Nurses' professional dignity in private health care: a descriptive phenomenological study.

AIM: This study explored and described nurses' experiences of factors that influenced their professional dignity in private hospitals in South Africa. BACKGROUND: Patients' dignity is a nursing professional value in high regard. Nurses' dignity, in particular nurses' professional dignity, has not been valued equally. Disrespect for nurses' professional dignity impacts on nurses' motivation to provide nursing care to their full potential. METHODS: Descriptive phenomenological research was conducted. Eleven professional nurses were interviewed at two private hospitals in the provinces of KwaZulu-Natal and the Free State of South Africa. FINDINGS: The participants were conscious of their 'professional standing due to own and others' percipience'. Their professional dignity was influenced by experiences such as perceiving one's own professional dignity; having contradictory experiences; being proud to be a professional nurse; receiving support, appreciation and respect; providing care in complex situations; performing as a professional nurse; valuing patient well-being; and being humiliated by others. CONCLUSION: Preserving nurses' professional dignity is crucial and should be acknowledged and encouraged by managers, health team members and nurses. IMPLICATIONS FOR NURSING/HEALTH POLICY: The need for preserving nurses' professional dignity necessitates the incorporation of professional dignity strategies in healthcare, nursing and education policies.

Support of adolescents to resist peer pressure and coercion to sexual activity.

AIM: The aim of this study was to explore and describe how peer pressure and coercion to sexual activity manifested among adolescents in a district in South African and how primary healthcare nurses could support them to resist it. BACKGROUND: When adolescents engage in early sexual activity, unplanned pregnancies and sexual transmitted infections become health threats. Notwithstanding the governmental health promotion programmes to improve the sexual health of the youth in South Africa, adolescents are still having unprotected sex and even multiple sex partners. METHODS: A constructivist grounded theory study was done. The initial sample consisted of 10 adolescents and nine professional nurses who were selected from six primary healthcare clinics in the identified district. Constant comparative data collection and analysis were done to identify the initial codes that were theoretically saturated through another round of data collection and analysis involving five participants (four professional nurses and one health educator). FINDINGS: The findings of the study refer to the definition of peer pressure and coercion and the relationship between professional nurses and adolescents. Ways to optimize the relationship in order for nurses to substitute for parental shortcomings in guiding adolescents towards responsible sexual behaviour and to address the adolescents' vulnerability regarding peer pressure were identified. CONCLUSION: Challenging adolescent-nurse interaction incidents were identified that warranted different approaches to build on existing initiatives to improve adolescent-friendly health services. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: Primary healthcare nurses should perform complementary roles to substitute for parents who do not have the skills to guide their adolescent children towards responsible sexual behaviour. Programmes need to be developed to enable nurses to optimize their relationships with adolescents and to deliver services through mobile healthcare units to adolescents where they regular socialize. Management should provide budgets for nurses to use multimedia to interact with adolescents.

Adaptation and validation of a self-report measure of youth-friendly primary healthcare services.

AIM: To adapt the Youth-Friendly Health Services-World Health Organization+ questionnaire to suit the health needs of youth in the South African context, and estimate its psychometric properties. BACKGROUND: Youth-friendly health services promote health-seeking behaviour amongst young people. The perceptions of youth and adolescents are thus important whilst assessing the youth-friendliness of health services. METHODS: We conducted six focus group interviews to evaluate the clarity and relevance of the questionnaire items and adapted the questionnaire which was was administered to 101 youth who visited primary healthcare clinics. We reduced the number of items through quantitative analysis of responses and item analysis. Cronbach's alpha was used to optimize internal consistency reliability. Experts established a baseline of youth-friendliness. We ranked the responses from the youth against the baseline of youth-friendliness and used independent two sample t-test to test for construct validity of the final adapted version, titled Youth-Friendly Health Services- South Africa. RESULTS OR FINDINGS: After the focus group interviews, we rephrased 27 items, removed four items and added eight items. We reduced the questionnaire to 57 items whilst optimizing internal consistency reliability. The statistical analysis supported construct validity. CONCLUSION: The Youth-Friendly Health Services-South Africa is the first English validated version and demonstrates good psychometric properties. IMPLICATION FOR NURSING PRACTICE AND HEALTH POLICY: The Youth-Friendly Health Services-South Africa can be useful to evaluate the youths' satisfaction with the health care and nursing service they receive. This study's findings indicate that the original questionnaire can be adapted for use in different contexts to shape local and global nursing practice and policies.

