Influence of work-related stress on patient safety culture among nurses in a tertiary hospital: a cross-sectional study

BACKGROUND

One of the global issues facing the nursing profession is work-related stress because it interferes with care quality and organisational competency. These kinds of stressful situations can cause damage to the mental ability of the affected individual resulting in low job productivity. In a Nigerian healthcare setting, patient safety is under-researched.

AIM

This study aimed to assess the influence of work-related stress on patient safety culture among nurses in a tertiary hospital.

MATERIALS AND METHODS

The study adopted a descriptive cross-sectional survey. The Population of the study was nurses who are currently serving as employees at Federal Medical Center Birnin-Kebbi. Proportional and systematic sampling methods were used in the selection of the sample of the study. The tools used for this study were adapted Hospital Survey on Patient Safety (HSOPS) and Nurses' Occupational Stressor Scale. Ethical approval was obtained from the research ethical committee of the hospital.

RESULTS

The moderate stress experience was having the highest percentage (45.0%). The highest percentage of the nurses (69.9%) practised a moderate safety culture. There were weak or very weak significant negative correlations (P < 0.01) between patient safety culture practices and occupational stress across all the subscales of the nurses' occupational stressors scale except in the occupational hazards subscale in which there was extremely weak and non-significant negative correlation. Work-family conflict was a significant predictor of patient safety culture, t (208) = -2.341, P < 0.05. Difficulty in taking leave was a significant predictor of patient safety culture, t (208) = -2.190, P < 0.05.

CONCLUSION

There was a significant negative correlation between stress and safety practice which implies that as stress increased safety practice decreased. These study findings can be used to develop ongoing strategies and targeted interventions in addressing work-related stress.

Exploring the barriers to Registered Nurses undertaking clinical teaching in clinical settings: A qualitative descriptive study

AIM

The study aimed to explore and describe the barriers affecting Registered Nurses in undertaking clinical teaching in clinical settings. The exploration was based on the experiences of Registered Nurses at a selected teaching hospital in Namibia. The researcher intended to identify strategies that could be used to mitigate the negative effects of barriers to effective clinical teaching.

DESIGN

A qualitative explorative, descriptive and contextual research design was used.

METHODS

Purposive sampling was used to select 16 participants. Data were collected through in-depth, semi-structured interviews, which were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis.

RESULTS

Clinical teaching is negatively affected by several barriers that hamper clinical teaching and nursing students' learning outcomes. Seven main themes were identified: (1) participants' understanding of clinical teaching; (2) organizational barriers; (3) patient barriers; (4) Registered Nurse barriers; (5) student barriers; (6) training institution barriers; and (7) strategies to mitigate barriers to clinical teaching.

CONCLUSION

The findings revealed that several barriers negatively affect clinical nursing education and hamper the clinical teaching and learning of nursing students.

PATIENT OR PUBLIC CONTRIBUTION

This study may assist in the development of targeted interventions that address the barriers that hinder clinical teaching at teaching hospitals. Additionally, this study could assist in improving the health care that is provided by nursing students to patients. The findings may assist with improved quality by reducing nursing students' theory-practice gap and by promoting collaboration between Registered Nurses and nurse educators in clinical settings.

Nursing students' experiences of communication in a multilingual and multicultural clinical environment: A qualitative study

AIM

The aim of this study was to investigate nursing students' experiences of communication in a multilingual and multicultural clinical environment.

BACKGROUND

Effective communication in a healthcare setting plays a crucial role in patient care. Yet, since universities, globally, have experienced an increase in the enrolment of both local and international students in various degree programmes, student populations have become increasingly multilingual and multicultural. This study was conducted in a multilingual country where many languages are not spoken by all citizens, which results in nursing students experiencing varied outcomes.

DESIGN

A qualitative, explorative, descriptive research design was used.

METHODS

Sixteen nursing students enrolled in either the Bachelor of Nursing Science (Clinical, Honours) or the Diploma in Nursing Science. Data were collected by means of in-depth, semi-structured interviews with a sample of 16 nursing students who were selected through convenience sampling. Data were analysed using thematic analysis.

RESULTS

The study revealed four themes: aspects that complicate communication; interesting aspects about communication; the need for communication assistance; and the need for policy intervention, which is key to addressing challenges in multilingual clinical environments.

