Allopathic medicine practitioners' experiences with non-disclosure of traditional medicine use

Background

A pertinent issue impacting patient treatment outcomes is the nondisclosure of traditional medicine (TM) use to Allopathic medicine practitioners (AMPs). For years, TM has been a controversial practice, with patients often using it alongside allopathic medicine without disclosing their use. It is imperitive to learn and understand the experiences of AMPs regarding the disclosure of TM use in Gauteng province to enable them to provide the best possible treatment outcomes for patients who use TM.

Aim

This study aimed to explore the experiences of AMPs regarding non-disclosure of TM use in Gauteng province.

Setting

This study was conducted in four district hospitals where outpatient care and services are rendered in Gauteng Province.

Methods

An interpretive phenomenological analysis (IPA) design was followed. Fourteen purposefully sampled AMPs participated in face-to-face, one-on-one, and semi-structured interviews. Interpretive phenomenological analysis in Atlas.ti was conducted.

Results

Three themes emerged: bedside manner of AMPs; stigmatising TM use; and individual belief systems. The belief of patients' disclosure hesitancy because of fear of judgment by the AMPs underpinned these themes.

Conclusion

Allopathic medicine practitioners are aware that patients who use TM could feel guilty and stigmatised. They acknowledged that patients use TM because of cultural and ethnic reasons, which should not be disregarded.

Contribution

The study highlighted that patients do not disclose their TM use because of AMPs' attitudes, stigmatising TM use, and their prejudices against the cultural beliefs of patients. Allopathic medicine practitioners should establish good communication with patients by providing patient-centred communication to facilitate disclosure of TM use.

Allopathic Medicine Practitioners' perspectives on facilitating disclosure of traditional medicine use in Gauteng, South Africa: a qualitative study

BACKGROUND

Traditional medicine (TM) plays a key role in maintaining health in many societies. Given the requirement for TM disclosure, Allopathic Medicine Practitioners (AMPs) must encourage open communication with patients to persuade those who use TM to disclose. Addressing patient non-disclosure of TM requires this dialogue to be facilitated. We sought to understand and describe how South African AMPs facilitate disclosure of TM use during a consultation with patients who use both TM and allopathic medicine (AM) and how it influences the patients' willingness to disclose TM use.

METHODS

This qualitative exploratory descriptive study on AMPs at Gauteng district public hospitals in South Africa was conducted between 2021 and 2022. Non-probability purposive sampling was employed to select a sample of 14 AMPs. Individual participants were encouraged to share their unique experiences and interpretations of the phenomenon concerning TM use disclosure. The raw transcribed textual data were processed using ATLAS.ti, and inductive content analysis was undertaken following the coding of the content to identify categories.

RESULTS

The data revealed four major categories: 'providing a suitable atmosphere for disclosure,' 'encouraging patients to disclose TM usage to AMPs,' 'patient autonomy,' and 'AMP training'. During a consultation with patients who use both TM and AM, participants expressed their experiences and perceptions of TM nondisclosure. They also discussed several methods for encouraging patients to disclose their TM usage, particularly when TM is used concurrently with AM.

CONCLUSION

This study expands on previously reported findings by describing how South African AMPs facilitate the disclosure of TM use during consultation. Many AMPs struggle to initiate TM conversations with their patients which results in non-disclosure. This study revealed that integrating TM into AM training programmes, promoting cross-practice, and creating a safe environment is necessary for the development and application of the most appropriate approaches that would assist in facilitating disclosure.

Utilisation of Maternal Health Services and its Impact on Maternal Mortality Rate: A Case for KwaZulu-Natal, South Africa

Despite several strategies in place in South Africa and globally to prevent maternal mortality and morbidity, maternal deaths remain high, especially in sub-Saharan Africa and lower to middle-income countries. The aim of the study was to identify the challenges that lead to pregnant women’s delays in seeking antenatal care (ANC) early and to find strategies to prevent such delays, contributing to a reduction of maternal deaths in South Africa. The study was conducted in two phases. Phase one analysed data on maternal deaths collected by the District Health Information System (DHIS) of the KwaZulu-Natal Department of Health from all 11 districts over a 10-year period (2009–2019). The data on maternal deaths revealed that there was a very high maternal mortality rate; between 800 and 1 780 per 100 000 live births. This correlated with very low antenatal visits; between 695–895 per 100 000 live births. In phase two, a literature review was conducted using several computer-assisted databases, bibliographies and websites to identify and source current policies. The literature review presents causes of delay in seeking ANC and strategies to prevent maternal deaths. Recommendations were made to consider strengthening education and awareness related to family planning; women empowerment through community health programmes and change in healthcare providers’ behaviours and attitudes; ensuring availability of maternal health resources; and developing strategies to ensure that the ANC services delivered are in line with the South African Department of Health Guidelines.

