Structural, Familial, and Psychosocial Factors Affecting Long-Term Antiretroviral Treatment Adherence amongst Adolescents Living with Perinatally Acquired HIV in Limpopo, South Africa.

After more than two decades of the expansion of antiretroviral treatment (ART) in adolescents living with perinatal HIV (APHIV) in sub-Saharan Africa, there is still poorly sustained long-term adherence to ART due to multifactorial factors with the consequence of increased mortality and morbidity. There are little data available on the familial and structural factors which affect sustenance to long-term adherence to ART. A qualitative exploratory design was used to conduct in-depth interviews with 21 APHIV attending HIV care and management in the rural health facilities of Vhembe district in Limpopo Province, South Africa. Transcripts were translated verbatim into English, and data were analyzed using Tesch's eight steps of qualitative data analysis. The sample consisted of APHIV 10-19 years old who were aware of their HIV status, and all had received ART for more than 5 years. They lived in extended, disrupted, grandparent- and child-headed households. They experienced food insecurities due to poverty or orphanhood, as well as living in disrupted households, which deterred them from long-term adherence. In addition, dependency on social support grants to sustain their livelihoods affected long-term adherence. APHIV had challenges with structural factors such as inconsistent clinic attendance, clashes between school activities and clinic appointments, and the lack of transport fare to the clinic, which affected adherence. Although APHIV were on one-pill fixed-dose ART, they were not able to sustain long-term adherence due to various familial, structural, and psychosocial challenges. In addition to institution-based interventions, there is a need for family, community-based, and multi-sectorial interventions to support long-term ART adherence among APHIV.

Support Needs of Parents of Adolescents Abusing Substances in Selected Hospitals in Limpopo Province.

Parents with adolescents who abuse substances need support. They have high stress levels and low quality of life compared to other parents. This is because they have unmet support needs, do not know what to do to help their adolescents, and are distressed. Most studies focus on the support needs of adolescents. Less is known about the specific support needs of their parents. This study explores the support needs of parents of adolescents abusing substances and being treated in five hospitals in Limpopo Province. A qualitative research approach was applied with an explorative, descriptive, and contextual design using semi-structured interviews to understand parents' views. Data saturation was reached at the 14th parent. Data were analyzed using the Tesch method. The parents mainly wanted informational and emotional support. The study identified specific parent-related support needs and adolescent-related support needs. This study is the first to explore the support needs of parents of adolescents abusing substances in a South African rural context.

Is the Triage System Welcomed in the Tertiary Hospital of the Limpopo Province? A Qualitative Study on Patient's Perceptions.

A triage system in the emergency department is necessary to prioritize and allocate scarce health resources to the medical needs of the patients to facilitate quality health service delivery. This paper aimed to ascertain if the triage system is welcomed in the tertiary hospital of Limpopo Province by exploring patients' perceptions in the emergency department in South Africa. A qualitative research approach was used in this study with descriptive, explorative, and contextual research design to reach the research objective. Purposive sampling was used to select the patients who participated in semi-structured one-on-one interviews, which lasted between 30 and 45 min. The sample size was determined by data saturation after 14 participants were interviewed. A narrative qualitative analysis method was used to interpret and categorize the patients' perceptions into seven domains of Benner's theory. The six relevant domains illustrated mixed patients' perceptions regarding the triage system in the emergency departments. The domain-helping role of the triage system was overweighed by the dissatisfaction of the needy patients who waited for an extended period to receive emergency services. We conclude that the triage system at the selected tertiary hospital is not welcomed due to its disorganization and patient-related factors in the emergency departments. The findings of this paper are a point of reference for reinforcing the triage practice and improved quality service delivery by the emergency department healthcare professionals and the department of health policymakers. Furthermore, the authors propose that the seven domains of Benner's theory can serve as a foundation for research and improving triage practice within emergency departments.

Prevalence of Work-Related Musculoskeletal Disorders and Its Effects amongst Nurses in the Selected Intellectual Disability Unit of the Limpopo Province.

The COVID-19 pandemic continuously highlights the need for occupational health and safety among healthcare professionals. Physical and mental health safety resulting from needle prick injuries, stress, infections, and chemical hazards are priority work-related musculoskeletal disorders for nurses, including those working in the intellectual disability unit. The intellectual disability unit provides basic nursing care to patients with known mental disabilities, such as learning, problem-solving, and judgment problems, which demand diverse physical activities. Nevertheless, the safety of nurses within the unit receives little attention. Thus, we adopted a quantitative cross-sectional epidemiological survey design to determine the prevalence of work-related musculoskeletal disorders amongst nurses working in the intellectual disability unit at the selected hospital in Limpopo Province, South Africa. A self-administered questionnaire collected data from 69 randomly selected nurses from the intellectual disability unit. Data were extracted, coded, and captured in MS Excel format (2016) and imported into the IBM Statistical Package for the Social Sciences (SPSS), software version 25.0, for analysis. The study reported a low (38%) prevalence of musculoskeletal disorders in the intellectual disability unit, with significant effects on nursing care and staffing. The effects of these WMSDs included missing work, interference with the daily routine, disturbance with sleeping patterns after work, and absenteeism from work. Since intellectually disabled patients depend entirely on nurses for the basic activities of daily living, this paper recommends the incorporation of physiotherapy among nurses in the intellectual disability unit to treat the incidence of lower back pain while mitigating nurses missing work or absenteeism.

