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Item Open Access Mental health literacy among primary healthcare nurses in the Dr Ruth Segomotsi Mompati district(University of the Free State, 2023) Morifi, Mmatlou Gabriel; Jansen, RonelleMental health literacy (MHL) is the ability to recognise, manage and prevent mental health disorders. Primary healthcare (PHC) nurses provide mental health services in the PHC facilities to all patients seeking help, even though many of them do not have adequate levels of MHL. The study aimed to describe and explore the MHL of PHC nurses in Dr Ruth Segomotsi Mompati (Dr RSM) district. Studies are done worldwide on MHL; few are found in South Africa (SA), while no study is in the Dr RSM district in the North West province of SA. A quantitative research methodology, utilising cross-sectional and descriptive methods, was used for this study. Eighty-four participants participated by completing questionnaires. The PHC workers who participated in the study all worked at PHC facilities in the Dr RSM district, North West province. The PHC nurses who participated gave informed consent by signing a consent form before participating in the study. The language used for this study was English. MHL questionnaires were used for data collection from participants working at PHC facilities in Dr RSM. The collected data was captured in Excel. Data analysis was done with the help of a biostatistician at the University of the Free State. The data analysis was done on the ability to recognise depression, suicidal thoughts, schizophrenia, anxiety disorders, and post-traumatic disorders using vignettes (scenarios). Most of the participants demonstrated good MHL by recognising these mental disorders, with an above-average percentage. They correctly identified suitable healthcare professionals for the management of mental disorders but also thought that clergy, ministers, or priests could assist. Psychotherapy and physical activities were believed to be helpful for the prevention of mental disorders, while some of the participants incorrectly indicated that alcohol would be helpful. The recommendations include that all PHC nurses undergo the necessary mental health training to have an adequate MHL when providing mental health services. There should be six-month refresher courses for those with mental health nursing qualifications. PHC nurses interested in the field should be allowed to specialise in mental health. Mental health awareness campaigns should be mandatory at each PHC facility. There should also be collaboration with stakeholders outside of the healthcare sphere who are consulted for mental disorders.Item Open Access Lived experiences of pregnant adolescents within a district of the Northern Cape(University of the Free State, 2023) Khara, Relebohile Silvia; Mpeli, M. R.; Shokane, M. A.Adolescent pregnancy is a significant issue in the world. According to the WHO (2020), globally, approximately 21 million adolescents between the ages of 15 and 19 in developing regions become pregnant annually, and 12 million of those adolescents give birth. Furthermore, 777 000 births occur among adolescents younger than 15 years from developing countries. The rate of adolescent pregnancy remains high in developing countries. In South Africa, birth rates among adolescents remain high in some of the provinces. Gaining insight into adolescents’ experiences may clarify the escalation of adolescent pregnancy and other related factors in the Northern Cape. It is against this background that the purpose of the study was to explore and describe the lived experiences of pregnant adolescents within a district of the Northern Cape. The study opted for a qualitative research approach to explore and describe the lived experiences of pregnant adolescents within a district of the Northern Cape. This study was further guided by an interpretivist paradigm, where phenomenology was chosen as tradition of inquiry. Unstructured in-depth interviews were conducted to gather data from nine purposively sampled pregnant adolescents who met the inclusion criteria. Empirical data were thematically analysed to construct comprehensible categories of meanings in relation to both the investigated problem and main purpose of the study. The results of the study reveal that participants were confronted with myriads of challenges, such as psychosocial challenges, impressions of being pregnant and emotions incurred. Social support (family and partner) was viewed as a fundamental instrument which aided participants to pull through with their pregnancy. As such, the key recommendation of the study addresses nursing education and practice, as well as future research.Item Open Access Lived experiences of mothers lodging at a public hospital in South Africa(University of the Free State, 2022) Ntuli, Matshediso Julia; Spies, CynthiaThe lived experiences of mothers who must make use of lodging residences while their sick babies have been admitted to a neonatal care unit (NCU) is understudied. The challenges that these mothers face daily is not well documented. To explore and understand the phenomenon of lodging at a public hospital in South Africa, this study focused on mothers and their experiences while waiting for the recovery of their babies. The research question to be answered was: What are the lived experiences of mothers lodging at a public hospital while their babies have been admitted to an NCU? Since little is understood about lodging and its challenges, the researcher selected a qualitative approach through which data could be obtained from participants who had first-hand experience of lodging. A sample of 13 mothers participated in the study. The research phenomenon was investigated using data obtained from in-depth individual interviews. The findings of the study included five categories with relevant subcategories. The five major categories were: lodging environment, emotional experiences, nursing care of babies, interaction with staff, and participant perspectives. From the data, it was inferred that participants experienced many challenges and multiple causes of stress during the lodging period and that they were not well supported by the service providers. In terms of recommendations, the institution providing the lodging should commit to developing support programmes and policies for mothers who must endure being away from family and social support structures. Extended research into the phenomenon of lodging mothers might lead to the development of a unique institutional approach that will ensure a stay as pleasant and supportive as possible. In turn, satisfied mothers and supportive staff relations may reflect positively on the well-being and health outcomes of the babies.Item Open Access Experiences of health sciences students residing on campus during university recess: a photovoice study(University of the Free State, 2023) Kekana, Palesa Mildred; van Jaarsveldt, Deirdre