Doctoral Degrees (School of Nursing)
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Item Open Access Enabling adult diabetes self-management in a Kenyan context: a design science research approach(University of the Free State, 2023) Opisa, Esther Asenahabi; Reid, Marianne; Swanepoel, JuanitaDiabetes is one of the non-communicable conditions of which the prevalence is increasing globally, with a particularly sharp increase experienced in low and middle-income countries (LMICs). If diabetes is not managed properly, it can lead to physical complications, and increase the financial burden on the individual, the health care system and the government. Since diabetes is a chronic condition, self-management is key in the control of this condition. However, it is evident that most people diagnosed with diabetes exhibit an uncontrolled condition. This is an indication that diabetes self-management (DSM) is suboptimal among people diagnosed with diabetes. The main aim of this study was to design a context-specific product that would enable DSM by adults in Kenya. This study was anchored on the integrated model of behaviour prediction (IMBP) theory, with IMBP distal variables forming the foundation for designing the product. This study was designed using a pragmatic approach, informed by design science research (DSR). DSR comprises three cycles that are closely related. The three cycles are relevancy, design and rigour. In the relevancy cycle, the problem was investigated. Preliminary design requirements (PDRs) and design requirements (DRs) were derived. The PDRs and DRs formed part of the acceptance criteria of the product. In the design cycle, the product was finalised and its practicability determined. The iterative nature of the prototype product was due to the synthesis of data obtained during the relevancy cycle. In the rigour cycle, the prototype product was evaluated against certain evaluation criteria. The final product was then designed. These three cycles were adapted as the phases of the study. Applying the general methodology of design science research (DSR) to the current study yielded three executable phases of the research study: 1) the problem explication phase, 2) the design phase, and 3) the evaluation phase. A multiple method design was used. In the first phase, the problem explication phase, a literature overview, a scoping review and Kawa group discussions were conducted. The findings of these three methods involve a list of four IMBP distal variables, nine PDRs and six DRs respectively. In the second phase, the design phase, surveys and design were the two methods that were applied. The surveys yielded additional 13 DRs, giving a total of 19 DRs. This phase gave rise to a prototype product and the evaluation criteria that were used by diabetes experts in the third phase of the study. The third phase, the evaluation phase, involved expert reviews. Four diabetes experts evaluated the prototype product using the evaluation criteria. Their feedback was analysed and the findings factored in the development of the final product. The final product is a DSM guide that will be used mainly by adults diagnosed with diabetes, either on their own or with the aid of health care providers during clinic visits. In this last phase, design principles were also articulated, based on the DRs that emerged throughout the study. This study makes a contribution to the body of knowledge in DSR, by unearthing design principles that other researchers can use to design similar studies elsewhere. Additionally, the DSM guide that emerged in this study may contribute to improved DSM by adults diagnosed with diabetes in Kenya. A context-specific DSM product was developed through the application of the DSR approach. Alongside the DSM product, the researcher also extracted DRs and design principles, which are the knowledge contribution of this study to DSR.Item 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.Item 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.Item Open Access A face-to-face peer support model for patients with type 2 diabetes(University of the Free State, 2020-07) Pienaar, Melanie; Reid, MarianneBackground: Prevalence of Type 2 diabetes has reached pandemic proportions globally. New and effective ways are needed to improve diabetes self-management. However, many barriers to self-management exist, such as lack of support, lack of resources, geographical constraints and lack of knowledge, which may be fuelling the increase of Type 2 diabetes. Face-to-face peer support may have the potential to improve self-management in Type 2 diabetes. Purpose: The purpose of the study was to establish the feasibility of a face-to-face peer support model for patients with Type 2 diabetes in a sub-district in the Free State province of South Africa. Methods: Multiple research methods, guided by the integrated model of behaviour prediction, were used to establish the feasibility of a developed face-to-face peer support model developed for patients with Type 2 diabetes. In the first stage of the study, a systematic review, guided by the steps of the Cochrane Collaboration (2006), was conducted to critically synthesise the best available evidence on face-to-face peer support models for adults with Type 2 diabetes in low and middle-income countries. Multiple data sources were consulted for the period January 2000 to December 2017. Screening and selection of papers followed, as well as critical appraisal and data extraction, by at least two reviewers and, finally, narrative synthesis was done. The synthesised data of the systematic review informed the pilot of the face-to-face peer support model. The second stage of the study established the impact of the implemented face-to-face peer support intervention on adults with Type 2 diabetes in South Africa. A cluster randomised control trial was conducted involving adults with Type 2 diabetes from six communities in a semi-urban rural area in the Free State province. Three communities were randomly allocated to the intervention group and three to the control group. Trained community health workers provided monthly group sessions and home visits to the intervention group. The control group received their usual care. The primary outcome of the study was taken as glycated haemoglobin measured by the BioHermes Automatic Glycohemglobin Analyzer; secondary outcomes were blood pressure, waist circumference and body mass index. Outcomes were assessed at baseline and after four months. Descriptive statistics was determined per group. The last stage of the study determined the experiences of the patients with Type 2 diabetes who took part in the face-to-face peer support intervention. Sesotho-speaking women who participated in the face-to-face peer support intervention were purposively sampled, and took part in this visual-based narrative inquiry. Textual and visual data was collected using the Mmogo-method® and data was analysed thematically. Results: In the systematic review, Stage 1 of the study, two common models of face-to-face peer support were identified for low and middle-income countries, namely, diabetic patients and community health workers. Essential components were highlighted for the planning and implementation of these models, such as recruitment, selection, training and supervision of peer supporters, as well as the nature of the peer intervention. The cluster randomised controlled trial study, Stage 2 of the study, resulted in a significant improvement in diastolic blood pressure of individuals (P=0.02) in the intervention group. No differences