Factors associated with caesarean sections among pregnant women admitted to a private academic hospital in Ongwediva, Oshana region, Namibia

Background

Caesarean section rates are increasing worldwide in both developed and developing countries becoming an issue of grave concern.

Objective

The aim of the study was to determine the factors associated with caesarean sections performed on pregnant women admitted to a private academic hospital in Ongwediva, Oshana region, Namibia.

Materials and Methods

A retrospective data approach was conducted on 200 patients' files using a self-administered checklist at a private academic hospital. A total of 200 records of mothers who underwent caesarean sections were systematically reviewed from January 2020 to December 2020 at a private academic hospital in Ongwediva, Namibia. A pretested structured checklist was used to record the data.

Results

The study revealed that 95.5% of women who had caesarean sections (C-section) were performed. A previous C-section was the most frequent indication, while 0.5% were performed due to patient requests. The p-value for the chi-square statistic was smaller than the standard alpha value (P<0.05), i.e., there is a relationship between the demographic characteristics and factors associated with caesarean sections, as well as between socioeconomic factors and factors associated with caesarean sections.

Conclusions

This study shows that 95.5% of C-sections are done as a necessity with clear indications, while only 0.5% are done due to patient requests. This study's findings can be used to develop strategies and targeted interventions geared towards reducing the increasing rates of cesarean section considering maternal age, the number of indications of primary cesarean delivery, and following standard operating procedures that might improve the quality of prenatal and delivery care.

Nutritional knowledge and practices of mothers with malnourished children in a regional hospital in Northeast Namibia

Background

An estimated 159 million children under five are affected by malnutrition, with an additional 101 million children under five being underweight in sub-Saharan Africa. In Namibia, 24% of children under age 5 are stunted and 8% are severely stunted. The Kavango region has the highest rate of stunting (38.8%) in the country.

Objective

The purpose of the study was to determine and describe the nutritional knowledge and practices of mothers with malnourished children regarding feeding at Rundu Intermediate Hospital, Kavango East Region, Namibia.

Materials and Methods

A quantitative cross-sectional research design was used. A convenience sampling technique was used to select 199 mothers with malnourished children who were admitted to the pediatric ward. Data were collected via self-administered questionnaires with closed-ended questions.

Results

51.8% of the mothers had correct nutritional knowledge regarding breastfeeding for six months before giving other food, and 74.4% believed that newborns should be initiated to breastfeeding within an hour after birth, while the same number breastfed their babies on demand. Furthermore, 35.6% of the participants followed appropriate practices regarding feeding.

Conclusions

Most mothers (51.8%) had appropriate nutritional knowledge. However, only a minority (35.6%) of the mothers had the appropriate practices regarding feeding their children. Hence, there was a knowledge/practice mismatch regarding the significance of exclusive breastfeeding during the first six months, and generally the vitality of breast milk to the child. These findings may be used to develop strategies and target interventions to create awareness among mothers regarding effective breastfeeding practices.

Barriers and Facilitators Affecting the Uptake of COVID-19 Vaccines: A Qualitative Perspective of Frontline Nurses in Namibia

Aim

Vaccinations remain one of the most effective measures to prevent and control the spread of COVID-19, while also reducing hospitalizations and deaths, yet many are unwilling to be vaccinated. This study explores the barriers and facilitators affecting the uptake of COVID-19 vaccines among frontline nurses.

Design

A qualitative, explorative, descriptive, and contextual research strategy was employed.

Methods

A sample of 15 nurses were selected via purposeful sampling to the point of data saturation. The participants were nurses at the COVID-19 vaccinations Centre in Rundu, Namibia. Data were collected using semistructured interviews and analyzed thematically.

Results

Three themes and 11 subthemes were identified, namely: (a) barriers, (b) facilitators, and (c) measures to increase the COVID-19 vaccine uptake. Barriers included living in deep rural areas, unavailability of vaccines, and misinformation, whereas scared of death, availability of COVID-19 vaccines, and family influence and peer pressure emerged as facilitators to the uptake of COVID-19 vaccines. Adoption of vaccination passport as a requirement to work premises and as an international travel requirement were the measures proposed to increase the COVID-19 vaccine uptake.