A Qualitative Study on Voices of South African Learner Nurses on Occupational Health and Safety during Clinical Learning: Pre-COVID-19 Pandemic.

The demanding and complex training of learner nurses in clinical practices requires various occupational health and safety measures to curb occupational health hazards among learner nurses. This paper aimed to explore learner nurses' experiences concerning occupational health and safety during clinical learning. A qualitative descriptive, contextual and exploratory design study was conducted. A total of 31 learner nurses were selected using purposive sampling. Data were collected by semi-structured interviews and analysed using Tesch's open coding method. Two themes emerged from this study: "The experiences of learner nurses concerning their health and safety during clinical learning" and "The measures to be taken to promote occupational health and safety during clinical learning." Highlighting challenges and measures to mitigate occupational health hazards among learner nurses in the South African context, Limpopo province, would be beneficial. The findings can assist stakeholders in developing specific precautionary guidelines for learner nurses. Effective and innovative occupational health and safety training programmes for learner nurses can be developed despite constrained environmental resources.

Qualitative Study on the Voices of Adolescents Living with Perinatally Acquired HIV in Selected Clinics in the Limpopo Province of South Africa.

The disclosure of HIV status among adolescents living with perinatally acquired HIV (APHIV) has become one of the core challenges in the management of APHIV. Disclosure is a challenge that undermines positive advances and achievements in HIV management. There is limited literature on the voices of APHIV on disclosure of their status. This study aims to explore the current disclosure process and how it affects APHIV. A qualitative exploratory design was employed to conduct one-on-one in-depth interviews using a semi-structured interview guide. Purposive sampling was used to sample 21 APHIV in 16 selected health facilities in the Vhembe district of Limpopo Province, South Africa. Data were analyzed using Tesch's qualitative data method. The findings of this study reflect the gaps in the current disclosure process and guidelines while acknowledging the importance of disclosure to APHIV. A notable finding in this study is that most APHIV, especially those in early adolescence, did not want to know their HIV status due to the stigma attached to an HIV-positive diagnosis. This study suggests that proper training and support of parents and/or guardians in the disclosure process are needed, as they are the primary caregivers of APHIV. The disclosure of HIV status must be a comprehensive part of the management and care of HIV for APHIV. Furthermore, dedicated support programs should be developed and implemented to improve their lives post-disclosure.

Rural Nurses' Views on Breastmilk Banking in Limpopo Province, South Africa: A Qualitative Study.

The development of breastmilk banks is being established among the African population, including in Limpopo Province. However, the views of nurses directly handling the donated breastmilk in the province remain unknown. This study was aimed at exploring and describing the views of nurses towards breastmilk banking in the Mankweng area, Limpopo Province. A qualitative, descriptive, and explorative study was undertaken at a tertiary hospital and a rural feeder clinic in the Mankweng area. Purposive sampling was employed to obtain participants for the interviews. One-on-one, semi-structured interviews were conducted to explore the views of these nurses. Data were analysed using Tesch's open coding method, with the information obtained being grouped into different themes and sub-themes. Almost all nurses were willing to donate their breastmilk to the bank. However, receiving donated breastmilk for their own children seemed to be a challenge due to the safety of the donated breastmilk, uncertainty about the screening process, and cultural issues. Although donation of breastmilk appeared to be well supported by almost all the nurses, the use of donated breastmilk seemed to be not fully acceptable. Increased awareness about breastmilk donation and banking should be prioritised in the province.

Exploring Occupational Health and Safety Standards Compliance in the South African Mining Industry, Limpopo Province, Using Principal Component Analysis.