Appreciation of the research supervisory relationship by postgraduate nursing students.

INTRODUCTION: The quality of the relationship between postgraduate students and their supervisors often determines the progress of the students. BACKGROUND: Successful supervision according to students is associated with the expertise of the supervisors and their willingness to share their knowledge with their students. On the other hand, supervisors expect their students to be able to work independently to a large extent. Contradictory expectations of supervisors and postgraduate students can cause delays in the progress of students. AIM: The aim of this study was to explore and describe the aspects of the supervisory relationship that postgraduate students in nursing science at a selected university in South Africa appreciate. METHOD: A qualitative research design with an appreciative inquiry approach was used and 18 students under the guidance of an independent facilitator provided the data during group interviews. FINDINGS AND DISCUSSION: Specific personal and professional qualities of the supervisors contribute to a valued supervisory relationship. Regarding personal qualities, the supervisors should show their understanding of the unique circumstances of the students in challenging times. Supervisors should also be expert researchers. The valued relationship refers to an open and trusting relationship between the students and the supervisors. CONCLUSION: The students' appreciation of the research supervisory relationship contributes to the understanding of the expectations of postgraduate students regarding the support that they need to become scholars in an academic discipline. IMPLICATIONS FOR NURSING AND HEALTH POLICY: There is a need for continuing professional development of supervisors to sensitize them about the expectations of the students.

Job satisfaction of registered nurses in a community hospital in the Limpopo Province in South Africa.

Nurses are confronted daily with the demands of an increased workload and insufficient facilities in the public healthcare sector in South Africa. The purpose of the study was therefore to determine the degree ofjob satisfaction of registered nurses in a community hospital in the Limpopo Province of South Africa. A quantitative descriptive design was used to meet the objectives of the study. The population was not sampled because of the small size of it. All the registered nurses who had one or more years experience in this hospital were included in the study. A self-administered questionnaire was used to collect data from them regarding the working conditions in the hospital including the emotional and social climate. The questionnaire was based on an instrument developed by Humphries and Turner (1989:303) to determine the degree of job satisfaction of nursing staff in a unit for elderly mentally retarded patients. The findings indicated that the majority of the respondents were dissatisfied about the working conditions and emotional climate in the hospital while they were fairly satisfied with the social climate. The workload and degree of fair remuneration, under the working conditions, were the most highly rated as dissatisfying (83% of the participants) while under the emotional climate they indicated that the pressure under which they worked was highly dissatisfying (82% of the participants). As the results indicated that the social climate was satisfactory; having a best friend at work and the chance to help other people while at work, were rated positively by 88% and 76% of the participants respectively. Recommendations made included that managers have to show the staff that their best interest is their number one concern. Leaders have to be available for the staff and being willing to buffer the stress caused by increased workload and insufficient resources. Greater visibility of supervisory staff should therefore be encouraged.

The management of infant developmental needs by community nurses. Part 1: description of the responsibilities of community nurses with regard to the management of infant developmental needs.

This article is one of two that describes the responsibilities of community nurses, according to their legal scope of practice, with regard to the management of developmental needs of infants in primary health care clinics in South Africa. A subsequent article describes the development of guidelines for the support of community nurses to address the developmental needs of infants 0-2 years. While evidence confirms that developmental surveillance should be incorporated into the ongoing health care of the infant, such services are not consistently provided in health care settings and, if provided, the delivery thereof suffers from significant inadequacies. A case study strategy was used to investigate the phenomenon and content analysis utilised to analyze the data. The Transactional Model of Development was selected to interpret the data obtained in the study. Findings of the study show that infant developmental care is not included to its fullest potential in the health care delivered to infants and their families, thereby indicating that community nurses do not meet the standards of the profession with regard to the management of infant developmental needs. Health service managers need to review their commitment and type of support to community nurses, if infant developmental care, as part of community nurses' responsibilities, is to be effective and of high quality. Furthermore, community nurses and other health care professionals must recognize the nature and potential of inter-professional collaboration to ensure positive outcomes for infants with developmental delays and disabilities.

The management of infant developmental needs by community nurses. Part 2: the development of guidelines for the support of community nurses in the management of infant developmental needs.

