ABSTRACT
Gender-related vulnerability is described as a crucial factor contributing to increased susceptibility of women to HIV; accounting for more women than men being infected. At the same time; empowerment interventions are being promoted as effective strategies for increasing the ability of women to adopt protective behaviours. The aim of the review was to identify; collate and categorise the factors determining the gender-related vulnerability of women to sexually transmitted HIV. A review of literature from theoretical and empirical studies using diverse methodologies was undertaken. Reports included those identified through electronic and manual searching. Twenty factors; forming five clusters; were identified as influencing the ability of women to adopt protective behaviours. Each factor was analysed to describe its component parts and the relationship between a factor; gender-related vulnerability; HIV risk level and empowerment status. Further analysis provided a description of markers named predictors and indicators. The literature portrays markers that can be identified and used to describe gender equality status; HIV risk level and related empowerment. This provides the potential to identify factors in gender equality status and HIV risk level to address in programmes designed to empower women in order to lower their risk to sexually transmitted HIV
Subject(s)
HIV Infections/transmission , Review , Sexually Transmitted Diseases , Vulnerable Populations , WomenABSTRACT
Premature and low birthweight infants pose particular challenges to health services in South Africa. While there is good evidence to demonstrate the benefits of kangaroo care in low birthweight infants; limited research has been conducted locally on the experiences of parents who provide kangaroo care to their preterm infants. This phenomenological study explores the lived experience of parents who provided their preterm infants with kangaroo care at a tertiary-level maternity centre in the Western Cape. In-depth interviews were conducted with six parents: four mothers and two fathers. Data was analysed using an adaptation of the approaches described by Colaizzi (1978:48-71) and Hycner (1985:280-294). To ensure trustworthiness; the trustworthiness criteria described by Guba and Lincoln (1989:242-243) were applied. Kangaroo care is a phased process; each phase bringing a unique set of experiences. The eight themes that emerged are described: unforeseen; unprepared and uncertain - the experience of birth; anxiety and barriers; an intimate connection; adjustments; roles and responsibilities; measuring success; a network of encouragement and support; living-in challenges; and living with the infant outside of hospital. Challenges facing health care providers are described and recommendations for information about kangaroo care and support for parents are made
Subject(s)
Infant Care , Mother-Child Relations , Parents , Premature BirthABSTRACT
Premature and low birthweight infants pose particular challenges to health services in South Africa. While there is good evidence to demonstrate the benefits of kangaroo care in low birthweight infants; limited research has been conducted locally on the experiences of parents who provide kangaroo care to their preterm infants. This phenomenological study explores the lived experience of parents who provided their preterm infants with kangaroo care at a tertiary-level maternity centre in the Western Cape. In-depth interviews were conducted with six parents: four mothers and two fathers. Data was analysed using an adaptation of the approaches described by Colaizzi (1978:48-71) and Hycner (1985:280-294). To ensure trustworthiness; the trustworthiness criteria described by Guba and Lincoln (1989:242-243) were applied. Kangaroo care is a phased process; each phase bringing a unique set of experiences. The eight themes that emerged are described: unforeseen; unprepared and uncertain - the experience of birth; anxiety and barriers; an intimate connection; adjustments; roles and responsibilities; measuring success; a network of encouragement and support; living-in challenges; and living with the infant outside of hospital. Challenges facing health care providers are described and recommendations for information about kangaroo care and support for parents are made
Subject(s)
Infant , Infant Care , Infant, Low Birth Weight , Infant, PrematureABSTRACT
"Background: Effective teamwork between doctors and clinical nurse practitioners (CNP) is essential to the provision of quality primary care in the South African context. The Worcester Community Health Centre (CHC) is situated in a large town and offers primary care to the rural Breede Valley Sub-District of the Western Cape. The management of the CHC decided to create dedicated practice teams offering continuity of care; family-orientated care; and the integration of acute and chronic patients. The teams depended on effective collaboration between the doctors and the CNPs.Methods: A co-operative inquiry group; consisting of two facility managers; an administrator; and medical and nursing staff; met over a period of nine months and completed three cycles of planning; action; observation and reflection. The inquiry focused on the question of how more effective teams of doctors and clinical nurse practitioners offering clinical care can be created within a typical CHC.Results: The CHC had established three practice teams; but met with limited success in maintaining the teams over time. The group found that; in order for teams to work; the following are needed: A clear and shared vision and mission amongst the staff. The vision was championed by one or two leaders rather than developed collaboratively by the staff. Continuity of care was supported by the patients and doctors; but the CNPs felt more ambivalent. Family-orientated care within practices met with limited success. Integration of care was hindered by physical infrastructure and the assumptions regarding the care of ""chronics"". Enhanced practitioner-patient relationships were reported by the two teams that had staff consistently available. Significant changes in the behaviour and roles of staff. Some doctors perceived the nurse as an ""assistant"" who could be called on to run errands or perform tasks. Doctors perceived their own role as that of comprehensively managing patients in a consultation; while the CNPs still regarded themselves as nurses who should rotate to other duties and perform a variety of tasks; thus oscillating between the role of practitioner and nurse. The doctors felt responsible for seeing a certain number of patients in the time they were available; while the CNPs felt responsible for getting all the patients through the CHC. The doctors did not create space for mentoring the CNPs; who were often seen as an intrusion and a threat to patient privacy and confidentiality when requesting a consultation. For the CNPs; however; the advantage of practice teams was considered to be greater accessibility to the doctor for joint consultation. The identification of doctors and CNPs with each other as part of a functioning team did not materialise. Effective management of the change process implied the need to ensure sufficient staff were available to allow all teams to function equally throughout the day; to be cognisant of the limitations of the building design; to introduce budgeting that supported semi-autonomous practice teams and to ensure that the staff were provided with ongoing opportunities for dialogue and communication. The implications of change for the whole system should be considered; and not just that for the doctors and nurses.Conclusions: Key lessons learnt included the need to engage with a transformational leadership style; to foster dialogical openness in the planning process and to address differences in understanding of roles and responsibilities between the doctors and the CNPs. The unreliable presence of doctors within the practice team; due to their hospital duties; was a critical factor in the breakdown of the teams.. The CHC plans to further develop practice teams; to learn from the lessons so far and to continue with the co-operative inquiry."
Subject(s)
Cooperative Behavior , Delivery of Health Care , Hospitals, Public , Nursing, Team , Physician-Patient Relations , Physicians , Primary Health Care , Public SectorABSTRACT
The implementation of the Choice on Termination of Pregnancy Act; Act No. 92 of 1996 brought many challenges; for the registered nurses/midwife assisting in the termination of pregnancy. In the gynaecological wards at a tertiary level hospital; registered nurses/midwives assist with the termination of pregnancies for women in the second trimester (13-20 weeks); using an oral medication; Misoprostol. A qualitative phenomenological study of the experiences of registered midwives who assist in termination of pregnancies was conducted. Registered nurses/midwives; each with at least six months experience in the assistance of terminations of pregnancies participated in this study. Indepth interviews were conducted with the participants. The audiotaped interviews were transcribed and analysed for themes and patterns within the transcriptions. Five theme categories emerged : obstacles experienced by the registered midwives; feelings evoked by the experiences; conflicts encountered; the coping mechanisms utilised and the need for support systems. Recommendations include the provision of support structures for registered midwives working in this setting