was that not all selected candidates register for the undergraduate nursing programme, thus contributing to the low number of degree qualified registered nurses. The second phase of the study reveals the main factors influencing undergraduate nursing students to discontinue the undergraduate programme to be academic and financial reasons. Another factor of a high occurrence that influenced former nursing students to discontinue their undergraduate studies was poor wellness and health. From the above-mentioned discoveries recommendations could be made with regards to the following: - Review the current selection criteria to perform a personal interview with each candidate, establish personality traits of applicants to further select the best possible candidate and include a general health questionnaire and medical certificate to declare the candidate fit to practice nursing - Establish and maintain a data base at each Nursing Educational Institution to determine the number of applicants, the number of candidates selected and the number of students who finally registered for the nursing programme as well as the number of nursing students who discontinue each year - Investigate reasons why selected candidates did not register for the undergraduate nursing programme - Share attrition and completion rates with the South African Nursing Council (SANC) to maintain a national data base - Perform an exit interview with a nursing student who voice the decision to discontinue the undergraduate nursing programme to determine and trend the possible factors that influenced the student to discontinue the programme - Identify retention strategies to best assist the at-risk nursing students to include academic and clinical support, financial assistance and wellness and health programmes
Open Access
Belewenisse van tuisversorgers van pasiënte met Alzheimer se siekte
(University of the Free State, 2000-11) Venter, Annelie; Van Rhyn, W. J. C.
English: The ageing of the population and the diminishing of subsidies to old aged homes has lead to the aged staying in the community and being cared for. The care and supervision of patients with a chronic condition such as Alzheimer's disease demands a great deal of time and is usually given by the same person. The purpose of this study was to investigate and describe the experiences of caregivers who care for patients with Alzheimer's Disease at home, as well as to describe the caring environment and the profile of the caregiver in order to develop guidelines that would·support these persons. This is a qualitative study with a quantitative component that is contextual with the purpose to explore and describe. The phenomenological approach is used in the study. Caregivers that meet with the following criteria were included in this study: Persons that are primarily responsible for the caregiving of patients who have been clinically diagnosed with Alzheimer's disease. Afrikaans or English mother tongue speakers, enabling the researcher to easily understand the described experiences of the caregivers Ethical matters were discussed with the respondents before informed consent was obtained. Data collection was done in two phases. In phase I, the qualitative section, a phenomenological interview was done with the caregiver, in which a description of the experience as caregiver was given. In phase II, the qualitative component, a questionnaire was completed by the researcher, to establish the caregiving environment and the profile of the caregiver. A pilot study was done beforehand and no problems concerning the execution of the study were identified. Data collection was sustained until saturation of data was reached. Saturation was reached after nine interviews. A recording was made during. each interview and transcribed thereafter. The transcription of the interview was analysed by using a systematic process as explained by Tesch in Creswell (1994:155). The SAS-computer programme was used in the analyzing of the questionnaires. The scientific trustworthiness of the study was ensured by credibility, transferability, reliability and confirmability. It became clear during data analyzing and review of the literature that these caregivers had negative experiences of home care of Alzheimer's patients. Information obtained from the data and literature made it possible to compose guidelines for support to the caregivers. The guidelines focussed on emotional and practical assistance.
Open Access
Beliefs of grade six learners' regarding adolescent pregnancy and sex
(AOSIS, 2007) Grobler, C.; Botma, Y.; Jacobs, A. C.; Nel, M.
Escalating adolescent pregnancy and risky sexual behaviour is becoming more common amongst young adolescents and especially amongst black adolescents in South Africa. Statistics confirm that South African adolescents as young as fourteen are already sexually active and become pregnant. The decision to become sexually active with resulting adolescent pregnancy whether planned or not, are directly influenced by the teenager’s beliefs. A person’s beliefs consist of a person’ own individual beliefs or attitude as well as what the individual subjective norm which the individual perceive as other people’s beliefs regarding the same object of reason. The aim of the study was to describe the attitude of black grade six learners under the age of fourteen, towards adolescent pregnancy and sex. A quantitative descriptive research design was used. Results were clustered according to demographic variables as well as beliefs that consist of attitude and subjective norm. Findings provided insight into the beliefs of grade six learners regarding sex and adulthood, the roll of peer pressure, relationships of adolescent parents, social interaction of teenage parents, ability of adolescent parent’s ability to provide in the needs of the baby, the adequacy of a child support grant to raise a baby as well as the levels of education of adolescent parents. This article provide a detailed reflection on these results and propose off a doll parenting intervention strategy as means of modification of attitude and subjective norms of grade six learners in order to alter sexual behaviour.