Conclusion

The study found several facilitators and barriers to COVID-19 vaccine uptake among frontline nurses. The identified barriers cover the individual, health system, and social factors hindering the COVID-19 vaccine uptake among frontline nurses. Whereas fear of COVID-19 deaths, family influence, and availability of vaccines were found to promote COVID-19 uptake. This study recommends targeted interventions to improve the uptake of COVID-19 vaccines.

Factors contributing to burnout among nurses at a district hospital in Namibia: A qualitative perspective on nurses

AIM

The aim of this study was to explore and describe the factors that contribute to burnout among nurses.

BACKGROUND

Burnout remains one of the major occupational health problems, posing risks to human health globally. In Namibia, there has been growing public criticism of nurses, stating that they are rude, or act in a manner that does not show professionalism toward their clients. Reasons for such unprofessional behaviour could be linked to negative attitudes on the part of nurses toward their clients, resulting from burnout syndrome.

METHOD

A qualitative, exploratory, descriptive and contextual research design was followed as the basis for conducting the study. Using a purposive sampling technique, a sample of 20 nurses was selected from a population of 69 nurses employed in this setting. This sample size was determined by the saturation of data as reflected in repeating themes. Data were collected using individual semi-structured interviews and were analysed using qualitative thematic analysis.

RESULTS

The following three themes emerged: understanding the concept of burnout, factors leading to burnout, and creating a conducive environment as a corrective measure to address burnout and to advance nurses.

CONCLUSIONS

Burnout is indeed real and affects nurses' performance negatively. Burnout has a negative impact on the wellbeing of nurses both physically and emotionally, which has the potential to compromise staff performance, productivity and the quality of patient care. Burnout among nurses is linked to many stressors such as poor staff management, inadequate resources, lack of support and lack of wellness programmes in the workplace.

IMPLICATIONS FOR NURSING MANAGEMENT

Strengthening communication between frontline health workers and management by engaging and involving them more in decision-making in matters that concern them is anticipated to address poor staff management, enhance staff performance and improve the quality of patient care. Staff wellness programmes in the workplace are believed to be a good coping mechanism to address work-related pressure and tensions, and they are believed to resolve some work-related stress which may result in increased staff productivity.

A qualitative descriptive enquiry of nursing students' experiences of utilising a portfolio as an assessment tool in nursing and midwifery education

BACKGROUND

The use of a portfolio as an assessment tool in nursing and midwifery education is still a relatively new phenomenon. Institutions of higher education should therefore continuously explore the experiences of nursing students in the use of a portfolio in clinical nursing education. In Namibia little research exists on the perspectives of nursing students on the use of a portfolio as an assessment tool.

PURPOSE

The purpose of the study was to explore nursing students' experiences with portfolio as an assessment tool in nursing and midwifery education.

METHOD

The study used the qualitative approach, with an explorative, descriptive, and contextual design. Fifteen (15) undergraduate nursing students participated in this study, using a snowball sampling technique. Data was collected through semi-structured interviews. Data was analysed using thematic analysis for recurring themes.

RESULTS

The following four themes emerged: understanding of a portfolio, positive experiences, negative experiences, and effective portfolio utilisation.

CONCLUSION

The results revealed nursing students' positive and negative experiences, with suggestions for improvement. The findings may help identify strengths and weaknesses in portfolio usage for assessment purposes in nursing and midwifery education. This study recommended well-articulated plans and actions from students, clinical instructors, lecturers, faculty management teams, and the nurses in practice facilities, to address the challenges identified.

Knowledge, attitudes and practices of HIV-positive mothers regarding the benefits of exclusive breastfeeding at a regional hospital in the north east of Namibia

Background

In sub-Saharan Africa, over 1,000 newborns are infected with HIV every day, despite available medical interventions. Mother-to-child transmission (MTCT) remains one of the primary sources of HIV infection in children and without interventions 40% of babies born from HIV-positive mothers would be infected with the virus. It is estimated that 300 000 children become infected with HIV worldwide, whilst 1.5 million children die when their mothers opt for other choices instead of breastfeeding.

Objective

The purpose of the study was to assess and describe the knowledge, attitudes and practices of HIV-positive mothers regarding the benefits of exclusive breastfeeding at Rundu Intermediate Hospital, Kavango East Region in Namibia.

