Masters Degrees (School of Nursing)
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Item 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, ReinetteEnglish: 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.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 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 programmesItem 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.Item 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.Item 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, LizemariWorldwide 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.Item 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.Item 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.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 Competencies for midwifery ultrasound education and practice in South Africa(University of the Free State, 2020-02) Human, Charne Eloise; Spies, C.Item 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.Item Open Access A description of the practice of advanced midwives(University of the Free State, 2011-05) Lesia, Nozimanga Gladys; Roets, LizethEnglish: Midwives, in the absence of medical practitioners are the most readily available health professionals to render care in Primary and Community Health Care settings. After obtaining a qualification in Advanced Midwifery and Neonatology, midwives should be placed and utilized in areas where they can use their competencies for the benefit of the mother and the baby. The aim of this study was to describe the practice of advanced midwives including their placement and utilization. A non-experimental and descriptive design was used. After a thorough literature analsis as well as a focus group discussion was done, a questionnaire for data collection was compiled. The data was collected after approval was obtained from the relevant roleplayers as well as from the Ethics Committee of the Faculty of Health Science from the local University. The population consisted of all (178) practicing advanced midwives who trained at the University of the Free State during 1995-2007. No sampling was done and 178 questionnaires were distributed to the practicing advanced midwives. Sixty nine questionnaires were returned (39% return rate) and analysed. The findings indicated that only 13 (n=13, 19%) of advanced midwives were placed and utilized correctly. Advanced midwives that were not placed and utilized correctly expressed a loss of self-confidence, lack of support and a lack of recognition. They also reported an inability to demonstrate their expertise in practice due to inappropriate placement and utilization. Nurse academics and Advanced midwifery Practitioners should publish research articles in Health Sciences Journals to make their competencies known. That might ensure that they are recognized by their colleagues and given the opportunity to practice what they have trained for.Item Open Access Development and testing of a competence assessment intrument for undergraduate nursing students(University of the Free State, 2017-01) Piek, Nicola; Botma, YvonneEnglish: Nursing roles and responsibilities in South Africa are evolving, demanding nursing practitioners to become more autonomous, responsible and accountable. Competent nursing practitioners who are able to apply their knowledge, skill and attitude in clinical practice are in great demand. Competence is therefore regarded as a prerequisite for nursing students entering the workforce as nurse practitioners. Competent student nurses demonstrate thinking processes such as critical thinking, clinical reasoning, sound clinical judgment and metacognition as they assess, diagnose and treat patients. In order for competent student nurses to apply these thinking processes the basis of foundational knowledge, conditional knowledge, functional knowledge and metacognitive knowledge need to be in place. At present there is no assessment instrument based on the thinking processes to assess the competence of student nurses in South Africa. The aim of this study was to develop a valid and reliable instrument to assess nursing students‟ competence through their demonstration of clinical judgment and metacognition in clinical settings A quantitative methodological study was done to prove the developed assessment instrument as reliable. Sixteen existing competence assessment instruments were accessed and analysed. Consequently a thematic analysis of nine of the existing competence assessment instruments delivered an assessment instrument comprised of 38 items, classified according to thinking processes. A panel of experts enhanced face and content validity of the developed assessment instrument before the instrument was implemented. Twenty respondents each assessed 15 second-year undergraduate nursing students who participated in a standardised patient simulation activity via video footage. A Cronbach Alpha coefficient test, Intraclass correlation coefficient (ICC) test and a Kendall‟s coefficient of concordance (W) test determined reliability of the developed assessment instrument. A Cronbach Alpha coefficient of .90 is indicative of good internal consistency and proves the developed assessment instrument as reliable. The ICC value of .85 indicates excellent inter-rater reliability as a continuum of all the respondents and further contributes to the reliability of the developed assessment instrument. However the W values of the developed assessment instrument were low and ranged between .04 and .40 per item. The low W values were attributed to the fact that some respondents were inconstant in assessing students, the fact that respondents could not validate the reasoning of students, and the large number of assessors (20) in comparison to