Elizabeth; Mathebula, MikatekoThis study addressed the lack of empirical research on the experiences of South African health sciences students residing on campus during university recess. The health professional governing bodies in South Africa require students to gain clinical competence through work-integrated learning, which is often undertaken during university recess. Yet, literature on this specific topic could not be retrieved. Studies on clinical learning in the health sciences environment focus solely on the clinical workplace, without considering students residing in campus residences during recess. The unknown struggles and potential challenges faced by health sciences students during recess could raise significant issues that higher education institutions in South Africa should consider. To address this research gap, participatory research utilising the photovoice method was employed to answer the research question: what are the experiences of health sciences students residing on campus during recess at a specific university? Four health sciences students were recruited through purposive sampling to participate in a series of workshops. They were provided with cameras to document their experiences on campus during university recess. Discussions and an exhibition of the photographs were conducted, resulting in the identification of 13 themes that were clustered into four, namely, sharing personal space, support services and structures, security, and character building and personal development. These clustered themes flagged that the co-researchers experienced a loss of sense of belonging, linked to inadequate support during university recess. Moreover, the study demonstrates the feasibility of implementing participatory research under challenging conditions, such as COVID-19 restrictions. The participatory method empowered co-researchers to advocate for themselves and others, thereby shedding light on issues that matter for institutional transformation. It would be advantageous to expand the research with more participants, across disciplines, and over longer periods of recess to inform policies and guidelines relating to recess periods.Item Open Access Lesbian, gay, bisexual, transgender, and intersex content in nursing education programmes: a mixed method systematic review(University of the Free State, 2023) Coetzee, Tyrone Brett; Van Jaarsveldt, Deirdre Elizabeth; Fichardt, Anna Elizabeth𝗜𝗻𝘁𝗿𝗼𝗱𝘂𝗰𝘁𝗶𝗼𝗻: A prevailing heteronormative approach observed within nursing programmes could perpetuate non-inclusive attitudes amongst nurses. A paucity of published evidence indicated the need to undertake a comprehensive synthesis of evidence regarding LGBTI content in nursing programmes. 𝗣𝘂𝗿𝗽𝗼𝘀𝗲: This MMSR set out to critically synthesise existing evidence in the literature on LGBTI content in nursing programmes in order investigate what evidence exists in the literature on LGBTI content in nursing programmes. The MMSR is provided an updated and comprehensive insight into the presence/inclusion of literature which covers LGBTI-related content in nursing education programmes. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀: A mixed method systematic review, conducted according to Joanna Briggs Institute (JBI) Manual for Evidence Synthesis Preferred Reporting Items for Systematic Reviews and Meta-Analyses using the (PRISMA) guidelines, guided the review process. The MMSR followed systematic approach to the search and selection of literature. Data sources were identified within EbscoHost Web, Scopus and Google Scholar. A convergent integrated approach for data integration and synthesis was followed. Data were extracted with the use of two standardised data extraction tools. Through inductive reasoning and MMSR processes of thematic analysis, data transformation, data integration and data synthesis of information from qualitative, quantitative, and mixed method studies. The main search identified 316 publications (n=316) resulting in ten (n=10) articles for quality appraisal. Data of nine (n=9) articles included in this review were extracted. A thematic analysis (manually performed) aided in identification of recurrent themes. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: LGBTI content in nursing programmes were found to be present but lacking specificity and relevance. The context in which the included studies were conducted linked several social and health related LGBTI aspects, regardless of location. However, location and local belief system dictated extremes to which LGBTI inclusivity was practiced. The review findings further elaborate that curricular revision is necessary in the advancement of social justice, to overcome challenges and barriers to LGBTI inclusion. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻𝘀 𝗮𝗻𝗱 𝗥𝗲𝗰𝗼𝗺𝗺𝗲𝗻𝗱𝗮𝘁𝗶𝗼𝗻𝘀: In nursing education, a prevailing heteronormative approach creates large gaps in cultural and clinical competencies regarding LGBTI health issues. The concepts of inclusivity, representation, respect, and recognition, according to the review findings, LGBTI content should be included in teaching and learning offerings provide new foci and understandings within the LGBTI research area. Education on LGBTI health disparities could foster a keen appreciation of the impact of stigma and discrimination experienced by LGBTI persons. To advance a social justice agenda for marginalised and vulnerable populations, LGBTI health-related content in nursing education and healthcare service delivery programmes could enrich and supplement content currently presented.Item Open Access Stress, burnout, and compassion fatigue of undergraduate nursing students at a public university during the COVID-19 pandemic(University of the Free State, 2021) Potgieter, Beatrice; Engelbrecht, Michelle; Wilke, MarisaThe Professional Quality of Life conceptual framework forms the foundation for this study and was developed by Stamm (2010:8). This framework explains how stress, secondary trauma, burnout, and compassion fatigue have a negative effect on undergraduate nursing students’ psychological wellbeing. Undergraduate nursing students have been found to have more stress than other students during their studies (Chowet al., 2018:2; Labrague, 2013:424; Turner & McCarthy, 2017:21). This is due to their high academic workload and clinical hours required for nursing competency (Chernomas& Shapiro, 2013:1; Labrague, 2013:428). Stress over a prolonged period of time can lead to burnout (Ferriet al., 2015:106). Burnout in combination with secondary trauma can cause compassion fatigue (Stamm, 2010:13). Secondary trauma is caused by being exposed to someone else’s extremely negative or traumatic experiences within a caring capacity (Stamm, 2010:13). Compassion fatigue summarises the negative effects of caring (Chachula, 2021:2). In opposition to the negative factors, there is compassion satisfaction (Stamm, 2010:12). Compassion satisfaction can be described as