Retaining Professional Nurses in South Africa: Nurse Managers' Perspectives

South Africa is experiencing a serious shortage of nurses; which has to be addressed to prevent crises in health care services. Previous studies (Fletcher 2001:324; Oosthuizen 2005:117) found that nurses change their work environment due to dissatisfaction with their job situations. This implies that creating a favourable environment in the workplace situation could help retain professional nurses in their posts; implying that retention strategies should be effective. An exploratory; descriptive; contextual and qualitative design was used to describe nurse managers' views on factors which could influence professional nurse retention; as well as their views regarding attributes that were required to enable them to contribute towards enhancing professional nurse retention. A purposive sample of nurse managers employed in public and private hospitals in the Gauteng province was selected. Semi-structured interviews were conducted with 21 nurse managers. The results were analysed qualitatively and contextualised within Vogt; Cox; Velthouse and Thames's Cork-Top (Bottleneck) Theory of Nurse Retention (1983) and Lewin's Force-Field Analysis Theory (1952). Factors pertaining to individual nurses; the organisation and nurse managers could influence the retention of professional nurses. Poor working conditions; long and inconvenient working hours; uncompetitive salaries and professional development of nurses have to be addressed to enhance professional nurses' retention. Unsafe working environments and a lack of resources threaten the safety and well-being of nurses and patients and contribute to high turnover rates. Nurse managers have to address shortcomings in their managerial and leadership skills and implement changes within a multigenerational nursing workforce and challenging working environments

Nurses' Perceptions about Botswana Patients' Anti-Retroviral Therapy Adherence

Anti-retroviral drugs (ARVs) are supplied free of charge in Botswana. Lifelong adherence to anti-retroviral therapy (ART) is vital to improve the patient's state of well-being and to prevent the development of strains of the human immunodef ciency virus (HIV) that are resistant to ART. Persons with ART-resistant strains of HIV can spread these to other people; requiring more expensive ART with more severe side-effects and poorer health outcomes. The purpose of this exploratory; descriptive; qualitative study was to determine nurses' perspectives on Botswana patients' anti-retroviral therapy (ART) adherence; and to identify factors which could promote or hinder ART adherence. Four ART sites were randomly selected and all 16 nurses providing ART services at these sites participated in semi-structured interviews. These nurses indicated that patients' ART adherence was inf uenced by service-related and patient-related factors. Service-related factors included the inaccessibility of ART clinics; limited clinic hours; health workers' inability to communicate in patients' local languages; long waiting times at clinics and delays in being informed about their CD4 and viral load results. Nurses could not trace defaulters nor contact them by phone; and also had to work night shifts; disrupting nurse-patient relationships. Patient-related factors included patients' lack of education; inability to understand the significance of CD4 and viral load results; financial hardships; non-disclosure and non-acceptance of their HIV positive status; alcohol abuse; the utilisation of traditional medicines and side effects of ART. The challenges of lifelong ART adherence are multifaceted involving both patient-related and service-related factors. Supplying free ARVs does not ensure high levels of ART adherence

The Impact of a Buddy System on the Self-Care Behaviours of Women Living with HIV/AIDS in Botswana

A needs assessment done among HIV-positive (HIV+ve) people in Botswana in 2000 indicated that these people required social support. Based on these results; a buddy system for and by HIV+ve women was instituted in Botswana during 2002. This study examined the impact of the buddy system on the self-care behaviours of 116 HIV+ve women volunteers who used the services of COCEPWA (Coping Centre for People with Aids) during 2002. The convenience sample comprised 39 buddies who completed the buddy training programme; 39 patients assigned to the 39 buddies and 38 controls who lived in areas where the buddy programme did not operate. The results indicate that HIV+ve patients who had buddies showed improved self-care behaviours from April 2002 until November 2002 compared to the controls. These self-care behaviours encompassed informing a number of other people about their HIV+ve status; compliance with tuberculosis treatment; CD4 quantification and adherence to antiretroviral therapy. Although the differences were not always statistically significant; the patients showed greater improvements than the controls in all self-care behaviours. Thus the buddy system might have assisted and empowered the patients to achieve higher levels of self-care behaviours than the controls

Implementing a community-based tuberculosis programme in the Omaheke region of Namibia: nurses' perceived challenges

Tuberculosis (TB) is a resurgent disease in many regions of the world; including Namibia; fuelled by poor TB control programmes; human immunodeficiency virus (HIV) and poverty. The purpose of this survey was to identify nurses' perceived challenges in implementing a community-based TB programme in the Omaheke region of Namibia. Structu- red interviews were conducted with 40 nurses involved in providing TB treatment and care in the Omaheke region. Patient-related challenges which hampered TB treatment included alcohol and drug abuse; poverty and stigma. Lack of transport for nurses to do community-based TB work; centralised TB services and patients' lack of transport were access-related challenges. Knowledge-related challenges involved a lack of TB knowledge by both nurses and community members. The HIV pandemic has increased the number of TB patients and increased nurses' workloads; aggravating the burden of TB as a resurgent disease in this region. Decentralisation of TB care to community and family levels would be necessary to reduce the number of people with active TB in the community; and to enhance the TB cure rates; in the Omaheke region of Namibia. In order to implement a successful communitybased TB programme; the patient-related; access-related and knowledge-related challenges; perceived by the nurses; need to be addressed effectively

