Health SA Gesondheid <p><em>Health SA Gesondheid - Journal of Interdisciplinary Health Sciences</em> is an open access, peer-reviewed interdisciplinary and interprofessional scholarly journal that aims to promote communication, collaboration and teamwork between professions and disciplines within the health sciences to address problems that cross and affect disciplinary boundaries.</p><p>The journal publishes original articles on issues related to public health, including implications for practical applications and service delivery that are of concern and relevance to Africa and other developing countries. It facilitates the gathering and critical testing of insights and viewpoints on knowledge from different disciplines involved in health service delivery.</p><p>The journal offers the breadth of outlook required to promote health science education, research and professional practice.</p><p>The journal with its interdisciplinary scope attracts interest from a wide audience of scientists and health professionals working in the areas of health care management, health care economics, policy making, nursing, psychology, sociology, ethics and education.</p><p>Unique features distinguishing this journal</p><div><hr align="left" noshade="noshade" size="5" width="100%" /></div><p>The journal has a strong regional focus (South Africa) with abstracts published in English. It offers a nurturing environment for young and novice researchers to showcase their work whilst upholding the standards of health science education, research and professional practice.</p><p> </p><p>The journal explores issues and posits solutions to current challenges existing in health care from an interdisciplinary perspective within Africa and other developing countries, including but not limited to:</p><ul><li>improvement of health safety and service delivery</li><li>management and measurement of health services</li><li>evaluation and assessment of health care needs</li><li>prevention of ill health and health-affecting behaviours</li><li>promotion of healthy lifestyles</li><li>health security, economics, policy and regulations.</li></ul>Other websites associated with this journal: <a title="" href="" target="_blank"></a> en-US Health SA Gesondheid 1025-9848 <p>The author(s) retain copyright on work published by AOSIS unless specified otherwise.</p><p><strong>Licensing and publication rights</strong></p><div align="center"><hr align="center" noshade="noshade" size="5" width="100%" /></div><p>Author(s) of work published by AOSIS are required to grant AOSIS the unlimited rights to publish the definitive work in any format, language and medium, for any lawful purpose. AOSIS requires journal authors to publish their work in open access under the <a href="" target="_blank"><strong>Creative Commons Attribution 4.0 International (CC BY 4.0) licence</strong></a>.</p><p>The authors retain the non-exclusive right to do anything they wish with the published article(s), provided attribution is given to the applicable journal with details of the original publication, as set out in the official citation of the article published in the journal. The retained right specifically includes the right to post the article on the authors’ or their institution’s websites or in institutional repositories.</p><p>Previously published work may have been published under a different licence. We advise the community that if they would like to reuse the work to consult the applicable licence at article level.</p><p>Note: If you need to comply with your funding body policy, you can apply for the CC BY license after your manuscript is accepted for publication.</p> Pain assessment and management: An audit of practice at a tertiary hospital <p><strong>Background</strong>: In spite of advances in techniques and analgesics for pain management, pain remains a major health problem. Regular assessment and reassessment of pain using guidelines with measurable goals is essential for effective pain management in surgical wards. Unfortunately, no such guidelines exist in South Africa. To implement appropriate precepts for the South African context, the&nbsp; current practice must be understood.<br><strong>Aim:</strong> The aim of this article was to evaluate pain assessment and management of patients in two surgical wards at a tertiary hospital in South Africa.<br><strong>Setting</strong>: The study was conducted within the Western Cape Province of South Africa in a government-funded tertiary academic institution. The patients at this hospital are generally from the low-income strata and live in resource-poor communities.<br><strong>Methods</strong>: A cross-sectional, retrospective medical record audit was conducted. The folders of all 215 patients admitted to a specific orthopaedic trauma and urogynaecological ward of a tertiary hospital in South Africa over a span of 1 month were targeted for review. Medical folders that were not available or had missing notes were excluded. Variables evaluated included the number of pain assessments recorded, pain assessor, assessment tool and management plan.<br><strong>Results:</strong> A total of 168 folders were available for review. Nearly half of the patients had no documented pain assessment. The Verbal Rating Scale was the predominant tool used, and assessments were mostly conducted by the ward doctor. Pain interventions appeared to be primarily based on the professional knowledge of the practitioner and were not evidence-based.<br><strong>Conclusion:</strong> Pain assessment and management was a problem in the two wards reviewed, which is similar to the findings from studies referenced in this text. Health professionals must be empowered to manage pain adequately. An assessment tool that integrates the biopsychosocial factors that influence the pain experience should be routinely employed by a multidisciplinary team to facilitate goal-directed therapy.</p> Agya B.A. Prempeh Rowan Duys Alma de Vaal Romy Parker Copyright (c) 2021-09-20 2021-09-20 25 Changing youth behaviour in South Africa <p><strong>Background</strong>: Youth behaviour in South Africa continues to be a public health concern. Primary prevention interventions remain a pre-requisite for promotion of improved social and health outcomes.<br><strong>Aim</strong>: The aim of the study was to assess the impact of a behavioural youth risk reduction intervention among grade 10 learners.<br><strong>Setting</strong>: The Study was conducted in KwaZulu-Natal high schools, at UMgungundlovu District Municipality.<br><strong>Methods</strong>: We conducted a cluster randomised controlled trial at 16 KwaZulu-Natal high schools where learners completed a self-&nbsp; administered questionnaire assessing youth risk behaviours. Schools were divided into two arms, intervention and a control arms.<br><strong>Results</strong>:The intervention reduced learners’ reports of carrying of a weapon to school in the past 30 days, but did not significantly reduce other assessed risk behaviours. Although the intervention appeared more likely to reduce learners’ risk behaviours when compared to thecontrol group, such as carrying weapons, risky sexual behaviour and alcohol and drug abuse.<br><strong>Conclusion</strong>: This study was unable to show statistical significance for these outcomes.</p> Nelisiwe Khuzwayo Myra Taylor Catherine Connolly Copyright (c) 2021-09-20 2021-09-20 25 Student nurses’ experiences regarding their clinical learning opportunities in a public academic hospital in Gauteng province, South Africa <p><strong>Background</strong>: During the training of student nurses, clinical placement is a compulsory requirement, as it exposes them to learning opportunities for the acquisition of clinical skills. This prepares them to become safe and competent professional nurses. However, the increased intake of student nurses in the Gauteng nursing colleges led to overcrowding in a public academic hospital, thus negatively influencing their learning experiences and availability of clinical learning opportunities.<br><strong>Aim:</strong> The purpose was to explore and describe the student nurses’ experiences regarding their clinical learning opportunities to make recommendations to enhance their clinical learning opportunities in order to address the optimisation of their learning experiences.