the psychological fulfilment of doing work well and acts as a protective agent against compassion fatigue and burnout (Hegneyet al., 2014:507; Hinderer et al., 2014:161; Manson, 2013:28; Mason & Nel, 2012:451; Stamm, 2010:12).The research design for this study was a descriptive cross-sectional survey. The levels of perceived stress, burnout, compassion fatigue, and compassion satisfaction experienced by undergraduate nursing students at a School of Nursing at a university in central South Africa were described. The levels of stress, burnout, compassion fatigue, and compassion satisfaction experienced by first- and second-year students during the coronavirus disease 2019 (COVID-19) pandemic were compared to the levels experienced by first- and second-year students prior to the pandemic in 2018, based on an existing dataset at the same university (Engelbrecht & Wilke, 2021:142). All students at the selected university who were enrolled in the Bachelor’s Degree in Nursing were asked to participate. Of the 288 students, 108 participated in the study; the response rate was 38%. Three previously validated and reliable scales were used – namely, the Maslach Burnout Inventory Human Services Survey (MBI-HSS), Professional Quality of Life Scale (ProQOL-5), and the Perceived Stress Scale (PSS). Additional biographical information and information concerning COVID-19 was also added. Data collection took place just before the ‘second wave’ of COVID-19 at the end of 2020, during the final examinations. No undergraduate nursing students were completing practical hours at this time. Data were cleaned and analysed in the Statistical Package for the Social Sciences (SPSS). Descriptive statistics, including frequency counts and percentages, were calculated for categorical variables. Means, medians, and standard deviations were calculated for continuous variables. Cronbach’s alpha was used to test the internal consistency of the scales and sub-scales. One-way analysis of variance (ANOVA) was used to determine whether there were any statistically significant differences between the means of first-, second-, third-, and fourth-year students on perceived stress, emotional exhaustion, depersonalisation, personal accomplishment, compassion fatigue, and compassion satisfaction. Multiple regression was run to predict compassion fatigue in nursing students from year of study, emotional exhaustion, depersonalisation, and perceived stress. The independent sample t-test was used to determine if there was a statistically significant difference between the mean scores for perceived stress, emotional exhaustion, depersonalisation, personal accomplishment, compassion fatigue, and compassion satisfaction of first- and second-year nursing students who participated in the 2018 study and first- and second-year nursing students who participated in the current study. Ethical clearance was obtained from the Health Science Research Ethics Committee of the Faculty of Health Sciences, University of the Free State. The results of the study indicated that undergraduate nursing students had moderate levels of stress. These findings were similar to other studies that also used the PSS in South Africa (Engelbrecht &Wilke 2021:142) and in Saudi Arabia (Shdaifat et al. 2018:33; Waled & Mohammed, 2019:121). With regards to burnout, the emotional exhaustion sub-scale suggested moderate risk for emotional exhaustion – the first stage of burnout. The participants were at average risk for depersonalisation – the second stage of burnout. Moderate levels of personal accomplishment were also identified. These study findings for burnout correlated with findings of another South African study (Engelbrecht & Wilke, 2021:142).The students were found to have moderate levels of compassion fatigue, which was similar to several other studies that also used the ProQOL– both internationally (Beaumont et al., 2016:242; Caoet al., 2021:1) and in South Africa (Engelbrecht & Wilke, 2021:142;Manson, 2013:28; Mason & Nel, 2012:454; Mathias &Wentzel, 2017:5). Moderate levels of compassion satisfaction were also reported, which correlates with several other South African studies (Engelbrecht & Wilke, 2021:142; Mason & Nel, 2015; Mathias & Wentzel, 2017:5). Second-year nursing students had higher mean scores for compassion fatigue than first-year nursing students. This might be due to the fact that second-year nursing students have to complete double the number of practical hours than first-year students. Emotional exhaustion, depersonalisation, and perceived stress were all statistically significantly associated with compassion fatigue. When comparing the first- and second-year nursing students' levels of perceived stress, burnout, compassion fatigue, and compassion satisfaction in this study to that of a previous study done at the same public university in 2018 (Engelbrecht & Wilke, 2021:142), it was found that students in the current study (during COVID-19) had higher scores on personal accomplishment than the students in the 2018 (pre-COVID-19) group. This might be because data collection took place during exams, when no practical hours were being worked by undergraduate nursing students. The findings of this study are similar to those identified in earlier international and national research publications. Therefore, the recommendations align with those of previous studies and include the introduction of stress- and time-management workshops (Langtree et al., 2018:94; Manson, 2013:23; Waled & Mohammed, 2019:121). It is recommended that future research explore how coping strategies could improve the psychological wellbeing of undergraduate nursing students.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 Feasibility of interactive diabetes workshops for primary health care nurses in a Free-State sub-district(University of the Free State, 2020-01) Mukurunge, Eva; Reid, M.; Fichardt, A.The health care system of South Africa is driven by the primary health care (PHC) system approach, of which nurses are the backbone of health care service provision. The aim of the PHC approach is to ensure universal accessibility of health care services in an environment characterised by an ever-increasing prevalence of non-communicable diseases, including diabetes. Research has revealed that, in a Free State sub-district, PHC nurses have decreased levels of motivation for and limited knowledge of the management of diabetes. This study forms part of a complex intervention research programme that followed a phased approach, which allowed researchers to assess the feasibility of a health dialogue model that had been designed in previous research. The aim of this study was to establish the feasibility of interactive diabetes workshops for PHC nurses in a Free State sub-district. In order to ensure achievement of the aim, four objectives were developed: a) development of an interactive workshop programme according to previously identified key diabetes-related