Open Access
Beskrywing van gesondheidsorgdiens wat aan MIV-blootgestelde/-positiewe kinders in die Vrystaatse publieke gesondheidsorgsektor gelewer word
(University of the Free State, 2009-11) Spies, Cynthia; Botma, Y.; Reid, M.
English: This study was conducted to describe the type of health service rendered by professional nurses to HIV exposed and HIV positive children in the public health care setting of the Free State province. Three objectives were set to achieve this, namely: to describe the type of service rendered to HIV exposed and HIV positive children by professional nurses in the Free State; to determine to what degree national and provincial guidelines are implemented in the management of HIV exposed and HIV positive children in the Free State; and to use the findings to make recommendations for effective service delivery to HIV exposed and HIV positive children. The researcher made use of a quantitative descriptive design to achieve the aim of the study. Data was gathered by means of structured interviews. Professional nurses, who deliver a service to children within public health care facilities, and who met the inclusion criteria, were approached to participate in the study. Data obtained showed that treatment components with regard to HIV exposed and HIV positive children were mainly rendered at primary health care facilities. In contrast herewith, it was found that treatment components in the pediatric sections of hospitals were not implemented to the same degree. Research further reflected a need for professional nurses to undergo additional training regarding the correct management of HIV affected children. Discrepancies pertaining to effective service delivery to HIV exposed and HIV positive children were also revealed. Suggestions were made with regard to approaches which could enhance service delivery. A subsequent research project regarding the quality of service which is presently being offered to HIV exposed and HIV positive children in the public health care sector of the Free State, could be of great value.
Open Access
Bridging the gap between self-directed learning of nurse educators and effective student support
(AOSIS, 2015) Van Rensburg, Gisela H.; Botma, Yvonne
Background: Self-directed learning requires the ability to identify one’s own learning needs, develop and implement a plan to gain knowledge and to monitor one’s own progress. A lifelong learning approach cannot be forced, since it is in essence an internally driven process. Nurse educators can, however, act as role models to empower their students to become independent learners by modelling their own self-directed learning and applying a number of techniques in supporting their students in becoming ready for self-directed learning. Objectives: The aim of the article is to describe the manifestations and implications of the gap between self-directed learning readiness of nurse educators and educational trends in supporting students. Method: An instrumental case study design was used to gain insight into the manifestations and implications of self-directed learning of nurse educators. Based on the authentic foci of various critical incidents and literature, data were collected and constructed into a fictitious case. The authors then deductively analysed the case by using the literature on self-directed learning readiness as departure point. Four constructs of self-directed learning were identified, namely internal motivation, planning and implementation, self-monitoring and interpersonal communication. Supportive strategies were identified from the available literature. Results: Nine responses by nurse educators based on the fictitious case were analysed. Analysis showed that readiness for self-directed learning in terms of the identified constructs was interrelated and not mutually exclusive of one other. Conclusion: The success of lifelong learning is the ability to engage in self-directed learning which requires openness to learning opportunities, good self-concept, taking initiative and illustrating independence in learning. Conscientiousness, an informed acceptance of a responsibility for one’s own learning and creativity, is vital to one’s future orientation towards goal-directed learning. Knowledge and understanding of one’s own and students’ selfdirected learning abilities are critical for nurse educators. In the nursing profession, it has been shown that self-directed learning by the nurse educators has a direct relationship towards the development of a lifelong learning approach by their students. Supporting students towards becoming self-directed learners throughout their professional life, in turn, will impact directly on the quality of nursing and midwifery practice.