were, however, found from baseline between groups regarding the variables glycated haemoglobin (P=0.87), systolic blood pressure (P=0.13), body mass index (P=0.21) and waist circumference (P=0.24). The Mmogo-method®, Stage 3 of the study, showed that the participants valued the face-to-face peer support intervention and acknowledged community health workers as an important source of support to them. Participants expressed that the intervention helped them to make positive lifestyle changes, and because they were exposed to the support continuously, their confidence in the self-management of diabetes improved. Conclusions: The study demonstrated that, despite modest results, a face-to-face peer support model for patients with Type 2 diabetes that involves community health workers is feasible and valuable in low and middle-income countries like South Africa.Item Open Access A mobile health communication framework for postnatal care in rural Kenya(University of the Free State, 2020-06) Mbuthia, Florence; Reid, Marianne; Fichardt, AnnaliBackground: Maternal and neonatal health remains a major challenge in low- and middle-income countries, resulting in the burden of a high rate of maternal and neonatal deaths. Postnatal care is an intervention recommended by the World Health Organization to promote maternal and neonatal health. In spite of this recommendation, uptake of postnatal care in Kenya, as in many other sub-Saharan African countries, has remained low, particularly in rural areas, despite targeted postnatal care services being implemented. Mobile health communication is proposed to promote the uptake of postnatal care; however, no theory-based framework has been developed in this regard to date. This study, therefore, aimed to develop a mobile health communication framework for postnatal care in rural Kenya. Methods: A multi-method research design guided the development of the framework through a multi-phased approach. The first phase systematically reviewed literature to gather the best available evidence on how mobile health communication could strengthen postnatal care in rural areas. The second phase of this study used a visual-based narrative inquiry to explore the experiences of postnatal mothers with health care providers and their views on mobile health communication in a rural area in Kenya. In the final phase, the findings of the preceding phases were used to draft the framework, which was validated by policymakers from the same rural area where data had been gathered. The theoretical underpinning of the study was provided by both the integrative model of behaviour prediction and the theory of change logic model. The integrative model of behaviour prediction was used to identify determinants of postnatal care uptake, while theory of change logic model underpinned the development of the mobile health communication framework by describing what the framework comprised. Results: The findings of the systematic review reveal that one-way messaging is the most common type of mobile health communication that is used in an attempt to strengthen postnatal care in rural areas. Evidence reveals that mobile health communication can be used to improve uptake of postnatal care by influencing the critical determinants that predict behaviour uptake, which are, according to the integrative model of behaviour prediction, intention, skills and environmental factors. The findings also reveal that changing beliefs related to attitudes, perceived norms and self-efficacy can enhance the intention to use postnatal care. Mobile health communication can enhance the skills necessary to use postnatal care, such as breastfeeding, cord care, thermal care, delayed bathing of babies, safer sleep practices, care-seeking and problem-solving. The environmental factors that are considered to hinder uptake of postnatal care in rural areas, and which can be reduced by use of mobile health communication, were inaccessibility, unavailability and unaffordability. The findings of the visual-based narrative inquiry reveal that postnatal mothers had expectations of health care providers, with some expectations being met, and others not. The postnatal mothers reported having positive experiences with their health care providers as a result of the physical and emotional support they received. The positive experiences had various outcomes for both mothers and their children. The findings also reveal that postnatal mothers had expectations of mobile health communication, viewing it as a way in which health education and psychological support in relation to postnatal care could be provided. In addition, they expressed positive attitudes towards mobile health communication – they regarded it as useful for improving access to health care providers, and the availability of and access to the health facility. From the validation exercise, guided by theory of change logic model, a mobile health communication framework for postnatal care in rural Kenya was developed. The model helped to address the problem caused by the absence of a mobile health communication framework in rural areas, by linking postnatal mothers’ needs, the desired results, influential factors and strategies. In addition, the assumptions behind the effectiveness of the framework were highlighted. The framework that was developed integrated the integrative model of behaviour prediction and theory of change logic model. In addition to the models, both users and policymakers’ inputs were incorporated, as was additional literature, which strengthened the framework. Conclusion: In this study, a theory-based mobile health communication framework for postnatal care in rural Kenya was developed on the basis of the best evidence available on mobile health communication, and users’ and the policymakers’ inputs. Given that the mobile health communication framework was developed on the basis of the contextual realities of rural Kenya, its piloting and implementation is recommended, as it is likely to improve the uptake of postnatal care, as well as both maternal and neonatal health, thereby helping to address the high rate of maternal and neonatal mortality, especially in rural settings and in low- and middle-income countries.Item Open Access A framework to strengthen leadership at a South African public nursing college(University of the Free State, 2021) Mogakwe, Lebuile John; Van Jaarsveldt, D. E.𝑬𝒏𝒈𝒍𝒊𝒔𝒉 Leaders at higher education institutions around the globe face difficulties emanating from a myriad of challenges introduced by the 21st century. Nursing education is not exempt from these demands, especially considering expectations of nurses operating on the frontline with health conditions that continue to threaten human existence. Therefore, the dire need for quality nursing education and training in this era is indisputable. In the midst of these threats, South African public nursing colleges are transitioning from provincial departments of health to higher education to form part of a unified higher education system. The need for strong leadership was identified as a key determinant through which a specific public nursing college could survive these challenges. A lack of evidence regarding leadership strengthening at Nursing Education Institutions in the country prompted the following research question: “How can leadership at a South African public nursing college be strengthened?” Rooted in the social constructionism paradigm, a qualitative, exploratory, descriptive, contextual, and collaborative research design was deemed the most appropriate to answer the research question. Having