messages; b) determination of diabetes-related knowledge by means of a pretest and posttest; c) facilitation of interactive diabetes workshops; and d) assessment of the feasibility of these workshops for PHC nurses post the interactive workshops. An exploratory experimental pretest-posttest control group design was used in this study. A random sampling method was used to select 10 PHC clinics in a sub-district of the Free State, with five PHC clinics for each of the experimental (Thaba Nchu) and control (Botshabelo) sites. Each of the five PHC clinics in both the experimental and control groups were in a 15 km radius of each of Thaba Nchu and Botshabelo towns. A convenience sampling method was used at the 10 PHC clinics to select nurses. The sample size of the experimental and control groups was 21 nurses each. Data used for the development of the interactive workshop programme was collected through a systematic search of literature using the first three steps of a systematic review process. Data of diabetes-related knowledge was collected using a pre/posttest questionnaire. A five-point Likert scale was used for collection of data on assessment of the interactive diabetes workshops. Descriptive statistics were used for data analysis. Results obtained from the systematic literature search revealed that, for workshops to be engaging, interactive activities should be used during facilitation. Interactive activities can include scenarios, small-group discussions, role playing, Kagan’s rally coach, rally robin and timed pair share strategies. Statistically significant results from pre/post-testing in the experimental group indicated improved knowledge related to peripheral sensation (0.03) and depression (<0.01). Across the experimental and control groups, results for questions related to insulin use (0.04) and depression (0.001) were found to be statistically significant. In order for interactive workshops to be feasible, the participants and the facilitator should have consensus about time for facilitation. Interactive workshops should be considered as a training platform for diabetes refresher training courses for nurses at PHC clinics. The content of the workshops should cover the key diabetes messages, and the facilitation should include interactive activities that are likely to enhance learning and participant engagement. In conclusion, the researcher considers interactive diabetes workshops to be a feasible training platform for PHC nurses in a Free State sub-district. The training events could empower nurses with knowledge and skills, leading to improved health care services for diabetes patients.Item Open Access Health literacy of Sesotho-speaking patients with end-stage renal disease in the Free State province(University of the Free State, 2020-11) Van Rensburg, Elsabet; Reid, M.; Pienaar, M.Background: End-stage renal disease is a global health concern, and health literacy is essential for managing this complex disease. In South Africa, the health literacy status of Sesotho-speaking patients is unknown. Meaningful data will only be generated if health literacy is tested and local context, and cultural and dialectal diversity is taken into consideration. Aim: This study aimed to assess the health literacy of Sesotho-speaking patients with end-stage renal disease in the Free State province of South Africa. Objectives: The objectives were to establish the health literacy association between Sesotho-speaking patients with end-stage renal disease in the Free State province who received haemodialysis and peritoneal dialysis at private and public dialysis centres in this province. Methodology: The researcher followed a quantitative, descriptive, cross-sectional design. The research technique used was the culture- and context-sensitive Sesotho Health Literacy Test (SHLT). Patients receiving haemodialysis and peritoneal dialysis in the private and public healthcare sectors in four towns of the Free State province were included in the study (N=420). Convenience sampling (n=263) was used to collect data. Frequencies and percentages for categorical data and medians and percentiles for numerical data were calculated per group. Associations were calculated utilising the Chi-square or Fisher’s exact tests for categorical data and the Kruskal-Wallis test for numerical data. Results: The researcher studied 263 respondents: 57.4% (n=151) were from the public sector, 74.9% (n=197) received haemodialysis, and 25.1% (n=66) were on peritoneal dialysis. Male gender predominated, with 60.3% (n=158) men, and the median age of respondents was 49 years. The majority (58.4%) of respondents had an education level between Grade 9 and 12. Hypertension (91.3%) and diabetes mellitus (27%) were the highest reported comorbidities. Respondents had been on renal replacement therapy for a median of four years, and 46.8% reported having problems reading due to inadequate eyesight. Low health literacy levels were identified in 12.9% (n=34), moderate health literacy levels in 49.4% (n=130), and high health literacy levels in 37.6% (n=99) of the respondents. Low health literacy levels were significantly associated (p<0.01) with lower education levels. Lower health literacy levels were not associated with healthcare sector groups (p=0.58), treatment modalities (p=0.80), gender (p=0.20), age (p=0.06), years on dialysis (p=0.50) or with a higher number of comorbidities (p=0.81). However, a significant association (p<0.01) was reported between lower health literacy levels and the scores obtained in appraisal and understanding questions. Recommendations: The South African Renal Society could possibly implement context- and culture-related health literacy assessment for end-stage renal disease patients when they are diagnosed. Training institutions could integrate health literacy training into the education of healthcare workers in the dialysis field. End-stage renal disease patients could benefit if they received education and training from dialysis role players in their home language. End-stage renal disease patients’ health outcomes could improve if the staff-to-patient ratio was 1:4. Health literacy levels of end-stage renal disease patients should be considered when selection for renal replacement therapy in the public sector, and selection for transplant in both sectors take place. Education and training of end-stage renal disease patients should be related to the language, cultural and environmental context of living of the patient, education level and age of the patient, whether the patient has inadequate eyesight, and the patients’ health literacy level. Knowledge about emergencies, the influence of lifestyle, understanding of prescriptions, volume measurement, tuberculosis and hepatitis B, and the impact of nephrotoxic medications have to be reinforced during patient training. Conclusion: The health literacy of Sesotho-speaking end-stage renal disease patients was unknown. The SHLT was applicable