<br><strong>Methodology:</strong> A qualitative, exploratory, descriptive and contextual research design was used. A purposive sampling method was used to select second-year student nurses registered in the Regulation (R425) programme for qualifying as a nurse (general, psychiatry and community) and midwife, as they would have acquired at least 1 year of clinical experience. Four focus groups, which comprised six to eight participants, were constituted, and research was conducted until data were saturated. Field notes were simultaneously taken to enrich the data collected. Thematic coding of qualitative data was used. Principles of trustworthiness and ethical principles were adhered to.<br><strong>Results:</strong> The study revealed four themes. Three were negative experiences that included overcrowding, negative emotional experiences of student nurses and challenges of professional nurses. A theme concerning positive experience entailed knowledge-sharing amongst various health care disciplines.<br><strong>Conclusion:</strong> It was evident that student nurses had more negative emotional experiences than positive experiences. Therefore, the need to enhance their clinical learning opportunities in order to address the optimisation of learning experiences is eminent.</p> Mpho N. Motsaanaka Agnes Makhene Hafisa Ally Copyright (c) 2021-09-20 2021-09-20 25 Conceptual framework for strengthening nurse-initiated management of antiretroviral therapy training and implementation in North West province <p><strong>Background</strong>: The implementation of nurse-initiated management of antiretroviral therapy (NIMART) management training is a challenge in the primary health care (PHC). It is evident from the literature reviewed and the data obtained from the North West province that gaps still exist. There is no conceptual framework providing guidance to NIMART training and implementation.</p> <p><strong>Aim:</strong> Therefore, the aim of this study was to develop a conceptual framework to strengthen NIMART training and implementation in the North West province to improve patients and human immunodeficiency virus (HIV) programme outcomes.</p> <p><strong>Setting:</strong> The study was conducted in the North West Province, South Africa.</p> <p><strong>Methods:</strong> A pragmatic, explanatory, sequential, mixed-methods research design was followed. A descriptive and explorative programme evaluation design was used. Data were collected from two sources: antiretroviral therapy (ART) statistics from District Health Information System (DHIS) &amp; of 10 PHC facilities to evaluate and determine the impact of NIMART on the HIV programme and five focus group discussions conducted amongst 28 NIMART nurses and three HIV programme managers to describe challenges influencing NIMART training and implementation.</p> <p><strong>Results:</strong> The study revealed that there was low ART initiation compared to the number of clients who tested HIV-positive. There was poor monitoring of patients on ART, which was evident in the low viral load collection and suppression, high loss to follow-up and deaths related to HIV. Challenges exist and this was confirmed by the qualitative findings, including human resource ratios, training and mentoring and the entire absence of a conceptual framework or model that guides training and implementation.</p> <p><strong>Conclusion:</strong> The study findings were conceptualised to describe and develop a framework needed to facilitate and influence NIMART&nbsp; training and implementation to improve the HIV programme and patient outcomes. Dickoff, James and Wiedenbach’s practice-oriented&nbsp; theory and Donabedian’s structure process outcomes model provided a starting point in the ultimate development of the framework. Although the study was limited to the North West province’s PHC clinics and community health centres and did not include hospitals, it is of high significance as there is no such conceptual framework in the province or in even South Africa.</p> Sheillah H. Mboweni Lufuno Makhado Copyright (c) 2021-09-20 2021-09-20 25 Predictors of aggression of university students <p><strong>Background:</strong> Post-secondary education forms the backbone of delivering high-powered persons in a country. Students are subjected to high levels of pressure to achieve success. This often promotes aggression towards self, others and even the environment. Predicting aggression is important as this can assist in managing aggression and the facilitation of the mental health of students. Little research has been published on the prediction of aggression in a university.<br><strong>Aim:</strong> To describe the prediction of aggression of students in one faculty in a university.<br><strong>Setting:</strong> Students in one faculty in a university.<br><strong>Methods:</strong> A deductive quantitative methodology was applied. Multivariate statistical techniques were used to answer the research questions. An online survey was conducted by using a questionnaire that comprised items related to biographic, personality and&nbsp; aggression aspects. Data were analysed by calculating Cronbach’s alpha values, various factor analyses (principal component analysis) and several multiple regression analyses to identify and describe the predictors of aggression.<br><strong>Results:</strong> Findings reflect that aggression can be predicted by intra- and interpersonal variables, such as ‘positive inclination towards&nbsp; others’, ‘positive inclination towards self’ and ‘acting responsibly towards self.’ Aggression is lower when a student’s positive inclination towards others is higher and towards self is lower and when a student acts with greater responsibility towards self.<br><strong>Conclusion:</strong> Students should understand and manage their own aggression. Overall, the findings showed that students are seemingly ‘adjusted’ conformists using an external locus of control. The facilitation of an internal locus of control and autonomous behaviour is imperative.</p> Chris Myburgh Marie Poggenpoel Cornelius M. Fourie Copyright (c) 2021-09-20 2021-09-20 25 Occupational exposure to blood and body fluids and use of human immunodeficiency virus post-exposure prophylaxis amongst nurses in a Gauteng province hospital <p><strong>Background</strong>: Healthcare facilities in South Africa are confronted by several challenges arising from Human immunodeficiency virus (HIV) and acquired immune diseases syndrome infection pandemic. All categories of nurses continue to experience accidental occupational exposure to blood and body fluids (BBFs) of patients who are HIV-positive. Studies conducted revealed that nurses fail to report the occurrence of the exposures. This represents a serious challenge because they contract HIV infections whilst in the process of helping others.<br><strong>Objectives</strong>: The purpose of this study was to determine the occupational exposures and use of HIV post-exposure prophylaxis (PEP) amongst nurses at the selected tertiary academic hospital, Tshwane district, Gauteng province, South Africa.<br><strong>Methods</strong>: A quantitative descriptive study was conducted with 94 male and female clinical nurses, using a self-administered questionnaire that facilitated collection of biographical data, occupational exposures to BBFs and use of HIV PEP. The data analysis included univariate and bivariate descriptive analyses.<br><strong>Results</strong>: Of the 94 nurses, n = 40 (43%) had been exposed to BBFs, either through sharp or needle prick injuries or splashes but only 16 (46%) of them reported the incident. Nurses were not keen to report accidental occupational exposures to BBFs in their own facility and rather sought HIV PEP outside their workplace. They gave different reasons for their behaviour. For example, ‘I did not know where to report’.<br><strong>Conclusion</strong>: Our study highlights the gaps that exist in reporting occupational exposure to BBFs and obtaining HIV PEP. Therefore, we recommend evaluation of these occupational exposures to BBFs and the management thereof, as well as to address the identified problems.</p> Melitah M. Rasweswe Mmapheko D. Peu Copyright (c) 2021-09-20 2021-09-20 25 Analysis of Patient Safety Incident reporting system as an indicator of quality nursing in critical care units in KwaZulu-Natal, South Africa <p><strong>Background</strong>: Patient Safety Incidents occur frequently in critical care units, contribute to patient harm, compromise quality of patient care and increase healthcare costs. It is essential that Patient Safety Incidents in critical care units are continually measured to plan for quality improvement interventions.