other inter-rater studies that have three assessors at the most. The competence of student nurses needs to be assessed in order to determine if they can apply their knowledge and reasoning in clinical practice. The value of this research is that the developed assessment instrument may aid nurse educators or preceptors to identify the specific learning need of a student. Furthermore the developed assessment instrument will give an indication of the competence of student nurses. This knowledge will encourage nurse educators to build in and expand teaching strategies that develop thinking processes into their pedagogies. It is recommended that future research, such as an exploratory and confirmatory factor analysis, be done in order to determine the construct validity of the developed assessment instrument. This will significantly enhance the validity of the developed assessment instrument.Item Open Access Development and testing of a tool to measure the supportive role of nursing preceptors(University of the Free State, 2016-01) Hugo, Lizemari; Botma, YvonneEnglish: South Africa needs competent nursing practitioners who are able to apply their minds in order to meet the high patient care demands. Nurse educators must support nursing students, our future nurse practitioners, in the clinical facility because they experience various unfamiliar and even traumatic situations. Effective system, tangible, cognitive and emotional support offered by preceptors enable students to transfer their classroom learning into practice and become competent nurse practitioners who are able to think critically, reason clinically and demonstrate sound clinical judgment. For effective precepting to take place, preceptors should consider a number of factors such as the student characteristics, educational outcomes, transfer climate as well as the physical environment and adapt their precepting style and technique according to the circumstances and students’ learning needs. At present, there is no measurement instrument to evaluate the all four types of support that preceptors offer to students in the clinical practice. A quantitative methodological study was done to standardise the newly developed instrument by determining its reliability and validity. Forty-two existing questionnaires on student support by preceptors were accessed and analysed. Consequently, sixty-nine relevant items were included in a draft questionnaire. Face and content validity were enhanced before testing the draft questionnaire. One hundred and ninety-two nursing students in an undergraduate programme were asked to evaluate their preceptors over two consecutive months. Reliability was determined by Cronbach’s alpha test and validity was determined by an exploratory factor analysis. A 0.98 Cronbach alpha value indicates a high reliability. The factor analysis identified three factors, namely system, cognitive and emotional support. Twenty-four items were evaluated by comparing cut-off values of >_ 0.4 and >_0.5. Twelve items were eliminated based on the cut-off values, leaving fifty-seven items to be included in the final questionnaire. Students need support to develop their thinking operations and to transfer classroom learning to clinical practice. The value of this research is that the developed tool provides an assessment or diagnostic instrument to determine the quality of precepting as experienced by nursing students. Lack of competence in a specific facet or domain may be diagnosed and training should be offered in order to improve the quality of precepting. It is recommended that further research, such as a confirmatory factor analysis, be executed in order to confirm the value of the tool in assessing and diagnosing the quality of preceptorship in South Africa.Item Open Access Development of an instrument to measure the clinical learning environment in health sciences(University of the Free State, 2020-11) Jordaan, Hanlie; Hugo-van Dyk, L.A positive and stimulating clinical learning environment (CLE) is key to health professional students’ as it increases their opportunities to transfer learning and become competent professionals. The evaluation of the CLE is crucial to determine the quality of the students’ clinical experience and learning opportunities, as well as to promote a supportive CLE for students. The CLE has received ample attention from researchers over the past three decades. From the literature, four major aspects are identified to contribute to a positive CLE, including the atmosphere of the clinical settings; teamwork; staff and student workloads; and learning opportunities offered by clinical settings to students to practice people-centred care. An instrument that is used to measure the CLE is expected to address these aspects to promote a positive CLE. An overview of existing CLE measuring instruments, however, revealed that the instruments failed to address all four of these major aspects. Failing to address those aspects in the measuring instrument may lead to the failure to identify weaknesses in current systems, or to measure new CLEs in terms of its potential contribution to work-integrated learning (WIL). Ultimately it may have a negative impact on the clinical learning of students. Therefore, a more comprehensive, valid and reliable instrument is needed to measure the complex characteristics of CLEs, and to determine whether they provide the essential learning opportunities for professional students. Therefore this research aimed to develop an instrument that measures the clinical learning environments of students in health sciences, addressing all major aspects associated with a positive CLE. This study was conducted in two phases. The first phase included the development