Internationalising university schools of nursing in South Africa through a Community of Practice.

INTRODUCTION: International nursing experiences in higher education have traditionally enabled and continue to enable nurses to appreciate '...the richness of the nursing mosaic...and the realities of nursing in many different cultural contexts'. This article describes a case study of the Collaboration for Higher Education of Nurses and Midwives in Africa in terms of its success in internationalising the nursing schools involved. BACKGROUND: Different types of international contact have led to a limited pattern of internationalization in the universities of Southern Africa, which often places African academics in a secondary or dependent position. Opportunities for truly equal international partnerships have been limited. METHODS: A qualitative analysis of the views of participants from the consortium of universities was carried out based on the conceptual framework of communities of practice. FINDINGS: An effective community of practice had been established, focused on the major knowledge domain of nursing and midwifery in Africa, and sharing the perception that their work was empowering and collaborative. The community had established its own ways of working, and articulated major institutional and individual benefits.

Measuring HIV Stigma for PLHAs and Nurses Over Time in Five African Countries

The aim of this article is to document the levels of HIV stigma reported by persons living with HIV infections and nurses in Lesotho; Malawi; South Africa; Swaziland and Tanzania over a 1-year period. HIV stigma has been shown to negatively affect the quality of life for people living with HIV infection; their adherence to medication; and their access to care. Few studies have documented HIV stigma by association as experienced by nurses or other health care workers who care for people living with HIV infection. This study used standardised scales to measure the level of HIV stigma over time. A repeated measures cohort design was used to follow persons living with HIV infection and nurses involved in their care from five countries over a 1-year period in a three-wave longitudinal design. The average age of people living with HIV/AIDS (PLHAs) (N=948) was 36.15 years (SD=8.69); and 67.1(N=617) were female. The average age of nurses (N=887) was 38.44 years (SD=9.63); and 88.6(N=784) were females. Eighty-four per cent PLHAs reported one or more HIV-stigma events at baseline. This declined; but was still significant 1 year later; when 64.9reported experiencing at least one HIV-stigma event. At baseline; 80.3of the nurses reported experiencing one or more HIV-stigma events and this increased to 83.71 year later. The study documented high levels of HIV stigma as reported by both PLHAs and nurses in all five of these African countries. These results have implications for stigma reduction interventions; particularly focused at healthcare providers who experience HIV stigma by association

A model for dealing with sudden death.

The purpose of this study was to attempt to provide health professionals working in emergency departments with guidelines to use in order to ensure the therapeutic management of the dead or dying client, the suddenly bereaved families, and fellow colleagues (health professionals). A 4-year action research study was undertaken involving semistructured interviews with health professionals (doctors and nurses) working in selected Level I emergency departments, suddenly bereaved families belonging to a local bereavement support group, and mortuary staff in KwaZulu-Natal, South Africa. Further analysis of the categories and themes that emerged from the interviews informed the development of the Dealing with Sudden Death Model, a family information pamphlet, a preparation checklist, and an incident evaluation checklist.

The use of PHC clinic-based women's groups for financial empowerment in a rural area.

The article is based on a four-year project during which Primary Health Care (PHC) nurses worked with women's groups in their areas. The aim of the study was to explore the involvement of PHC nurses in economic empowerment, both in terms of health promotion and in terms of the PHC approach. In particular the objectives were to establish whether nurses could lead economic empowerment groups, whether such groups could establish adequate external links and become financially viable. Eleven groups were used as case studies, and a cross-case analysis was done in terms of the three objectives. It was found that between the women and the nurses, adequate leadership existed for the groups to function well. Very limited external linkages were established, notwithstanding efforts in this regard. Nine out of 11 groups contributed to financial welfare of their members after 18 months, but a range of problems with regard to financial viability are identified.

Social support and health behaviour in women living with HIV in KwaZulu-Natal.

The article explores the relationship between social support and health behaviour of rural and urban women who are living with HIV in South Africa. Our study was a descriptive survey of a group of pregnant and non-pregnant women living with HIV. The sample size was 262 women, 165 from urban area and 97 from rural area. Data were collected using 3 instruments, namely a demographic questionnaire, the health behaviour schedule and the Medical Outcomes Study (MOS) Social Support Survey. Significant findings indicate that in the urban area 71% of women had disclosed their HIV status to someone, while in the rural area 49% had done so. A total of 77% of the women indicated that they were sexually active--21% had 2 partners and 20% indicated that they had at least one episode of a sexually transmitted disease since finding out their HIV status. A total of 16% said that they currently received counselling, which was significantly more frequent in the rural sample (27%) than the urban (11%). The membership of support groups is at 12% among the participating women, and social support as well as membership of a support group was higher in the rural group than the urban group. Good social support showed an association with condom use, support group attendance and taking vitamins. However, receiving counselling as well as membership of a support group showed stronger association with positive health behaviour than social support on its own. The higher social support was not associated with increased disclosure.

