Self-Reported Level of Cultural Competence of Midwives in the North-West Province of South Africa.

INTRODUCTION: Limited research on cultural competence in nursing, midwifery, and education exists within low- and middle-income countries such as South Africa (SA). This study aimed to describe midwives' self-reported levels of cultural competence toward women receiving maternal care. METHODOLOGY: A descriptive, cross-sectional survey design and an all-inclusive sample of (N = 104; n = 82) midwives yielded a 79% response rate. Data were collected using the Transcultural Self-Efficacy Tool (TSET) questionnaire. Participants included midwives recruited from maternity units of five hospitals in South Africa: different hospitals that included one large district, two regional, and two tertiary hospitals in the North-West Province of SA. An all-inclusive sample of (N = 104; n = 82) midwives participated, representing a 79% response rate. RESULTS: Midwives reported an overall moderate level of competence regarding their knowledge and understanding of cultural factors; it was concerning that their confidence in interviewing patients from different cultural backgrounds on factors such as acculturation and worldview were the lowest. DISCUSSION: To the best of the authors' knowledge, this was the first study to assess the cultural competence of midwives in SA using TSET. The study highlighted the need for midwives' training to improve their cultural competence.

Challenges in the working relationship between professional nurses and clinical associates in selected district hospitals in South Africa.

Background: Clinical associates were introduced in South Africa to address physician shortages in healthcare. Professional relationships between physicians and professional nurses (PNs) have been widely researched, but none specifically between the new cadre of clinical associates and PNs. Aim: This study aimed to understand the professional working relationship between PNs and clinical associates. Setting: Selected district hospitals within Mpumalanga Province, South Africa. Method: A qualitative descriptive design was used. Professional nurses were purposely sampled, and an all-inclusive sampling method was used for clinical associates in selected district hospitals within Mpumalanga Province, South Africa. Twelve (N = 12) semi-structured, individual interviews (PNs n = 6; clinical associates n = 6) guided by an interview guide were conducted in English. The interviews were audio recorded and transcribed verbatim by an independent transcriptionist. Tesch's eight steps of data analysis were employed to analyse the data. An independent co-coder assisted with data analysis. Results: This study yielded four themes: (1) professional relationship defined, (2) professional relationship characteristics, (3) professional challenges applicable to both PNs and clinical associates and (4) personal professional challenges applicable to clinical associates only. Conclusion: This study demonstrated that the professional relationships between PNs and clinical associates are affected by various challenges, which could be resolved within the department through in-service training and good communication. Contribution: This is one of the first studies that highlight the professional relationship challenges between PNs and clinical associates.

Perceptions of secondary school management teams in managing pregnant learners in an urban context.

Background: Teenage pregnancy is a complex issue globally, which is also a challenge in South Africa. Pregnant learners are allowed by the law to attend school for the whole duration of pregnancy. Although not medically trained or equipped to handle any emergencies, the school management teams are tasked to manage these learners by the Measures of the Prevention and Management of Learner Pregnancy Policy. Aim: This study aimed to determine the school management teams' perceptions of managing pregnant learners in urban secondary schools. Setting: This study was conducted in four secondary schools in Gauteng province, Soweto-Pimville District 10. Methods: This study employed a qualitative, descriptive design. Purposive sampling was carried out (n = 13), semi-structured WhatsApp video call interviews were conducted and Tesch's data analysis steps were utilised to analyse the data. Results: Five themes emerged: Theme 1: the role of school management teams in managing pregnant learners; Theme 2: challenges of unplanned deliveries at school; Theme 3: personal thoughts of educators on managing pregnant learners; Theme 4: skills training requirements for educators to manage pregnant learners; and Theme 5: coping mechanisms for school management teams. Conclusion: Collaboration between the department of health, department of education and the department of social development is essential in the management of pregnant learners at school. Contribution: Similar studies have been conducted in various rural areas of South Africa. Limited literature was found for urban areas; therefore, the researcher is of the opinion that the findings of this study could contribute to the body of knowledge.

Comorbidities of Child Malnutrition in Low- and Medium-Income Countries: A Systematic Review.