of an instrument that measures the CLE based on pre-existing instruments and literature. Nineteen instruments, consisting of 454 items, were identified. The items were thematically analysed and refined to develop the first version of the instrument. The first version instrument consisted of 66 items. The second phase included a Delphi study to determine the face and content validity of the first version instrument. A consensus Delphi technique, with an agreement rate of 70% was used to validate the inclusion of items for the final instrument. An expert panel of qualified healthcare professionals proved to be most suitable to obtain the face and content validity of the items. The panel members included diverse expert healthcare professionals from various African countries and healthcare facilities. Of the 54 experts initially invited, 36 indicated an interest to participate. During the first round, 22 panel members responded to the instrument while 16 panel members responded during round two. Ten panel members took part in the third and final round. A possibility for professional attrition may be that all healthcare practitioners were called to the frontline during the CoVID-19 pandemic. Based on the results of the Delphi-study, four of the original 66 items were eliminated due to a lack of consensus. The remaining 62 items were judged to have face and content validity and were included in the final instrument. The 62 items in the second version of the instrument address all major aspects that contribute to a positive CLE. The instrument developed in this research can benefit a range of role-players involved in the WIL of students in the healthcare profession. It could be used as an evaluation instrument for new CLEs, and to measure its potential contribution to WIL; it could assist in identifying inherent weak areas in the system that need strengthening; professional governing bodies could use it to accredit clinical settings for placements of health professional students. It is recommended that the construct validity and reliability of the instrument be tested in future research.Item Open Access The distinctive attributes of registered nurses in a South African military context(University of the Free State, 2021-11) April, Karen Ann; Spies, C.Registered nurses who work in the military have the dual role of being both a soldier and a nurse. This unique situation has prompted research about the attributes necessary for them to fulfil their roles. Besides providing general day-to-day nursing care, the reality of unrest in South Africa, terrorism, natural and human-made disasters, and deployment has led to the question of whether South African military nurses have the attributes to manage these added demanding and stressful situations. The differences between the uniqueness of military nursing in relation to civilian counterparts in South Africa are not well reflected in literature. The question was thus posed: “What are the distinctive attributes of registered nurses in a South African military context?” Since little is known or understood about the distinctive attributes of military nurses, the researcher selected a qualitative research approach through which data could be obtained from registered nurses who experience the challenges of working in the South African military context on a daily basis. The study was conducted at one specific military healthcare institute. The accessible population included 90 registered nurses at the specific military healthcare institute. The researcher used the nominal group technique (NGT) to obtain nominal and descriptive data about the distinctive attributes of registered nurses within the South African military context. The inclusion criteria for the groups were as follows: • Being a professional nurse registered with the South African Nursing Council; • Having two or more years’ experience of working within the South African military context; and • Being available to participate in the study; e.g., not being deployed during the period of data collection. To gather sufficient and relevant data, two NGT discussions were conducted. The researcher analysed the various sets of data by using six of the seven steps to analyse the data from multiple nominal groups as described by Van Breda (2005:4-12). The results of this research study indicate that the general characteristics of military nurses can be categorised as multi-skilled, military discipline, resilience, physical fitness, occupational respect, compliance, and military etiquette. Fostering and cultivating these attributes among registered nurses in the South African military healthcare context is important to ensure that the calibre of nurses meets the required standard in order to achieve the organisation’s goals.Item Open Access The effect of three types of endotracheal tubees on ventilator-associated pneumonia(University of the Free State, 2004-11) Phillips, Maria Jacoba Johanna; Botma, Y.English: Ventilator-associated pneumonia is associated with a high mortality, morbidity and medical cost and is common and has major complications. Prevention of ventilator-associated pneumonia is dependent on how well we understand the pathogeneses of the disease. The pathogeneses starts with the colonization of the upper airway and the gastrointestinal tract, pooling of secretions in the subglottic space and aspiration of this contaminated secretions past the endotracheal cuff (endogenous source of pathogens). As the host’s defences are overcome, tventilator-associated pneumonia develops. Newer types of endotracheal tubes were designed with a dorsal lumen for the removal of subglottic secretions. This prevents the aspiration of contaminated secretion into the lower sterile