Mentorship needs in an intrapartum setting - mentor-centred approach: A qualitative descriptive study.

AIM: The study aimed to explore and describe the needs of registered midwives in labour rooms in the North-West Province of South Africa with regard to clinical mentorship of student midwives to identify the strengths and gaps in the clinical mentorship programme and make recommendations to optimise clinical mentorship for student midwives in this setting. BACKGROUND: The South African healthcare system is overburdened by numerous problems, particularly in maternity services. It has been reported that nurses are not skilled enough to provide quality care to pregnant women. The onus is on nursing education institutions to produce competent midwives to improve the quality of care. Mentorship has been proven to improve competence among mentees and this strategy can be used to address this health problem in South Africa. DESIGN: The study employed a qualitative descriptive design and purposive sampling was used to select the participants from the level 2 hospitals in the North-West province in South Africa. METHODS: Data were collected using individual telephonic interviews and 14 participants from three level 2 hospitals in the North-West province participated in the data collection process. RESULTS: Three main themes emerged from interviews conducted with the participants. Their needs to successfully mentor student midwives in an intrapartum setting are a positive environment for learning, teaching and mentorship; a collaborative relationship between the nursing education institutions and the health facilities where they are employed as well as positive student conduct. The sub-themes under theme 1, a positive environment for teaching, learning and mentorship, are patience, teamwork, mutual respect and human and material resources. Theme 2, a collaborative relationship between the nursing education institutions and the health facilities, had three sub-themes, namely, presence, effective communication on students' objectives, activities and progress and opportunities for self-development and empowerment. Commitment to learning (presence, patience and pre-knowledge) is the sub-theme that emerged from the theme of positive student conduct. CONCLUSIONS: For successful mentorship in the clinical setting, the focus should not just be on the mentees themselves and creating an environment where they can learn. There is a need to look into how the mentors, who provide learning opportunities and teach, guide and support mentees in order for them to be competent, can be assisted to enjoy mentorship.

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.

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.

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.

Experiences of student nurses regarding the bursary system in KwaZulu-Natal province, South Africa.

BACKGROUND: During 2010, the South African nursing education system was restructured, changing student nurses from having supernumerary status to being bursary holders. Changes with the introduction of this new bursary system included institutional factors and benefits that could be removed from the students, potentially hampering students' sense of belonging. AIM: This study aimed to describe the experiences of students receiving bursaries in KwaZulu-Natal (KZN) province and to make recommendations for improving the system to bursary providers, educational institutions and practical settings based on these students' experiences of the bursary system. SETTING: The experiences of student nurses regarding the bursary system are described within a specified setting comprising two nursing campuses in KZN. METHOD: A qualitative study design was used and seven focus group interviews were conducted with purposively selected participants, representing the target population of first-, second- and third-year male and female nursing students registered for the Diploma in Nursing (General, Psychiatric, Community) and Midwifery. RESULTS: Two main themes and eight subthemes were identified. The findings indicated that some of the bursary system's experiences were negative as opposed to students having supernumerary status. These experiences had negative socio-economic, psychological, clinical, academic and family impacts. Many concerns related to staff members' attitudes, shortages of nurses and service demands during students' clinical practice assignments. CONCLUSIONS: The bursary system was not viewed as being beneficial to students as they did not receive all the benefits from being bursary holders. Support in clinical and academic areas was lacking as they were considered to be employees during their clinical assignments. There is an urgent need to review the bursary system.