<br><strong>Aim:</strong> To analyse Patient Safety Incident reporting system, including the evidence of types, frequencies, and patient outcomes of reported incidents in critical care units.<br><strong>Setting:</strong> The study was conducted in the critical care units of ten hospitals of eThekwini district, in KwaZulu-Natal, South Africa.<br><strong>Methods:</strong> A quantitative approach using a descriptive cross sectional survey was adopted to collect data from the registered nurses&nbsp; working in critical care units of randomly selected hospitals. Self-administered&nbsp; questionnaires were distributed to 270 registered nurses of which 224 (83%) returned completed questionnaires. A descriptive statistical analysis was initially conducted, then the Pearson Chi-square test was performed between the participating hospitals.<br><strong>Findings:</strong> One thousand and seventeen (n = 1017) incidents in ten hospitals were self-reported. Of these incidents, 18% (n = 70) were insignificant, 35% (n = 90) minor, 25% (n = 75) moderate, 12% (n = 32) major and 10% (n = 26) catastrophic. Patient Safety Incidents were classified into six categories: (a) Hospital-related incidents (42% [n = 416]); (b) Patient care-related incidents (30% [n = 310]); (c) (Death 12% [n = 124]); (d) Medication-related incidents, (7% [n = 75]); (e) Blood product-related incidents (5% [n = 51]) and (f) Procedure-related incidents (4% [n = 41]).<br><strong>Conclusion:</strong> This study’s findings indicating 1017 Patient Safety Incidents of predominantly serious nature, (47% considering moderate, major and catastrophic) are a cause for concern.</p> Thusile M. Gqaleni Busisiwe R. Bhengu Copyright (c) 2021-09-20 2021-09-20 25 Challenges influencing nurse-initiated management of antiretroviral therapy training and implementation in Ngaka Modiri Molema district, North West province <p><strong>Background</strong>: The increasing number of people testing human immunodeficiency virus positive and who demand antiretroviral therapy&nbsp; (ART) prompted the Department of Health to adopt World Health Organization’s task shifting where professional nurses (PNs) initiate ART rather than doctors. This resulted in decentralisation of services to primary healthcare (PHC), generating a need to capacitate PNs on nurse-initiated-management of ART (NIMART). The impact of NIMART was assessed and even though there was an increased number of patients on ART, the quality of care is of serious concern.<br><strong>Aim:</strong> The aim of this study was to explore and describe the challenges influencing NIMART training and&nbsp; implementation amongst PNs and programme managers.<br><strong>Setting:</strong> The study was conducted from the PHC facilities, in the rural districts of the North West province.<br><strong>Methods:</strong> An exploratory programme evaluation and contextual research design was used in the study. Purposive sampling was used. Focus group discussion (n = 28) and individual interviews were used to collect data. Data was analysed using ATLAS.ti software.<br><strong>Results:</strong> The results revealed two themes: inadequacy in NIMART training and the healthcare system challenges that influence NIMART training and implementation. Theme 1 included among others the lack of standardised curriculum and model or conceptual framework to strengthen NIMART training. And theme 2 included patient and district healthcare structural system.<br><strong>Conclusion</strong>: There a need to improve NIMART training and implementation through the standardisation of NIMART curriculum,&nbsp; introduction of pre-service NIMART training in institutions of higher learning, addressing staff shortages and negative attitude of PNs providing ART.</p> Sheilah H. Mboweni Lufuno Makhado Copyright (c) 2021-09-20 2021-09-20 25 Consciring subjects: Q methodology described <p><strong>Background:</strong> Despite the availability of Q methodology as a qualitative research alternative that seemingly circumvents the limits of&nbsp; standard qualitative methods across various fields, a recent review of qualitative research literature in leading health-related South African journals indicated that Q methodology is hardly a method of choice in South Africa.<br><strong>Aim</strong>: This article demonstrates the application of Q methodology, a qualitative research option, in psychological research. The&nbsp; methodology is suitably designed to investigate and clarify diverse subjective experiences, attitudes, opinions and/or beliefs held by a group of people on a given topic.<br><strong>Methodology</strong>: A study on the subjective understandings and perceptions of epilepsy is used to illustrate how Q methodology works. In this particular study, a diverse group of participants, comprising students, traditional healers, doctors, nurses, pastors, high school&nbsp; teachers, laypeople domiciled in rural and urban areas, and speakers of two of the dominant African dialects in the area, was used.<br><strong>Results</strong>: Analysis produced three distinctive factors that are appositely named the scientific, the moderated traditionalist and the&nbsp; community-oriented stances. Each factor, constituted on the basis of close resemblance and statistical association between the rank orderings, represents an identifiable understanding of epilepsy by an exclusive grouping of participants.<br><strong>Conclusion</strong>: Concluding remarks about Q methodology are provided.</p> Ntandeni Moseya Solomon Mashegoane Saraswathie Govender Malose Makhubela Copyright (c) 2021-09-20 2021-09-20 25 Ethical conflicts experienced by intensive care unit health professionals in a regional hospital, Limpopo province, South Africa <p><strong>Background</strong>: Conflicts arise when healthcare providers disagree about providing optimal care to critically ill patients where resources and services are constrained.<br><strong>Aim:</strong> This study investigated ethical conflicts experienced by intensive care unit (ICU) healthcare professionals working in a regional hospital, Limpopo province of South Africa.<br><strong>Setting:</strong> The study was conducted at a rural public regional hospital in Vhembe district, Limpopo Province. Communities served by the hospital are poor and medically uninsured.<br><strong>Methods:</strong> This study adopted a qualitative, exploratory and descriptive design. The target population comprised Health care professionals working in an ICU of the regional hospital. Purposive sample was selected and 17 unstructured interviews were conducted. Tesch’s method of data analysis was used. Ethical considerations were adhered to.<br><strong>Results:</strong> Patients’ care needs were compromised because of the unavailability of beds and high-technology equipment, such as well-functioning ventilators. Doctors were not having the necessary skills required in the ICU as the majority were on community service/internship and nurses acted beyond their scope of practice because of a lack of adequately trained intensive care specialists. Infection control practices were overlooked and ‘use once’ pieces of equipment were reused. Conflicting values between nurses, patients and family of patients exist.<br><strong>Conclusion:</strong> Lack of resources compromises provision of optimal and intensive care. Patients were prone to infections and their safety might have been compromised.</p> Dorah U. Ramathuba Hulisani Ndou Copyright (c) 2021-09-20 2021-09-20 25 Experiences of the homeless accessing an inner-city pharmacy and medical student-run clinic in Johannesburg <p><strong>Background:</strong> Mental and physical health problems are both contributory factors and drivers of homelessness. Adding to this, the homeless encounter numerous barriers when accessing healthcare services.<br><strong>Aim:</strong> The aim was to determine the experiences of the homeless when accessing healthcare services and the reason why they visit Trinity Health Services (THS).<br><strong>Setting:</strong> Trinity Health Services, a student-run clinic (SRC) based at an inner-city church in Johannesburg, South Africa, provides free acute healthcare services to the homeless.<br><strong>Methods:</strong> This qualitative study comprised three focus group discussions (FGDs) with the homeless who access services provided by the church. Those who had previously visited THS on at least one occasion were invited to participate in FGDs. The FGDs were audio-taped and transcribed verbatim. The data were analysed thematically using Tesch’s eight steps.