for assessing the health literacy of these patients. Almost 50% of Sesotho-speaking end-stage renal disease patients have difficulties with measurement, possess inadequate knowledge about health, nutrition and exercise, and experience problems following medication prescriptions. This study suggests that end-stage renal disease patients’ health literacy status should be known, to improve self-management and health outcomes.Item Open Access South African midwives’ knowledge of placental triage(University of the Free State, 2021-02) Van Rensburg, Amori; Bekker, E.The placenta is an underexplored and underappreciated organ. Examining the placenta is routine after birth. It is given a glance-over, but never a second thought. Placental histology provides a valuable in-depth investigation into placental pathology. Abnormalities can be identified by a macroscopic examination of the placenta. This investigation can be considered as a triage of the placenta to determine if histological investigation is required. One of the biggest contributors to litigation in obstetrics comprises to children with Cerebral Palsy (CP). Factors contributing to the development of CP can be shown to be present in utero, rather than during labour, by sending the placenta for histology. Litigation costs in South Africa in the field of maternal and child health is increasing exponentially. This increased risk for litigation and the high number of unexplained stillbirths are the drivers behind the value of macroscopic placental examination and histology. This research focussed on answering the research question: What is the existing knowledge of midwives educated in South Africa regarding placental triage? To answer this research question, a quantitative research approach was chosen, and a survey method used. A questionnaire was developed to determine and describe the knowledge of South African midwives. The total number of participants were 157. Of all participants, 64% stated that they always examine placentas. The Department of Health South Africa (DoHSA) require a basic examination of the placenta to always be performed. The regulation relating to the conditions under which registered midwives may carry their profession, R2488, also stipulates that a placenta must be inspected for completeness of the disc and membranes. This finding confirms non-conformity to the guidelines for submission of placentas for histology. The overall median for the questionnaire was 61.9%. The lowest obtained score was 14.3% and the highest score was 81%. This indicated that the participants had 60% knowledge of the macroscopic placental examination. Little literature is available regarding investigated placental examination or knowledge within South Africa. The DoHSA admits to constraints in the education system leading to poor competency and limited clinical exposure. As most participants were employed in the public sector, it was expected that they complied with the procedures described in the in the documentation prescribed by the DoHSA. Yet, through the study findings it became clear that some midwives were not compliant. Only 61% of participants answered that there were placental histology services available in the units they worked in. That left a gap of 40% of institutions that did not have these services available and raises the question of what was being done in these facilities when an abnormal placenta was identified. In conclusion, forty per cent (40%) of participants did not know what the histology report of the placenta could be used for. This proved that more awareness should be shared on this subject and the benefits it provides, for midwives. A staggering 97% of participants stated that the institution they worked at could benefit from further education regarding placentas and placental histology. It is reassuring that 88% stated that they could benefit from advanced training regarding examination of placentas. It is evident that examination of the placenta is paramount in the prevention of litigation cases and for future treatment of the mother and baby.Item Open Access Motivation of students in higher education to transfer learning: a scoping review(University of the Free State, 2021-01) Bredenkamp, Doreen; Botma, Y.; Nyoni, C. N.Background: Motivation is a critical factor in students’ performance, productivity and transfer of learning. Even when students have the right skills, education, and support from peers and or educators, they would not be able to use knowledge learned in one context to solve a problem in a new context without motivation. Purpose: The purpose of this scoping review was to describe and summarise the literature on motivation to transfer learning in higher education and to identify the gaps regarding the research topic. Methodology: Scoping reviews are used to determine the extent, range, and nature of the scientific literature. The nine-step descriptive, analytical method of conducting a scoping review was used, as described by Peters et al. (2020: 413) in the methodology manual of the Joanna Briggs Institute (JBI). The researcher used an organised process with the help of an experienced librarian and two co-researchers to identify articles that included all the words in the title of the research. The studies were independently screened for eligibility by the researcher and co-researchers during three rounds of review (title, abstract and full-text). Results: The results of this scoping review were presented in a descriptive, diagrammatic and tabular format that aligns with the review question and objective. Of the 84 articles identified, 60 titles, 4 abstracts, and 20 full-text articles were screened for eligibility. The review included 8 studies. Findings and limitations: Findings – A combination of the various of factors, influencing the motivation to transfer learning is proposed, suggesting further research to build a strong transfer theory in higher Background: Motivation is a critical factor in students’ performance, productivity and transfer of learning. Even when students have the right skills, education, and support from peers and or educators, they would not be able to use knowledge learned in one context to solve a problem in a new context without motivation. Purpose: The purpose of this scoping review was to describe and summarise the literature on motivation to transfer learning in higher education and to identify the gaps regarding the research topic. Methodology: Scoping reviews are used to determine the extent, range, and nature of the scientific literature. The nine-step descriptive, analytical method of conducting a scoping review was used, as described by Peters et al. (2020: 413) in the methodology manual of the Joanna Briggs Institute (JBI). The researcher used an organised process with the help of an experienced librarian and two co-researchers to identify articles that included all the words in the title of the research. The studies were independently