The surgical burden of breast disease in KwaZulu-Natal province.

BACKGROUND: The current surgical workload assessments in KwaZulu-Natal (KZN) are inadequate to inform strategies to improve surgical services. Breast diseases have a well-defined spectrum and surgical treatment options, analysis of which could guide health policy in the field. This project aimed to quantify and analyse the operative workload for breast pathology in KZN. METHODS: A retrospective review of breast-related operations conducted at public sector hospitals in KwaZulu-Natal province between 1 July and 31 December 2015 was undertaken. Data was collected from theatre operative registers and manually categorised as follows: sepsis, benign pathology, malignant pathology, and by hospital, according to geographic location, and complexity of care to determine factors to improve the service for breast care in the province. RESULTS: In the 6-month study period, 13 282 general surgical procedures were performed of which 776 (5.8%) were breast-related operations. There were 372 (47.9%) operations for breast sepsis, 140 (18%) for benign breast lesions, 17 (2.2%) for cosmetic indications and 27 (3.5%) for diagnostic procedures. There were 223 (28.7%) procedures for nonbenign disease: 21 (2.6%) wide local excisions (WLE), 203 (26.2%) mastectomies of which 161 (72.2%) mastectomies had an axillary lymph node dissection and 26 (11.7%) were performed as onco-plastic procedures. Hospitals in the Durban and Pietermaritzburg metropolitan areas performed 75% of the breast-related procedures. The majority (69.6%) of sepsis-related procedures were performed at secondary/regional facilities, while 58.3% of non-benign breast surgeries were performed at tertiary and quaternary centres. CONCLUSION: Breast sepsis accounts for almost 50% of the surgery and is mainly dealt with at hospitals above district level. One-third of breast surgery in KZN province is for non-benign disease. There is a paucity of breast-conserving surgery. Elucidation of these observations can guide improvement in the provincial breast care service.

Survey of root canal irrigating solutions used in dental practices within Germany.

AIM: Irrigant usage information in relation to years of professional experience was collected from general dentists in different German federal states by means of a questionnaire. METHODOLOGY: A short survey concerning endodontic treatment and use of irrigants was mailed to 4240 dentists or delivered to 3720 dental offices as an extra page in a journal in eight German states. Detailed information concerning the most frequently used irrigants, their concentrations, the spectrum of disinfectants used in root canal treatment concepts for vital and nonvital pulps, main topics of continuing education as well as years of professional experience was collected. The statistical analysis of differences found amongst the dentists in relation to professional experience or federal state was performed using the chi-square test. RESULTS: Of a total of 7960 invitations, 1630 replies were evaluated (response rate 20.5%). The majority of the dentists (57.3%) had >20 years of professional experience, 23% had >30 years. Dentists with long-standing professional experience (20-30 years) used H2 O2 significantly more often than dentists with less experience (P < 0.001), and of the older colleagues (>30 years of professional experience), 14.6% never used NaOCl, whilst the younger colleagues almost always used it (P < 0.001). Differences were also found for the usage of irrigants amongst dentists from the various German states. CONCLUSIONS: Whilst NaOCl was used in almost all states, regional differences were found regarding the choice of additional irrigants, which were mainly determined by the irrigation protocols taught at different universities.

[Oral health conditions in women with or without occupation--results from a regional examination and survey]. / Mundgesundheit von berufstätigen und nicht berufstätigen Frauen--Ergebnisse einer regionalen Untersuchung und Umfrage.

AIM: In the present study oral health conditions and oral hygiene measures of women with and without occupation were examined and compared. In addition to a dental assessment, oral hygiene measures and socio-demographic data were collected by means of a questionnaire. METHOD: A total of 415 subjects (210 women with and 205 women without occupation) with an age range of 25-65 years were enrolled in this study. All women underwent a dental assessment, including a radiographic examination (orthopanthomogram). The dental assessment comprised the number of teeth, caries frequency (DMFT index), type and frequency of restorations, quality of oral hygiene (API), degree of gingival inflammation (SBI), probing depths and the presence of recessions. In addition, a questionnaire, concerning anamnestic data and information about the familial situation, level of education and occupation, was filled in. The study was approved by the ethics commission (Rhineland-Palatinate). RESULTS: Of the women without occupation (mean age: 38.1±9.7 years) 90% were married, only 3% were heavy smokers, and only 2% had a university degree. Of the working women (mean age: 43.2 ±11 years) 73% were married, 17% were heavy smokers (> 20 cigarettes/day), and 10% had a university degree. Oral hygiene of the working women was slightly better than that in women without occupation; however, severe periodontal disease was seen more frequently in working women (15% vs. 3.3%; p<0.027). With respect to the periodontal situation, the probability of developing an aggressive periodontitis was with an odds ratio of 4.23 (95% CI: 0.77-23.17) considerably higher for the group of working women. CONCLUSION: The oral health of women with or without occupation differed slightly. These findings suggest that occupation, level of education and life style of the women have an influence on oral hygiene measures and on oral health.