taken a strengths-based approach and assuming a dialectic stance, perspectives were obtained from the college leadership via an Appreciative Inquiry and from South African nursing education leadership experts by means of a modified Delphi. The data sets were separately analysed from which various themes and subthemes emerged. The findings were then synthesised and integrated to create a whole picture, which culminated in a framework that was validated by college stakeholders. The framework to strengthen leadership at a South African public nursing college offers transformational leadership approaches, leadership competency, and capacity development as its foundational aspects. Technology, research, and community engagement are supportive constructs, whilst governance, legislation, leadership, and policy together form the overarching element. With implementation and continuous research, each construct should be further developed. Although contextual, the findings could resonate with nursing education leadership elsewhere and be explored further by replicating the research. As the research product, the framework is considered to be a modest contribution to knowledge, and is presented in the belief that it could enable the college to successfully navigate its challenges and its transition into higher education. ___________________________________________________________________Item Metadata only An mHealth communication framework for caregivers of adolescents with mental health issues(University of the Free State, 2020-06) Jansen, Ronelle; Reid, MarianneThis study focused on developing an mHealth communication framework for rural caregivers of adolescents with mental health issues. Adolescents carry a high burden of mental health issues. Their caregivers, usually parents, relatives or community members, play a pivotal role in caring for these adolescents, which causes challenges for the caregivers. Caregivers in rural settings face specific challenges relating to adolescents with mental health issues, leading to unmet support needs. The potential value of using communication technology to support rural caregivers has been recognised by research. The aim of the study was to develop an mHealth communication framework for caregivers of adolescents with mental health issues in the Kopanong municipality of the Free State province of South Africa. This study is best conceptualised as the developmental phase of a complex intervention. A pragmatic study was undertaken by employing a multiple method design and harnessing a three-phase approach that was guided by the theory-of-change logic model, while the integrated model of behaviour prediction (IMBP) served as a conceptualisation of the programme that targeted rural caregivers. Phase 1 implemented a visual-based narrative inquiry that collected data through the Mmogomethod®, and aimed to explore caregivers’ interest in using communication technology in two towns of the Kopanong municipality in the Free State province of South Africa. The researcher collected data from rural caregivers (n=17) comprising three groups in the towns of Springfontein and Trompsburg. Through a stepwise literature-based process for investigating textual and visual data, the researcher identified four themes. Three themes represent challenges facing caregivers, namely, psychosocial, social resources and informational challenges. Interest in communication technology was the fourth theme. Caregivers favoured using SMS (short messaging service), phone calls and computers. In Phase 2, literature was reviewed systematically to find the best evidence available to strengthen positive behaviour by caregivers of adolescents with mental health issues by using communication technology interventions. Five articles out of an initial 1 746 articles met the eligibility criteria and were included in the data synthesis. The researcher derived three thematic conclusions: 1) The target population included parents and family members serving as caregivers; 2) Caregivers experienced improved IMBP determinants (self-efficacy, knowledge, parent/child communication, parental skills), which was reflected in positive behaviour; and 3) Caregivers used various types of communication technologies (SMS, emails, phone calls, online communication, social media). Findings from these two phases were triangulated to develop a draft framework based on the theory-of-change logic model components. The completed draft framework was presented to expert stakeholders in the third phase during a workshop. Phase 3 comprised a one-day validation workshop that was attended by nine expert stakeholders involved in various adolescent healthcare settings. An experienced facilitator coordinated the workshop, thereby enabling a discussion on each component suggested in the theory-of-change logic model, using forward and backward mapping. Expert stakeholders contributed to three theory-of-change components depicted in the framework, specifically, community needs, desired results, and evidence-based strategies, to finalise the framework. This validation workshop concluded after consensus was reached on the final framework. Through evidence-based research, the framework can facilitate a programme for supporting caregivers through an mHealth initiative that results in positive caregiver behaviour change. This framework for an mHealth initiative for rural caregivers of adolescents with mental health issues illustrates the development phase of a complex intervention. Piloting this framework will be the next phase. The researcher will participate in the piloting, with the Free State Department of Health being a key stakeholder.Item Open Access Transformative learning experiences of nurse educators implementing high-fidelity simulation: an interpretative phenomenology analysis(University of the Free State, 2017-05) Phillips, Maria Jacoba Johanna; Van Rhyn, L.; Van Jaarsveldt, D. E.English: Globally, the use of high-fidelity patient simulation (HFPS) in healthcare professions education has escalated over the past two decades. HFPS is an innovative, effective learning strategy for bridging the gap in students’ understanding between theory and practice. Nurse educators accept that HFPS will play an important role in education in the near future. The future success of HFPS is dependent on nurse educator competence in this andragogy. However, HFPS is a challenging andragogy, also for nurse educators in South Africa. The study’s purpose was to explore, analyse and interpret nurse educators’ transformative learning experiences while they implemented HFPS at a school of nursing at a university in South Africa. An interpretative phenomenology analysis methodology helped to explore, analyse and interpret the learning experiences of nurse educators who successfully implemented HFPS. Seven voluntary participants took part in individual and dyadic, face-to-face, semistructured interviews and an unstructured face-to-face discussion, they kept reflective journals, and provided a summary of their learning experiences. The researcher recorded reflective notes after each interview. Data analysis adhered to phenomenological, hermeneutic and idiographic principles and was done from both inductive and deductive paradigms. The study complied with institutional ethical approval and other requirements. Five main themes transpired, namely, 1) frames of reference of participants before exposure to HFPS, 2) discovering a new world, 3) critical reflection on experiences, 4) critical self-reflection, and 5) transformation in action. Nurse educators experienced a deep