<br><strong>Results:</strong> Three themes were identified. The first theme, homelessness affecting health, explains how limited access to food, ablution facilities and shelter negatively impact their well-being. This led to the second theme, health needs, where tuberculosis, influenza, sexually transmitted diseases and dental infections were identified as ailments occurring frequently. The need for healthcare services was explicit, yet participants were reluctant when accessing healthcare services as they faced stigma and discrimination. The third theme, THS in addressing health needs, denotes the value of THS in the community it serves where they were treated with compassion and empathy.<br><strong>Conclusion</strong>: The needs of this homeless community as well as the role played by THS were clearly identified. However, THS provides limited services, and integration with existing healthcare services is essential.</p> Deanne Johnston Patricia McInemey Hilary Thurling Copyright (c) 2021-09-20 2021-09-20 25 Experiences of mental healthcare providers regarding integration of mental healthcare into primary healthcare at the iLembe health district in KwaZulu-Natal province <p><strong>Background</strong>: Institutionalisation of mental healthcare users was a prevalent treatment approach in the apartheid era in South Africa. The introduction of community-based mental healthcare is aimed at improving mental healthcare services. The integration into primary healthcare improves access to mental health services. This integration is implemented by professional nurses working in the primary healthcare clinics.<br><strong>Aim:</strong> The aim of this study was to explore and describe experiences of professional nurses regarding&nbsp; integration of mental health into primary healthcare at the iLembe district of KwaZulu-Natal.<br><strong>Setting</strong>: This study was conducted at a public hospital in the iLembe health district of KwaZulu-Natal province.<br><strong>Methods</strong>: An explorative, descriptive and contextual qualitative research study was conducted. Semi-structured interviews were conducted with 15 professional nurses. Data were transcribed verbatim, organised into codes and finally analysed thematically using Tesch’s method of data analysis.<br><strong>Results:</strong> This study revealed that majority of participants experienced and faced challenges regarding&nbsp; integration of mental health into primary healthcare. Professional nurses stated that they require support from the management and training to equip themselves with knowledge and skills to render effective mental&nbsp; healthcare services.<br><strong>Conclusion:</strong> The integration of mental healthcare into primary healthcare is pivotal to ensure easy and&nbsp; accessible mental healthcare services to its users. This strategy requires planning and implementations of available policies and guidelines regarding mental healthcare. Furthermore, adequate funding is required to secure human and material resources to aid the integration of mental healthcare into primary healthcare.</p> Siphiwe T. Madlala Respect M. Miya Mdumiseni Zuma Copyright (c) 2021-09-20 2021-09-20 25 Roles of role players in the implementation of school-based human immunodeficiency virus and acquired immunodeficiency syndrome prevention programmes in local high school settings <p><strong>Background:</strong> Worldwide, a large proportion of all new HIV infections occur in people under the age of 25. HIV and AIDS remain the leading cause of deaths among adolescents in sub Saharan Africa and second leading cause of death globally. Preventing new HIV infections and AIDS-related deaths are at the heart of South Africa’s National Strategic Plan on HIV and AIDS, STIs and TB 2017-2022.<br><strong>Aims:</strong> Explore and describe the roles of the local role players in the implementation of the school-based HIV and AIDS prevention programmes in local high school settings.<br><strong>Settings:</strong> The study was conducted in the Bushbuckridge local municipal area in Mpumalanga Province.<br><strong>Methods:</strong> A qualitative, explorative, descriptive design and contextual study was used. Individual interviews and focus group interviews were conducted with the purposively selected participants from the clinic, health centre, high schools and community members. Data was analysed using Tesch’s method of data analysis.<br><strong>Results:</strong> Although all the local role players were found to have important roles to play in the implementation of the school-based HIV and AIDS prevention programme, gaps exist in the rendering of youth friendly services (YFS); accessible clinic times; HIV and AIDS education; life skills education; Life Orientation (LO) and health education; information sessions; counselling; school health programmes; campaigns as well as collaborative working strategy.<br><strong>Conclusion</strong>: Successful development and collaborative implementation of the school-based HIV and AIDS prevention programme can result in significant changes in knowledge and attitudes that affect sexual&nbsp; behaviour of young people, leading to significant decrease in HIV infection among young people</p> Constance B. Sekgobela Doriccah Peu Maretha de Waal Copyright (c) 2021-09-20 2021-09-20 25 Acceptance of ambulatory blood pressure monitoring in a semi-rural population in South Africa <p><strong>Background:</strong> Ambulatory blood pressure monitoring is a valuable tool that helps in providing an insight into the diagnosis and management of hypertension; however, no evidence exists of its acceptance in the diverse South African population.<br><strong>Aim:</strong> We assessed the acceptance of an ambulatory blood pressure monitor in patients attending public sector primary health care (PHC) clinics.<br><strong>Setting:</strong> Five PHC clinics in the Makana subdistrict in the Eastern Cape.<br><strong>Method:</strong> A cross-sectional study was conducted with 70 hypertensive patients. Eligible patients were between 40 and 75 years old, taking either enalapril and hydrochlorothiazide or enalapril, hydrochlorothiazide and amlodipine. Socio-demographic, clinical and acceptance data were collected. The monitor cuff remained in place for 24 h. Acceptance was assessed after the monitor was removed. An overall acceptance score was generated to classify acceptance as either good or poor.<br><strong>Results:</strong> The mean years of schooling was 5.9 years, with 22 reporting no school attendance. Generally,&nbsp; acceptance was good, with 70% of the population rating the technique as ‘acceptable’ (acceptance score of &gt; 23/30). Most participants reported minimal discomfort with only 13.3% reporting that it hindered normal daily activities. Night readings interrupted sleep in 43%, with extreme sleep disturbance (≥ 3 awakenings) reported in just over half the patients. Increased years of schooling was the only variable associated with acceptance score (r = −0.243, p = 0.042).<br><strong>Conclusion:</strong> Ambulatory blood pressure monitoring was generally well-accepted, with few adverse effects being reported. Use of this technique at PHC facilities could reduce the incidence of misdiagnosis and uncontrolled hypertension.</p> Farisai Chiwanza Yoland Irwin Ros Dowse Copyright (c) 2021-09-20 2021-09-20 25 Knowledge, attitude and practices of environmental health practitioners conducting food-borne disease outbreak investigation at a local municipality in Gauteng province, South Africa <p><strong>Background:</strong> Food-borne disease (FBD) outbreaks are a common occurrence that is either not investigated or poorly investigated. According to anecdote evidence, this is because of nonuniformity to environmental health practices in South Africa.<br><strong>Aim</strong>: This study aimed to determine and describe the knowledge, attitude and practices (KAP) of environmental health practitioners (EHPs) when conducting outbreak investigations of FBD at a local municipality.<br><strong>Setting</strong>: This study was conducted in three sub-districts of Ekurhuleni Metropolitan Municipality (EMM), one of five municipalities in Gauteng province, South Africa.<br><strong>Methods:</strong> A descriptive cross-sectional study was conducted to collect data using a semi structured&nbsp; questionnaire. Data collected were analysed using IBM Statistical Package for the Social Sciences. Continuous variables were compared using analysis of variances, and correlation was used to determine any association.