Method

The study was a descriptive cross-sectional survey that used convenience sampling, as the researcher sought to use subjects available during the time of study to select 79 HIV positive mothers.

Results

Participants in this study (94%; n=51) had good knowledge of the benefit of exclusive breastfeeding and that the benefits of breastfeeding outweigh the risk of HIV transmission from mother to child. The results confirmed that (77.2%; n=42) of the mothers opted to take ART with the babies until they stop breastfeeding.

Conclusion

HIV positive mothers had good knowledge, attitudes and practices regarding the benefits of exclusive breastfeeding. A significant number of mothers were, however, not sure about breastfeeding exclusively for 6 months as they would stop if offered free formula milk for the baby. Support by the fathers and others in the community is vital.

Knowledge, Awareness and Willingness to use HIV Pre-Exposure Prophylaxis (PrEP) Among Students at the University of Namibia

Adequate knowledge, awareness and willingness to use HIV Pre-Exposure Prophylaxis (PrEP) is very important for HIV prevention mostly in developing countries where the burden of HIV infection continues to increase. The purpose of this study was to ascertain the level of knowledge, awareness, willingness to use HIV PrEP among tertiary students at the University of Namibia (UNAM), Rundu Campus. A quantitative, descriptive, cross-sectional design was used with a total of 232 first-year students across all three faculties at UNAM, Rundu Campus being selected using stratified random sampling. The study results showed that the majority (52% of the participants were female and 72% of the participants were aged between 18 and 24 years. It was also found that 45% of the participants reported that they had heard of PrEP and, of this number (n = 104), 88% reported that they were willing to use PrEP, although 8% only of the respondents had actually used it. Of the respondents who reported that they had heard of PrEP, both gender and the faculty at which they were studying were significantly associated (all p-values were less than 0.05) with their awareness and knowledge of, and willingness to use, PrEP. The study findings indicated a low level of awareness, knowledge and use of HIV PrEP among the respondents, although the degree of willingness to use PrEP was high among them.

Factors Contributing to Pregnancies among Tertiary Students at the University of Namibia

The Government of Republic of Namibia through the services rendered by the Ministry of Health and Social Services (MoHSS) continues to provide various free health services including contraceptives to its citizens. Nevertheless, several challenges related to unplanned pregnancies among tertiary student&rsquo;s remains a challenge, which includes poor reproductive health status, socio-economic consequences rapid-population growth, rural-urban migration of youths accompanied by proliferation of informal settlements around cities, high youth unemployment and crime. This requires institutions of higher learning to establish which strategies are likely to address these problems of unplanned pregnancies among tertiary students. The aim of this study was to explore and describe the contributing factors to pregnancies amongst tertiary students at a selected satellite campus in order to make recommendations to the University of Namibia (UNAM). An exploratory, descriptive and qualitative design was used. The study was contextual in nature. A convenient sampling was used. The data were collected through three focus-group discussions with 19 students from the three faculties namely: Education, Health Sciences and Management Sciences. Data were analyzed through qualitative content analysis. Strategies to ensure trustworthiness and ethical implementation of the study were implemented. It became evident from the study findings that factors which are contributing to pregnancies, as evidenced by the four emerged themes namely: Personal factors, institutional related factors and improvements measures. This study has implications for higher education institutions in terms of promoting sexual and reproductive health information and increasing access to a range of contraceptive methods of campus which are key in the prevention of pregnancies among tertiary students. Participants in this study recommended that peer educators and students counsellor within the campus should be used as a vehicle to provide support and guidance to students on reproductive health choices.

Nursing Students Perceptions on the Use of Preceptors to Improve Clinical Competence at the University of Namibia

The purpose of this study was to investigate the perceptions of nursing students in relation to the use of preceptors to improve their clinical competence at the School of Nursing at the University of Namibia. Thus, the objectives of the study were to assess and describe the perceptions of nursing students regarding the use of preceptors to improve their clinical competence with a view to make recommendations based on the findings of the study. A quantitative, descriptive, cross-sectional design was used with a total of 100 nursing students from all four cohorts for the Bachelor of Nursing (Honours) (Clinical) at one of the university campuses being conveniently to participate in the study. Self-administered questionnaire were used to collect the data from the participants. The data derived from the questionnaire was analysed using SPSS version 24. The findings from the study revealed, inter alia, that 70% of the participants indicated that the use of preceptors has a positive effect on the students&rsquo; clinical competence. The study therefore recommended sustainment and strengthening of preceptorship strategies for clinical accompaniment of students. Notwithstanding positive findings, the study also recommends improvement of skills for teaching and time management skill, punctual report on duty and efficient utilization of clinical time for preceptors for more efficient implementation of student teaching during clinical accompaniment.