Experiences of student nurses regarding the bursary system in KwaZulu-Natal province, South Africa

Background: During 2010, the South African nursing education system was restructured, changing student nurses from having supernumerary status to being bursary holders. Changes with the introduction of this new bursary system included institutional factors and benefits that could be removed from the students, potentially hampering students' sense of belonging. Aim: This study aimed to describe the experiences of students receiving bursaries in KwaZulu-Natal (KZN) province and to make recommendations for improving the system to bursary providers, educational institutions and practical settings based on these students' experiences of the bursary system. Setting: The experiences of student nurses regarding the bursary system are described within a specified setting comprising two nursing campuses in KZN. Method: A qualitative study design was used and seven focus group interviews were conducted with purposively selected participants, representing the target population of first-, second- and third-year male and female nursing students registered for the Diploma in Nursing (General, Psychiatric, Community) and Midwifery. Results: Two main themes and eight subthemes were identified. The findings indicated that some of the bursary system's experiences were negative as opposed to students having supernumerary status. These experiences had negative socio-economic, psychological, clinical, academic and family impacts. Many concerns related to staff members' attitudes, shortages of nurses and service demands during students' clinical practice assignments. Conclusions: The bursary system was not viewed as being beneficial to students as they did not receive all the benefits from being bursary holders. Support in clinical and academic areas was lacking as they were considered to be employees during their clinical assignments. There is an urgent need to review the bursary system

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

Challenges in implementing continuous support during childbirth in selected public hospitals in the North West Province of South Africa.

BACKGROUND: According to a Cochrane review, continuous support during childbirth increases the mother's chances of a vaginal birth without identified adverse effects. However, this evidence-based practice is not universally implemented. The objective of the study was to identify challenges encountered in implementing continuous support during childbirth in public hospitals in the North West Province of South Africa. METHOD: An explorative, descriptive and contextual qualitative approach was used. The data were collected during 2013 by conducting focus group interviews with 33 registered midwives who had worked in maternity units in three selected public hospitals in the North West Province for at least two years. RESULTS: Midwives identified challenges that negatively impacted the implementation of continuous support during childbirth at organisational and interpersonal levels. At the organisational level, challenges included human resources, policies and guidelines as well as the architectural outlay of the maternity units. The personal challenges related to communication and attitudes of nurses, patients and their families. CONCLUSIONS: Organisational and personal challenges had a negative impact on the provision of continuous care during childbirth.

Taxonomy for complexity theory in the context of maternity care.

BACKGROUND: The linear focus of 'normal science' is unable to adequately take account of the complex interactions that direct health care systems. There is a turn towards complexity theory as a more appropriate framework for understanding system behaviour. However, a comprehensive taxonomy for complexity theory in the context of health care is lacking. OBJECTIVE: This paper aims to build a taxonomy based on the key complexity theory components that have been used in publications on complexity theory and health care, and to explore their explanatory power for health care system behaviour, specifically for maternity care. METHOD: A search strategy was devised in PubMed and 31 papers were identified as relevant for the taxonomy. FINDINGS: The final taxonomy for complexity theory included and defined 11 components. The use of waterbirth and the impact of the Term Breech trial showed that each of the components of our taxonomy has utility in helping to understand how these techniques became widely adopted. It is not just the components themselves that characterise a complex system but also the dynamics between them.

Intrapartum practices to limit vertical transmission of HIV.

The need to improve health services to HIV-positive women requires a specific focus on limiting mother-to-child transmission. Vertical transmission most often takes place during the intrapartum period; hence, it is essential to alert midwives to what constitutes safe or risky intrapartum practices. Midwives in the southern region of the North West Province of South Africa were surveyed for their knowledge of safe intrapartum practices that can limit vertical transmission of HIV, consequently indicating which intrapartum practices prevail in the region. We used a quantitative survey design and collected data by means of a questionnaire and checklist. A purposeful availability sample of 31 midwives who work in all four hospitals in the province was used and a random sample of 401 obstetric records was audited. Data were analysed by means of frequency analysis, effect sizes and cross-reference. A slight majority of the midwives had sufficient knowledge to distinguish between risky and safe practices. However, safe intrapartum practices are not always carried out and this raises concerns. Accordingly, we formulate general recommendations for nursing education, future research, and midwifery practice. In particular we suggest ways the national Guidelines for Maternity Care in South Africa may be adapted and better implemented to enhance safe intrapartum practices to limit vertical transmission of HIV.