Factors leading to disruptive behaviours at central hospitals in Harare Metropolitan Province: Radiography managers perspectives

BACKGROUND

The negative consequences of disruptive behaviours involving healthcare workers threatens the institution's image, staff morale, finances, and patient safety. While all kinds of health organisations or settings are potentially exposed to disruptive behaviours, some are at higher risk than others because of both environmental and cultural factors. Such risk should be assessed having regard to the specific situation and conditions in which each healthcare organization operates.

AIM

The aim of this study was to explore radiography manager's perspectives on the environmental and cultural factors leading to DBs involving radiographers at central hospitals in Harare Metropolitan Province.

METHODS

An exploratory qualitative study employing in-depth interviews with 11 radiography managers across five departments at three central hospitals selected by criterion purposive sampling was done. The interview data were analysed using Tesch's method of qualitative analysis.

RESULTS

The key environmental and cultural factors identified included three themes: power hierarchy, work environment and reporting framework. Power hierarchy comprised categories, superiority, professional boundaries and representation. The work environment incorporated categories, trust in leadership, burnout and fatigue and remuneration. Lastly, reporting framework included categories, lack of protocol and reporting culture.

CONCLUSION

Radiography managers believe that environmental factors play a bigger role in leading to disruptive behaviours that involve radiographers at central hospitals in Harare Metropolitan Province. This underscores the need for hospital and radiography managers to pay particular emphasis on these when formulating policies and procedures to address these behaviours. Addressing DBs ensures that healthy work environments are promoted which in turn ensures that patients receive optimum and safe care.

IMPLICATIONS FOR PRACTICE

The paper provides an insight into the environmental and cultural dynamics that may trigger disruptive behaviours involving radiographers. This information is invaluable in formulating policies and procedures for addressing these unprofessional behaviours.

Back pain in pregnant women attending an antenatal clinic in KwaZulu-Natal, South Africa

Background

Back pain is not uncommon in pregnant women, but it is often under-reported and can be disabling. International studies report a high prevalence of back pain, especially in the last trimester. Little is known about the prevalence of back pain in South African pregnant women.

Aim

To determine the prevalence and risk factors of back pain in a cohort of pregnant women

Setting

Public primary healthcare clinics and the eThekwini municipality of KwaZulu-Natal (KZN), South Africa

Methods

A descriptive cohort design was used to survey pregnant women (n = 303) over the course of their pregnancy. Data were collected at the first antenatal visit and again in the third trimester. Participants gave consent and ethical clearance was obtained from an institutional research ethics committee, from the eThekwini Health District and KZN Provincial Department of Health.

Results

The respondents were young Black African women (mean age of 25.8 (± 6.0), who were mostly unemployed (70.7%), and resided in a resource poor setting. Back pain prevalence at the first antenatal visit and the third trimester was 12.4% (n = 35) and 10.9% (n = 5), respectively. This condition was associated with carrying water and residing in a hostel or an employee’s property. Being single was associated with less risk for developing back pain.

Conclusion

The prevalence of back pain was low in this cohort of women, yet it resulted in a negative impact on the women’s ability to cope with daily life.

Contribution

This is one of the first studies to describe back pain in a South African pregnant population.

A practice framework for the cooperative treatment of cancer between traditional health practitioners and radiation oncologists in KwaZulu-Natal province, South Africa

Background

Cooperative practice between traditional health practitioners (THPs) and radiation oncologists (ROs) is crucial for the continuity of care in the treatment of patients with cancer. However, scant information exists on how to co-ordinate cooperation between these health practitioners without interrupting the treatment of the patients.

Aim

The study aimed to explore the practices of THPs and ROs in cancer treatment and ultimately derive a workable practice framework between these health practitioners in the KwaZulu-Natal (KZN) province.

Setting

The study was conducted in selected districts, namely eThekwini, uThukela, Amajuba, uMkhanyakude, iLembe, uMzinyathi and uMgungundlovu, in KZN.

Methods

A qualitative study by using a descriptive phenomenological approach was conducted to collect data from 28 THPs involved in the treatment of cancer and four ROs from public oncology hospitals. Focus groups and one-on-one semi-structured interviews by using open-ended questions were conducted to collect data from THPs and ROs, respectively. Framework analysis was used for data analysis to identify themes.