The health and safety of the miners in the South African mining industry are guided by the regulations and standards applied to promote a healthy work environment. The miners must comply with these regulations/standards to protect themselves from potential occupational health and safety risks, accidents, and fatalities. The status of compliance to safety regulations and standards in the mining industry of Limpopo Province has received little attention from scholars. This study explores the practices related to occupational health and safety standards compliance in the mining industry. A total of 277 miners were randomly selected from 1300 respondents in the mining industry. Data were collected using a 31-item survey questionnaire, administered to miners to explore occupational health and safety standards compliance from December 2019 to May 2020. Principal Component Analysis (PCA) extracted key attributes of occupational health and safety standards compliance in the mining industry and uncovered relationships between different dimensions. The study revealed that seven factors could measure occupational health and safety standards practices. It was observed that Factor 1 (occupational health practice related to regulations) is correlated with Factor 2 (measures to reduce risk of injuries/accidents). Additionally, Factor 2 (measures to minimise the risk of injuries/accidents) is correlated with Factor 4 (impact of the environment and production). There is a correlation between non-compliance with the safety regulations and the occurrence of injuries and accidents.

How Is It to Live with Diabetes Mellitus? The Voices of the Diabetes Mellitus Clients.

Background: Diabetes mellitus is described as a chronic disease resulting from failure of the pancreas to generate enough insulin or inability of the body to efficiently utilize the insulin it generates. Diabetes clients must adjust their lives to live healthy with the diseases for the rest of their lives. Optimizing diabetic knowledge and awareness among people living with diabetes will yield better health outcomes. This study seeks to investigate the knowledge, practices, and challenges of diabetes mellitus clients regarding management of the disease at selected clinics in the Capricorn District of Limpopo Province, South Africa. Methods: This study used a qualitative research approach and a phenomenological research design. A purposive sampling method was used to acquire the 18 participants for this study. Semi-structured interviews with a guide were used to collect data. Tesch's coding method was employed for data analysis. Results: The study findings revealed that there are comparable explanations of what it means to follow medication instructions by diabetes mellitus clients, and challenges living with DM. The findings also indicate that there are problems related to conceptualization of medication instructions among diabetes clients. Conclusion: This study indicated that diabetes mellitus clients have poor knowledge regarding management of the disease and its process, and problems related to medication instructions. Therefore, proper teaching of clients and guidance regarding diabetes and its management are required to improve compliance and delay of long-term complications.

Provision of Care to the People with HIV: Voices of Professional Nurses in the Public Hospitals of Limpopo Province, South Africa.

The battle against the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) epidemic are still raging in South Africa (SA) despite all the preventive strategies implemented via the five-year strategic plan (2011-2015). The intensity of the AIDS pandemic in SA creates additional challenges for the health workers as they have to deal with an increasing number of people who suffer from this disease. Professional nurses are a critical part of the workforce. The qualitative, explorative, descriptive, and contextual study design was conducted in five public hospitals from each district of Limpopo Province. The purpose of the study was to explore and describe experiences regarding support received by professional nurses while providing care to HIV and AIDS patients in the public hospitals of Limpopo Province. Purposive sampling was employed to select the participants who provided care to HIV and AIDS patients for 24 months or more. The recruitment of participants continued until data saturation was reached at participant number 20. Data were collected through face-to-face individual interviews using a semi-structured guide. Data were analyzed using Tech's qualitative data analysis method. Trustworthiness was measured through credibility, dependability, confirmability, and transferability. Findings: Emotional and physical strain due to a shortage of staff, heavy workload, staff turnover, and high absenteeism were experienced by the nurses fulfilling these tasks. Exhaustion, fatigue, increased levels of stress, and lack of training, counselling, debriefing sessions, recognitions, and reward systems were also experienced. Recommendations: A program for support of all professional nurses providing care to HIV and AIDS patients should be conceptualized and implemented.

Strategies to Enhance Knowledge and Practical Skills of Triage amongst Nurses Working in the Emergency Departments of Rural Hospitals in South Africa.

Purpose: Lack of knowledge and practical skills on triage remains a global problem, especially within rural hospitals, and very little is known about enhancing the knowledge and skills of emergency nursing staff in rural hospitals of South Africa. The objective was to describe the perceived strategies for enhancing knowledge and practices of triage among nurses working in the emergency departments (EDs) of rural hospitals in South Africa. Research methods: A descriptive qualitative research design was applied to achieve the research objective. A non-probability sampling method was applied to select 17 professional nurses from rural hospitals. An unstructured face-to-face interview method was used to collect data. Data collected were analyzed using Tesch's method of data analysis. Results: The study findings highlighted the academic needs of nurses working in the ED of rural hospitals. Two themes emerged from this study; (1) The consistent description of the importance of triage training for emergency unit staff, and (2) The description of measures to enhance triage practices amongst emergency unit staff. Findings indicated that triage knowledge and practice remains a challenge, but with formulated strategies like continuous training by workshops, refresher courses, and offering a training module on triage, evaluation of developed guidelines and benchmarks is often enhanced. Conclusions: The study describes the strategies to enhance the conversion of knowledge and practice of triage amongst nurses working in the ED of rural hospitals. The paper argues that the knowledge and practical skills of nurses working in ED are enhanced through the provision of continuous training as workshops, triage module, evaluating the developed guidelines to implement triage, and benchmarking with other hospitals.