Cultural knowledge of non-Muslim nurses working in Saudi Arabian obstetric units.

Culture defines how persons behave towards each other. When nurses and patients belong to different cultures, culture-based misunderstandings could influence the nurse-patient relationships and interactions adversely. The purpose of the study was to determine non-Muslim nurses' knowledge about Muslim traditions pertaining to obstetric units in a Muslim country. A quantitative descriptive research design was adopted. The population comprised 67 nurses, but the accessible population consisted of 52 nurses who were working in the participating hospital's gynaecological wards during the data collection phase. However, only 50 nurses completed questionnaires as two nurses did not want to participate in the study. The Statistical Package for the Social Sciences (SPSS Version 11.5) was used to analyse the data. The research results indicate that non-Muslim nurses lacked knowledge about Muslim practices concerning breastfeeding, Ko'hl, the "evil eye", modesty, medicine and food taboos. If these aspects could be addressed during the recruitment and in-service education of non-Muslim nurses working in Muslim countries, this could enhance the quality of culture-competent nursing care.

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

Adolescent mothers' non-utilisation of antenatal care services in Bulawayo, Zimbabwe.

Adolescent pregnancies are high risk obstetric occurrences. Antenatal care (ANC) provides opportunities to recognise and treat obstetric complications, enhancing the pregnancy outcomes for mothers and babies. The purpose of the study was to identify factors influencing adolescents' non-utilisation of ANC services in Bulawayo. The Health Belief Model (HBM) was used to contextualise the study. A quantitative, non-experimental, descriptive research design was adopted, using structured interviews to collect data. Purposive, non-probability sampling was used to conduct structured interviews with 80 adolescent mothers from the postnatal wards who had delivered their babies without attending ANC. Factors influencing these adolescent mothers' non-utilisation of ANC services included socio-economic issues, individuals' perceptions about ANC, limited knowledge about ANC, policies and structural barriers. However, these adolescents knew that delivering their babies with skilled attendance could enhance the outcomes for the mothers and babies, would help secure documents to facilitate the acquisition of their children's birth certificates, and that obstetric complications required the services of skilled midwives/doctors. Policy-related issues, such as requiring national identity cards from pregnant adolescents (or from their spouses) prohibited some of them from utilising ANC services. There is a need to improve adolescents' reproductive health outreach (including ANC) programmes and to offer free ANC services in Zimbabwe. Restrictive policies, such as the required identity cards of the pregnant adolescents (or their husbands), impacted negatively on the accessibility of ANC services and should be addressed as a matter of urgency in Bulawayo.

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

Factors contributing to low institutional deliveries in the Marondera district of Zimbabwe.

The purpose of the study was to identify factors contributing to low institutional deliveries in the Marondera District, Zimbabwe, among women who attended ante-natal clinics, in order to enhance the number of institutional deliveries. A quantitative descriptive survey, gathering data by conducting structured interviews with 80 women, was used in this study. All 80 women attended ante-natal clinics but 40 delivered at home and 40 delivered at an institution. The Health Belief Model (HBM) was used to contextualise the data. The research results indicated that factors that contributed to the low number of institutional deliveries included that women's minimal expectations of cleanliness and noninterference during labour and delivery could be met during home deliveries; institutional deliveries' costs included traveling expenses, losing family support and the inability to meet cultural expectations; women's lack of knowledge about danger signs of pregnancy; and women's negative perceptions of nurses working at the institution(s). The recommendations include reduced costs of institutional deliveries; allowing family members (especially the mother-in-law) to be present during institutional deliveries and to perform cultural rituals whenever possible. The nurses' attitudes and competence levels should be addressed through in-service education sessions and sustained follow-up evaluations, including evaluations by pregnant women.

Critical care nurses' perceptions of stress and stress-related situations in the workplace.