Results

The study found that in KZN, THPs and ROs are working in parallel and that there are problems when patients seek cancer treatment from both health practitioners. Furthermore, the THPs and ROs work in an environment where there is no relationship, respect and trust, open communication and referral of patients by ROs to THPs. Both teams indicated that patients consult both traditional medicine (TM) and allopathic medicine (AM) by moving between the two health practitioners, resulting in interruptions in treatment. In addition, the study found that cooperation between THPs and ROs is understood as the provision of continuity care, where the parties work independently but share certain information of the patient on treatment, or as already being treated by each of them. The focus was on the type of relationship, enablers and common grounds for cooperation.

Conclusion

The workable cooperative practice framework could be an inclusive health system where the parties work in parallel, with the patient being the main actor in the collaboration.

Perceptions of student accoucheurs regarding gender inequality in midwifery training at Free State maternal healthcare institutions

Background

Worldwide, gender inequality has been a dominating factor in the training of student accoucheurs in most maternal healthcare institutions. This poses challenges for the maternal healthcare institutions where student accoucheurs are placed for clinical practice as most women become reluctant or refuse to accept their services. Gender inequality has a negative impact on the training of student accoucheurs as most of them become demotivated which could lead to a high attrition rate.

Objectives

This study explored and described the perceptions of student accoucheurs regarding gender inequality in midwifery training at the Free State maternal healthcare institutions.

Method

An explorative and descriptive qualitative research design was undertaken. There were 40 student accoucheurs that formed 10 focus group discussions. Each focus group discussion had four participants. Tesch’s eight-steps of data analysis was used to analyse data.

Results

Three major themes emerged during data analysis: meeting the training requirements in midwifery, women’s autonomy in a choice of healthcare provider versus student accoucheurs’ autonomy to be trained in midwifery and staff establishment to render maternal healthcare.

Conclusion

The participants perceived prejudice, rejection and resistance by women in maternity units as a contributing factor to gender inequality, which has a negative impact on their training in midwifery. The study recommends that health directorates, nurse managers and training institutions should consider revising maternal healthcare policies regarding the recruitment and placement of willing accoucheurs in maternity units in order to address gender inequality.

A model to enhance job satisfaction for radiographers in the public healthcare system in Gauteng province, South Africa

INTRODUCTION

The World Health Organization seeks to address the maldistribution of healthcare professionals which results in inequitable services to underserved communities (World Health Organization (WHO), 2015). In South Africa, the underserved areas are the public sector hospitals and the rural areas. Radiographers, like other healthcare professionals, are also unequally distributed between the public and private sector hospitals, and between the rural and urban areas. Since one of the perceived factors for maldistribution is job satisfaction, it is essential to explore factors that contribute to job satisfaction/dissatisfaction amongst radiographers to develop a model to attract and retain radiographers in the public sector.

METHODS

The study used exploratory sequential mixed methods approach to explore job satisfaction amongst radiographers, employed by public tertiary hospitals in the Gauteng province, South Africa. In phase one of the study (qualitative), individual and focus group interviews were used to collect data, and in phase two (quantitative), a self-developed questionnaire was used. The data collected was analyzed in sequential order, where thematic analysis was performed for phase one of the study, and SPSS version 23 was used in phase two.

RESULTS

In phase one, five themes emerged, namely the influence of government policies on job satisfaction, lack of career pathing, poor remuneration, working conditions, and the role of the human resources department. In phase two, the Pearson's correlation test was performed which showed that there was a significant correlation of intent to leave, p = .005 with the following factors: government policy on Occupational Specific Dispensation (OSD) and Performance Management Development System (PMDS), working conditions, supervision, equipment and infrastructure, and poor remuneration.

CONCLUSION

Government policies, working conditions, and poor remuneration play a significant role in job satisfaction amongst radiographers employed by public tertiary hospitals in the Gauteng province.

IMPLICATIONS FOR PRACTICE

The proposed model could enhance job satisfaction for radiographers employed by the public sector hospitals and ultimately increase attraction and retention rates of radiographers for this sector.

Nutritional status and dietary diversity of pregnant women in rural KwaZulu-Natal, South Africa

Background

Pregnancy is a critical period during which maternal nutrient intake and nutritional status impact both the mother and the infant. Various factors including good nutrition play a role in a healthy pregnancy outcome. A healthy diet has an important role in the birthweight and well-being of both the mother and the child.

Aim

The aim of this descriptive study was to determine the nutritional status and food intake of a group of pregnant women (N = 100) in early pregnancy (up to 24 weeks gestation).

