Value-Sensitive Clinical Accompaniment in Community Nursing Science

Clinical community health facilities where undergraduate students are placed for their practical work in community nursing science are dynamic and have undergone major transformation over the past few years. In the clinical field; community nurses and undergraduate students are representative of the different races and language and ethnic groups in the South African population; with each group espousing different value systems. Both parties - students and community nurses - report that; due to these differences; value conflicts are experienced during clinical accompaniment and that this has negative effects on clinical learning in community nursing science. The goal of this study was to explore and describe the experiences of students with regard to value-sensitive clinical accompaniment in the community nursing environment. An exploratory; descriptive and contextual design was used. Interactions between community nurses and students during clinical accompaniment were explored for value sensitivity by means of video recordings; participant observation and focus group interviews. Data were collected by means of video recordings; participant observation and focus group interviews. The data were analysed and coded by the researcher and the external coder; using an inductive descriptive method to identify important segments of the regularity of behaviour. The focus group interviews were transcribed; analysed and coded by the researcher and the external coder; using Tesch's steps of analysis (Creswell 1994:155-156). Lincoln and Guba's criteria (1985:290) for trustworthiness were applied to the study. The general findings indicate that clinical accompaniment in community nursing is not value sensitive and; as a result; guidelines for value-sensitive clinical accompaniment need to be developed for undergraduate students in the community nursing environment. The following values (values for which guidelines need to be developed) were identified: respect during clinical accompaniment; value-sensitive communication and sensitivity to the quality of clinical accompaniment. People's thoughts often focus on the suicide victim immediately after a completed suicide. Yet; the real victims of such an event are those individuals who are left behind to cope with the aftermath of the suicide. This phenomenological psychological study explored the lived experiences of lateadolescent suicide survivors; particularly those negative experiences that seemed to worsen in the weeks and months after a significant other's completed suicide. The research participants were five female late-adolescents (aged 17-22 years) who were recruited by means of purposive sampling at a South African tertiary institution and at youth camps. Data collection consisted of collagefacilitated; face-to-face phenomenological interviews. In addition; some participants provided documentary material in the form of personal diaries; letters and poems. The data analysis was conducted according to Giorgi's phenomenological method. The following salient experiences emerged during the data analysis: guilt; self-blame; blaming others or God; anger; loss or restriction of 'self'; depression; suboptimal behavioural coping patterns; changes in relationship dynamics; and suicidality. The results of this study can be used by mental health professionals and caregivers to support adolescent suicide survivors effectively; in the midst of their mourning

Evidence-Based Nursing Interventions and Guidelines for Prone Positioning of Adult; Ventilated Patients: a Systematic Review

Although the prone positioning of a critically ill patient poses a challenge to nursing interventions; it remains the responsibility of nurses to develop a way to provide the same basic and intensive care to those patients lying prone as to those lying supine. The purpose of this study was firstly to conduct a systematic review of the literature as explora-tion and description of the evidence in support of the beneficial nursing interventions during prone positioning of ventilated patients; and secondly to develop evidence-based nursing guidelines for the nursing process. This exploratory; descriptive and retrospective systematic review includes data from 45 clinical trials; with a total population of 2 148 patients. Data was extracted onto data abstraction forms; assessed for methodological quality and finally summarised in evidence tables. All statistical calculations for the meta-analysis were performed by the RevMan 4.2.8 program. Prone positioning showed significant (p 0.0001) increases in the partial pressure of oxygen in arterial blood (PaO2) weighted mean difference (WMD CI = 11.36; 31.8). The effects of complications; oxygenation and haemodynamic outcomes compared with the different prone-positioning protocols produced in conclusive results. Nursing guidelines for prone positioning were developed based on the best available evidence. The lack of related articles on nursing care of prone positioning was a drawback. Based on these results; recommendations are made towards further study on the nursing care of prone-positioned patients

The Experiences of Mothers who Lost a Baby during Pregnancy

The purpose of this study was to explore and describe the experiences of mothers who lost a baby during pregnancy and care given by doctors and midwives during this period. To realise this goal the researcher followed a qualitative; exploratory; descriptive and contextual approach. Data were collected by using in-depth unstructured interviews. The interviews were taped and transcribed verbatim. Data were analysed through open coding. Data were collected until saturation had occurred. All mothers who were interviewed described their experiences of the loss of a baby during pregnancy. Some shared the same experiences and others did not. In the findings of this research; it became clear that mothers with the loss of a baby during pregnancy had experienced hardships and difficult times during this period. They expressed the wish that people acknowledge their loss; be considerate; sensitive; and give them a listening ear and emotional support. On the other hand; mothers identified the inability of health workers to give them the appropriate support

The experiences of parents where pregnancy ended in an unplanned caesarean section.