<br><strong>Results:</strong> Knowledge responses were scored out of 9. Open-ended questions were themed into five items (support, guidelines, resources, training and specialisation). Sixty-one (76.3%) participants were randomly selected to participate in the study. There were more female participants (55.7%) than male participants, and the mean age was 30.9 years. The participants’ knowledge scores ranged from 1 to 9. There were 17 (27.9%) participants who have conducted FBD outbreak investigation. Twenty-six (42.6%) believed that they were properly trained to conduct FBD outbreak investigations. Age was associated with position (p = 0.000) and qualification (p = 0.033).<br><strong>Conclusion</strong>: The results indicated that there are gaps and challenges in the knowledge, while the practices were not consistent amongst environmental health practitioners. However, the attitude of EHPs was positive with regard to their role in FBD outbreak investigations.</p> Thokozani P. Mbonane Nisha Naicker Copyright (c) 2021-09-20 2021-09-20 25 Trust in independent community pharmacies: Do employee-related factors matter? <p><strong>Background:</strong> Offering quality healthcare services in South Africa’s remote areas remains a challenge.&nbsp; Pharmacies, and independent community pharmacies (ICPs) in particular, can play a vital role in providing access to pharmaceutical products and services in these areas.<br><strong>Aim:</strong> Part of the success of ICPs is the role that their employees play in building trusting relationships with&nbsp; pharmacy clients. It is against this background that this article investigates key employee-related factors that contribute towards building affective, calculative and contractual trust when pharmacy clients are serviced.<br><strong>Setting:</strong> Clients of a specific ICP group participated in the study. The selected ICP group, which manages eight pharmacies across the Western Cape Province, has between 8000 and 41 000 active client profiles per&nbsp; pharmacy.<br><strong>Methods:</strong> All 299 respondents who participated in the study were personally interviewed. Statistical analyses were done through Statistica, and structural equation modelling (SEM) with partial least squares (PLS) was used to assess both the measurement and the structural model.<br><strong>Results:</strong> Although a number of significant relationships were confirmed, the importance of especially familiarity is highlighted when trust is managed in a pharmacy client-employee relationship.<br><strong>Conclusion:</strong> Given their geographical location, ICPs are ideally situated to provide access to healthcare services in the more remote areas of South Africa. By focusing on managing trust, ICPs can ensure a more constructive experience to their clients. </p> Edwin Theron Almeri Pelser Copyright (c) 2021-09-20 2021-09-20 25 Factors influencing patient falls in a private hospital group in the Cape Metropole of the Western Cape <p><strong>Background:</strong> The fall rate of patients in hospitals is a worldwide concern due to the impact falls have on patients, the family or relatives, as well as the healthcare setting. Factors influencing patient falls are&nbsp; categorised as intrinsic and extrinsic. Intrinsic factors refers to physical conditions and the extrinsic factors include the environment of the patient, nursing staffing levels and skill mix.<br><strong>Aim:</strong> The study aimed to determine the factors that influence patient falls.<br>Setting: A private hospital group in the Cape Metropole of the Western Cape.<br><strong>Methods:</strong> A quantitative retrospective descriptive research approach was used by analysing 134 records of patients that have fallen from October 2016 to February 2018. Data was collected using a data extraction sheet and analysed using the Statistical Package for the Social Sciences (SPSS).<br><strong>Results:</strong> Intrinsic factors contributing to patient falls included the patient’s age, hypertension, co-morbidities and the use of benzodiazepines as a sedative. Extrinsic factors were the incorrect use of bed rails and the skill mix of the staff. In over half of the cases (n = 68; 50.7%), risk assessments were not performed according to the protocol. Only 5 (3.7%) patients sustained major injuries due to the falls. However, the risk of more severe falls increased 2.4 times with the lack of risk assessment.<br><strong>Conclusion:</strong> The lack of accurate and consistent patient fall risk assessments, use of benzodiazepines as a sedative and the staff skill mix were contributors to the fall rate in these hospitals.</p> Renee Janse van Rensburg Anita van der Merwe Talitha Crowley Copyright (c) 2021-09-20 2021-09-20 25 Here and now: Lived experiences of professional nurses practising caring presence in a rural public hospital in the North West Province, South Africa <p><strong>Background:</strong> Practising caring presence is recognised as an important nursing intervention indispensable to high-quality, patient-centred care. An awareness of the real world of professional nurses (PNs) practising caring presence will assist in expanding and supporting the existing literature on the same. A clear and rich description of what the concept of caring presence entails within the unique South African nursing context may guide nurses in the art of this nursing skill, enhance their professionalism and facilitate the formulation of<br>recommendations on how to encourage nurses to implement the practice of caring presence within nursing.<br><strong>Aim:</strong> This study explored and described the lived experiences of PNs practising caring presence in a rural public hospital.<br><strong>Setting:</strong> The study setting was a 120-bed, level-two district hospital in the North West Province of South Africa.<br><strong>Methods:</strong> A descriptive phenomenological method, specifically Husserl’s approach, informed this study. Semi-structured interviews were conducted with a purposive sample of 10 PNs. Data were coded and analysed using Colaizzi’s seven-step method.<br><strong>Results:</strong> Five themes emerged from the data analysis: professional caring presence, ethical caring presence, personal caring presence, healing caring presence and what caring presence is not.<br><strong>Conclusion:</strong> Professional nurses experience practising caring presence as professionally and personally fulfilling, as an expression of their passion for the profession, as a way of portraying ethical care, as a willingness to be personally present and as a healing experience that involves commitment and taking care of patients holistically. Unprofessional, unethical behaviour and depersonalisation of patients were indicated as uncaring behaviour.</p> Petronella S. Hobbs Emmerentia du Plessis Petronella Benadé Copyright (c) 2021-09-20 2021-09-20 25 Perceptions of grandmothers and HIV-infected mothers on infant feeding practices in a rural South African distric <p><strong>Background:</strong> Despite enormous interventions aimed at preventing mother-to-child transmission (MTCT) of HIV, cultural practices on mixed infant feeding remain prevalent. Complementary food provision to infants seems to be the most common and acceptable form of infant feeding highly endorsed by grandmothers.<br><strong>Aim</strong>: This study aimed to explore the perceptions of grandmothers and HIV-infected mothers on infant feeding practices in the context of prevention of mother-to-child transmission.<br><strong>Setting:</strong> This study was undertaken in two primary healthcare facilities in the Mpumalanga province, South Africa.<br><strong>Methods:</strong> A qualitative exploratory narrative design was used to conduct four focus group discussions with 32 purposefully selected grandmothers and 21 in-depth interviews with postnatal HIV-infected women in the two identified health facilities. Data were analysed using an interthematic inductive analysis approach, resulting in major themes and subthemes supported by participants’ excerpts.<br><strong>Results:</strong> Four themes emerged showing (1) high mixed feeding endorsement because of the need to adhere to conventional practices, strengthen the umbilicus and have fuller, fat and calmer babies; (2) infant feeding&nbsp; fallacies and stigma reflected by exclusive breastfeeding period confusion, breastfeeding scepticism and infant feeding stigma; (3) breastfeeding endorsement for other disease prevention and family support for&nbsp; breastfeeding and (4) conflict between traditional and western infant feeding approaches.