Setting

The study took place in a Public Health Care Facility located at Umkhumbane (Mayville) and forms part of the EThekwini district operated by the Provincial and eThekwini Municipality situated in Kwa Zulu Natal, South Africa.

Methods

This study utilised a quantitative, descriptive research design and included 100 pregnant women attending a public healthcare clinic in KwaZulu-Natal province, South Africa. Consenting women were measured for height and weight to determine body mass index (BMI) as an indicator of nutritional status. Food intake was evaluated through two 24-h dietary recall questionnaires and a food frequency questionnaire. Actual food intake was analysed for nutrient content and compared to the Dietary Reference Intake for women aged 19-30 years. A food variety score and food group diversity score were determined to establish the adequacy of the diet to support the first phase of pregnancy.

Results

Except for carbohydrates and vitamin A, all the nutrients consumed by the women were lower than the recommended daily amounts. Fruit and vegetable intake was half of the recommended daily amount and a medium food variety score was observed. A large percentage (55%) of the women had a BMI that fell in the obese category.

Conclusion

Although various factors can impact birth outcome, food choices made by women did not reflect the food choices to maintain a healthy pregnancy and contribute to a healthy birth outcome. Nutrition education aimed at girls of childbearing age and pregnant women is important to increase their awareness about a healthy pregnancy and healthy birth outcome.

Financial management roles of nurse managers in selected public hospitals in KwaZulu-Natal province, South Africa

Background

The public health sector in South Africa has been facing severe financial cutbacks and financial constraints in recent times. The nurse manager (NM) is faced with the task of managing and reducing expenditure in the nursing sector without compromising the quality care. This requires skills and understanding of financial management.

Aim

This study aimed to explore the financial management roles of NMs and to identify financial management development needs necessary for NMs’ practice.

Setting

The study was conducted in KwaZulu-Natal. A total of eight hospitals from the five health districts were included.

Methods

The study used the naturalistic paradigm with a constructivist grounded theory approach. Interviews were used to initially gather data from six NMs who were purposively selected. Theoretical sampling was used to further recruit financial managers, chief executive officers, assistant nurse managers and operational managers. The final sample consisted of 18 participants.

Results

Financial management of the hospitals is the primary function of the financial managers and the chief executive officers. However, the role of NMs extends to the performance and participation in various activities relating to the financial functioning of the hospital. These include financial planning, financial monitoring, financial decision-making and financial control.

Conclusion

Nurse managers have a financial management function in public health care organisations but lack the necessary skills, knowledge and competencies to function in this role and require additional training. Recommendations included that a competency framework be developed to improve the financial management competencies of NMs.

Challenges affecting the implementation of the Policy on Integration of Mental Health Care into primary healthcare in KwaZulu-Natal province

Background

Since the publication of the White Paper for the Transformation of the Health System in South Africa in 1997, which included Policy on Integration of Mental Health Care into primary health care (PHC), there has been an emphasis on the promotion of health as well as the re-engineering of PHC to include the integration of mental health care into PHC. Although South Africa has made significant advances at the level of health-related policy development and legislation in trying to bring the country in line with international trends, there have been challenges with regard to implementation of policies, including that of integration of mental health care into PHC.

Objectives

The aim of this study was to determine the challenges affecting the implementation of the Policy on Integration of Mental Health Care into PHC in KwaZulu-Natal (KZN) province of South Africa and to seek possible solutions.

Method

A qualitative exploratory descriptive design was used to determine the challenges affecting the implementation of the Policy on Integration of Mental Health Care into PHC in KZN. The sample consisted of 42 participants of whom 4 were PHC managers, 6 were operational managers and 22 were professional nurses who were directly involved in implementing the policy at the operational level.

Results

The challenges identified included lack of training in mental healthcare services for staff working in PHC, unavailability of mental health policies, inadequate resources, poor communication between management and staff, lack of skills among PHC nurses in identifying signs of mental illness and misdiagnosis of patients.

Conclusion

Considering the challenges pertaining to PHC nurses’ abilities and skills to implement the Policy on Integration of Mental Health Care into PHC, PHC-trained nurses should engage in lifelong learning and be encouraged to develop their knowledge, skills and competence throughout their professional lives.

Circulating soluble fms-like tyrosine kinase-1, soluble endoglin and placental growth factor during pregnancy in normotensive women in KwaZulu-Natal, South Africa

BACKGROUND

Based on the increased pre-eclampsia and HIV antenatal incidence in South Africa, we determined the angiogenic profiles due to its mechanistic link in preeclampsia development, throughout uncomplicated pregnancies in HIV positive and negative women.