Open Access
Care needs of the frail elderly at home in Matwabeng
(University of the Free State, 2020-09) Nieuwenhuis, Elizabeth C.; Venter, Idalia; Hugo, Lizemari
Worldwide the population of the elderly is growing larger. South Africa experiences the same significant ageing phenomenon as the rest of the world, with the number of persons aged 65 and older increasing yearly. The elderly population in Matwabeng (Senekal), that forms a part of the Thabo Mofutsanyane Local District Municipality in the Free State, shows the same international tendency. It is ageing population place a greater burden for care on several resources, including relatives, caregivers, communities, the Department of Health, Department of Social Development and other relevant non-governmental organizations. Ageing populations have a significant impact on all types of health care provision, because the increasing years may not necessarily be spent in good health. Added to the escalation in the number of chronic medical conditions that forms part of the natural ageing process, and elderly care becomes more complicated. The growing number of older people in communities inevitably leads to an increased demand for nurses to work with the elderly. More, older persons visiting local clinics brings an increase in chronic medical conditions, while the existing clinics are already being overcrowded. Primary health care services encounter pronounced challenges in providing frail care services to the elderly due to the cumulative effects of the variety of chronic medical conditions that need more nursing attention than can be provided during a single visit. Frail care services need a new innovative plan to address the needs of the elderly in the community because current primary health care services cannot provide for all the various needs of frail elderly residents in in a community. Furthermore, there are not enough resources to accommodate all the frail elderly in residential care facilities in their own communities. Literature on the requirements and care of the frail elderly is extremely limited and to plan for the rational long-term care of these people, more information is needed. This study aimed to determine specifically what the care needs of the frail elderly living at home were. This will assist the decision makers in planning in caring for this growing group of people. In order to determine the needs of frail elderly residing at home, the researcher examine the frail elderly living in Matwabeng with regard to their needs by means of questionnaires.
Open Access
Challenges facing nurse educators in the implementation of high fidelity simulation at a public nursing college
(University of the Free State, 2020-11) Kapp, Jacinta Maria; Jacobs, A. C.
The new nursing curriculum, Regulation 171 for introduction at Nursing Education Institutions throughout South Africa, as approved by the South African Nursing Council and Council for Higher Education, stipulates that 20% of practical hours are to be spent in simulation laboratories. High fidelity simulation is available in varying degrees at all the campuses of the public nursing education institution selected for this study, yet it is not formally being utilised. The purpose of this study was to identify the challenges that nurse educators perceived to be standing in the way of their implementing high fidelity simulation at this nursing education institution. A qualitative, explorative, descriptive research design was employed and data was collected by means of the nominal group technique. The empirical data was analysed and themes, categories and subcategories were identified. The three main themes identified were stakeholders, readiness of staff and high fidelity simulation. Stakeholders’ four categories included finances, human resources, physical and material resources and attitudes. The three readiness of staff categories were identified as nurse educators’ training, empowerment/autonomy and students’ training. The three categories, responsibilities of the high fidelity simulation manager, standards of high fidelity simulation sessions and the information technology control centre were identified under the theme high fidelity simulation. Key recommendations included the coming together of all stakeholders for budgeting and financial purposes, the careful management of human resources, early consultation of nurse educators, comprehensive training and preparation of nurse educators for the implementation of high fidelity simulation and the availability of a fully functional information technology-controlled simulation laboratory, complete with control room.