screened for eligibility by the researcher and co-researchers during three rounds of review (title, abstract and full-text). Results: The results of this scoping review were presented in a descriptive, diagrammatic and tabular format that aligns with the review question and objective. Of the 84 articles identified, 60 titles, 4 abstracts, and 20 full-text articles were screened for eligibility. The review included 8 studies. Findings and limitations: Findings – A combination of the various of factors, influencing the motivation to transfer learning is proposed, suggesting further research to build a strong transfer theory in higher education, including the full spectrum of factors on the transfer of learning model. The review highlighted the development of instruments to assess the same concepts and variables, and test the multidimensionality of the motivation to transfer learning in higher education more completely. Furthermore, the review proposes a concept analysis of motivation to transfer learning be done in higher education as part of health sciences to ensure that educators and researchers are able to characterise and understand what motivate students to transfer learning to improve the quality of education and healthcare delivered. Limitations – Prior research studies relevant to the scope of this review were limited. This limitation can be considered as a significant opportunity for this review to identify new gaps in the prior literature and to present the need for further development in the area of this review. Practical implications: The current literature highlights many factors influencing the transfer regime in the context of human resource development, but unfortunately, not much work has been done in higher education, especially in the field of health sciences. To improve the effectiveness of transfer of learning, we advocate that more in-depth qualitative research is required that involves other stakeholders such as students and educators. Further research should also investigate which variables make a difference in the complex process of motivation of students in higher education to transfer learning. A better understanding of the concept of motivation to transfer learning, the variables, and developing a theory, including the spectrum of variables influencing motivation to transfer learning, will assist educators to design more structured and evidence activities that ensure the motivation of students to transfer learning to the workplace, improving the delivery of healthcare. Value: This scoping review contributes to the dormant higher education transfer literature by prosed a combination of variables that provides a theoretical basis for building a strong theory/model on motivation to transfer learning for higher education.Item Open Access Exploring registered nurses' compliance to standards for medical male circumcision(University of the Free State, 2020-11) Ntsupa, Mamokete; Mpeli, M. R.; Hugo, L.Medical Male Circumcision (MMC) is recommended as a Human Immune Virus (HIV) prevention strategy in countries with high HIV prevalence and low MMC prevalence. Lesotho, as the country with the second-highest HIV infection globally, is implementing this strategy. Although MMC services have been accessible to the intended recipients, there is a challenge of poor compliance with WHO standards by Registered Nurses that are providing MMC services in Lesotho. These have been noted during regular quality assessments conducted at MMC sites in Lesotho by supervisors and researcher. The focus group participants had to answer the following research question: What factors can influence the RNs' compliance with quality standards at the MMC sites in Lesotho? The purpose of the study is to explore and describe the factors that influence Registered Nurses' compliance with MMC standards. A qualitative, exploratory, descriptive, and phenomenology research design was used. A purposive sample was utilized. The target population for this study was all the RNs offering MMC services in the five lowlands districts of Lesotho. Explorative interviews were conducted before the main study to determine the questions and pre-empt the problems that might arise in the main study. For the main study, focus group interviews were conducted with 19 registered nurses. The data were analyzed using ATLAS. ti Windows 8 User Manual. The ethical standards regarding the principles of respect for persons, beneficence and justice were adhered throughout the study. The research revealed three key themes: (1) knowledge of quality standards, (2) barriers to compliance, and (3) perceived enabling working environment. This research highlights that system barriers such as poor infrastructure, insufficient staffing, and inadequate supplies make it difficult for RNs to comply with standards. Furthermore, fatigue and burnout were prevalent among MMC providers due to workload. MMC providers have also stated that carelessness in their work brought on by overconfidence in one's skills often led to poor compliance with quality standards. This research's main conclusions show that high workloads and limited resources contribute to poor compliance with quality standards. The studies revealed that a well-established quality improvement framework increases accountability and prevents the risk of intentional errors. It also enhances systems that reduce the recurrence of similar mistakes. Furthermore, the study and literature findings demonstrate that it is possible to address the quality of MMC using a Continuous Quality Improvement (CQI) approach, supportive supervision, and feedback. Key recommendations are as follows: managers should establish programs for continuous professional development and evaluate their clinical practice impact. Performance-based incentives should be linked to appraisals for better quality services, and the strengthening of accountability is recommended. Healthcare institutions should establish and sustain human resources that will meet the population's needs to provide quality services. Managers must be held accountable for the provision of quality health care. Registered nurses should take an active role in quality improvement activities in a healthcare setting and align nursing practice with professional values.