OBJECTIVE

To determine the angiogenic profiles throughout uncomplicated pregnancies in HIV positive and HIV negative women. We explored possible correlations between angiogenic serum levels and selected maternal characteristics (HIV status, gestational age, maternal factors, and pregnancy outcomes).

METHOD

This study was conducted at a primary health care facility in Durban, South Africa. Forty-six pregnant women aged 18-45 years, were enrolled at 10-20, 22-30 and 32-38 weeks' gestation, respectively through convenient sampling. Serum samples were collected and quantitatively evaluated using ELISAs. Clinical and epidemiological data were analysed using STATA (version 14). A probability level of p < 0.05 was considered statistically significant.

RESULTS

Of those enrolled, 28.3% were nulliparous, 82% were HIV positive and none developed pre-eclampsia. Systolic and diastolic blood pressure increased slightly throughout pregnancy. Fluctuating angiogenic and anti-angiogenic levels were demonstrated during pregnancy.

CONCLUSION

This study contributes to the current angiogenic knowledge in normotensive pregnancies, and may assist as a reference range against which these factors may be compared in HIV complicated pregnancies.

A practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into primary health care in KwaZulu-Natal province

BACKGROUND

 Mental health care at primary health care (PHC) still remains a challenge despite the Policy on Integration of Mental Health Care into PHC which was developed in 1997 at the time when the White Paper for the Transformation of the Health System in South Africa was published. The White Paper made provision for a new health care system based on the principles of the PHC approach to care. This was followed by the promulgation of the Mental Health Care Act No. 17 of 2002 which is based on the principle that mental health care should be integrated into PHC; however, there have been challenges with regard to the implementation of this policy.

AIM

 This study aimed to analyse the implementation of Policy on Integration of Mental Health Care into PHC with the ultimate aim of developing a practice framework for PHC nurses to enhance such implementation in KwaZulu-Natal (KZN).

SETTING

 The study took place in selected health districts in KZN, namely, Ugu, eThekwini, iLembe and uMgungundlovu.

METHODS

 A qualitative approach using grounded theory design was used to develop a practice framework to enhance the implementation of Policy on Integration of Mental Health Care into PHC. A theoretical sampling method was used to select the sample from PHC managers, operational managers and professional nurses for the collection of data. The sample consisted of 42 participants. Data were collected by means of one-on-one interviews and focus group interviews. Strauss and Corbin's approach of data analysis was used for analysing data. The paradigm model was used as a guide to develop a practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into PHC in KZN.

RESULTS

 This study found that integration of mental health care into PHC is understood as a provision of comprehensive care to mental health care users using either a supermarket approach or a one-stop-shop approach at PHC clinics. Strategies that are used at PHC clinics in KZN ensure that the integration of mental health care into PHC is implemented, includes the screening of all patients that come to the PHC clinic for mental illness, fast tracking of mental health care users once they have been assessed, and found to be mentally ill and management of all mental health care users as patients with chronic diseases.

CONCLUSION

 The practice framework developed identifies comprehensive mental health care being offered to mental health care users using either a supermarket approach or a one-stop-shop approach, depending on the availability of staff with a qualification in psychiatric nursing science.

Nutritional status and dietary diversity of pregnant women in rural KwaZulu-Natal, South Africa

BACKGROUND

Pregnancy is a critical period during which maternal nutrient intake and nutritional status impact both the mother and the infant. Various factors including good nutrition play a role in a healthy pregnancy outcome. A healthy diet has an important role in the birthweight and well-being of both the mother and the child.

AIM

The aim of this descriptive study was to determine the nutritional status and food intake of a group of pregnant women (N = 100) in early pregnancy (up to 24 weeks gestation).

SETTING

The study took place in a Public Health Care Facility located at Umkhumbane (Mayville) and forms part of the EThekwini district operated by the Provincial and eThekwini Municipality situated in Kwa Zulu Natal, South Africa.

METHODS

This study utilised a quantitative, descriptive research design and included 100 pregnant women attending a public healthcare clinic in KwaZulu-Natal province, South Africa. Consenting women were measured for height and weight to determine body mass index (BMI) as an indicator of nutritional status. Food intake was evaluated through two 24-h dietary recall questionnaires and a food frequency questionnaire. Actual food intake was analysed for nutrient content and compared to the Dietary Reference Intake for women aged 19-30 years. A food variety score and food group diversity score were determined to establish the adequacy of the diet to support the first phase of pregnancy.