Social Support and Health Behaviour in Women Living with HIV in KwaZulu-Natal

The article explores the relationship between social support and health behaviour of rural and urban women who are living with HIV in South Africa. Our study was a descriptive survey of a group of pregnant and non-pregnant women living with HIV. The sample size was 262 women; 165 from urban area and 97 from rural area. Data were collected using 3 instruments; namely a demographic questionnaire; the health behaviour schedule and the Medical Outcomes Study (MOS) Social Support Survey. Significant findings indicate that in the urban area 71 of women had disclosed their HIV status to someone; while in the rural area 49 had done so.A total of 77 of the women indicated that they were sexually active - 21 had 2 partners and 20 indicated that they had at least one episode of a sexually transmitted disease since finding out their HIV status. A total of 16 said that they currently received counselling; which was significantly more frequent in the rural sample (27) than the urban (11).The membership of support groups is at 12 among the participating women; and social support as well as membership of a support group was higher in the rural group than the urban group. Good social support showed an association with condom use; support group attendance and taking vitamins. However; receiving counselling as well as membership of a support group showed stronger association with positive health behaviour than social support on its own. The higher social support was not associated with increased disclosure

A comparative study of professional competence of nurses who have completed different bridging programmes.

The aim of the study was to compare professional competence of nurses who completed different bridging programmes. Forty professional nurses from two different bridging programmes participated in the study. The newly qualified registered nurses were all from the province of Kwazulu- Natal working in various hospitals. The researcher utilized Slater Nursing Competencies Rating Scale. The instrument had the following categories (a) psychosocial (individual), psychosocial (group), (c) physical needs, (d) general, (e) communication and (f) professional implications. The results showed that newly qualified nurses from different bridging programmes were professionally competent. Age, experience and examination results had no relationship with the professional competency of the newly qualified nurse.

The lived experiences of health professionals confronting the sudden death of clients in level I emergency departments in KwaZulu-Natal.

AIM: The aim of this study was to describe the lived experiences of the health professionals confronting the sudden death of clients in three Level I Emergency Departments (ED's) in KwaZulu-Natal. METHOD: A qualitative phenomenological approach was used to explore the experiences of nurses and doctors confronting the sudden death of their clients. Two private institutions and one state institution in the Durban area were involved in the study. FINDINGS: A total of 13 health professionals were individually interviewed over a period of approximately seven months. With the aid of a computer package a number of themes emerged from the data namely; "it's a personal matter, what is caring, where is the time, what is coping and which group are you in?" These findings suggested that staff in these departments have a unique way of defining their situation and that collaboration between the doctors and nurses working in the ED is limited. In order to improve the working experience for these health professionals, the ED organisational culture needs to be addressed.

Managing AIDS stigma.

According to anecdotal reports, AIDS stigma and discrimination continue to influence people living with and affected by HIV disease as well as their health care providers, particularly in southern Africa where the burden of AIDS is so significant. Stigma is perceived as a major limiting factor in primary and secondary HIV/AIDS prevention and care. It reportedly interferes with voluntary testing and counselling, and with accessing care and treatments, thereby increasing suffering and shortening lives. Many health care workers in southern Africa have come to the conclusion that unless stigma is conquered, the illness will not be defeated. While there is substantial anecdotal evidence of the impact of stigma on AIDS care, very little rigorous research has been conducted. This article explores three questions: What is AIDS stigma? What is the impact of AIDS stigma? How can health care providers help to manage AIDS stigma?

Pathways to mental health care in KwaZulu--Natal.

The understanding of popular beliefs about mental health care and the pathways clients take prior to admission to a mental health institution is vital in planning to reduce delays in seeking treatment. The objectives of this exploratory survey were to determine pathways of care the clients with mental illness take, which ultimately lead to the mental health institution, the effects of socio-cultural and economic factor on the pathways to mental health care and the satisfaction with different service providers consulted. Data was gathered through semi-structured interviews. The results indicate that African clients interpret mental illness as bewitchment. Delays in seeking appropriate mental health care are experienced because traditional and faith healers are the first port of call. The short pathways are used when the first signs of psychotic features are severe, including like aggressive or violent behaviour. Financial constraints seem to be the problem for most of the clients in accessing mental health care. Furthermore, defaulting treatment was also observed due to the fact that mental illnesses are stigmatised in African communities.

Spirituality in nursing: an analysis of the concept.