The purpose of this study was to determine the experiences of parents prior to, during and following an unplanned caesarean section. Parents who experienced this event had mixed emotions. The related occurrences may have influenced their behavior and consequently their relationships with their spouses, themselves and their environment. These continually interacted with each other and thus needed to be looked at in context. "The Nursing of the Whole Person Theory" ensured a holistic approach to the parents. Unstructured, in-depth interviews held with five mothers and five fathers, respectively, on day three post-delivery, were transcribed and analysed. At six weeks a follow-up semi-structured questionnaire was answered by these same respondents and analysed. The experiences of the parents were then compared. A literature survey was undertaken in order to determine the conclusion of other researchers in this field, the results of which were compared with those of the present study and conclusions were reached. Recommendations concerning nursing practice, education and further study were made at the end of the study. A list of limitations affecting the study is included.

Noise in a neonatal unit: guidelines for the reduction or prevention of noise.

Advances in medical technology have led to major technological developments in the field of neonatal care. Over the past three decades there has been increasing concern about noise levels in neonatal intensive care units. The experience of working in a neonatal intensive care unit (NICU) and exposure to high noise levels of such a unit prompted the researcher to investigate the sources of noise further and to explore ways of reducing or preventing the occurrence of such noise. The environment of one NICU consisting of a critical care area and a "grower type" nursery was surveyed with the aim of establishing noise levels in such a unit. A GR (General Radio) 1565-B sound level meter was used to measure the noise levels in the NICU and recordings of noise levels were made. Data were entered into the checklist each time a sound level was recorded and later analysed. In the critical care area sound levels ranged from 64-66 dB (A) (A weighted decibel scale) and in the grower nursery from 50-60 dB (A). Recent British and American Standards require that the mean noise levels inside the incubator should not exceed 60 dB (A) which is safe for the adult human ear (Wolke 1987). When compared with the in utero environment the noise levels of the neonatal unit are high and potentially hazardous because of the large numbers of staff and the amount of equipment present. The main findings of the study were that: There is a considerable level of noise in the NICU and this noise persists throughout day and night.(ABSTRACT TRUNCATED AT 250 WORDS)

[The experiences of parents with an ill premature baby]. / Die belewenis van ouers met 'n siek premature baba.

The purpose of this study was to identify and describe the experience of the parents of an ill premature infant in order to identify the needs of the parents going through this potential crisis. As a result of the constant medical and technological progress the percentage of premature infants is continually increasing. It is therefore of vital importance that the nursing and other medical staff are made aware of the trauma that these parents experience. This will enable them in giving adequate support and accompaniment in the prevention of social pathology. Unstructured in-depth interviews were held with five couples on two occasions. The first interview was held shortly after the birth of the premature infant. The second interview was held approximately two weeks after the baby was discharged from a private hospital in the Johannesburg region. The emotions of the parents were identified and compared. A literature study was done to consult other authors' findings on this topic. Recommendations were made at the end of the study concerning applications to practise, education and further research needed.

[Knowledge and expectations of childbirth in primigravidas]. / Kennis en verwagtinge van die primigravida oor baring.