RESULTS

Except for carbohydrates and vitamin A, all the nutrients consumed by the women were lower than the recommended daily amounts. Fruit and vegetable intake was half of the recommended daily amount and a medium food variety score was observed. A large percentage (55%) of the women had a BMI that fell in the obese category.

CONCLUSION

Although various factors can impact birth outcome, food choices made by women did not reflect the food choices to maintain a healthy pregnancy and contribute to a healthy birth outcome. Nutrition education aimed at girls of childbearing age and pregnant women is important to increase their awareness about a healthy pregnancy and healthy birth outcome.

Experiences of facilitators regarding the extended curriculum programme offered at a higher education institution in the province of KwaZulu-Natal in South Africa

BACKGROUND

 Much like the rest of the world, student access and success are primary concerns of the South African higher education institutions, especially in the face of data that suggest that up to 50% of students do not successfully complete their course of study. Despite compulsory and free basic education for all South Africans, and increased government funding for education, there has been little impact on learner performance and the majority of primary schools remain poor. To improve access and success and in keeping with international practice, the Department of Nursing at the selected university of technology in 2013 offered for the first time the extended curriculum programme (ECP). To date, the impact of the programme has never been evaluated.

OBJECTIVES

 The aim of the study was to explore the experiences of the facilitators regarding ECP in the undergraduate nursing programme.

METHOD

 Guided by this, the current article describes a qualitative exploration of the experiences of six purposively selected facilitators regarding ECP in the Department of Nursing. In-depth interviews were conducted with the ECP facilitators. Tesch's method was used to analyse the data.

RESULTS

 Four main themes emerged from the data: stigmatisation and lack of confidence, lack of self-will, additional workload of facilitators and gradual improvement of students' performance. The participants reported that although students displayed and verbalised negative attitude towards the ECP, the performance of students showed gradual improvement and thus a need to continue to offer the programme to increase access and success in higher education institutions.

CONCLUSION

 It was concluded that ECP should continue to increase access and success in higher education institutions; however, there is a need for additional resources to support ECP students.

Experiences of community caregivers in the assessment of malnutrition using mid-upper arm circumference measurement in children under 5 years old

Background

Malnutrition is a major public health challenge in developing countries. It has been identified as an important cause of child mortality and morbidity and leads to inadequate physical and cognitive development in children. The South African government implemented a strategy for malnutrition assessment in children under 5 years by community caregivers (CCGs), who would then refer children at risk or those having developed malnutrition to primary health care clinics. Irrespective of this strategy, children still present at clinics with severe malnutrition.

Aim

The aim of the study was to explore and describe the experiences of community caregivers with the assessment of malnutrition in children under 5 years old.

Setting

The study was conducted in North Area six of eThekwini district in the province of KwaZulu-Natal.

Methods

A qualitative, exploratory descriptive approach was used to collect data from 13 purposively selected CCGs. Content analysis was used to analyse data.

Results

The majority of participants were dissatisfied with the training, as it was conducted in a language in which they were not proficient. They reported a lack of support and supervision in their performance such that mid-upper arm circumference was non-prioritised. They were dissatisfied with work overload not matched by remuneration and they worked under unsafe conditions.

Conclusion

Effective training of CCGs needs to be conducted in the language that they understand to combat malnutrition in children under 5 years. CCGs have multiple roles and may need to prioritise their work; this is not easy and requires specific guidance from skilled health professionals.

Frequency and reasons for missed appointments of outpatient mental health care users in the uMgungundlovu District

Background

Over the years, there has been a rapid growth in the use of mobile technology which has been proven to increase treatment adherence. Short message services may improve service delivery through appointment reminders and improve communication between health care workers and patients. Missed appointments are becoming common amongst mental health care users, and this has a significant economic burden on mental health symptoms.

Objectives

The aim of the study was to determine the frequency and reasons for missed appointments of outpatient mental health care users for their follow-up care in the uMgungundlovu District.

Method

This study used a quantitative survey. A non-probability convenient sampling method was used to select 182 participants at the psychiatric clinics.

Results

Of the 182 participants, results of the study indicated that n = 84 (46.2%) respondents had missed their appointment at some stage. Of the n = 84 (46.2%) respondents who had missed appointments, n = 28 (33.3%) had missed their appointment once, and n = 45 (53.6%) had missed their appointment 2–3 times. Most common reasons for missed appointments included mental health care users forgetting (n = 58; 69%), work commitments (n = 14; 16.7%), no transportation (n = 4; 4.8%) and financial constraints (n = 5; 6%).