airways. The aim of this research was to determine the effect of three types of endotracheal tubes on ventilator-associated pneumonia. A single center, blind, prospective, controlled clinical trial has been selected to investigate the effect of three types of endotracheal tubes on ventilator-associated pneumonia. Prior to the commencement of the study, approval for the performance of the study was obtained from the Ethics Committee of the Faculty of Health Sciences of the University of the Free State, the Universitas hospital, the manager of the intensive care units and neurosurgical intensive care unit as well as from the head of the neurosurgical department. Informed consent was obtained from candidates or if the candidates were unable to provide consent from their spouse, child or parent and information regarding the purpose, procedure, and possible adverse effects relevant to the study, were provided. Written consent was obtained. If the candidates was unable to give consent themselves and their family was unavailable, the researcher obtained telephonic consent from above-mentioned family members. The consent forms were available in Afrikaans, English and South-Sotho. If the subject did not understand English or Afrikaans, the researcher made use of a registered nurse as a translator to explain the purpose, procedure, and possible adverse effects relevant to the study. A witness co-signed all consent forms. Seventy-one candidates that met the inclusion criteria were screened for enrolment into the study. Thirty-four of these candidates were successfully enrolled. Subjects were consecutively allocated into three study groups. Each study group was intubated with the type of endotracheal tube for the specific study group and studied for the development of ventilator-associated pneumonia. The two experimental groups were subjected to two hourly subglottic suctioning. One experimental group’s cuff pressures were measured and maintained within normal limits, whereas a Lanz™ valve maintained the other experimental group’s cuff pressures. The control group was intubated with the conventional type of endotracheal tube. The implementation took place over a period of 18-months. Data was statistically analysed and presented by means of frequencies, medians and comparison of 95% confidence intervals. This study has found that none of the subjects in the experimental groups (received subglottic suctioning) developed late-onset ventilator-associated pneumonia compared to 16.67% in the control group. The incidence of early-onset ventilator-associated pneumonia was also much higher (75%) in the control group than the experimental groups. The relative risk for late-onset ventilator-associated pneumonia indicated that subglottic suctioning was not a preventative factor in the prevention of late-onset ventilator-associated pneumonia in the experimental groups. The time of intubation of the control group was longer than the two experimental groups. No significant difference was found in the morbidity and the mortality of the three study groups. Recommendations are that the study should be repeated with a larger study group and the subjects should be ventilated for a longer period. The benefits of subglottic suctioning may present it more clearly. The benefits of the LanzTM valve have not been investigated sufficiently in this study. In closing a repetition of some wise words: “Keep an open mind toward pneumonia. Our grandchildren will be interested and are likely to have as many differences of opinion…as we have.” William Osler. 1900 (Craven & Steger, 1995:1S)Item Open Access Die emosionele uitdagings van verpleegkundiges in die kindersaal van ʼn privaat hospitaal(University of the Free State, 2014-01-06) Lourens, Madelien; Jacobs, A. C.English: Most of the available research studies focus primarily on the child’s experience of hospitalisation, rather than that of the nurse. This study explores the nurses’ experience in order to improve quality care of children. The purpose of this study was to explore the emotional challenges faced by nurses when taking care of children, as well as possible solutions. The researcher used a qualitative, exploratory, descriptive research design. Data was collected with the nominal group technique (NGT). The participants were nurses working in a children’s ward in a private hospital. One nominal group was selected and multiple strategies were used to ensure that the study was ethical and trustworthy and met the standards set by the University of the Free State. The first emotional challenge faced by nurses in the children’s ward is job satisfaction. Job satisfaction is an emotional challenge that can be successfully overcome when committed nurses build a relationship of trust with the children they nurse. The second emotional challenge is handling the diverse emotions they experience when taking care of the children. The negative emotions are frustration, empathy, stress, anxiety, anger and sadness. A variety of positive experiences also occur on a daily basis. The solution to the various emotional challenges lies in the fact that child-centred nurses should be passionate about caring for children, and will then be unconditionally committed. Communication, as the second theme under possible solutions, consists of seven categories: Team-building events, exchanging of tips, communication between colleagues, communication with physicians, support, professional counselling and expression of frustration. The third solution is in-service training, which will make the nurses experts in their field. During in-service training the skills of all nursing staff can be updated and the management skills of all nurses can be developed. With regard to