<br><strong>Conclusion:</strong> Total elimination of MTCT of HIV in a rural context calls for targeted education for grandmothers addressing their perceptions and practices of infant feeding. The knowledge of the identified factors&nbsp; encouraging mixed infant feeding can assist in designing programmes to change community beliefs on infant feeding. Cultural, social and psychosocial factors should be addressed when making recommendations for exclusive breastfeeding for HIV-positive mothers </p> Motlatso G. Mlambo Karl Peltzer Copyright (c) 2021-09-20 2021-09-20 25 Experiences and mentoring needs of novice nurse educators at a public nursing college in the Eastern Cap <p><strong>Background:</strong> When novice nurse educators enter academia, they are expected to demonstrate and implement knowledge in the clinical and classroom environment. However, when one enters academia without proper guidance and support, these expectations create lack of role models. Although mentorship has proved to make the transition easier, there is a lack of mentoring in most nursing schools and/or departments at higher&nbsp; education institutions in South Africa because of scarcity of mentoring programmes for novice nurse educators.<br><strong>Aim:</strong> The aim of this study was to explore and describe the experiences and mentoring needs of novice (newly qualified) nurse educators at a public nursing college in the Eastern Cape, to make recommendations for the mentoring of novice nurse educators.<br><strong>Setting:</strong> Urban and rural public nursing college campuses and sub-campuses in the Eastern Cape.<br><strong>Methods:</strong> Qualitative research approach and exploratory, descriptive, contextual and phenomenological&nbsp; designs were used. Sampling was purposive, data were collected by using semi-structured individual interviews and analysed using Tesch’s method.<br><strong>Results:</strong> Five themes emerged from this study. Findings indicated that novice nurse educators experienced lack of theoretical and clinical mentoring and lack of orientation and resources. Participants also provided recommendations to optimise the experience and performance of novice nurse educators.<br><strong>Conclusion:</strong> Lack of mentoring causes difficult transition by novice nurse educators from the nursing role into the nurse educator role. The implementation of the recommendations on mentoring of novice nurse educators would optimise the experience and performance of the novice nurse educators, thus enhance their smooth transition into academia.</p> Khanyisa Annelice Sodidi Sihaam Jardien-Baboo Copyright (c) 2021-09-20 2021-09-20 25 The role of pharmacists in the renal multidisciplinary team at a tertiary hospital in South Africa: Strategies to increase participation of pharmacists <p><strong>Background</strong>: Pharmacists are often marginalised from participating fully in a Multidisciplinary Team (MDT). Pharmacists can contribute in the renal MDT by minimising drug-related problems and optimising therapy.<br><strong>Aim</strong>: The study aimed to explore the current role of pharmacists in renal care at a tertiary hospital in South Africa, and to recommend strategies to improve their participation in the renal MDT.<br><strong>Method</strong>: An exploratory descriptive qualitative study was conducted using semistructured interviews. The participants were selected using purposive sampling. The audiotaped interviews were transcribed exactly as spoken and analysed using thematic content analysis.<br><strong>Results</strong>: Three themes emerged from the analysis: pharmacist’s current scope of practice within the renal MDT, potential future roles of pharmacists, and perceived barriers to participation of pharmacists within the renal MDT. Furthermore, participants provided recommendations to increase pharmacist’s participation in the renal MDT: that is standardisation of practice, skills development of both pharmacist and pharmacist assistants and recognition of pharmacist services in the wards.<br><strong>Conclusion</strong>: The role of pharmacists at Pietersburg Hospital is the official name of the hospital is confined to stock management and dispensing. Efforts should be made to improve the participation of pharmacists in the MDTs with the intention to standardise the practice of pharmacists in the wards, equip both pharmacists and pharmacist assistants with the necessary skills and recognise pharmacist’s services in the wards.</p> Tebogo L. Manyama Rendani M. Tshitake Noko B. Moloto Copyright (c) 2021-09-21 2021-09-21 25 A model to facilitate self-management of human immunodeficiency virus in students within a university setting and promoting their mental health <p><strong>Background:</strong> The introduction of antiretroviral treatment (ART) has resulted in people with HIV living longer. Antiretroviral treatment&nbsp; demands a lifelong commitment from patients not only in terms of adherence to the medication but also in relation to lifestyle changes in general. This poses a challenge to a student living with HIV (SLHIV) who only spends a few years at university before entering the&nbsp; workplace and relocating. It also means that the care, support and treatment received at the university will no longer be available to them as these services are only offered to enrolled students. It is imperative for practitioners at universities to help SLHIV effectively manage their illness.<br><strong>Aim:</strong> The aim of the article is to illustrate the process followed to develop a model that could serve as a frame of reference to facilitate the management of HIV as an integral part of the mental health of SLHIV within a university.<br><strong>Setting:</strong> The model is designed for professional practitioners in university settings who support students living with HIV in managing their illness.<br><strong>Methods:</strong> A theory-generative, qualitative, exploratory, descriptive and contextual study design was utilised. The central concept was derived from the experiences of practitioners and SLHIV by conducting individual interviews using appreciative inquiry. The common themes and categories identified in the interviews served as a basis for the identification of the central concept for the study. The process included the identification, definition and classification of the central concept and essential attributes. The conceptual framework was then described. Measures to ensure trustworthiness were also adhered to in the study and approval for the study was granted (Ethical clearance #2014-071).<br><strong>Results:</strong> The central concept was identified as the ‘facilitation of self-management’. It was defined and classified, and these definitions and classifications were used as the basis for the model. Thereafter, the model was described.<br><strong>Conclusion</strong>: The model can be used as a frame of reference to assist SLHIV in effectively managing their illness.</p> Teolene G. Diedricks Chris P.H. Myburgh Marie Poggenpoel Copyright (c) 2021-09-21 2021-09-21 25 Childhood cancers in a section of the South African private health sector: Analysis of medicines claims data <p><strong>Background:</strong> Although childhood cancers are rare, increases in incidence have been observed in recent times. There is a paucity of data on the current incidence of childhood cancers in South Africa.<br><strong>Aim:</strong> This study described the epidemiology of childhood cancers in a section of the private health sector of South Africa, using medicines claims data.<br><strong>Setting:</strong> This study was designed on a nationally representative medicine claims database.<br><strong>Method:</strong> A longitudinal open-cohort study employing children younger than 19 years and diagnosed with cancers between 2008 and 2017 was conducted using medicine claims data from a South African Pharmaceutical Benefit Management company. Cases were identified using International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes C00 to C97, together with a medicine claim&nbsp; reimbursed from oncology benefits. Crude incidence rates were calculated per million persons younger than 19 years on the database and standardised using the Segi 1960 world population. Temporal trends in incidence rates, analysed using the joinpoint regression, were reported as annual percentage changes (APCs).