Factors that May Influence South African Nurses' Decisions to Emigrate

Although no accurate statistics about the number of South African nurses working in other countries are available; the Organisation of Economic Cooperation and Development estimated that 35 000 South African nurses were working outside South Africa and/or outside the health care system (Horning; 2005:58). The global shortage of nurses; creating opportunities for South African nurses to work in foreign countries; as well as a variety of factors related to nursing; health care and the general living conditions in South Africa influence nurses' decisions to emigrate. The purpose of this study was to explore and describe the factors that influence nurses' decisions to emigrate. Maslow's Hierarchy of Needs Theory was used as a point of departure to establish what motivates the behaviour of nurses to emigrate from South Africa. A quantitative approach was used. The target population comprised all the nurses (n=3 331) on the registers of the South African Nursing Council (SANC) who completed their basic training during 2002. A random sample of 15 (n=501) of the total population of nurses who completed their basic training during 2002 was selected. Data were collected by structured questionnaires. The analysis of the data indicated that nurses' inadequate remuneration; poor working conditions; excessive workloads; lack of personal growth and career advancement possibilities and inability to meet their safety and security needs were major factors that influenced nurses' decisions to emigrate. The recommendations include improved remuneration for nurses; enhanced working conditions with adequate supplies and equipment; reduced workloads by employing more nurses; expanded career prospects and improved safety

Swazi Youths' Attitudes and perceptions Concerning Adolescent Pregnancies and Contraception

This study investigated Swazi adolescents' attitudes and perceptions concerning adolescent pregnancies and contraceptive practices in order to help address the continued challenge posed by large numbers of adolescent pregnancies in Swaziland. Thirty boys and thirty girls aged from 16 to 18; from an urban and a rural area participated in focus group interviews. The adolescent girls revealed that they are expected to bear children at young ages and are competing for men's love by bearing their children. Adolescent boys expressed contradictory notions in expecting girls to refuse unprotected sex; but also maintaining that men are the sole decision-makers about sexual issues. The adolescent Swazi boys and girls identified health service barriers to accessing contraceptives; had reservations about using modern contraceptives; and preferred traditional contraceptives which they perceived to be without harmful side-effects

Contraceptive Challenges Experienced by Women who Requested Termination of Pregnancy Services in Mpumalanga Province

Although contraceptives are available free of charge throughout South Africa; the number of requests for termination of pregnancy (TOP) services continues to increase. This research investigated challenges preventing women from using contraceptives effectively. Structured interviews were conducted with 55 women who requested TOP services. As many as 85.5 of these women had used contraceptives. They discontinued using contraceptives when sideeffects occurred; necessitating them to request TOP services. Knowledge about; access to and the actual use of contraceptives did not enable these women to prevent unwanted pregnancies. More effective counseling about contrace- ptives' side-effects and enhanced accessibility of contraceptives over weekends and during lunch breaks could enable more women to prevent unwanted pregnancies; reducing the number of requests for TOP services

Factors Influencing Adolescent Mother's Non-Utilisation of Contraceptives in the Mkhondo Area

This study investigated factors influencing adolescent mothers' non-utilisation of contraceptives in the Mkhondo (previously known as the Piet Retief) area. Although contraceptives are available free of charge; the number of adolescent mothers continues to increase in this area. Questionnaires were completed by 107 adolescent mothers. Many participants (70.0) lacked knowledge about contraceptives. Subsequent to the birth of their babies; only 59.81used contraceptives; risking further pregnancies.The findings indicate that adolescents; from the age of 12; should receive education about contraceptives. The availability of contraceptives during weekends could help adolescents to prevent unplanned pregnancies. Health education should be given to the mothers in the Mkhondo area so that they can provide more effective education about contraceptives to their daughters

The Role Played by Recruitment Agencies in the Emigration of South African Nurses

Active recruitment of foreign nurses might offer solutions to many countries' nursing shortages. During 1999; the International Council of Nurses (ICN) expressed concerns regarding the aggressive international recruitment of nurses.The ICN maintained that internationally recruited nurses might be particularly at risk of exploitation or abuse. The ICN denounced unethical recruitment practices that might exploit nurses (ICN; 1999a:1-6). Many nurses who leave the Republic of South Africa might use recruitment agencies' assistance. These concerns raised by the ICN indicated the need for obtaining information about the emigration of South African nurses and the role played by recruitment agencies. The purpose of this study was to explore and describe how recruitment agencies contributed to the emigration of South African nurses. Both qualitative and quantitative approaches were used. A purposive sample of recruitment agencies that recruited South African nurses to practise in foreign countries (N=4) was drawn. The second sample; a purposive sample selected through snowball sampling consisted of South African registered nurses who were practising in foreign countries (N=27). The findings obtained from structured interviews conducted with recruitment agencies were supported by findings from e-mail responses from nurses working in foreign countries. These research results indicated that recruitment agencies in South Africa provided professional services to nurses who wanted to work in foreign countries. Contrary to research reports published in other countries; no evidence was found of nurses being exploited by recruitment agencies in South Africa

Contraceptive Practices of Women in Northern Tshwane; Gauteng Province

Despite the availability of free contraceptives in the Republic of South Africa (RSA); unwanted and unintended pregnancies continue to pose challenges to reproductive health services. Structuredinterviews were conducted with 83 women in the Northern Tshwane area of the Gauteng Province about their contraceptive practices. All the participants couldgain more knowledge about the effective use ofmodern contraceptives. Knowledge about emergency ontraceptives was extremely limited. Although most participants knew about legalised termination of pregnancy services in the RSA; they didnot know how to access these services. The recommendations address ways in which contraceptive services could be improved