Open Access
Clinical placement models for undergraduate health professions students: a scoping review
(BMC, 2021) Nyoni, Champion N.; Hugo-Van Dyk, Lizemari; Botma, Yvonne
Background: Clinical learning is fundamental to undergraduate health professions students. There are several calls for the transformation of health professions education, which have direct implications on clinical learning. Clinical placement models provide structure to clinical learning. Therefore, this scoping review could contribute to supporting curriculum transformation to enhance learning in the clinical environments for undergraduate health professions students. Objectives: This scoping review identified the characteristics of research evidence related to mapping the purpose, methodologies used, outcomes, and specific recommendations associated with clinical placement models in undergraduate health professions education. Design: A scoping review method was used in this study. A search string developed from the title of the review was used to search online databases to identify research published between January 2000 and March 2020. Results: Forty-eight articles reporting on ten clinical placement models were included in this review. The majority of these articles originated from Australia and predominantly report on nursing. The aims of these articles aligned with the evaluation of the implementation of a clinical placement model. Seven categories of outcomes of the clinical placement models are reported namely, relationships, influence, environment, facilitation, inputs, knowledge scores, and student perceptions. Conclusions: As clinical learning is fundamental to undergraduate health professions education, clinical placement models should prioritise the development of competence among undergraduate students. Insights into outcomes reported in literature could guide educators in fostering optimal learning in students who may then be able to influence community health outcomes positively.
Open Access
Communication strategies to accomplish effective health dialogue in adults with chronic diseases in low and middle income countries: an integrative review
(University of the Free State, 2015-11) Pienaar, Melanie; Reid, M.; Van der Walt, S. J. C.
English: Communication strategies are used to inform, influence and motivate individuals and communities about health. It is, however, imperative that health communication strategies suit the needs of the audience in order for the audience to comply with the health recommendations. In an era where chronic diseases in low- and middle-income countries (LMIC’s) are reaching endemic proportions, using communication strategies that can accomplish effective health dialogue is crucial. The purpose of the study was to provide a critical review and synthesis of the best available evidence of communication strategies used to accomplish effective health dialogue in adults with chronic diseases in low- and middle-income countries from the year 2000 to 2014. The methodology of an integrative review was used since it is the broadest type of research review and can include theoretical literature, empirical literature, or both. A focused review question based on the PICO format (PICO = population, intervention, comparison intervention, outcome) guided the review process. Multiple databases and search methods were used to identify studies relevant to the review question. The systematic search strategy identified 3464 records and after a filtering process, eight studies met the criteria and were selected for critical appraisal. Four researchers critically appraised the studies in a round table discussion using standardised critical appraisal tools. Seven out of the eight studies were found methodologically adequate and were used for analysis. The seven studies made up a heterogeneous sample of five randomised controlled trials, one case-study and one qualitative study, and consequently, a meta-analysis was not feasible. After thematic analysis, the synthesis process led to the formulation of the following concluding statements related to the review question. The researcher also provided one example of the recommendations per concluding statement: Which communication strategies are used during effective health dialogue with adults with chronic diseases in low and middle income countries in terms of: 1) How is communication conducted? A variety of strategies can be used to accomplish effective health dialogue in adults with chronic disease in low- and middle-income countries. Recommendation: Since healthcare providers mostly are involved in one-on-one and small-group health dialogue with adults affected by chronic diseases in low- and middle-income countries, a greater sensitivity needs to be created towards the benefits of tailoring such communication. This goes hand in hand with equipping these healthcare providers with the necessary skills to conduct such tailored communication. Skills training in tailored communication ideally should form part of undergraduate education, but also be included in in-service training of qualified healthcare providers. 2) When is communication conducted? Frequently scheduled communication strategies can be used to accomplish effective health dialogue in adults with chronic disease in low- and middle-income countries. Recommendation: Since the frequency of communication reported differs from study to study, the healthcare provider should take the information needs of the patient into consideration and plan communication sessions according to the information needs of the patients. 3) What is communicated? A communication strategy that provides focused and specific information to the individual or group can be used to accomplish effective health dialogue in adults with chronic disease in low- and middle-income countries. Recommendation: Since the focus of the communication was unique to each study reported, it is recommended that the healthcare providers who decide to make use of the strategy, should provide communication according to the condition and needs of the patient(s) involved. The healthcare provider should use a multi-strategy approach, for example, one-on-one communication augmented by brochures or mobile messages to re-enforce the message. A dedicated national and provincial health communication unit focusing on such a multi-strategy would strengthen healthcare providers’ hands to implement such a strategy. 4) Where is communication conducted? A communication strategy that accomplishes effective health dialogue in adults with chronic disease in low- and middle-income countries, takes place in a convenient and private setting. Recommendation: The use of private rooms within nearby community facilities needs to be actively pursued by healthcare providers, especially in the light of the challenges faced by public healthcare facilities – space being one such a challenge. Involving community members when creating clinic committees could be an example of how to go about securing such facilities. 5) By whom is communication conducted? A communication strategy that accomplishes effective health dialogue in adults with chronic disease in low- and middle-income countries is provided by trained lay persons and/or healthcare professionals, as well as automated computer systems. Recommendation: Since ‘trained’ volunteers and peer leaders may not always be readily available, such individuals and groups should be purposefully involved in the health activities of the health facilities. The groups may be identified from patients, non-governmental organisations, or non-profit organisations in the community. Healthcare providers should become involved in the training of these groups. Training could involve disease management, but could also include communication skills. The comprehensive synthesis of the literature has led to the creation of new knowledge and perspectives that might be of great value in developing and using communication strategies in patients with chronic disease in LMICs.