<br><strong>Results:</strong> Overall, 173 new cases of childhood cancers were identified in the database, translating into an age-standardised incidence rate (ASR) of 82.3 per million. Annual incidence of cancer decreased from 76.7 per million in 2008 to 58.2 per million in 2017. More incident&nbsp; cases were identified in males (68.8%). The highest proportion of incident cases was recorded for leukaemias (39.9%), the 5–9 year age group (34.1%) and the Gauteng Province (49.7%).<br><strong>Conclusion:</strong> The incidence of childhood cancers decreased over time in the section of the private health sector studied. Leukaemias were the major drivers of childhood cancer incidence.</p> Marianne N. Otoo Martie S. Lubbe Hanlie Steyn Johanita R. Burger Copyright (c) 2021-09-21 2021-09-21 25 Anaemia prevalence and dietary diversity among women in the rural Free State, South Africa <p><strong>Background</strong>: Anaemia, a global public health problem that particularly affects women, holds major consequences for human health.<br><strong>Aim</strong>: Determining dietary diversity, prevalence of anaemia and contraception use.<br><strong>Setting</strong>: Rural women, 25–49 years, in the Free State Province, South Africa.<br><strong>Methods</strong>: In a cross-sectional descriptive quantitative study, dietary diversity was determined with a 24-h recall; biochemical markers of anaemia, iron deficiency and inflammation were measured; and contraceptive use was recorded.<br><strong>Results</strong>: Of 134 women (median age 41 years), 51.5% had medium, and 44.8% had low dietary diversity. Overall, 76.9% consumed flesh&nbsp; meats and fish, but only 25.4% ate dark green leafy vegetables. Anaemia was present in 4.6%; 1.5% presented with iron deficiency; and 0.7% presented with iron deficiency anaemia, evidenced by low ferritin levels. However, 45.0% had elevated C-reactive protein (CRP).&nbsp; Overall, 7.5% presented with elevated homocysteine levels, but only 3.8% had low red cell folate levels. More than half (54.1%) reported&nbsp; menstruating regularly and 71.6% used injectable contraceptives. Significant associations were found between median mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) and dietary diversity score.<br><strong>Conclusions</strong>: Although the prevalence of anaemia is low in this population, elevated CRP in almost half indicates that inflammation may mask iron deficiency. The older median age of the sample and approximately half of the women not menstruating regularly may also contribute to the low anaemia prevalence. Attention should be given to the women’s diets as almost half consume diets of low diversity, and not all consume foods rich in haemopoietic nutrients.</p> Elizabeth M. Jordaan Violet L. van den Berg Francois C. van Rooyen Corinna M. Walsh Copyright (c) 2021-09-21 2021-09-21 25 A road less travelled: Undergraduate midwifery students’ experiences of a decentralised clinical training platform <p><strong>Background</strong>: In South Africa, the critical skill base shortage of healthcare workers, the under performing global health indicators and the planned roll out of the National Health Insurance have burdened South African higher education authorities to rapidly expand nursing student enrolments. The expansion in student numbers has placed increased demands on overstretched educational institutions, and students are confronted with challenges of congestion in classrooms and clinical facilities, while lecturers encounter difficulties in the process of clinical allocation. A solution is to utilise decentralised clinical training platforms (DCTPs) and allocate students in rural hospitals.</p> <p><strong>Aim</strong>: To explore and describe undergraduate midwifery students’ reflections of their DCTP experiences, in order to inform future practice of decentralisation in student training.</p> <p><strong>Setting</strong>: The study was conducted in the nursing discipline of an urban-based university in KwaZulu-Natal, South Africa, involving&nbsp; undergraduate midwifery students. The university had commenced a programme of allocating students to decentralised clinical sites.</p> <p><strong>Method</strong>: Elo and Kyngäs’ content analysis was used to analyse the experiences of DCTP by undergraduate midwifery students (n = 14) as expressed in a focus group (n = 11) and three individual interviews (n = 3).</p> <p><strong>Results</strong>: The following four categories emerged: Recognition as a team member, engaging support, win–win platform and juxtaposed challenges.</p> <p><strong>Conclusion</strong>: In the presence of support and teamwork, rural settings can develop undergraduate student midwives, not only in the areas of midwifery competency but also in their personal capacity, and strengthen the responsiveness, preparedness and relevance of midwifery graduates.</p> Olivia B. Baloyi Gugu G. Mchunu Charlene Williams Mary-Ann Jarvis Copyright (c) 2021-09-21 2021-09-21 25 Psychologists’ experience of a malpractice complaint: Their relationship with and processes at the regulator <p><strong>Background</strong>: Professional malpractice complaints in the South African health arena have increased over the last decade. There is a lack of research on how South African health practitioners experience professional malpractice complaints and complaint processes.<br><strong>Aim</strong>: This article reports on one aspect of the findings in a more extensive study relating to the complaint experience of psychology&nbsp; practitioners, namely how a group of psychology practitioners experienced their relationship with and the processes at the regulator&nbsp; during a malpractice complaint. The regulator refers to the professional registration body which manages complaints against&nbsp; practitioners.<br><strong>Setting</strong>: The study included 10 registered South African psychologists who experienced a malpractice&nbsp; complaint.<br><strong>Methods</strong>: After sampling, semi-structured interviews were conducted, audio-recorded and transcribed. The data were managed using interpretative phenomenological analysis (IPA) to elicit the personal, subjective experience of the individual participants.<br><strong>Findings</strong>: Two superordinate themes and related subthemes emerged from the analysis. First, relating to the experience of the complaint procedures and processes, participants experienced an extended timeframe for complaint management, a lack of communication during complaint management, legal challenges during some disciplinary proceedings and some complaints as unjustified and frivolous. Second, participants were unsure of their relationship with the regulator. Their responses denoted instances of vulnerability and inequality during proceedings.<br><strong>Conclusions</strong>: The findings call for closer collaboration between the registration body and practitioners during complaints management, to eliminate vexatious complaints, to streamline processes and to encourage guidance of and support for the professional.</p> Hanlé Kirkcaldy Esmé van Rensburg Kobus du Plooy Copyright (c) 2021-09-21 2021-09-21 25 Experience of nurses regarding the clinical mentoring of student nurses in resource-limited settings <p><strong>Background</strong>: One of the major challenges associated with nursing education in this 21st century is the practice preparation of student nurses to serve in complex healthcare environments and to ensure their fitness to practise in these environments. Clinical mentoring has shown promise in providing clinical learning support for student nurses. Most approaches are, however, biased towards higher-income settings without giving due consideration to the resources, culture and structures of health systems in resource-limited settings. It is also<br>unclear how qualified nurses who act as nurse teachers experience the clinical mentoring of student nurses in resource-limited settings.<br><strong>Aim</strong>: This study aimed to explore and describe the experiences of qualified nurses regarding the clinical&nbsp; mentoring of nursing students in resource-limited settings.<br><strong>Setting</strong>: The study took place in Mauritius, a developing country.<br><strong>Methods</strong>: A qualitative, exploratory, descriptive approach was used with a purposive sample of eight nurses. Data were collected through face-to-face interviews and thematically analysed.