There is scientific evidence that the spiritual well being of a person can affect quality of life and the response to illness, pain, suffering and even death. In spite of this evidence, spirituality in nursing has not been examined within a South African context. The purpose of this study was to describe the phenomenon of spirituality from the perspective of nurses and patients/clients with the aim of generating a middle range theory of spiritual care in nursing. A qualitative mode of inquiry using a grounded theory method was applied. A sample of 56 participants composed of 40 nurses, 14 patients and 2 relatives of patients was recruited by theoretical sampling procedure from one public hospital, one private hospital and one hospice setting. Focus group interviews and one on one in depth interviews were conducted. An audio tape recorder was used to record the interviews. Field notes and memos were also kept. Data were collected and analyzed simultaneously. Non numerical Data Qualification Solutions NUDIST software was used to code data into different levels of codes. The results were rich descriptions of the concept of spirituality. This concept was described as a unique individual quest for establishing and, or, maintaining a dynamic transcendent relationship with self, others and with God/supernatural being as understood by the person. Faith, trust and religious belief were reported as antecedents of spirituality, while hope, inner peace and meaningful life were reported to be consequences of spirituality.

The perceptions of nurses in a district health system in KwaZulu-Natal of their supervision, self-esteem and job satisfaction.

BACKGROUND: Supervision has been identified as a major issue in quality of care. Although increasing attention is being given to supervision in the District Health System, there have been no studies describing the current situation. This article describes a survey done in two health districts in KwaZulu-Natal involving 319 nurses from all types of government health care settings. METHODS: This was a quantitative descriptive study that described the current supervision, job satisfaction and self-esteem in two (2) health districts, that is the Ugu and the uThukela health districts. The three variables were described using a mailed questionnaire. A total 319 nurses participated in this study. RESULTS: The majority of the nurses (53%) felt that positive supervision behaviours listed in a rating scale, occurred never or seldom. The average self-esteem score was very positive (83%), and the average job satisfaction score was 60%. Nurses were most satisfied with the factor reflecting "personal satisfaction about their contribution to the work" (72%) and the least satisfaction with the factor that has to do with "pay and prospects" (50%). While there was no relationship between any of the demographic variables and supervision, there was a low but significant relationship between supervision and job-satisfaction. A significant relationship was also found between the personal satisfaction factor of job satisfaction and self-esteem. CONCLUSION: As nurses form the backbone of the health services, it is incumbent that health service managers safeguard the nursing workforce. Targeted strategies are necessary to ensure retention of the nurses for the health care of the South African population.

Exploring the fear of contracting HIV/AIDS among trauma nurses in the province of Kwazulu-Natal.

A qualitative study, using phenomenology as an approach was conducted. The title of the study was "Exploring the fear of contracting HIV/AIDS among trauma nurses in the province of Kwazulu-Natal". Participants were selected on the basis of category (registered nurses), workplace (level one trauma units), and work experience (six months experience in a trauma unit). Twelve nurses participated in the study, six from the state institutions and six from the private institutions. The objectives of the study were to explore the fear of contracting HIV/AIDS, its effect on their personal/working lives and how they coped with it. The findings of the study revealed that trauma nurses perceived themselves to be at risk of acquiring HIV/AIDS from their working environment despite the available precautionary measures. Needlestick injuries appeared to be the main source of fear. They used different coping and defence mechanisms effectively to cope with this fear of contracting HIV and none were in any emotional crisis. Education at different levels and development of support networks has been recommended as the key strategies to decrease these fears. Other recommendations include improving the quality and availability of protective materials and equipment, making HIV/AIDS a notifiable disease as well as improving general and specific beliefs that increase coping.

Selected outcomes of community-oriented, problem-based nursing programmes in South Africa.

UNLABELLED: Whilst there is a significant body of research on the outcomes of problem-based learning (PBL) programmes (Albanese and Mitchell, 1993; Vernon and Blake, 1993), there is little information regarding the outcomes of community-oriented programmes (COL) for nursing students. Between 1994 and 1997, four university schools of nursing implemented problem-based, community-oriented learning (COL) programmes. This research sought to describe, evaluate and compare the outcomes of graduates from these four universities with graduates who had followed conventional programmes. RESEARCH OBJECTIVES: These were to describe and explore the incorporation of illness prevention and health promotion of graduates from PBL/COL programmes and non-PBL/COL programmes in South Africa, as described by the graduates and their supervisors. Secondly, to describe whether and how the graduates from PBL/COL and non-PBL/COL programmes engaged themselves in continued learning. RESEARCH METHODOLOGY: This was a qualitative evaluation study, which is descriptive and comparative in nature. In-depth interviews were held with the graduates and their supervisors about six months after completion of their training. Use was made of Miller and Crabtree's (1994) Template Analysis Style and of Benner's (1984) interpretative approach to analyze data. Analysis was done using the NVIVO computer programme. This programme was used to manage the categories which were developed with regard to each concept as the analysis proceeded. FINDINGS: Both the graduates and the supervisors appeared to have difficulty describing activities relating to health promotion and illness prevention. Only three types of health promotion were described--mass education, increasing personal skills and creating a supportive environment. The most commonly mentioned means of illness prevention were health education and medical-surgical asepsis. A few graduates described activities which indicated that they had taken context into consideration during patient care.