The primigravida's experience of childbirth is influenced by the knowledge and expectations she has of childbirth. Her expectations of childbirth are based on the information she got from the antenatal clinic, the nursing staff, her mother, friends and family. The purpose of this research was to determine the knowledge and expectations the primigravida has of childbirth. An exploratory, descriptive design was used within the context of an academic hospital in Johanneburg. The survey method was used. The method of research firstly consisted of a literature study of the primigravida's knowledge and expectations of childbirth. This was done in order to put the problem in perspective and also to serve as a theoretical framework for the study. Secondly, a structured questionnaire was used to make a survey of the primigravida's knowledge and expectations of childbirth. From this research it is clear that the respondents had insufficient knowledge of childbirth and the handling of pain during childbirth. This insufficient knowledge can mainly be attributed to the poor attendance of antenatal preparation classes, inadequate professional counselling and the mother of the primigravida as the primary source of information on childbirth. The respondents, however, had realistic expectations with regard to their handling of labour, as well as of the role of the midwife and the doctor. From this research it is clear that a large gap exists in the primigravida's preparation for childbirth. The group participating in this research is therefore not adequately prepared for childbirth to have realistic expectations. The group must rely on the support of the midwife in the labour ward.(ABSTRACT TRUNCATED AT 250 WORDS)

The standards for postnatal care by the midwife in the hospital and the community.

The child-bearing events are normal physiological processes in the body of the woman and embryo/foetus/baby. Many changes in the internal and external environments of the family take place, simultaneously with these normal processes. These changes lead to the development of certain tasks and responsibilities that must be successfully accomplished during the postnatal period. A description of the midwife's caring functions during the post-natal period, in the hospital as well as in the community, is therefore essential. This description forms the part of an article that was published in the previous issue of Curationis. Thereafter the formulation of valid standards for postnatal care by the midwife can contribute to quality post-natal care in South Africa. The aim of this second part of the study was to formulate valid general standards for postnatal care by the midwife; Concept standards were formulated with the model of postnatal care and the stated prerequisites of caring as conceptual framework. The statistical validity of all the standards were determined by midwifery experts.

The phenomenon of caring by the midwife.

The child-bearing events are normal physiological processes in the body of the woman and embryo-foetus/baby. Many changes in the internal and external environments of the family take place, simultaneously with these normal processes. These changes lead to the development of certain tasks and responsibilities that must be successfully accomplished by the family during the child-bearing events. Many changes have also taken place in midwifery during the last half of this century. These changes in midwifery practice, together with the changes that take place during child-bearing events, may cause the new family to feel insecure during this stage of their lives. Very often when the family comes into contact with the midwife the factors contributing to feelings of insecurity are present already or soon become present. Their insecurity causes the family to look to the midwife for help and support. The questions that arise are: What are the caring activities which the midwife should carry out to assist and facilitate the new family to grow on the health continuum during the postnatal period? How can the humanistic values of caring be combined with the scientific knowledge base that guides the midwife's actions to form the science of caring? A description of the midwife's caring functions during the post-natal period, in the hospital as well as in the community, is therefore essential. Thereafter, formulation of valid standards for postnatal care by the midwife can contribute to quality post-natal care in South Africa.

The postnatal review: the task of the midwife.

There is growing realization that women's health and involvement in health care are essential keys to health for all. One way in which the midwifery profession can contribute to women's health is by providing high quality care during the six week postnatal review/checkup. A study in three provincial hospitals in the Port Elizabeth area showed that the actual structure of the postnatal review fell far short of the ideal as specified by the literature. Of all the elements included in the ideal postnatal review, only 23.5% of these were performed or supervised by the midwife. Seventy percent (70%) of these elements were not performed at all, thus emphasising the fact that a comprehensive health service is not being provided at the postnatal clinics in Port Elizabeth.

[Women's experience during infertility treatment]. / Die belewenis van vroue tydens infertiliteitsbehandeling.

With this research it was endeavoured to gain more knowledge about the experiences of women during the treatment of infertility. The midwife and other medical staff involved with the treatment of infertility can use this knowledge to have better insight into the total problem of these women and also care for and support them better. A study of the literature was done to determine what the experts have already ascertained of this phenomenon. An in-depth study of the phenomenon was undertaken in which the autobiographical method was used. During April 1989 unstructured interviews were conducted with six selected infertile women living in the Witwaterand area. From the findings of this research it appears that infertile women have unique experiences of their infertility and the treatment of it. Universal experiences, e.g. pain and disappointment were identified, although the causes of these experiences sometimes differed. Recommendations were made on how the midwife can contribute by filling the gap (established during the research) in the care in this field. Suggestions were also made with regard to further research on this phenomenon.