Factors Contributing to Poor Environmental Hygiene in Kehemu location, Rundu, Namibia

Solid waste management in Rundu, Namibia, is a major challenge, resulting in significant environmental health hazards. The purpose of this study was therefore to identify and describe the factors contributing to poor environmental hygiene specifically in Kehemu location in Rundu, while the objectives were to explore the factors contributing to poor environmental hygiene in the area. A qualitative approach was employed comprising an explorative and descriptive design. The research population for this particular study consisted of residents of Kehemu location and a sample was drawn from this population using purposive sampling. Data were collected from focus group discussions conducted with 15 (fifteen) residents. The transcribed interviews and narratives from the research notes were organised into codes, main themes and sub-themes. The results from this study revealed, among other things, that the methods used by most households for disposing of waste included digging holes, burning the waste and dumping it in open areas. In addition, factors contributing to poor environmental hygiene in Kehemu location include a lack of dumping sites, dustbins and refuse removal services. The findings of this study call for well-articulated actions to address the factors identified as being associated with poor environmental hygiene in Kehemu. The study recommends that the town council should empower the community by providing dustbins, initiating clean-up campaigns and providing education and awareness-raising as some measures for curbing problems related to environmental health.

Knowledge, Attitudes and Practices of Contraception Among Tertiary Students at the University Campus in Namibia

The purpose of the study was to investigate the knowledge, attitude and practices of female tertiary students at the University of Namibia regarding contraception. The objective of the study was to assess and describe the knowledge, attitudes and practices of University of Namibia Education students at Rundu campus, regarding contraception with a view to make recommendations based on the findings of the study. A quantitative, descriptive cross-sectional design was used and a total of 220 female tertiary students from Rundu Campus were selected using simple random sampling. Data was collected from participants by the use of a self-administered questionnaire. Findings from this study showed amongst other that majority (80%) 166 showed poor practices towards contraception. However, the study showed that (91%) 202 has positive attitude regarding contraceptives and that this greatly contributes to high rate of unintended pregnancies as well as Sexually Transmitted Infections among them. It is recommended that in order to prevent unintended pregnancies as well as high incidences of Sexually Transmitted Infections among tertiary students, the Ministry of Health and Social Services must introduce a regular reproductive health outreach programme on campus, or establish a clinic on campus. Neglecting youth&rsquo;s contraceptive needs contributes to high rate of unintended pregnancies, Sexually Transmitted Infections, HIV/AIDS and, indirectly; maternal mortality.

Knowledge on HIV Prevention Measures Among Male Learners in Secondary Schools in Oshana Region, Namibia

Human Immunodeficiency virus (HIV) has continued to pose significant social, economic and developmental challenges worldwide.The purpose of the study was to assess the knowledge on HIV prevention among male learners in secondary schools in Oshana Region. The objectives of the study were to: assess and describe the knowledge of male learners in Secondary Schools in Oshana Region about HIV preventive measures. A quantitative, cross sectional design, based on the self-report of the participants, was utilized to achieve the aim of the study. Findings of this study showed that 95.4% had knowledge that HIV can be prevented by consistent and correct use of a condom during sexual intercourse. It has become evident that much still need to be done to make HIV prevention among youth more effective.It is hereby recommended that the Ministry of Education takes the lead to educate the learners on HIV preventive and control measures.