Critical care nurses (CCNs) experience stressful situations in their daily working environments. A qualitative research approach (exploratory, descriptive and contextual) was used to explore and describe the stressful situations experienced by critical care nurses in the Tshwane metropolitan are of South Africa. Focus group interviews were conducted with critical care nurses. Data was generated by means of focus group interviews. The results revealed CCNs' perceptions and experiences about stressful events, factors contributing to stress in the critical care environment, as well as their needs for support systems.Critical care nurses experience stressful situations in their daily working environments. The question arises for nurses: are there adequate support systems in the critical care environment and what are critical care nurses doing to maintain their own health and well-being? Facilitating conscious awareness among critical care nurses could enhance their resiliency and their hardiness, strengthening their coping capacities in stressful working situations. The contextual framework adopted for this research was the Neuman Systems Model. A qualitative research approach (exploratory, descriptive and contextual) was used to explore and describe the stress experienced by critical care nurses. Focus group interviews were conducted with critical care nurses and individual interviews with nurse managers. The results revealed their perceptions and experiences about the effects of stress in the critical care environment, as well as some of their coping strategies. The recommendations include that stress management programmes should be implemented and evaluated; debriefing services should be available to CCNs, in-service education programmes should address raising CCNs' consciousness awareness and enhance their resiliency skills. Effective communication systems should be established between managers and CCNs to address inconsistencies as they arise, including critical shortages of staff and equipment.

Factors influencing nurses' job satisfaction in selected private hospitals in England.

The quantitative descriptive survey used self-completion questionnaires to study factors influencing nurses' job satisfaction in selected private hospitals in England. Herzberg's Theory of Motivation was used to contextualise the results obtained from 85 completed questionnaires. In terms of Herzberg's Theory of Motivation, the most important extrinsic (hygiene) factor was no satisfaction with their salaries compared to nurses' salaries in other private hospitals in England, in the NHS and even at their own hospitals. However, most nurses were satisfied with the other extrinsic factors (organisation and administration policies, supervision and interpersonal relations). The most important intrinsic factors (motivators), influencing nurses' job satisfaction was their lack of satisfaction with promotions (including the fact that their qualifications were reportedly not considered for promotions), lack of advancement opportunities and being in dead-end jobs, and lack of involvement in decision- and policy-making activities. Nurses' levels of job satisfaction might be enhanced if promotion policies could be consistent, advancement opportunities implemented, qualifications considered for promotions, salary issues clarified, and if nurses could be involved in decision- and policy-making. Enhanced levels of job satisfaction could help to reduce turnover rates among registered nurses at the private hospitals in England that participated in this study.

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

Professional nurses' attitudes towards providing termination of pregnancy services in a tertiary hospital in the north west province of South Africa.

The Choice on Termination of Pregnancy Act (no 92 of 1996) was implemented during 1997. This study attempted to investigate professional nurses' attitudes towards rendering termination of pregnancy (TOP) services at a tertiary hospital in the North West Province of South Africa. A quantitative descriptive research design was used to study professional nurses' attitudes towards providing TOP services. The research results, obtained from questionnaires completed by professional nurses, indicated that most professional nurses' attitudes included that women should be at least 16 years of age to access these services; women should not be able to access repeated TOPs; nurses would prefer to administer pills rather than to use vacuum aspirations; nurses should work in TOP services by choice only. TOP centers should have better equipment, more resources and more staff members. Nurses working in TOP services would appreciate receiving more support from their families, friends, managers and communities. Some professional nurses experienced guilt, depression, anxiety and religious conflicts as a result of providing TOP services. Despite the legalisation of TOPs, these services remained stigmatised. Professional nurses did not want to work in these services and also did not want to be associated with them.

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

Nurses' perceptions of their psychiatric nursing competencies in the Kwa-Zulu Natal Province.

This research report discusses the results of a quantitative exploratory descriptive survey which investigated specific psychiatric competencies of nurses who completed the R425 diploma programme and who were working in psychiatric clinical units in and around Durban and Pietermaritzburg during 2003. Forty-five nurses completed questionnaires, indicating their perceptions of their psychiatric nursing competencies on Likert scales and by responding to open-ended questions. The Statistical Package for Social Sciences, (SPSS) was used to analyse the data from the 45 completed questionnaires. Findings revealed that nurses who completed the R425 programme, and who were working in psychiatric clinical units, perceived themselves to be competent in performing some of the psychiatric clinical competencies contained in the questionnaires, but not all.

Factors influencing post abortion outcomes among high-risk patients in Zimbabwe.

Post abortion complications remain one of the major causes of mortality among women of child bearing age in Zimbabwe. Based on this problem, factors associated with mortalities due to abortion were investigated with the aim of improving post abortion outcomes for Zimbabwe's women, and possibly also for women of other African countries. Cases and controls were selected from 4895 post abortion records to conduct a retrospective case-control study. Significant risk factors identified for reducing mortalities due to post abortion complications included the administration of oxytocic drugs and evacuation of the uterus whilst anaemia and sepsis apparently reduced these women's chances of survival. Women who died (cases) from post abortion complications apparently received better reported quantitative care than controls. Recommendations based on this research report include improved education of health care workers and enhanced in-service training, regular audits of patients' records and changed policies for managing these conditions more effectively in Zimbabwe.