The study intended to review the best evidence on prevalence, diagnosis, and treatment outcomes of comorbidities associated with child malnutrition. The study design was a systematic review of quantitative studies. Critical appraisal tools were used to assess the methodological quality of the studies. Data were extracted according to the predetermined data extraction table. Data were further analyzed narratively according to the set study objectives and main concepts. Fifteen studies were eligible to include in the review. All 15 studies reported on the prevalence of 4 child malnutrition-associated comorbidities. Five (n = 5/15) studies reported on length of hospitalization/stay, 10 (n = 10) studies on recovery rate, and 9 (n = 9/15) studies on mortality rate as treatment outcomes of child malnutrition associated comorbidities. The most prevalent child malnutrition associated comorbidities were tuberculosis, pneumonia, gastroenteritis, and anemia. The treatment outcomes identified included the length of hospitalization/stay, recovery rate, and mortality rate. Screening of prevalent comorbidities in children admitted with malnutrition should be standard procedure in practice. More research needs to be done on the diagnosis of under-5 child malnutrition associated comorbidities.

Relation between Halls' Professionalism Scale and nurses' demographic characteristics.

OBJECTIVE: Nursing Professionalism was measured by Hall's Professionalism Scale, consisting of 50 items. The scale was developed to measure the attitudes and ideologies held by professionals in various professional occupations by measuring five attitudinal constructs of professionalism, namely 'sense of calling to the field', 'autonomy', 'using a professional organisation as a major referent', 'belief in self-regulation', and 'belief in public service'. This study focussed on determining the practically significant differences that exist between the means of the five constructs of Hall's Professionalism Scale and certain demographic variables among nurses in South Africa. The 11-item demographic profile included the following variables: gender (1), age (2), age when becoming a professional nurse (3), undergraduate qualifications (4), marital status (5), number of children (6), employment sector (7), years' of nursing experience (8), international experience (9), employment status (10) and satisfaction with nursing as a career (11). RESULTS: Only (7/11) demographic profile variables had an association with one or more of the five Hall's Professionalism Scale constructs The variables included the following items: age (2), age when becoming a professional nurse (3), number of children (6), years of nursing experience (8), international experience (9), employment status (10), and satisfaction with nursing as a career (11).

Maternal and neonatal factors associated with perinatal deaths in a South African healthcare institution.

BACKGROUND: Research indicated the prevalence of perinatal deaths of infants immediately or up to a week after birth and includes fresh and macerated stillbirths and neonatal deaths. Worldwide, there is a decline in perinatal deaths. However, in South Africa, it is not the case. Often the quality of maternity care is considered as the most important contributing factor for these deaths. However, maternal and neonatal factors can also contribute. AIM: The aim of the study was to determine the maternal and neonatal factors associated with perinatal deaths in a single selected district hospital within the Free State Province of South Africa. SETTING: The maternity unit of the largest district hospital in the specific district in the Free State Province of South Africa. METHOD: A clinical audit design was used. Units of analysis comprised the Perinatal Problem Identification Programme (PPIP) database of neonates born during 2015, and their mothers. A random sample of 384 alive neonates and an all-inclusive sample of 43 deceased neonates were taken from a total of 2319. Descriptive statistics were reported and Cohen's effect sizes, d, were calculated to identify practically significant differences between the neonates in the alive and the deceased group, respectively. RESULTS: Cohen's effect sizes and logistical regression analyses indicate that the Apgar score recorded 10 min after birth, gestational age, birth weight of neonate and the parity of the mother were the most practically significant factors influencing a neonate's chances of survival. CONCLUSION: Quality maternity care is not the only cause of perinatal mortality rates; maternal and neonatal factors are also contributors.

Exploring occupational gender-role stereotypes of male nurses: A South African study.

AIM: The aim of the study was to investigate stereotypes of occupational gender roles about male nurses, as viewed from both emic and etic perspectives. BACKGROUND: Male nurses are a minority group in health institutions. Stereotypes have been questioned regarding these males' occupational role and presence in the nursing profession. DESIGN: A qualitative description design was used. METHODS: During 2016, semi-structured interviews (N = 30) were conducted with male nurses (n = 10) (emic group), female nurses (n = 10) and discharged patients (n = 10) (etic groups) from four public hospitals. RESULTS: Seven categories with respective themes and subthemes emerged. Three categories were captured for emic groups, namely, existing stereotypes, experiences of stereotyping and the influences of stereotypes on work performance. Four categories emerged for etic groups, namely, treatment preferences, types of stereotyping towards male nurses, origin of stereotypes and effects of stereotypes. CONCLUSION: Positive and negative stereotypes were reported by both emic and etic groups, with etic groups revealing more stereotypes. Effort should be made by both management in the practice environment and the media to counter the stereotyping of male nurses.

Developing a competency profile for newly graduated registered nurses in South Africa.