A job analysis of selected health workers in a district health system in KwaZulu-Natal. Part One: Job analysis of nurses in hospital settings.

The aim of this descriptive survey was to do a job analysis of different categories of nurses in a District Health System in order to clarify job expectations, describe current practice of nurses in hospitals and clinics and to make recommendations about skills mix in district services. A mail questionnaire requested the sampled nurses to rate the frequency and importance of the tasks they perform. Only 19% of the nurses (41 nurses of all categories) returned the questionnaire, and an index taking into account frequency and importance, was calculated. The self-report data was compared with data from non-participant observation done over 19 days in 14 units in all three hospitals. A total of 39 tasks were done more than six times per week, of which most (16) were in the category of clinical assessment and recording. Counselling and teaching (8 tasks), were the second most frequent type of task. Only two tasks were rated as very important (giving injections and assessing respiratory status). When frequency and importance were combined into a Task Index, a large number of tasks scored in the middle range, with very few very high or low. Respondents identified 33 tasks that did not appear on the questionnaire. The observations showed that all categories of nurses shared many tasks in hospital settings. However, Registered Nurses were involved in specialized treatment and care, as well as administration of the unit. The specialists type tasks of Registered Nurses were also clear in Operating Theatre settings. The implications of the study are discussed and recommendations are made.

A job analysis of selected health workers in a district health system in KwaZulu-Natal. Part Two: Job analysis of nurses in primary health care settings.

The aim of this descriptive survey was to do a job analysis of different categories of nurses in a District Health System in order to clarify job expectations, describe current practice of nurses in hospitals and clinics and to make recommendations about skills mix in district services. This article deals with the clinics only. A mail questionnaire requested the sampled nurses to rate the frequency and importance of the tasks they perform. A total of 71% of the nurses (60 nurses of all categories) returned the questionnaire, and an index taking into account frequency and importance, was calculated. The self-report data was compared with data from non-participant observation done over 11 days in five clinics. The respondents rated 11 tasks as being performed more than six times per week, and no task as being important in that more than 70% of respondents felt it could never be omitted. However, on the task index, which combines frequency and importance, 57 tasks received the highest possible score of ten, and few (25%) were rated below five. The work context of nurses in PHC settings and hospitals was compared using Exhaustion-Disengagement Model and it was proposed that hospital nurses had higher job demands and lower job resources, and therefore ran a higher risk of both exhaustion and disengagement. A clear difference in the roles of different categories of nurses was found, although they have many tasks in common.

A job analysis of selected health workers in a district health system in KwaZulu-Natal. Part three: Other categories of health workers.

This article described the third part of a study aimed at doing a job analysis of nurses and non-professional health workers in a district health system. This article describes the tasks of five categories of workers, their training and their work-load over an ordinary week. Interviews were done with 52 workers from three hospitals and five clinics, of whom 14 were men and 38 women. The three PHC guards had a much more varied job than the hospital security staff (also three). All of them have had specific task related training. The six General Assistants in Primary Health Care settings were almost exclusively involved in cleaning, while the 23 in hospitals added food and drink management and running errands to their work. Only one had training pertaining to the specific tasks. All three clerks were found in the PHC setting, and their tasks were mainly that of receptionist. None had specific task related training. The three Ground's Men worked at gardening and cleaning at PHC clinics, but a range of other tasks were added from time to time. Porters, of whom ten were interviewed, did mainly transporting of patients and running errands. GA's and security staff were also used to control violent patients and visitors, something for which none of them have had training. Recommendations were made about training and work redesign in the district.

The practice of community caregivers in a home-based HIV/AIDS project in South Africa.

The aim of this study was to describe the practice of community caregivers in a home-based AIDS care project at seven sites in South Africa. The community caregivers felt positive about the contribution they made, but found it difficult to cope with the poverty and complexity of problems they were faced with. They visited each client an average of five times per month, and their care usually involved counselling and informing, symptom control, psychosocial support and welfare assistance. The caregivers worked in close collaboration with the South African Hospice Association and clinic staff, and each site developed a work pattern suitable to its resources.

Evaluation of the Integrated Community-Based Home Care model.

In 1999-2000 the Integrated Community-Based Home Care model for the care of people with AIDS in communities were implemented in seven sites across the country. The post-implementation evaluation showed that most respondents felt that the model could be replicated if a functioning and informed network including all partners, and a strong management team were in place. The effects of the project were mainly positive for all stakeholders (hospice, clinic, hospital, PWA and their carers, professionals and other community members). Hospitals and community-based services became more aware of and involved in the needs of PWA and felt that the model enabled them to address these needs. PWA and their carers felt supported and respected.