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 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 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 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 Learning needs of caregivers of older persons in residential care facilities: an explorative case study(University of the Free State, 2020-12) Marais, Cecilia; Van Jaarsveldt, D. E.; Spies, C.Caregivers play a prominent role in rendering basic care to older persons in residential care facilities, whose needs are intricate and unpredictable. Yet, caregivers were found to be underprepared, especially in rural areas of the Northern Cape province in South Africa. Substandard education, training and the absence of formal in-service training programmes contribute to varied quality of care, as well as caregiver stress and burnout. Therefore the question arose: What are the learning needs of caregivers of older persons in residential care facilities in two sub-districts of the Northern Cape province? Guided by constructivism, knowledge was socially constructed by incorporating the perspectives of various role players. In accordance with the research question and the need to obtain multiple perspectives within a particular geographical context, an explorative case study design was applied. Data were collected by means of four respective nominal groups with caregivers and family members of residents, as well as a small group interview with the registered nurses working at three facilities. During data analysis the different data sets were individually analysed and then consolidated. Eight main categories of learning needs were identified, namely: basic nursing skills, hygiene, Alzheimer’s disease, medication, communication, rights and responsibilities, as well as staff monitoring and evaluation. Many of the suggested learning needs were, however, beyond the expected tasks of caregivers set by the South African Qualifications Authority unit standard for the provision of care to a frail person. The ignorance of the caregivers with regard to essential aspects such as their rights and job description revealed unfair labour practices. Ethics of employment emerged from the findings as underlying theme with unrealistic work expectations and a power disadvantage as subthemes. A formal in-service training programme addressing the learning needs, appropriate for the caregivers’ expected level of functioning could enrich the quality of their caring for older persons in the particular residential care facilities. Action should also be taken to address the emerging issues affecting both the caregivers and quality of care rendered to older persons in this setting. Further, larger scale research could cast light on the research issue in other contexts and ostensibly inform policy development in this regard.Item Open Access Peer support guidelines for nurse educators during curriculum innovation in Lesotho(University of the Free State, 2020-06) Shawa, Mirriam; Botma, Y.Background: The curriculum for the education of nurses and midwives in Lesotho was transformed through the adoption of competency-based education. Competency-based education promotes the capabilities of the students. Transforming the curriculum challenged educators’ skills, necessitating new sets of facilitation and assessment skills to enable appropriate enactment of the student-centred curriculum. Such major changes imposed by the curriculum innovation required commensurate professional development and ongoing support for the educators. The absence of ongoing supportive strategies during a curriculum innovation naturally led to unstructured support among educators. However, unstructured peer support is threatened by chaotic implementation and a possible curriculum drift. Therefore, there is a need for structured peer support through the provision of practice guidelines. Purpose: This study sought to develop guidelines to enhance peer support among nurse educators during a curriculum innovation in Lesotho. Methods: A qualitative approach with multiple data collection methods was used to develop peer support guidelines according to the World Health Organization’s Handbook for Guideline Development. The research was undertaken in three phases. Phase I described the existing peer support strategies through an integrative review. Phase II described the experiences of nurse educators related to unstructured peer support during the implementation of midwifery curriculum innovation through an exploratory descriptive qualitative study. Phase III integrated the findings from phases I and II to develop guidelines for peer support during a curriculum innovation in Lesotho. An international expert panel validated the guidelines through two iterative Delphi rounds. Results: Phase I of the study described the existing peer support strategies through an integrative review. Six themes emerged, namely types of peer support strategies, characteristics of peer supporters, characteristics of an effective peer support strategy, outcomes of effective peer support strategies, challenges of implementing peer support strategies and lessons learnt from the peer support strategies. Phase II of the study described experiences of educators regarding peer support during midwifery curriculum innovation and revealed five themes, namely motivation for educators to participate in peer support, attributes of educators that influence the extent of interaction and uptake of support, unstructured peer support strategies, consequences of peer support among educators and model performance inspires engagement with the new curriculum. The results from the two phases were triangulated and informed the development of the practice guidelines to enhance peer support among nurse educators during curriculum innovation. Five priority areas and seven recommendations were developed. The priority areas were peer supporters, peer support strategies, content/support needs, outcomes of peer support, and monitoring and evaluation of the peer support strategy. External reviewers validated the developed practice guidelines using AGREE II tool and attained an agreement of between 80 and 100% across the items on the tool. Conclusion: Transforming curricula for nursing and midwifery education is inevitable globally. Curriculum changes challenge the capabilities of the implementers and necessitate planned ongoing professional development and support of the implementers of the new curriculum. Such ongoing support strategies may be costly for low- and middle-income countries, such as Lesotho, and could benefit from structured peer support. The absence of such supportive strategies may compromise the fidelity of the implementation of the curriculum change. This study proposes peer support as an affordable intervention to enhance the implementation of a new curriculum, especially in low- and middle-income countries. The effectiveness of such intervention requires the commitment of institutional leaders, experienced and committed peer support providers, a clear modus operandi, tailor-made activities, appropriate resources, and monitoring and evaluation mechanisms. The proposed guidelines may enhance peer support during curriculum innovation.Item Open Access Health literacy of Sesotho-speaking patients diagnosed with chronic conditions: Setsoto, Free State province(University of the Free State, 2020-11) Mofokeng, Mita Sarah; Reid, M.; Pienaar, M.Health literacy plays an integral role in ensuring positive patient outcomes, because it makes the processing and understanding of health information possible. Assessing the health literacy of patients