BACKGROUND: Newly graduated registered nurses experience various challenges when entering the clinical practice environment. Typical challenges include lack of specific knowledge, skills and attitude competencies which is aggravated further by factors such as transition problems, workloads, lack of confidence and independence which potentially causes poor quality care. The aim of the study was to develop a competency profile for newly graudated registered nures, based on the perceptions of both nurse educators and final-year nursing students regarding the knowledge, skills and attitudes needed to deliver quality patient care in South Africa. METHODS: A qualitative descriptive design was used. Semi-structured individual interviews were conducted with 42 participants consisting of 23 nurse educators and 19 final-year nursing students at three nursing education institutions. The interviews were guided by an interview guide that examined three predetermined themes: knowledge, skills and attitudes as competencies to deliver quality patient care. Data were processed using thematic analysis. RESULTS: The predetermined theme knowledge, was broken down into themes: theoretical knowledge, holistic care, cultural diversity and code of conduct, with its relating sub-themes. The predetermined theme skills delivered the following themes: interpersonal, management, administrative, practical and personal skills with its sub-themes. Attitudes unpacked into the following themes: being positive, caring, humble, friendly, empathetic, life-long learning, going the extra mile, compassionate, having passion, approachable, sensitive, helpful, and non-judgemental. CONCLUSIONS: Rich, in-depth knowledge, skills and attitudes were identified to develop a competency profile that may assist newly graduated registered nurses when entering the clinical practice environment to deliver quality patient care.

Construct validity and internal consistency of Hall's Professionalism Scale: tested on South African nurses.

OBJECTIVE: In South Africa, appropriate criteria to measure the professional standing of professional nurses are essential. Internationally, there are professionalism scales by which to measure professionalism, but none could be identified that were particular to the South African context. Hall's Professionalism Scale consists of 50 items and was specifically developed to measure the attitudes and ideologies held by professionals in various professional occupations by measuring five attitudinal components of professionalism, namely: Sense of calling to the field; Autonomy; Using professional organisation as major referent; Belief in self-regulation; and Belief in public service. In this study, the construct validity and internal consistency of the constructs of Hall's Professionalism Scale were assessed among professional nurses in the South African context. RESULTS: Originally Hall's Professionalism Scale comprises 50 items. This scale was reassessed by Snizek, who retained only 25 items of the original scale to measure professional standing. During preliminary analysis of the South African data, 23 items were included.

Health students' experiences of the process of interprofessional education: a pilot project.

The need for interprofessional education (IPE) in health science disciplines is a current global trend. However, despite international support and demand, IPE is still new to many health professions curricula in South Africa. Furthermore, while ample existing academic literature addresses commonly encountered barriers to IPE, there is still a need to investigate the dynamics and challenges associated with the process of implementing IPE at universities. IPE is not yet part of the formal curriculum at a faculty of health sciences at a South African Higher Education Institute, so a pilot project was conducted to investigate the experiences of an IPE process by students from different health professions toward informing the planning and implementation of IPE in the formal curriculum. To this effect, a multi-layered IPE project was piloted across pharmacy, nursing, social work, psychology, dietetics, and human movement sciences within this Faculty of Health Sciences. The aim of this research was to determine the dynamics between the different health professions by exploring and describing the students' experiences of the IPE process. Theoretical case studies were presented to third-year students, who were grouped into interprofessional teams from the six different health professions at the Higher Education Institute's health sciences faculty. Data were gathered from reflective journals over a five-week period and a questionnaire was administered at the end of the project. Data were analysed and evaluated based on the interprofessional learning domains listed in the IPE framework of the World Health Organization. All participating health professions students felt positive about the project and agreed that it provided them with valuable IPE experiences. However, their long-term participation and commitment presented difficulty in an already demanding curriculum. The interprofessional dynamics were influenced by the relevance of the scenarios presented in the case studies to the different professions, the students' personalities and their previous experiences. Although the nursing students took initial leadership, contributions from the other professions became more prominent as the case studies unfolded. The findings indicated that the inclusion of different health professions in an interprofessional team should be guided by the specific scenarios incorporated to simulate interprofessional cooperation. The availability of the students and their scope of practice at third-year level should also be taken into account.

Secondary school teachers' experiences related to learner teenage pregnancies and unexpected deliveries at school.