In the previous article, the author described, according to the scope of practice of registered nurses, the responsibilities of community nurses with regard to the management of infant developmental needs in primary health care clinics in South Africa. In this article, the focus is on the development of guidelines for the support of community nurses in fulfilling these responsibilities. Before the development of the guidelines is addressed, a brief overview of the background of the study, assumptions of the researcher and the methodology of the study is given. The development of the set of guidelines (DEFINE HOPE) is set against the background of the drive to improve the quality of developmental care for infants and their families. As guidelines help to translate scientific information into statements, it could be valuable to community nurses to improve their delivery of developmental care. To gather evidence for the formulation of the guidelines, the researcher utilised the themes identified during the analysis process in phase one of the research; investigated research articles; and compared findings and recommendations of the articles with the research findings obtained in phase one. In addition to the research findings and literature review, a focus group (health care professionals represented in the case study), was utilised to assist with the final development and validation of the guidelines. The researcher adapted a number of desirable attributes for guidelines, which are indicated in the literature, to compile the criteria for validation of the guidelines. In conclusion, guidelines are necessary to support community nurses in finding "best practice" within their scope of practice to ensure higher quality of developmental care to families with infants 0-2 years.

Health-related problems and proposed solutions identified by women in Ivory Park, Midrand. A participatory research approach.

People living in informal settlements do not realise that they could make a significant change in their circumstances by first engaging in introspection and secondly identifying their intellectual resources. In this study, participatory research was done, whereby emphasis was placed on the importance of active participation by all concerned in the project. The participants were women from the community who were able to identify the problems they encountered in their daily living that threatened their health and that of their families. After reflecting on their intellectual resources, an awareness of the power they had over their current situation surfaced. This awareness enabled them to find solutions to their problems. Participatory research is a means of community participation that ultimately leads to empowerment of the community as a whole.

Health education as education of the oppressed.

Paolo Freire's theory of critical thinking shows remarkable similarities to the principles supported by health education. In his capacity as Brazilian educationalist, Freire emphasized man's active participation in his own development. Without this active involvement, growth and development become quite impossible to attain. Freire's theory is therefore generally well suited for use by those supporters of the currently emphasised actions of community empowerment and community involvement. Health education, and more particularly successful health education, is nothing more than community empowerment. It enables each individual, within a community, to take control of his/her own life and well-being. The health care professional cannot assign power and control to the individual; it can only be assumed by each individual within the community. In this regard it becomes evident that passive conveyance of the health care message, albeit from health care professional to individual recipient (in this instance to the patient), is of no use to the community, whereas active involvement of the individual displays greater success. According to Paolo Freire, health education should focus on collective knowledge, the latter being the result of the group dynamics, produced by discussion on past experiences, and the analyses there-of. The professional guides these dynamic processes, not only to identify needs regarding health education, but also to assist in making decisions on health. Ultimately each individual will then experience the responsibility for his/her own health. A discussion of the use of the theory of critical thinking, as well as the implementation there-of in practice, is provided.

[Nursing students' perceptions of the factors in the field of general clinical experience which facilitate learning]. / Studentverpleegkundiges se persepsie van faktore in die algemene kliniese ervaringsveld wat leer fasiliteer.

Learning through clinical experience forms an integral part of student nurses' academic and professional foundation. The extent to which learning is facilitated for student nurses is determined by the structuring of the field of clinical experience as well as by student nurses' perception of the field of clinical experience. The purpose of this study is to determine student nurses' perception of factors in the field of general clinical experience which facilitate learning. Literature pertaining to factors in the field of general clinical experience which impact on the learning by students was studied. A descriptive, exploratory survey was done through the medium of a questionnaire completed by B.Cur-students. The results of this study indicate, despite the fact that student nurses experience some aspects pertaining to learning in the general clinical field negatively, their overall impression is positive and favourable. Factors restraining learning were identified. Recommendations are made to counter the restraining factors.

[Adaptation of the Health Belief Model for the prevention of HIV infection]. / Die aanpassing van die gesondheidsoortuigingsmodel vir die voorkoming van HIV infektering.