transformative process similar to that described by the transformative learning theory of Jack Mezirow. The theoretical contribution of this study relates to nurse educators’ experiences of transformative learning while they implemented HFPS. Each participant described a unique engagement with self- determined learning.Item Open Access Nurse-educators' perception of cultural congruent nursing care: a model for education of novice nurses(University of the Free State, 2005-05) Masipa, Lebobe Asnath; Van den Berg, R. H.English: The population of South Africa is multicultural and because of this multiculturalism, health care practitioners render care to health care consumers of different cultural backgrounds. For practitioners to render holistic care that satisfies the consumers, nurses must have been comprehensively educated to render culturally congruent nursing care to all health care consumers. For nurseeducators to be able to impart the science and art of culturally congruent, holistic nursing care to novice nurses, the nurse-educators must themselves have been educated on culturally congruent and holistic nursing care. The purpose of the study was to ascertain how nurse-educators at universities and nursing colleges perceive culturally congruent nursinq.care, as well as the implications this has on the education of novice nurse practitioners. A nonexperimental research design of a descriptive, explorative, phenomenological and contextual nature was used to achieve the goal of the study. The point of departure for collecting the data was the "Reflective inquiry methodology" using focus group interviews, a questionnaire and a checklist to collect the necessary data. The focus group interviews were used to ground the formulation of questions included in the questionnaire while the checklist was used to audit the generic nursing education programmes on the educational grounding of culturally congruent, holistic nursing care. Based on the results obtained, it became clear that nurse-educators are not well prepared to teach holistic, culturally congruent nursing care. Furthermore, the majority of respondents recommend that culturally congruent nursing care be included in the curriculum of generic nursing education programmes. Based on the recommendations that were made, a model for the education of both the educators and the novice nurse practitioners was developed and adopted, taking the Brokering Model as described by Chalanda as a point of departure. The model ensured that both nurse-educators and practitioners possess the right mindset and have a comprehensive view of the science and art of nursing care, enabling them to teach and to render value-led, comprehensive and culturally congruent, holistic health care to all health care consumers.Item Open Access A model for facilitation in nursing education(University of the Free State, 2002-05) Lekalakala-Mokgele, Eucebious; Du Rand, P. P.Abstract not availableItem Open Access Verpleegsorgbehoeftes van HIV positiewe pasiënte(University of the Free State, 1996-05) Basson, Petro Magdalena; Van Rhyn, W. J. C.; Viljoen, M. J.English: HIV infection causes AIDS, a communicable, stigmatised and terminal disease. It leads to the progressive deterioration of the immune system that ends in death. HIV infection affects the total human being. Never in history were health care workers so drastically challenged to look beyond an illness and to take on a holistic approach to health, as in the case with AIDS. The research was done in two phases. The first phase was the reconnaissance and description of HIV positive patients' nursing care needs as well as nurses' view thereof. The selection of nurses and patients were done by purposiveness selection. The researcher has established the nursing care needs of the HIV positive patient in the study by in-depth interviews. Nurses' views of the nursing care were also obtained through in-depth interviews. Interviews were recorded on tape and were transcribed afterwards. Data analysis was done according to Giorgi's model. After data analysis had been done, the results were controlled and verifted with the literature. The abovementioned processes were completed according to the philosophic foundation of the researcher, namely the Christian anthropology. Several needs and problems of the HIV positive patients with regard to their nursing care were identified. Nurses also experienced problems in the delivery of their nursing care. The primary problems that nurses experienced were, a lack of information about HIV and AIDS as well as limited time to deliver quality nursing care. Phase two: From the gathered information from HIV positive patients, nurses and literature, a nursing care model was compile to provide in the needs of the HIV positive patients. The model makes provision for application in any stage of AIDS. The family, community, resources and the multi-disciplinary team fugerate in this model. The nurse is the key role player in the model. The model is framed by the 15 aspects of Dooyeweerd and therefore shows that the HIV positive patient is nursed according to the holistic approach. The description and reconnaissance of the concepts applicable to the model were done according to the theory generated by Marriiler-Tomey,(1989:5), Woods and Catenzaro (1988:20), Walker and Avant (1988: 10) and Kim (1983: 131). This middle range theoretical model was compiled to ease the task of the nurse in practice and also to deliver quality nursing care to HIV positive patients.Item Open Access The lived experiences of rural-based grandparents raising HIV/AIDS-orphaned grandchildren in the Kingdom of Swaziland: a proposed self-care health education programme(University of the Free State, 2009-11) Sithole, Sifiso I.; Van Rhyn, LilySince the late 1990s, the Swazi adult population has been dying from HIV/AIDS related illnesses and leaving behind children who end up being looked after by older adults, in particular grandparents in rural areas. Empirical evidence abounds with findings that indicate that older adulthood is predominantly characterized by declining health. Owing to the HIV/AIDS epidemic that has killed many Swazi adults, most grandparents, especially those in rural areas have become primary caregivers of HIV/AIDS-orphaned minors. This research investigated 14 rural-based grandparents whose ages ranged from 60 through 88 years and looked after, on a full time basis, grandchildren orphaned through HIV/AIDS in the lowveld of the Kingdom of Swaziland. Primarily, the study sought to explore and describe the lived experiences of rural-based grandparents raising grandchildren orphaned through HIV/AID. Secondly and based on the findings, the ultimate purpose of the study was to formulate a strategy to address the findings thereof. The study was guided by the four phases of the nursing process, namely assessment, planning, implementing and evaluation. While phase one focused on exploring and describing the day-to-day personal realities of these rural-based grandparents raising grandchildren orphaned through HIV/AIDS, phase two described the development of the conceptual framework that was used to guide the development of the health education programme. Phase three focused on the structure and process of the actual programme. Phase four evaluated the developed programme. Phase one: This phase was the phenomenological part of the study and had a design that was qualitative, exploratory, descriptive and contextual. As the study was naturalistic, the data were collected at the homesteads of the participants through audio taped face-to-face unstructured in-depth interviews that were guided by the following two open-ended-questions, ‘‘Ngiccela ungichazele kabanti kutsi engabe kunjani kunakekela batukulu bako labashiywa batali babo?