BACKGROUND: The incidence of learner teenage pregnancies can be reduced, provided that the major stakeholders, which include the Department of Education and the Department of Health, combine to address this issue. Despite the implementation of Life Orientation as a school subject, which focuses on sexual behaviour, health, decision-making, pregnancy risk, sexually transmitted infections and HIV and AIDS, the prevalence of learner teenage pregnancies at secondary schools remains alarmingly high. AIM: The purpose of this study was to explore and describe teachers' experiences of learner teenage pregnancies in secondary schools in a province in South Africa. SETTING: Secondary schools in KwaZulu-Natal. METHOD: A qualitative approach with exploratory, descriptive and contextual strategies was used in this research. Semi-structured interviews were conducted with teachers who had been selected through purposive sampling. Tesch's steps of systematic open coding were used to analyse all of the interviews. RESULTS: The results that emerged during the data analysis indicate that firstly, teachers' experiences of having pregnant learners in their classrooms are negative as these learners are frequently absent from school, perform badly and drop out of school. Secondly, teachers' experiences related to unexpected deliveries are coloured by their lack of the necessary skills and competencies to deal and their resultant insecurity. Thirdly, the teachers feel that they do not receive the assistance they need to deal with teenage pregnancies as well as unexpected deliveries. CONCLUSIONS: Collaboration between and continuous support from the Department of Health and the Department of Education are crucial if teenage pregnancies at secondary schools are to be handled with greater success. Support from health care personnel should include guidance on contraception and health campaigns should target both the teachers and secondary school learners. Furthermore, coping strategies for the teachers should form part of the preservice curriculum of teachers.

Secondary school teachers' experiences related to learner teenage pregnancies and unexpected deliveries at school

Background: The incidence of learner teenage pregnancies can be reduced, provided that the major stakeholders, which include the Department of Education and the Department of Health, combine to address this issue. Despite the implementation of Life Orientation as a school subject, which focuses on sexual behaviour, health, decision-making, pregnancy risk, sexually transmitted infections and HIV and AIDS, the prevalence of learner teenage pregnancies at secondary schools remains alarmingly high.Aim: The purpose of this study was to explore and describe teachers' experiences of learner teenage pregnancies in secondary schools in a province in South Africa.Setting: Secondary schools in KwaZulu-Natal.Method: A qualitative approach with exploratory, descriptive and contextual strategies was used in this research. Semi-structured interviews were conducted with teachers who had been selected through purposive sampling. Tesch's steps of systematic open coding were used to analyse all of the interviews.Results: The results that emerged during the data analysis indicate that firstly, teachers' experiences of having pregnant learners in their classrooms are negative as these learners are frequently absent from school, perform badly and drop out of school. Secondly, teachers' experiences related to unexpected deliveries are coloured by their lack of the necessary skills and competencies to deal and their resultant insecurity. Thirdly, the teachers feel that they do not receive the assistance they need to deal with teenage pregnancies as well as unexpected deliveries.Conclusions: Collaboration between and continuous support from the Department of Health and the Department of Education are crucial if teenage pregnancies at secondary schools are to be handled with greater success. Support from health care personnel should include guidance on contraception and health campaigns should target both the teachers and secondary school learners. Furthermore, coping strategies for the teachers should form part of the preservice curriculum of teachers

Secondary school teachers' experiences related to learner teenage pregnancies and unexpected deliveries at school

Background: The incidence of learner teenage pregnancies can be reduced, provided that the major stakeholders, which include the Department of Education and the Department of Health, combine to address this issue. Despite the implementation of Life Orientation as a school subject, which focuses on sexual behaviour, health, decision-making, pregnancy risk,sexually transmitted infections and HIV and AIDS, the prevalence of learner teenage pregnancies at secondary schools remains alarmingly high. Aim: The purpose of this study was to explore and describe teachers' experiences of learner teenage pregnancies in secondary schools in a province in South Africa. Setting: Secondary schools in KwaZulu-Natal. Method: A qualitative approach with exploratory, descriptive and contextual strategies was used in this research. Semi-structured interviews were conducted with teachers who had been selected through purposive sampling. Tesch's steps of systematic open coding were used to analyse all of the interviews. Results: The results that emerged during the data analysis indicate that firstly, teachers' experiences of having pregnant learners in their classrooms are negative as these learners are frequently absent from school, perform badly and drop out of school. Secondly, teachers' experiences related to unexpected deliveries are coloured by their lack of the necessary skills and competencies to deal and their resultant insecurity. Thirdly, the teachers feel that they do not receive the assistance they need to deal with teenage pregnancies as well as unexpected deliveries. Conclusions: Collaboration between and continuous support from the Department of Health and the Department of Education are crucial if teenage pregnancies at secondary schools are to be handled with greater success. Support from health care personnel should include guidance on contraception and health campaigns should target both the teachers and secondary school learners. Furthermore, coping strategies for the teachers should form part of the preservice curriculum of teachers

Evaluating the Integrated Management of Childhood Illness counselling skills of professional nurses in the North West Province of South Africa.