[Maintaining epidural anesthesia by the midwife]. / Die instandhouding van epidurale narkose deur die vroedvrou.

Epidural anaesthesia as a method of pain relief during labour has lately become very popular. Statistics show that in some labour units up to 70 per cent of all patients undergo epidural anaesthesia. The popularity of this method can be attributed to its effectiveness in relieving pain during labour. The anaesthetist commences an epidural block by introducing an epidural catheter into the epidural space. The anaesthetist administers the test dose and the first therapeutic dose. Within a short duration of time (10 to 20 minutes) the patient can already experience the numbing effect of the anaesthetic. This anaesthetic loses its numbing effect within two to three hours and effective pain relief can only be achieved by administering a further dose of local anaesthetic via the epidural catheter. This procedure can be repeated between three to six times during the average duration of labour. Alternatively, a continuous epidural infusion procedure can be used. The last method, however, sometimes requires the administration of additional epidural "top-ups". There are some risks in administering additional "top-up" dosages. The possibility exists of the anaesthetic causing a spinal block as a result of being administered into the spinal fluid. The "top-up" can also cause convulsions if administered intravenously. In some units it is expected of the midwife to maintain epidural anaesthesia on prescription by the doctor. These side-effects can, however, also occur when the patient is being treated by medical personnel with ample experience and knowledge. It is expected of some midwives to maintain an epidural block on prescription by the anaesthetist. If the midwife lacks the necessary knowledge of epidural anaesthetic and its maintenance, she might unintentionally administer the local anaesthetic into the spinal fluid or intravascularly. This might cause a threat to the mother's and baby's lives. This research covers the maintenance of epidural anaesthesia as carried out by the midwife. The level of involvement of the midwife in the maintenance of epidural anaesthesia has been investigated. The midwife's knowledge about the maintenance of epidural anaesthesia, her legal rights, obligations and emergency treatment of patients have been investigated. It has also been considered whether protocols in the maintenance of epidural anaesthesia exist. All the abovementioned information was acquired by submitting a questionnaire for completion by midwives practising in labour wards in the Johannesburg area. The results of this research show that the midwife's knowledge as regards to epidural anaesthesia and its maintenance is inadequate.(ABSTRACT TRUNCATED AT 400 WORDS)

[Study of the quality of interhospital transport of sick neonates by selected ambulances in the Witwatersrand area]. / 'N ondersoek na die gehalte van interhospitaalvervoer van siek neonate deur geselekteerde ambulanse aan die Witwatersrand.

The quality of the inter hospital transport of ill neonates, by selected ambulances in the Witwatersrand area, was investigated by means of the case study method. Of the fifteen case studies investigated, eleven neonates were transported by a private ambulance and four by provincial ambulances. Data regarding the maternal- and neonatal history, the optimal maintenance of the neonate's condition, the communication system, as well as aspects relating to the transport personnel, were collected by means of a structured instrument. Retrospective auditing of records, structured interviewing and direct observation/inspection were utilised as the research techniques. The quality of the inter hospital transport of ill neonates, especially by the private ambulance, is not up to standard. Deterioration of the neonate's body temperature, heart and respiration rates, as well as the serum glucose values after transport, were of the more important findings. The lack of equipment, especially in the private ambulance, increases the risk of transport. Staff development and formal control by a local committee, as well as a national control body, are recommended.

[Standards for the interhospital transport of sick neonates]. / Standaarde vir die interhospitaalvervoer van siek neonate.

The transport of ill neonates between hospitals and/or health care centres, plays an important role in the mortality rate of these seriously ill neonates. It is therefore important that the ill neonate is transported under optimal conditions. A lack of standards in this regard hampers the evaluation of the quality of inter hospital transport of ill neonates. The purpose of this study is to formulate valid standards for the transport of seriously ill neonates between hospitals (and/or other health care institutions) to form the basis for the evaluation of the quality of this service. Factors that need to be considered in the transport of ill neonates include the ambulance, equipment and stock, the transport personnel and communication. These factors were systematically explored and described and standards were formulated accordingly.