“ [“What/How is it like to care for your grandchildren whose parents died through HIV/AIDS?“] and “Ukhona njani kumelana netidzingo tonkhe telabatukulu bako?“ [“How do you manage to look after your grandchildren whose parents dies through HIV/AIDS?“] An exploratory interview preceded the main data collection for the purpose of ensuring that the two questions were clear enough for the participants to understand and describe their day-to-day encouters with such children. Other sources of data were: field notes, health records and to a lesser extent, photographs that were taken of objects and relevant scenary but not the participants. The researcher adhered to the prescribed research standards. Data analysis started soon after completion of each interview. The data were analyzed through the method of Tesch (1990:93). Six major categories were identified: NO SUPPORT, COMPROMISED HEALTH, RESOURCE AND BASIC NEEDS CONSTRAINTS, FEELING OVERWHELMED, CONCERNS ABOUT THE FUTURE OF THE GRANDCHILDREN and SACRIFICING. The majority of the afore-mentioned identified categories needed interventions that were collaborative between various stakeholders. However, the category COMPROMISED HEALTH was found to be an area that nursing could do something about. Consequently, a health education programme to empower with self-care rural-based grandparents raising GOTHA in the lowveld was the strategy that was chosen. With the completion of data analysis phase one had been completed. Phase two: This phase marked the post research stage and focused on the development of the conceptual framework that guided the development of the proposed health education programme to empower with self-care rural-based grandparents raising grandchildren orphaned through HIV/AIDS in the lowveld. Its structure and process were described. Phase three: Phase three was divided into two interrelated parts, namely phases 3(a) and 3(b). While phase three(a) described the structure of the proposed health education programme, phase three(b) focused on describing the process apsect of its implementing. The implementers of the proposed health education programme were identified as community health nurses. Phase four: Phase four formed the final phase of the development of this research and sought to evaluate the programme. Selected stakeholders were requested for their input on the developed health education programme. Also discussed in this phase were the study contributions, limitations and implications, especially to government and community health nursing practice, education, management and research. Recommendations were suggested.Item Open Access A strategy for meaningful simulation learning experiences in a postgraduate paediatric nursing programme(University of the Free State, 2016-01-31) Spies, Cynthia; Botma, YvonneEnglish: Learning through simulation is a relatively young science in nursing education. Although the benefits of simulation as an effective learning strategy in nursing education are supported by extensive research on the subject, the development of meaningful simulation learning experiences can be challenging, especially to nurse educators who do not feel prepared for this type of educational approach. The purpose of this study was to develop a strategy for meaningful simulation learning experiences in a postgraduate paediatric nursing programme. An educational action research design, based on a social constructivist paradigm, was used to answer the research question: How can meaningful simulation learning experiences be achieved in the postgraduate paediatric nursing programme? Through the process of three action cycles extending over a period of two years, a strategy was developed, refined and finalised, based on data gathered from two separate groups of paediatric nursing students. The first group of participants consisted of 21 students, and the second group of participants consisted of 18 students. Qualitative data were gathered by means of the nominal group technique, field/reflective notes, recording of debriefing sessions and focus group interviews. In the third cycle, in addition to qualitative data, quantitative data were gathered by means of a simulation evaluation questionnaire. At completion of the two-year project, a final strategy for meaningful simulation learning experiences emerged, based on a synthesis of data gathered. Aspects relating to meaningful simulation learning experiences included a safe learning environment, authenticity, a responsive simulator, cognitive processes such as reflection-on-action, independent thinking, and meaningful knowledge construction. Furthermore, the students valued simulation learning experiences as opportunities to improve competence, psychomotor skills, self-confidence and teamwork. They learned to integrate theory and practice and experienced a paradigm shift that influenced their view of the conditions under which nursing care should be provided to children. A major hindrance to learning through simulation was the students’ dependence on an educator and reluctance in taking ownership of their own learning. This finding related to a discovery made in the first action cycle, which was that nurse educators should be careful to assume that postgraduate nursing students, who are considered mature individuals, naturally have the characteristics of adult learners. Apart from a strategy consisting of specific action items and expected outcomes upon their implementation, seven characteristics of meaningful simulation learning experiences were identified, namely constructively aligned instruction, challenging learning tasks, a non-judgmental student-centred approach to students, collaboration through a community of learning, deliberate practice, an authentic learning environment, and relevant student preparation. The strategy developed in this study endorses the use of constructivist learning theory and Kolb’s experiential learning theory to achieve meaningful simulation learning experiences. The study contributes to the practice of simulation in nursing education because it gives nurse educators a theoretically and empirically founded plan for implementing simulation in a way that students find meaningful and conducive to learning. The paediatric nursing students experienced a paradigm shift in terms of their practice as healthcare providers to children, which translated into strengthened nursing values and renewed motivation to transfer their learning to the practice setting.Item Open Access A problem-based education programme for registered nurses in advanced midwifery and neonatology(University of the Free State, 1996-05) Fichardt, Anna Elizabeth; Viljoen, M. J.English: It is the aim of the current government that primary health care should be established in South Africa to address the health care needs of the entire South African population. In this regard midwives are seen as the key figuires to establish comprehensive perinatal health care. The altered focus of the delivery of health care from curative to primary health care demands expertise from midwives to enable them to meet the needs of the community. This requiires an alternative approach to nursing education. Various researchers expressed a concern regarding continuing professional education for midwives. To address these problems, grass root involvement by practising midwilves is proposed, in order to prepare them for continuing