Open Access
Community health model to manage health hazards related to Mount Cameroon eruptions in West Africa
(University of the Free State, 2010-05) Atanga, Mary Bi Suh; Van der Merwe, Anita S.
Mount Cameroon is one of Africa’s largest and most active volcanoes, the last eruption occurring in 1999-2000. Communities in close proximity to this mountain were and could again be adversely affected by such volcanic eruptions. The goal of the study was to develop a community health adaptable model for the management of health care related hazards – not only for this community, but also for others within Cameroon and Africa. An exploratory qualitative approach to data collection and analysis was used in order to gain insight into what would be acceptable to the community. Purposive sampling was used to identify three groups of community members and a group of health care workers who have lived through a previous eruption (who turned out to be nurses and nurses’ aids only). Data was transcribed, notes made among researcher and assistants and cross-matched to arrive at occurring themes. The significance attached to the mountain and its eruptions, management strategies from the perspective of the community members and an identification of what matters most in this regard were elicited. An analysis of documented evidence from local resources focused on the realities of such a hazard, prevention and mitigation measures, as well as adaptable methods that could inform the model. The exploration of international relevant strategies in managing natural disasters in general, and volcanic disasters in particular, as well as a literature review, was conducted. The findings were triangulated to inform the development of an adaptable model. After an exploratory pilot study (pretest), using members of another community that was affected to some extent during the 1999-2000 eruption, two participant focus group discussions were held with each of three groups of community members. These included a group of elders, men and women. The findings indicated that community members regarded the mountain as a god to be appeased. Thus, some of the cultural practices exposed the community even further to hazards related to a volcanic eruption. They emphasised the protection of women and children, had some traditional health care actions in place, respected the local council for its important role, but thought that their role was marred by limitations such as infrastructure and resources. They were concerned about any evacuation process and confirmed previous negative experiences in this regard. Focus group discussions with a group of health workers indicated a slightly more scientific view of the eruptions and emphasised the livelihood value of the fertile soil surrounding the mountain. The group expressed concerns regarding cultural practices and the severe lack of health care infrastructure and resources, and expressed limited management strategies to deal with a health hazard of such magnitude. Documented evidence and literature was limited, but it was found that within Africa, concerns were similar. Management strategies were linked to a number of government departments’ involvement and scientific research and monitoring done by academic institutions or other facilities. Internationally, a number of directive frameworks exist but the need for an in-country framework, incorporating the needs of local communities, is emphasised in some models and approaches. Triangulation of focus group results, and an analysis of local and national documented evidence and international literature, indicated that a critical need exists to focus on the community’s intricate relationship with the mountain (inclusive of cultural and religious practices), the involvement of community members as critical role-players, the enhancement of health care services, the development of the knowledge and skills of health care workers, and addressing or even simplifying the complex nature and directives on national level to deal with such emergency situations. These five major focus areas form the basic tenets of a community adaptable model that values being, belonging and becoming. In this way, community members are active participants in assessment, planning, implementation and evaluation.
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.
Open Access
Competences of South African midwifery educators: a transformative framework
(University of the Free State, 2020-11) Bekker, Elgonda Eritzema; Van Jaarsveldt, Deirdre E.