Conclusion

The main reasons for missed appointments that were identified included forgetfulness, work commitments, lack of transportation and financial constraints. A significant number of participants (53.6%) had missed their appointments 2–3 times.

Perceptions of young men at the Free State School of Nursing with regards to teenage pregnancy

BACKGROUND

Teenage pregnancy is a socio-economic challenge and a serious public health problem for communities in South Africa. It is, therefore, imperative that effective interventions and programmes be implemented to address this problem. A number of research studies have been conducted on teenage pregnancy in South Africa, but their focus was mainly on teenage girls excluding young men's involvement in teenage pregnancy.

AIM

The aim of the study was to determine the perceptions of young men between the ages of 18 and 23 years towards teenage pregnancy.

METHODS

A qualitative, explorative semi-structured interview descriptive design was used toconduct the study. The study was guided by the Johnson's Behavioral System Model. Purposive sampling was used to select 10 participants with whom semi-structured interviews were conducted. Thematic analysis of data were performed.

SETTING

The study was conducted in Free State School of Nursing's two main campuses.

RESULTS

The findings of this study revealed that young men were not involved in reproductive health programmes aiming to prevent teenage pregnancies. Father and son's poor communication on issues related to sex and teenage pregnancy contributes to unprotected sexual intercourse resulting in teenage pregnancy. Cultural and traditional practices such as the withdrawal method, not using contraceptives, and misleading teachings at the initiation schools contribute to risk factors of teenage pregnancy.

CONCLUSION

There is still a gap in reproductive health that needs to be filled by involving young men to reduce teenage pregnancies. Involving young men in reproductive health programmes could lead to a decreased number of teenage pregnancies. Factors, such as cultural and traditional practices, and father and son sexual health education, need to be taken into consideration to prevent teenage pregnancies.

Perceptions of student nurses on the writing of reflective journals as a means for personal, professional and clinical learning development

Background: Reflective journals are used by the students to voice their views on the daily activities during clinical placement. Reflective journals are aimed at helping the student to observe and record as many facts about daily practice as the student finds relevant. Reflective journal writing can therefore be used as a tool to evaluate that clinical learning is actually taking place and what challenges students are experiencing which may influence their learning. Findings by Harris (2006:460–461) are encouraging that through journaling students will develop ability to identify and analyse their difficulties, make suggestions for solving problems and ask and pursue questions on their own. Some of the participants confirmed improved values clarification, self-valuing and personal growth. Bulman & Schutz (2008:172) recommends journal writing for recording processes the student observe, copy and internalize in her journey towards professional development.Objectives: This study aimed to determine student nurses' perceptions of reflective journal writing as a means for personal, professional development and clinical learning development.Method: A quantitative and descriptive survey was conducted in September 2013. Forty participants were recruited from second year student nurses of a University of Technology in uMgungundlovu District of KwaZulu-Natal. Purposive convenience sampling strategy was used. A structured questionnaire was designed by the researcher from literature reviewed. The questionnaire was piloted and modified, then used after permission had been granted by the Ethics Committee of the university concerned. The Statistical Package for Social Sciences (SPSS 17) programme was used for data analysis.Results: Results indicated that the participants generally experienced writing of reflective journals to be a valuable tool enhancing personal development, professional growth and clinical learning. A significant number (n = 24/60%) confirmed that they improved in making proactive decisions and taking on the spot corrective actions; 52% (n = 21) of the participants were empowered to examine their attitudes and perspectives to a given situation and 55% (n = 22) participants increased in active involvement and ownership of their learning.Recommendations: It is recommended that clinical staff be reminded of their responsibility as role models for student nurses so as to enhance their personal, professional development and clinical development. The writing of reflective journals must be encouraged in nurse education and students given guidance and constructive feedback.

Experiences of homosexual patients' access to primary health care services in Umlazi, KwaZulu-Natal

Background

Homosexual patients are affected by social factors in their environment, and as a result may not have easy access to existing health care services. Prejudice against homosexuality and homosexual patients remains a barrier to them seeking appropriate health care. The concern is that lesbians and gays might delay or avoid seeking health care when they need it because of past discrimination or perceived homophobia within the health care thereby putting their health at risk.

Aim of the study

The aim of the study was to explore and describe the experiences of homosexual patients utilising primary health care (PHC) services in Umlazi in the province of KwaZulu-Natal (KZN).

Method

A qualitative, exploratory, descriptive study was conducted which was contextual in nature. Semi-structured interviews were conducted with 12 participants. The findings of this study were analysed using content analysis.