What Is the Impact of a Context-Specific Training Program for Home-Based Carers? An Evaluation Study.

INTRODUCTION: In South Africa (SA), home-based carers (HBCs) play a crucial role at the community level for non-communicable diseases (NCDs) including diabetes mellitus (DM) public health care. The work of HBCs requires them to be knowledgeable about diabetes, and lack of knowledge has implications on their roles for the provision of health information and dietary advice. HBCs need to be provided with specific training to develop their knowledge and skills necessary to enable them to provide care to people with diabetes (PWD) because organizations need to benefit from a pool of well-trained HBCs. Therefore, a training program was developed to improve care for chronic conditions based on local needs. AIM: To implement and evaluate the training program for the HBCs for PWD in Ga-Dikgale village. METHODS: HBCs working at Ga- Dikgale villages in four clinics-namely, Dikgale, Seobi Dikgale, Sebayeng, and Makotopong-participated voluntarily. Fifty-five (55) HBCs who attended the training program completed satisfaction survey tools, and furthermore, 45 HBCs completed both pre-training and post-training knowledge questionnaires. Training divided into two sessions which each lasted for two days was conducted. Satisfaction with the training, improvement of knowledge, and perceived impact on daily practice were evaluated using both qualitative and quantitative approaches. RESULTS: Quantitative results indicate that 72% had poor knowledge of pre-training and only 9% post-training. They scored more in a post-test with the following differences: Post-test (mean = 6.00, SD = 1.26); pre-test (mean = 3.31, SD = 1.77). The t-test results indicated the difference to be significant, t = -9.241, p = 0.000. From the qualitative results, the themes that emerged during data analysis from group discussions were HBCs' achievements from the training, challenges related to diabetes and diet, and suggestions for further training. CONCLUSIONS: A context-specific training increased diabetes knowledge among the HBCs for PWD. The results highlighted the importance of training in improving the knowledge of HBCs about the care of PWD. The improvement in diabetes knowledge among HBCs needs to be maintained and sustained to achieve major health benefits for PWD.

Comprehensive Women Health Services at Beverage-Producing Industries of Limpopo (South Africa): Women's Perspective.

(1) Background: Women remain highly vulnerable to numerous risks at work, including labor rights violations, violence and harassment, myriad general and reproductive health risks. The availability of the comprehensive services remains the only hope for these women, yet very little is known about their perspective. (2) Aim: To determine the experiences of women regarding the availability of comprehensive women's health services in the industries of Limpopo (South Africa). (3) Methods: The project adopted the qualitative research method to determine the experiences of women related to the availability of comprehensive women's health services. Non-probability purposive and convenience sampling was used to select 40 women employed in two beverage producing industries. A semi-structured interview with an interview guide was used to collect data that were analyzed using thematic analysis. (4) Results: Four themes emerged about the available health services in the two industries; diverse experiences related to available women's health services, knowledge related to women's health services, and diverse description of women's health services practice and risks. The themes are interpreted into ten sub-themes. (5) Conclusions and Recommendations: There is a lack of available comprehensive women health services at the two beverage producing industries. Thus, women face challenges regarding accessing comprehensive women's reproductive health care services as well as being exposed to health hazards such as burns, bumps, injuries and suffering from inhalation injuries and burns from moving machines, noise, slippery floors, and chemicals that are used for production in the industry. Women expressed dissatisfaction in the industries regarding the provided general health and primary healthcare services that have limited women's health-specific services. We recommended that the industries should prioritize designing and developing the comprehensive women health services that to enable women at the industries to have access to good-quality reproductive health care and effective interventions.

A conceptual framework for cost management training in the Limpopo Province of South Africa.

AIMS: This paper describes the perceptions of nurse managers about their dual role in nursing units as cost centres. BACKGROUND: The tertiary hospital in the Limpopo province is the first institution to appoint nurse managers with a dual role in cost centres. The development of a conceptual framework for a context-specific programme for Cost Centre Managers is the first of its nature in South Africa. METHOD: A qualitative, exploratory, descriptive design was followed. The target population included nurse managers (n = 35) formally appointed as cost centre managers with a dual role of delivering quality care and cost management. A focus group and individual interviews were conducted until data saturation occurred. RESULTS: Personal and professional distress, an empowering potential of being a cost centre manager, and the need for decentralized cost centre management were indicated as barriers for nurse managers that led to a framework for a context-specific training programme. CONCLUSION: There is a need for a context-specific training programme for cost centre managers in a hospital with cost centres. IMPLICATIONS FOR NURSING MANAGEMENT: The training of cost centre managers for their dual role in cost centres could enhance cost effectiveness, quality care and staff satisfaction.