Midwifery educators’ competencies are a crucial component in strengthening midwifery education and maternal healthcare. Moreover, quality midwifery education is fundamental in reaching universal health coverage by 2030. In this research, a transformative paradigm with the focus on gender inequality as the social justice element, enhanced by theoretical perspectives from feminism and social constructionism, was followed. A concurrent mixed-method design was deemed most appropriate to answer the research question: ”How can midwifery educators’ competencies best be strengthened to transform midwifery education in South Africa?” Competence strengths were defined and discovered, dreams were expressed, and the designed destiny framed during an Appreciate Inquiry session. The strengths-based approach was integrated with a realistic view of South African midwifery educators’ competencies gained by the self-administered WHO Midwifery Educator Core Competency Gap Analysis Tool. After analysis of the separate data sets, inference of the findings in triangulation with literature culminated in a transformative framework, which was refined by experts in maternal healthcare and midwifery education through a non-consensus Delphi. The meaning of all the contributions from the different perspectives of the interprofessional stakeholders were incorporated to strengthen the framework, thus taking a dialectic stance. The transformative framework consists of consecutive building blocks. Compliance with global standards for midwifery education, regulation and essential competencies forms the foundation. An enabling environment is the next element that facilitates national capacity building to address gaps in midwifery educators’ competence. Supported by the building blocks, midwifery education competence could ultimately improve the quality of midwifery care. The context of midwifery, including education, is framed by four elements emanating from a feminist approach, resulting in agency for midwives and women. This agency contributes to empowerment of women and decolonisation of midwifery, aimed at knowledge democracy. The transformative framework is presented to strengthen midwifery educators’ competencies and transform midwifery education in South Africa.
Open Access
Competencies for midwifery ultrasound education and practice in South Africa
(University of the Free State, 2020-02) Human, Charne Eloise; Spies, C.
Open Access
Cultural congruent nursing care of black patients in the maternity section of public hospitals in Bloemfontein
(University of the Free State, 1999-05) Sesing, Agnes Seatile; Van den Berg, R.; Venter, I.
Afrikaans: Die inwoners van die Republiek van Suid-Afrika is vanaf verskeie kulture afkomstig en toon 'n multikulturele aard. Die gesondheidsorg wat in alle gesondheidsorginstansies gelewer word, is op die westerse gesondheidsorgmodel geskoei. Die westerse gesondheidsorgmodel sluit geen kulturele gesondheidsbehoeftes, soos geopenbaar deur Afrika-etnosentriese bevolkings, in nie. Kulturele konflik en wanbegrip wat gekenmerk word deur geen samewerking tussen pasiënte en praktisyns, die nienakoming van die sorgplan deur pasiënte en die stereotipering van pasiënte deur verpleegkundiges, kom algemeen tussen pasiënte en gesondheidsorg praktisyns . Die doel van die studie was om vas te stelof vroedvroue oor die nodige kennis beskik rakende en sensitief is vir die kulturele gesondheidsbehoeftes van swanger- en lakterende vroue wanneer verpleegsorg verleen word. Die navorsingsontwerp is nie-eksperimenteel met 'n beskrywende en verkennende aard. Die opnaine-metode is gebruik om die data mee in te samel. Die volgende navorsingstegnieke is gebruik: 'n vraelys is deur die verpleegkundiges voltooi; 'n gestruktureerde onderhoud is met die moeders gevoer en die nodige gesondheidsorgdokumente (beleide en verpleegsorgverslae) is geouditeer. Die verwerking van alle oop-einde vrae is volgens die metode soos deur Tesch beskryf, gedoen. Alle data is op die nominale beskrywende vlak geanaliseer. Die resultate toon dat daar geen verband bestaan tussen kennis oor verpleegsorgpraktyke rakende kultuur-kongruente verpleging en die verpleegsorg wat pasiënte verwag en kry. Hierdie tendens word ook in die gesondheidsorgdokumente vergestalt daar kultuur-kongruente verpleegsorg nie onderskryf word nie en ook nie aangeteken word nie.