HIV Voluntary Counselling and Testing in Namibia: Status, Successes, and Barriers

Voluntary Counselling and Testing is one of the strategies to respond to the increasing number of Human Immunodeficiency Virus/Acquired immunodeficiency syndrome (HIV/AIDS) new infections. The purpose of this study was to assess the current status of HIV Voluntary Counselling and Testing (VCT) in Rundu urban and identify the barriers to fully effective service.The objectives of the study was to identify the barriers that prevents effective HIV Voluntary Counselling and testing services; asses its success and determine its status in urban, Namibia. A qualitative explorative and descriptive design was employed in this study where all health care and HIV/AIDS professionals including hospital nurses, employees and New Start VCT Centres, and representatives from relevant NGOs, Community-Based Organizations (CBOs), and the Ministry of Health and Social Services (MoHSS)providing Voluntary Counselling services in Rundu urban in Namibia were interviewed. In this study, in depth individual interview structured in accordance with interview guide was used. Content analysis method was employed to analyze the data. Themes that emerged from this study includes: Fear of a positive results (stigma that accompanies seropositivity) and lacks of perceived benefit to getting tested. In addition, financial barriers affecting the poorest populations in Rundu. To increase access and relevance of VCT services, it is recommended that the Ministry of Health and Social Services should develop more detailed counselling guidelines and increase the scope of counselling by addressing the inadequacies of current risk reduction. Despite these hopeful possibilities a number of barriers remains before VCT can be fully effective.

Factors Influencing the Uptake of HIV Counselling and Testing Services: The Case of the Employees of the Namibian Correctional Service at Elizabeth Nepemba Correctional Facility

Despite the growing public awareness about the burden of HIV and AIDS in Namibia, HIV Counselling and Testing (HCT) uptake remains to be low. The aim of this study was to explore factors influencing the HCT uptake amongst correctional officers deployed at Elizabeth Nepemba Correctional Facility (ENCF) in Rundu, Namibia. The study employed a quantitative approach, and a sample of 31 participants was constituted who completed self-administered questionnaires. This research focused on correctional officers deployed at ENCF. Participants were randomly selected from the employee list. It was found that the majority of the respondents (74%) accessed HCT services in the past twelve months, of which 31% indicated having tested at Elizabeth Nepemba HCT Facility. Factors such as confidentiality and privacy issues, the condition of service and staff competency along with accessibility, fear of rejection from families and friends, information provision, education, future planning and risky behaviour were identified as having an influence on HCT uptake. This study concluded that there is a need for more awareness campaigns, information dissemination and involvement of stakeholders to address HIV-related issues for correctional officers at ENCF. This study recommends that the AIDS Committee and employee wellness department should spearhead workshops, information dissemination and educational programmes for correctional officers, so to improve their visibility and influence as well as improve HCT uptake. In addition, Regular workshops and seminars should be organized to empower correctional officers with the knowledge and skills related to HIV behavioural change; as well as resolve any issues related to fear of stigma or rejection.

Perceptions of Mothers and Caregivers Regarding the Factors Affecting Low Uptake of Measles Immunisation Among Children Under 5 Years in Nyangana District, Namibia

Immunisation is considered to be amongst the most successful and cost-effective disease prevention interventions available. The aim of this study was, to investigate the perceptions of mothers/caregivers on the factors that impact on the uptake of measles immunisation in the Nyangana Health District, with a view to improving measles immunisation coverage. A qualitative exploratory study design was used to collect data from the study participants by the use of interviews. Data was audio-taped and transcribed verbatim. The recorded interviews were translated from the Gciriku language to English. Data was analysed through the use of the Thematic Content Analysis approach. Mothers whose children were vaccinated and those whose children were not vaccinated had both positive perceptions about immunisation. The findings indicates that, despite awareness and willingness for some mothers to bring their children for subsequent follow-up vaccinations, barriers such as inability to pay for transport, lack of support for single mothers and absence of support structures was hindering factors to immunisation uptake. Additionally, health system factors such as health care provider attitudes, staff shortages, inconvenient immunisation services, time constraints, inadequate outreach services and lack of tracking services for children who missed their measles immunisation were found to have an influence on the immunisation uptake. The children who missed their immunisation doses were mostly for single mothers and for those mothers who stayed far away from the clinic. The study concludes that the relationship between health care providers and mothers/caregivers and support from other social structures, should be good, in order to motivate mothers to use immunisation services. The study recommends that the following aspects be addressed, as they have the potential to improve the low uptake of measles immunisation: patient/provider relationship, information sharing, and supervision in the health facility, access to services, availability of outreach services, improved data tracking and active involvement of all stakeholders. These children should be targeted through improved outreach services and the use of health extension workers for contact tracing of children who missed their immunisation.