education. A proposal was made that continuing professional education should be implemented in the regions. The Perinatal Committee of the Free State supported the need for an education programme for midwives in the region. In response, the learning needs of the registered nurses were formally assessed and the Advanced University Diploma in Midwifery and Neonatolog1y was developed and implemented. The community's perinatal health care problems and the learning needs of the potential students played a significant role: in the development of the objectives and the selection of the content. An innovative teaching methodology, namely problem-based learning was chosen. With the development and implementation of the Advanced University Diploma in Midwifery and Neonatology the researcher not only tried to prepare graduates who can function in clinical context with the demands placed on them are constantly changing, where problems and situations are not easily defined or solved and where the body of knowledge is rapidly changing. The researcher also aimed to prepare health workers who will contribute maximally to the improved health of the individuals and communities they serve and tried to help students to learn how to learn, that is to create independent learners who will assume active responsibility for a lifetime of continuing education and who will be able to keep up with advances in their field.Item Open Access Models of care for antiretroviral treatment delivery : a faith-based organization's response(University of the Free State, 2012-04-14) Wilke, Marisa; Botma, Y.; Stark, R.; Van Rensburg, H. C. J.Background: Since 1849, Catholic religious have provided health services in South Africa. They have established hospitals, clinics, and have provided community-based preventive and curative services throughout the country. Today faith-based organizations (FBOs) continue to play an important role in healthcare delivery and are crucial to the goal of providing universal access to antiretroviral therapy (ART). In order to scale up HIV care and treatment, there is a need to describe and analyze ART models of care (MOC) that address the challenges faced by developing countries. The South African Catholic Bishops’ Conference (SACBC) manages twenty ART clinics in medically underserved South African communities, where the need is great, but the resources limited. These SACBC managed ART clinics operate on different MOC. A study to describe, analyze and compare the different MOC can inform future directions in healthcare delivery in resource-constrained settings. Method: A single case-study design was used to describe, analyze and compare four different MOC (managed by the SACBC) for ART delivery, as embedded units of analysis. A mixed method approach was used, incorporating qualitative and quantitative information. Data were collected using structured interviews (n=1,006 adult ART patients), file audits (n=1,006 files of the respondents), semistructured interviews (n=27 healthcare workers) and nominal groups (n=12 groups with Home Based Care-workers). Descriptive and inferential data analyses were conducted by a biostatistician from the Department of Biostatistics at the University of the Free State and the researcher. Findings: In the study, patients accessed care late (CD4=119 cells/mm3). Decentralized care provided better access. Family members are a potential source of support because disclosure rates to relatives and others were high (95.63%). Nurse-driven, doctor supported care was not inferior to doctor-driven care. Task-shifting to registered nurses and HBC-workers can be implemented successfully with support. Differences exist between the South African Government (SAG) -managed model and the FBO–managed models. Partnership between the SAG and FBO strengthened the SAG-managed MOC, while capitalizing on the sustainability of the government services. Functional information systems, developed by the FBO, were implemented at all the MOC in 2009. All the MOC focused on acute care. Conclusions: Nurse-driven decentralized service can most effectively and appropriately address the chronic nature of HIV and strengthen the healthcare system by a paradigm shift to a chronic care model. Based on the findings, a chronic care model was adapted for South Africa that has seven elements: (1) an integrated, decentralized chronic care system based within a primary health setting; (2) partnerships with NGOs; (3) an effective information management system; (4) patients and their families; (5) self-management support to patients; (6) provider decision support and (7) delivery system redesign. Implications for the nursing profession include adaptation of focus and training, as well as the recognition of the nurse practitioners/specialist role in South Africa.Item Open Access A framework to expand public health services to HIV exposed and HIV positive children(University of the Free State, 2009-07) Reid, Marianne; Botma, Y.The aim of this study was to develop a framework to expand public health care services to HIV exposed and HIV positive children in the Free State. The objectives set in order to meet the aim were to identify strategies to expand health care services to these children and to then develop a framework to expand health care services to them within the Free State public health sector. The study consisted of various component projects, depicted as phases. The researcher conducted two components, Phase 1b and Phase 2 which links to the fore mentioned objectives of the study. A colleague, conducting research as Master student, conducted Phase 1a of the study, describing health care services rendered to HIV exposed and HIV positive children in the Free State public health sector. The researcher was intimately involved in Phase 1a, as she was acting as co-study leader. Health policy research was used, which is a type of health systems research, in an effort to inform higher levels of health on policy choices. Health managers were therefore active stakeholders in the development of the framework. The identification of strategies to expand health care services to HIV exposed and HIV positive children were one such activity where stakeholders assisted in the development of the framework. The Nominal Group Technique was used to identify mentioned strategies. A draft framework was developed using the Theory-of-Change Logic model as theoretical underpinning of the framework, with the empirical foundation being based on triangulated data obtained from literature findings, Phase1a and Phase 1b of the study. During a workshop with stakeholders, the framework was finalized, providing stakeholders the opportunity to validate the identified problem, namely that of fragmented care being delivered to HIV exposed and HIV positive children, due to over-verticalisation of programs. The validation of the framework was completed by confirming the desired results, possible influential factors that could impact on the results, as well as strategies that could be followed to expand health care services to fore mentioned children. Since health policy research only informs policy choices, the extent to which the framework will actually inform policy is in the hands of the Free State Department of Health.Item Open Access A framework to improve postnatal care in Kenya(University of the Free State, 2015-01) Chelagat, Dinah; Roets, L.; Joubert, A.English: More than half a million women encounter complications during childbirth annually with a significant number of fatalities (UNFPA 2009: Online). It is estimated that 1,000 girls and women die