The spreading of AIDS in the RSA occurs mainly through sexual transmittance, therefore people that divulge in high risk behaviour must be motivated to change their behaviour to such an extend that they won't expose themselves as well as other people to HIV infection. An AIDS tragedy in SA can only be averted by preventing HIV infection. That can only occur by changing HIV risk behaviour. As there is no antidote against AIDS, the changing of risk behaviour is the only preventative mechanism against the feared disease. The Health Belief Model is repetitively proved to have been a successful model to change behavioural patterns. The model is specifically adapted for this study.

PIP: Approximately 25,000 HIV-positive persons had been reported in Sub-Saharan Africa during 1989, which amounts to 16% of the global total of reported HIV cases. 25-50% of all hospital beds were occupied by AIDS patients in Central Africa in 1989. A Health Belief Model has been developed to bring about the necessary behavioral change to avoid AIDS. The model can be divided into three major categories: 1) individual perceptions, 2) modifying factors, and 3) the probability of action. Factors in the spread of HIV include sex, age, geography, interpersonal relationships and sex preferences (homo- and bisexuality), socioeconomic factors, peer pressure, awareness and knowledge about AIDS, and education/prevention. The largest proportion of AIDS cases is in the 20-29 age group. In the Sub-Saharan region 20-30% of all sexually active individuals in the age group of 20-40 years are infected with HIV. In South Africa most AIDS cases are found in the 20-40 year age range. From a geographical point of view, the spread of AIDS is heaviest in central, eastern, and southern Africa. The interrelationship between socioeconomic factors and susceptibility to HIV infection has been proven. Low economic status coupled with helplessness, psychological weakness, social isolation, and low income promote HIV infection. Peer pressure and experimentation among youngsters with high risk behavior are also contributing factors. AIDS awareness and education programs are the only means of prevention of the spreading of AIDS in the absence of drugs against AIDS. School-based education programs could exert an influence on the knowledge level of students and induce behavioral change. AIDS is also a disease of the poor, and 26 out of 35 of the poorest countries in the world are in Africa. Safe sex practices would also diminish the risk of contracting HIV.

The needs of postpartum women.

The postpartum period is characterized by a revival of the pregnancy and birth experiences, as well as adjustment to new roles, and the adjustment of the family to the new family member. In the case of a first baby, it also represents a developmental milestone for the man and woman whose lives will no longer be unfettered. Adequate education in accordance with the needs of women is necessary to enable them to handle changes in the postpartum period and to meet these demands. This researcher is aware of several postpartum education programmes in operation in South Africa at present, but none have been compiled on the basis of a published investigation of the specific needs of these women. The aim of this study therefore was to determine the needs of postpartum women. An exploratory study was undertaken by means of a qualitative research design. The research was limited to women living in Bloemfontein. White married women, primiparae as well as multiparae, women who breast-fed or bottle-fed their babies and who had either vaginal delivery or a caesarean section were included in the study. Women who were discharged from hospital without their babies were excluded. The researcher concluded that women in the postpartum period experience common needs and problems regarding self-care and baby care but their priorities were needs and problems related to self-care. The reason could be that they had gained experience of baby care in hospital. Moreover, while there are many books and articles on baby care, few are available on self-care. Postpartum education is recommended for all mothers, both primiparae and multiparae.

[Pain experience and its assessment in patients with cancer]. / Die pynervaring en die beraming daarvan by pasiënte met karsinoom.

A large percentage of patients with carcinoma experience so much pain that specific nursing interventions are imperative. Appropriate interventions are possible only if the nurse has a thorough understanding of the clinical picture and the causes of pain in patients with carcinoma. She should also be cognisant of the assessment possibilities regarding the identification of the nature and intensity of their pain.

[Psychosocial, economic, sexual and religious related needs and problems of women with carcinoma of the breast]. / Die behoeftes en probleme van die vrou met karsinoom van die mammae wat verband hou met psigososiale, ekonomiese, seksuele en godsdienstige aspekte.

The psychosocial, economic, sexual and religious related needs and problems of women with carcinoma of the breast are explored. White women with carcinoma of the breast experience particular needs and problems related to psychosocial, economic, sexual and religious matters. These needs and problems are also influenced by a number of aetiological factors. Apart from the tension caused by a diagnosis of carcinoma, and particularly one of carcinoma of the breast, the treatment which these women receive contributes to their needs and problems. The research clearly showed that the majority of women did not experience serious problems in coping with their illness--there was a universally low average intensity of needs and problems. They did, however, require help and support in coping with and accepting the consequences of the carcinoma and the attendant treatment.