BACKGROUND: The Integrated Management of Childhood Illness (IMCI) strategy provides guidelines for supporting and improving the health system to reduce under-5 children's mortality rates. This strategy specifically assists professional nurses with the case management of children aged birth-5 years. AIM: The purpose of this study was to investigate how professional nurses provided counselling to caregivers of under-5 children based on the IMCI strategy in Primary Health Care facilities of one district in the North West Province of South Africa. SETTING: Primary Health Care (PHC) facilities of one district in the North West Province. METHOD: A quantitative, descriptive and observational design was used. Counselling provided by the professional nurses was observed and a checklist was completed. This IMCI counselling checklist was based on aspects in the counselling section of the Health Facility Survey, formulated according to the IMCI strategy's requirements. RESULTS: Counselling that focused on feeding, administration of medication and counselling skills used during the consultation were good. However, counselling of caregivers of children aged 13 months to 5 years could be improved and the caregivers' health status should also be addressed. CONCLUSION: Counselling provided to caregivers of under-5 children regarding feeding, administering of medication and caregivers' health status used effective communication skills. However, technicalities of feeding such as lactation and nutritional guidance posed challenges.

Experiences of partners of professional nurses venting traumatic information.

BACKGROUND: Professional nurses employed in trauma units encounter numerous stressors in their practice environment. They use different strategies to cope with this stress, including venting traumatic information to their partners and other family members. AIMS: To describe how partners of professional nurses cope with traumatic information being vented to them. METHODS: A qualitative research method with an interpretive descriptive inquiry design was used to explore, interpret and describe the coping experiences of the nurses' partners. Purposive sampling was used to select a total of 14 partners, but only ten participated in semi-structured interviews. Tesch's eight steps of open coding were used for data analysis. RESULTS: Four main themes were identified indicating adaptive and maladaptive coping skills, namely partners' experiences of traumatic information vented to them; partners' coping activities; reciprocal communication and relationship support between partners and nurses; and resilience of partners to deal with the nursing profession. CONCLUSION: Partners employed different ways to cope with traumatic information. It was essential for partners and nurses to be supported by nurses' practice environments and to develop resilience to fulfil reciprocal supportive roles in their relationships.

The role of triage to reduce waiting times in primary health care facilities in the North West province of South Africa.

BACKGROUND: Worldwide, patients visiting health care facilities in the public health care sector have to wait for attention from health care professionals. In South Africa, the Cape Triage Score system was implemented successfully in hospitals' emergency departments in the Cape Metropole. The effective utilisation of triage could improve the flow of primary health care (PHC) patients and direct the patients to the right health care professional immediately. AIM: No literature could be traced on the implementation of triage in PHC facilities in South Africa. Consequently, a study addressing this issue could address this lack of information, reduce waiting times in PHC facilities and improve the quality of care. SETTING: PHC facilities in a sub-district of the North West province of South Africa. METHOD: A quantitative, exploratory, typical descriptive pre-test-post-test design was used. The study consisted of two phases. During phase 1, the waiting time survey checklist was used to determine the baseline waiting times. In phase 2, the Cape Triage Score system that triaged the patients and the waiting time survey checklist were used. RESULTS: Data were analysed using Cohen's effect sizes by comparing the total waiting times obtained in both phases with the waiting time survey checklist. Results indicated no reduction in the overall waiting time; however, there was a practical significance where triage was applied. Referral was much quicker to the correct health professional and to the hospitals. CONCLUSION: Although the results indicated no reduction in the overall waiting time of patients, structured support systems and triage at PHC facilities should be used to make referral quicker to the correct health professional and to the hospitals.

Creating positive practice environments in a primary health care setting.

AIM: The aim of this study was to explore and describe the perceptions of nurse managers, nurses, and a physician in the community health centre with the most positive practice environment in a province of South Africa. METHODS: Ten (N = 10) semistructured individual interviews were conducted with personnel of the community health centre with the most positive practice environment. RESULTS: Personnel cited the following as the most important characteristics of a positive practice environment in a primary health care setting: support, leadership and governance, collegial nurse-physician relationships, and quality of care. CONCLUSION: In a primary health care setting, it is important to train, appoint, and support managers who in turn will be able to train and support their personnel. Furthermore, reciprocal community involvement must be encouraged between personnel of the community health centre and stakeholders in the community to improve the health status of the community. Finally, group cohesions between all health care workers and managers at different organisational levels should be encouraged, as this enhances teamwork and a culture of teaching-learning and improves the competence of all staff.