diagnosed with chronic conditions in their home language is essential for improving their health outcomes. This study was conducted in Setsoto, Free State province, and the Sesotho Health Literacy Test (SHLT) was used to measure the health literacy level of Sesotho home-language speakers. The study aimed to assess the health literacy of Sesotho-speaking patients diagnosed with chronic conditions in Setsoto, Free-State province. The objective was to establish the associations between the socio-demographics of chronic patients attending public health facilities in Setsoto subdistrict, and items on the SHLT that reflect appraisal and understanding. The research design applied in the study was a quantitative descriptive cross-sectional design. The population consisted of patients diagnosed with a chronic condition and attending a primary healthcare (PHC) facility (n=12) in the Setsoto subdistrict. The respondents (n=264) were conveniently sampled from the PHC facilities in the subdistrict. Data was collected using a structured questionnaire, namely the 10-item SHLT questionnaire. Descriptive statistics, namely frequencies and percentages for categorical data, and medians and percentiles for numerical data, were calculated per group. The groups were compared by means of the Chi-square test for categorical data and KruskalWallis test for numerical data. The researcher studied 264 respondents from 12 public health facilities, of whom more were female respondents (82.6%) than were male respondents (17.4%). The median age of the respondents was 43 years. The majority (56.8%) of the respondents indicated Grades 9–12 as the highest grade passed, and 53.4% of the respondents indicated they had a problem reading due to poor eyesight. Human immunodeficiency virus (HIV) was the most common chronic condition (62.1%) the respondents had been diagnosed with. The findings indicate that 35,6% (n=94) of respondents could be classified as possessing a high health literacy level; 43.6% (n=115) achieved moderate health literacy scores, and 20.8% (n=55) had low health literacy scores on the SHLT. No association (p=0.143) was found between health literacy level and gender distribution, or between health literacy levels and the respondents’ inability to read due to poor eyesight (p=0.209). Associations (p=0.001) were established between a high health literacy level and age; a high health literacy level and respondents with Grades 9–12 (p=0.001), and between a high health literacy level and items in the SHLT reflecting appraisal and understanding of health information. The implementation of the SHLT and developing a guideline for PHC facilities will assist healthcare providers to develop a comprehensive treatment management plan for patients diagnosed with chronic conditions. This will also assist the Free State Department of Health to alleviate pressure on the healthcare system.Item Open Access An integrative review of supportive clinical learning environment strategies for undergraduate students in health sciences(University of the Free State, 2020-09) Orton, Annelie Magrietha; Pienaar, M. A.; Botma, Y.The clinical learning environment is essential for the development of healthcare students’ clinical training, clinical competence and professional identity. A supportive clinical learning environment is needed to provide the opportunity for students to integrate their theoretical knowledge with the clinical practice. The aim of the study was to critically synthesise the best available evidence describing strategies for a supportive clinical learning environment for undergraduate students in health sciences. An integrative review was chosen as research method, as studies with various methodologies can be incorporated in an integrative review. The researcher followed the five stages as stated by Whittemore and Knafl (2005:548552), namely problem identification, literature search, data evaluation, data analysis and presentation. The PICO-format (Population, Intervention, Comparative intervention and Outcome) was used to compile the review question, which again led the integrative review. EBSCOHost served as a platform to search for electronic data in 13 databases. Google Scholar was also used as a database to allow for the identification of relevant grey literature. The electronic database search strategy identified 500 potential studies, and after the filtering process, 11 studies were identified for critical evaluation. A critical evaluation was conducted in the form of a round table consensus by the researcher, the supervisor, the co-supervisor and a senior reviewer with experience in conducting integrative reviews. During the critical evaluation, 10 studies were selected for analysis. The selected studies were heterogenous and so a meta-analysis was not feasible. The results of the thematic analysis culminated in a conceptual framework of a supportive clinical learning environment. Three concluding statements, as stated below, summarise the findings of the study: 1) A variety/network of student supporters, who have been carefully selected, may be allocated specific clinical responsibilities while supporting the undergraduate student in the clinical learning environment. 2) The relationship between the student, the student supporter and the clinical staff is crucial to create a sense of belonging, self-efficacy and selfdirectedness. The relationship depends on the roster and ratio of students per student supporter, as well as appropriate learning opportunities. 3) Higher education institutions and healthcare providers (such as healthcare facilities) should support students through formal collaboration/partnerships, with student supporters employed by the institutions, and these institutions should support the student supporters in various ways. A few recommendations made by the researcher include: 1) Higher education institutions and healthcare providers should attempt to forge beneficial relationships in order to support the students. 2) Higher education institutions should support student supporters in the clinical learning environment with adequate and timely information regarding student placement, the students’ level of competence and the students’ outcomes, and also with training and support regarding student problems. 3) Healthcare providers should assist the higher education institutions by providing placement, opportunities for students to learn, and by supporting the students in clinical learning. 4) Student supporters should have certain qualities that enhance clinical teaching and student supporters should be willing to spend time with students. The comprehensive synthesis of the best available evidence has led to new insights regarding creating and maintaining supportive clinical learning environment strategies for undergraduate students in health sciences. These strategies may be implemented in innovative ways to provide the students with the best clinical learning opportunities.