the findings, the following recommendations were made: recruitment requirements should be adjusted, emotional support should be provided to current nurses, team-building gatherings are essential, a formal opportunity to verbalise needs should be created, professional counselling should be available, and facilitation programmes, child psychiatry, case studies and workshops are essential.Item Open Access Enhancing the therapeutic role of registered nurses in a care-and-rehabilitation facility(University of the Free State, 2021-02) Mofokeng, Anna N.; Jansen, R.Registered nurses, as frontline health care providers, render nursing care to people with intellectual disabilities in care-and-rehabilitation facilities. It is their responsibility to deliver therapeutic nursing care by creating a therapeutic milieu for people with intellectual disabilities in long-term wards. They are however challenged by various difficulties addressing these needs in unconducive environments. The purpose of this study was to explore and describe the recommendations of registered nurses to enhance their therapeutic role in care-and- rehabilitation facilities. The study followed a qualitative, explorative and descriptive research design. A purposive selection of participants (n=22), consisting of registered nurses working in a care-and-rehabilitation facility at the Free State Psychiatric Complex, was conducted. Nominal group discussions were administered by an experienced facilitator that explored the registered nurses' recommendations on their therapeutic role in a careand-rehabilitation facility. Four nominal group discussions were held with 22 registered nurses that produced 66 statements. Van Breda’s multiple group data analysis steps were followed to analyse the data collected. Themes and sub-themes were identified from data gathered during the nominal group discussions. Seven themes emerged, namely communication, staff support, healthcare environment, care delivery, education, legislative and policy framework as well as resources. Each theme produced relevant sub-themes. The findings led to specific recommendations related to the themes and sub-themes. These could guide the various stakeholders to assist registered nurses to render competent and comprehensive therapeutic nursing care for people with intellectual disabilities in care-and-rehabilitation facilities.Item Open Access Evaluation of problem-based learning in an undergraduate nursing education programme(University of the Free State, 1999-05) Becker, Susanna; Viljoen, M. J.; Botma, Y.English: The aim of this study was to evaluate problem-based learning in an undergraduate nursing education programme. The School of Nursing at the University of the Orange Free State implemented problem-based learning as a teaching and learning strategy in the undergraduate programme in 1997. The 1998 course was evaluated to determine the success of this innovative method of instruction. It was done by administration of an audit to determine whether the methodology and process of PBL were followed; all the variables (internal and external) were considered during programme development, and whether requirements for outcomes as required by the South African Qualifications Authority were met. Student satisfaction was determined by means of a perception questionnaire and changes that took place in learning styles were determined by means of a learning style inventory that was developed in Lancaster. The grades students obtained in problem-based learning subjects were compared to the grades they obtained in subjects that were instructed by means of traditional lectures, as well as their grade 12 results secondary schooling. The audit revealed that this course was carefully planned and implemented to be one of exceptional quality. An action research model was used to monitor the integrated curriculum model with an emphasis on the PBL philosophy. This curriculum was found to be successful in portraying the South African health context in a lifelike and comprehensive manner, as the design was community-based. This curriculum addressed the tendency to overload and divided curricula in the disciplines, which bears little resemblance to the reality of the South African health context. A deficiency found is the lack of a formal quality assurance programme, which will enhance the maintenance of the high standard. Students in the course were under a lot of stress as they had to leave the comfort zones of traditional learning and some reacted with anger and resentment. Learning did take place in spite of all the hurdles students were confronted with. Superiority in meaning orientation, intrinsic motivation, deep approaches and comprehension learning was detected by the LAS! when results were compared to the scores of similar studies done in first-world countries (see Appendix J). Unfortunately a decrease in student-centredness took place, which could be ascribed to group sizes that were too large, fear of failure (as bursaries would be forfeited if students did not perform up to certain standards) and a heavy workload. Assessment results of PBL subjects were very positive in spite of students' indications that they found the course difficult. Assessment scores were much higher for PBL subjects than for traditional lecturing subjects, as well as Anatomy, which was instructed by means of video-assisted instruction. Nearly half the students obtained better assessment results in PBL than in their matriculation examinations. The most positive aspect of the first-year nursing course was the fact that students became self-directed learners and that a pattern of lifelong learning was created to equip them for the challenges that lie ahead in the 21st century.