Results

Two major themes emerged from the data analysis, namely, prejudice against homosexual patients by health care providers and other patients at the primary health care facilities, and, homophobic behaviour from primary health care personnel.

Conclusion

Participants experienced prejudice and homophobic behaviour in the course of utilising PHC clinics in Umlazi, which created a barrier to their utilisation of health services located there. Nursing education institutions, in collaboration with the National Department of Health, should introduce homosexuality and anti-homophobia education programmes during the pre-service and in-service education period. Such programmes will help to familiarise health care providers with the health care needs of homosexual patients and may decrease homophobic attitudes.

Factors influencing successful implementation of the basic antenatal care approach in primary health care facilities in eThekwini district, KwaZulu-Natal

BACKGROUND

In a move to alleviate the burden of consistently high maternal and perinatal mortality rates, the South African National Department of Health (DoH) introduced Basic Antenatal Care (BANC) in all Primary Health Care facilities that were providing antenatal care services. However, not all facilities in the eThekwini district have successfully implemented the approach. The aim of the study was to identify the factors that influence successful implementation of the BANC approach.

OBJECTIVES

The objectives were to identify facilities that had successfully implemented the BANC approach and the factors that influenced successful implementation of the BANC approach, in order to make recommendations on these factors.

METHOD

A descriptive quantitative design was used. Firstly, primary health care facilities that were successful in implementing the BANC approach were identified through a retrospective record auditing. A total of 27 facilities were identified, of which 18 facilities were included in the study. This was followed by data collection from 59 midwives in order to identify the factors that influenced successful implementation of the BANC approach. The data was analysed using version 19 of the Statistical Package for the Social Sciences.

RESULTS

The positive factors that influenced successful implementation of the BANC approach included: the availability and accessibility of BANC services, policies, guidelines and protocol; various means of communication; a comprehensive package of and the integration of primary health care services; training and in-service education; human and material resources; the support and supervision offered to the midwives by the primary health care supervisors; supervisors' understanding of the approach and the levels of experience of midwives involved in implementation of the BANC approach.

CONCLUSION

The success that the facilities had achieved in implementing BANC approach was attributed to these positive factors.

A model for the integration of primary health-care services in the province of KwaZulu-Natal, South Africa

AIMS

To analyse integrated primary health care and ultimately develop a model for integrated care.

BACKGROUND

In South Africa, Integration of Services Policy was enacted in 1996 with the aim of increasing health service utilization. However, the problem with the policy arises in the implementation of integrated primary health care as there is no agreed understanding of what this phenomenon means in the South African context.

METHOD

A cross-sectional study, using Strauss and Corbin's grounded theory approach was utilised. Policy makers as well as primary health care nurses at functional level participated in the study. The data was collected by means of observations and interviews. The sample size for interviews comprised 38 participants.

RESULTS

Integrated primary health care was understood either as comprehensive health care, supermarket approach or one-stop shop.

CONCLUSION

It was concluded that integrated primary health care meant different things in different contexts.

IMPLICATIONS FOR NURSING MANAGEMENT

Integrated primary health care, if implemented, would advance health equity in all countries rich and poor and, as a result, promote human and national development. This model could be used to guide policy formulation and implementation of integrated primary health care at provincial and national levels.

A model for the integration of primary healthcare services in the province of KwaZulu-Natal, South Africa

Introduction

Aims

Results

Conclusion

An assessment of the implementation of the provincial cervical screening programme in selected Primary Health Care Clinics in the Ilembe Region, KwaZulu-Natal

Cervical cancer is almost completely preventable, yet it is the second most prevalent cancer amongst women in South Africa. KwaZulu-Natal (KZN) in particular has a high mortality rate of cervical cancer and 1: 40 women die from cancer of the cervix. Therefore, in 1997 a cervical screening policy and programme was implemented in the province. The purpose of the study was to evaluate the implementation of selected aspects of the Provincial cervical screening programme in selected Primary Health Care (PHC) clinics in Ilembe Region, KZN. Results indicated that there was a lack of resources needed for implementing the programme in rural clinics compared to urban clinics. However, all clinics in the study had an adequate supply of the drugs needed for the treatment of abnormal smears. On reviewing the records, the researcher noted that most of the results indicated that smears had adequate cells needed for analysis. However, the results indicated that there was a problem with follow-up of clients with abnormal smears. Feedback to the clinics from the referral hospital regarding the outcome of the visit was inadequate. The results indicated that the mechanisms of record keeping were inadequate. Therefore, the above results indicate that problems exist at the selected PHC clinics that may result in ineffective implementation of the cervical screening programme.