in pregnancy or child birth each day (The White Ribbon Alliance 2010: Online; Ashford, Wong and Sternbach 2008:457-473). Ashford et al. (2008) further state that almost 40% of women experience complications after delivery with about 15% of these women developing potentially life-threatening complications. Maternal mortality can occur either during the antenatal, intrapartum or postnatal period. However, strategies to reduce maternal mortality have focused on the antenatal and the intrapartum periods (Ministry of Health, Kenya 2006: 52). Maternal mortality can be reduced with improved postnatal care by skilled health care professionals , the majority of whom are the midwives in many low and middle income countries (Senfuka 2012: Online; UNFPA 2011c: Online). Maternal mortality is greatest during the postnatal period which remains the most neglected stage of maternal care especially in the LMICs Kenya included (Safe motherhood 2011: Online). The aim of this study was to develop a Framework to improve postnatal care in Kenya. The study was accomplished in three phases whereby the first objective was to determine factors contributing to the current state of postnatal care services in Kenya which was undertaken in Phase 1.This objective was achieved through data collection where by 258 midwives completed a self-administered questionnaire plus a checklist used in 37 hospitals to assess the availability of physical resources required in the provision of postnatal care. Data analysis revealed that shortage of midwives exists in all the hospitals utilised for the study with a nurse midwife ratio of more than 10. It was further observed that midwives received incomplete orientation on being posted to the maternity units/postnatal wards hence their inability to provide quality postnatal care services. Policies and guidelines were reported to be inaccessible by a majority of the midwives and that cultural and religious beliefs of clients were deemed to have some influence on the provision of the postnatal care. The Nominal Group Technique was used among 13 Reproductive health coordinators in phase 2 to identify the strategies they deemed if employed would improve postnatal care in Kenyan hospitals.The six strategies identified in order of priority are capacity building, data management, quality assurance, human resource management, supportive supervision and coordination of postnatal care activities. The objective of this phase of study was achieved as the NGT process was followed scientifically and results obtained (the strategies) contributed to the development of the Framework as one of the important components of The Theory of Change Logic Model. The third objective and final phase of the study was to develop a Framework to aid in improving postnatal care in Kenya. Development of the framework was accomplished by triangulating the results obtained from Phases 1 and 2. The Framework development was guided by the Theory of Change Logic Model which describes the casual linkages that are assumed to occur from the start of the project to the goal attainment (Frechtling 2007: 5; Taylor-Powell and Henert 2008: 4). The components of the Theory of Change logic by Kellogg (2004: 28) are the problem or issue, community needs, desired results, influential factors, strategies and assumptions (Kellogg 2004: 28). The draft Framework was presented to the Reproductive Health coordinators for validation in a meeting held on 12th March 2014. The stakeholders who are the Reproductive Health coordinators added their expert input to the components of the Theory of Change Logic Model during the validation process leading to a complete Framework aimed at improving postnatal care in Kenya.Item Open Access Die onderrig van professionele praktyk in die geïntegreerde, vierjaar verpleegkunde program(University of the Free State, 2009-08-05) Botha, Delene Ellen; Roets, L.English: Florence Nightingale was 206 years ago of opinion that Nursing is not a household sercide or charity service and that nurses should be educated Nursing today is acknowledged as a profession and the aim of Nursing Education, as formulated by the South African Nursing Council (SANC) is that student nurses should be holistically developed. In contrast to 20 years ago, professional nurses today have to function autonomously, scientifically, within legal and ethical frameworks as well as cultural congruently. It is no more expected from professional nurses to only act on doctors’ prescriptions, to perform technical procedures or to only observe patients and record information. They have to practice as independent practitioners. In accordance to SANC requirements, students are educated in the science and art of Nursing, other related sciences as well as Ethics and Professional Practice (Björkstrom, et al., 2006:505; Davis, Tschudin & de Raeve, 2006:21; Jormsri, Kunaviktikul, Ketefian & Chaowalit, 2005, intyds; Gastmans, 2002:intyds; Taft, 2000:intyds; Hussey, 1996:251) When students apply for registration with SANC after they have completed their studies, they actually declare that they comply with the autonomy, responsibility, values and norms of Nursing and are prepared to practice accordingly. This implies that they declare that they have developed a professional identity. Development of professional identity is an ongoing process and has to be addressed, amongst others, in the teaching of Ethos and Professional Practice. The aim of this study was to understand what the nature of Professional Practice is and to assess the process of teaching of Ethos and Professional Practice at national level. The research was explorative, descriptive and explainatory in nature and both quantitative techniques and qualitative techniques were used for gathering of data. Data gathering was done in different phases, namely analysis of disciplinary hearings, focus groups, literature analysis as well as telephone interviews. The results indicate that the majority of nursing institutions teach the content appropriate to SANC’s guidelines. These guidelines were drafted in 1985 and is currently being revised. The profile of the students who are entering Nursing has changed. It is therefore a concern that traditional teaching techniques, such as lectures, class room discussions as well as written assessment are still mostly used in teaching Ethos and Professional Practice. These techniques do not improve development of professional identity. The time allocated to the teaching of [Ethos and] Professional Practice is problematic if the development of professional identity is required. Teaching and following-up of students with regard to [Ethos and] Professional Practice in the clinical setting was found to be insufficient. Taking this into account as well as the fact that there are not sufficient positive role models present, make it impossible for students to develop a professional identity. Students who do not develop a professional identity have a greater risk of unprofessional conduct. A framework, aimed at teaching [Ethos and] Professional Practice in order to develop a professional identity was compiled. This aims to enhance professional conduct.Item Open Access A framework to foster intrapreneurship amongst unit managers working at three public hospitals in Mangaung, Free State(University of the Free State, 2013-07) Letsie, Thandiwe Marethabile; Van der Merwe, Anita; Botha, DeleneEnglish: Introduction and background: Dynamic environmental challenges compel different organizations such as the health sector to focus on innovative changes to address difficult health care challenges. The aim of the study was to develop a framework to support the fostering of intrapreneurship within unit/operational nurse managers working in three public hospitals situated in Mangaung, Free State.The objectives of the study were to analyse the concept of intrapreneurship using Walker and Avant’s framework for concept analysis; to explore the conduciveness towards intrapreneurship of unit/operational managers within the hospital working environment, to explore the intrapreneurial characteristics of unit/operational nurse managers as well as their understanding and view of intrapreneurship within the hospital working environment. Methodology: A convergent parallel mixed method design that included a concept analysis, exploratory qualitative research methodology in the form of focus groups and the application of a quantitative-type descriptive survey using Hill’s Intrapreneurial Index questionnaire III (2003) were used. Reliability was determined through the use of a pilot case study, split-half and test-retest reliability. An exploratory pilot study lead to the adaptation of a number of concepts in the survey to suit the population better. Purposive sampling was used to select participants for the qualitative data collection process that included five focus groups managed by an expert facilitator. In the quantitative data collection process, all members of the population (N=104) had a chance to participate. Ethical clearance was obtained from the Faculty of Health Sciences, University of the Free State. The ethical principles of beneficence, respect for human dignity, and justice were considered. Participation in the study was voluntary, participants were informed of the risks and benefits of the study and homogeneity of the group was maintained at all times. Findings: The concept analysis process underlined the complexity of the multifaceted concept of intrapreneurship and highlighted critical attributes such as innovation, creativity and risk-taking. The majority of the antecedents were located within the organization whilst the consequences highlighted innovative ventures, the identification of opportunities and improved performance. A total of 42 participants attended the focus group sessions with 8 to 9 participants per group. The participants were mostly women (89.7%) and between 50-59 years (55.3%). The focus group discussions yielded a number of interesting results. Participants considered the concept to relate to a business venture, innovation, involvement and of being valued. Factors that were considered conducive to intrapreneurship included for example training and development, planning, quality improvement initiatives and a business focus in the organization. They considered the infrastructure, limited resources, poor security, communication, limited respect for rights and lack of incentives as detriemental to intrapreneurship. Within the quantitative data collection process the response rate was 40% (n=42). Findings from the survey indicated a primarily low intrapreneurial intensity index. Five of the six intrapreneurial indexes as postulated by Hill scored low (leadership, policies, culture, structure and task) whilst only the employee index scored relatively high, indicating participants’ self-valuing of own innovative vision, and courage to embrace change. Conclusion: The analysis and triangulation of data provided the conceptual data to develop a framework to support intrapreneurship in this context. The framework hinges on the external and internal environment – highlighting the positive and negative influences that come to play. The positive external environmental factors included environmental dynamicity and uncertainty as compared to negative factors such as limited organizational ownership and legislative obstacles. The internal environment outlines the importance of organizational wellbeing, organizational leadership, support and communication. Attributes within the intra-environment include innate, personal attributes of unit/operational managers, demographic and situational attributes. Recommendations from the study focussed on the enhanced teaching and learning of intrapreneurship principles and practices in the public hospital environment, the utilization of the intrapreneurship framework in nursing management programmes (formal and nonformal), the support of intrapreneurial activities at national and provincial level and the inculcation of a paradigm shift to embrace the intrapreneurial approach within health care services. The use of transformational leadership style and the capacity building of nursing teams seem to be pivotal in this process. Limitations: The small sample size in the quantitiatvie survey was a cause of concern, whilst the participants’ limited knowledge and understanding of the concept of intrapreneurship may have influenced the meaningful identification of factors that hinder or foster intrapreneurship in the public hospital work environment – this might have lead to a focus on challenges they face from day-to-day. The current health care services context was seen to create uncertainty and fear of cutting positions. This may have resulted in insecurity amongst unit/operational nurse managers and their willingness to freely disclose matters of concern.Item Open Access A problem-based education programme for registered nurses in advanced midwifery and neonatology(University of the Free State, 1996-05) Fichardt, Anna Elizabeth; Viljoen, M. J.It is the aim of the current government that primary health care should be established in South Africa to address the health care needs of the entire South African population. In this regard midwives are seen as the key figures to establish comprehensive perinatal health care. The altered focus of the delivery of health care from curative to primary health care demands expertise from midwives to enable them to meet the needs of the community. This requires an alternative approach to nursing education. Various researchers expressed a concern regarding continuing professional education for midwives. To address these problems, grass root involvement by practising midwives is proposed, in order to prepare them for continuing education. A proposal was made that continuing professional education should be implemented in the regions. The Perinatal Committee of the Free State supported the need for an education programme for midwives in the region. In response, the learning needs of the registered nurses were formally assessed and the Advanced University Diploma in Midwifery and Neonatology was developed and implemented. The community's perinatal health care problems and the learning needs of the potential students played a significant role in the development of the objectives and the selection of the content. An innovative teaching methodology, namely problem-based learning was chosen. With the development and implementation of the Advanced University Diploma in Midwifery and Neonatology the researcher not only tried to prepare graduates who can function in clinical context with the demands placed on them are constantly changing, where problems and situations are not easily defined or solved and where the body of knowledge is rapidly changing. The researcher also aimed to prepare health workers who will contribute maximally to the improved health of the individuals and communities they serve and tried to help students to learn how to learn, that is to create independent learners who will assume active responsibility for a lifetime of continuing education and who will be able to keep up with advances in their field.