<br><strong>Results</strong>: The findings indicated that mentoring per se was not practised, but rather general support, supervision or coaching. This resulted in the practice being less effective for its original purpose. Possible explanations included a lack of policy directives. Additionally, the mentoring practice was informal with unclear role expectations. Poor material and personal resources further compounded the&nbsp; challenges. An absence of buy-in and involvement of management along with a lack of monitoring clinical mentoring by the nursing school concludes the picture.<br><strong>Conclusion:</strong> Effective clinical mentoring requires an understanding of the mentoring process from a broader perspective. Mentors should be equipped with core competencies. Successful mentoring outcomes are dependent on a conducive clinical learning environment and a clear mentoring approach.</p> Dhunraj Foolchand Jeanette E. Maritz Copyright (c) 2021-09-21 2021-09-21 25 Registered nurses’ knowledge, attitude and practice regarding their scope of practice in Botswana <p><strong>Background:</strong> The articulation of the scope of practice in nursing is important to provide boundaries for registered nurses in which to&nbsp; practice. Registered nurses in Botswana have frequently experienced challenges and raised concerns with their scope of practice.&nbsp; Research related to registered nurses’ knowledge, attitudes and practice regarding their scope of practice appears to be limited in the African context, particularly in Botswana.<br><strong>Aim:</strong> The aim of this study was to develop guidelines for professional nurses to explore and describe registered nurses’ knowledge,&nbsp; attitude and practice regarding their scope of practice in Botswana.<br><strong>Methods</strong>: A convergent parallel mixed-methods design was employed using a three-tier sampling approach to ensure a representative sample of various settings, health facilities and nurses. For the purpose of this article, the data from the qualitative component are reported. Thirty registered nurses, working in the public health sector in Botswana, participated in semi-structured interviews. Data were analysed using thematic content analysis.<br><strong>Findings</strong>: Data analysis revealed that registered nurses’ scope of their knowledge was lacking. Registered nurses’ attitudes were reflected in the adaptation process to expanded practice, as demonstrated through emotive aspects, adjustments to practice beyond scope and the learning of new skills considered beyond scope. Participants reported implementing many skills deemed beyond their scope, whilst their motive to do so included their experience of a lack of control over practice, lack of resources or they were doing so out of consideration for the patient. Guidance in terms of their scope was found to be inadequate.<br><strong>Conclusion</strong>: As in other resource-limited countries in Africa, registered nurses in Botswana experience challenges with their scope of&nbsp; practice. Inadequate boundaries may result in compromised nursing care and may have detrimental consequences for both the patient and the nurse.<br><br></p> Maria M. Feringa Hester C. de Swardt Yolanda Havenga Copyright (c) 2021-09-21 2021-09-21 25 A spotlight on the surfacing of self-management of employees with diabetes seen by professional nurses in selected occupational health clinics in Cape Town <p><strong>Background</strong>: Diabetes is considered one of the largest global health challenges of this century and one of the top 10 causes of death&nbsp; across the world. Studies indicate an increased economic burden in relation to diabetes, not only on government revenue but also within private industries. Exploring the perceptions of employees with diabetes mellitus as related to their self-management practices could assist in encouraging behaviours that are associated with positive management outcomes.<br><strong>Aim</strong>: The purpose of this study was to explore and describe the perceptions of employees with diabetes mellitus, seen by professional nurses in selected occupational health clinics, about the self-management of their disease.<br><strong>Methods</strong>: A qualitative, exploratory, descriptive contextual design was followed through 17 individual interviews with 17 employees&nbsp; working in various industries in Cape Town, using a semi-structured interview schedule. Open coding of the data followed, and four&nbsp;&nbsp; themes emerged. Measures to ensure trustworthiness were also adhered to in the study, and approval for the study was granted.<br><strong>Results</strong>: The study findings gave insight into the manner in which employees perceived their behaviour changes in terms of their self-management practices. Various emotions were expressed by employees relating to the disease as well as the lifestyle adaptations required for self-management thereof. Employees noted that knowledge acquisition and greater understanding of the motivators for lifestyle&nbsp; changes could improve aspects of their day-today living as well as the disease outcomes.<br><strong>Conclusion</strong>: Employees expressed an awareness of the changes and lifestyle adaptations needed but found aspects thereof to be an&nbsp; ongoing challenge. The areas of challenge varied amongst employees. A&nbsp; consciousness of the possible consequences of poor self-management practices and self-modification behavior to address these was observed.</p> Natalie Copeling Karien Jooste Copyright (c) 2021-09-21 2021-09-21 25 Adolescent mothers’ lived experiences whilst providing continuous kangaroo mother care: A qualitative study <p><strong>Background:</strong> Kangaroo mother care (KMC) is the practice of skin-to-skin contact between an infant and parent and has been found to&nbsp; improve the growth and decrease the morbidity and mortality of low-birth-weight and premature infants. Adolescent pregnancy is&nbsp; associated with a preterm birth or low-birth-weight infant; therefore, it is possible that an adolescent mother may have to provide KMC. The adolescent mother, who is likely to have her first experience of motherhood, may have to be supported to ensure that she is able to&nbsp; provide KMC and the routine care for her preterm infant. The literature review did not reveal any research conducted in the Western Cape province on the experiences of adolescent mothers whilst providing KMC. It is, therefore, important to conduct research on this&nbsp; phenomenon so that the lived experiences of adolescent mothers whilst providing KMC can be described.<br><strong>Aim:</strong> The aim of this study was to explore the lived experiences of adolescent mothers whilst providing continuous KMC.<br><strong>Setting:</strong> The study was conducted in a district and central hospital KMC wards in Cape Town in the Western Cape province of South Africa.<br><strong>Methods:</strong> A qualitative, descriptive, phenomenological research design was used. Ten adolescent mothers were selected through&nbsp; purposive sampling. Semi-structured in-depth interviews were conducted, transcribed and analysed using Colaizzi’s framework.<br><strong>Results:</strong> Three themes emerged from the data: providing KMC, the interactions and the support received.<br><strong>Conclusion:</strong> Supportive educative environments should be established in the KMC wards to ensure that the adolescent mothers receive holistic support.</p> Anneline E. Robertson Talitha Crowley Copyright (c) 2021-09-21 2021-09-21 25 Knowledge and attitudes towards complementary medicine by nursing students at a University in South Africa <p><strong>Background</strong>: The increased popularity of complementary medicine has created the need for patients to receive accurate information from nurses who are front-line healthcare providers. Studies have demonstrated that patients are more likely to discuss other medication and therapy use with nurses, rather than with general practitioners or other health professionals. It is, therefore, important to determine nurses’ knowledge and attitudes towards complementary medicine.<br><strong>Aim</strong>: The aim of this study was to determine nursing students’ knowledge and attitudes toward the use of complementary medicine.<br><strong>Setting</strong>: The study was conducted with <em>Baccalaureus Curationis</em> (nursing) students registered at a large public university in Gauteng, South Africa.<br><strong>Methods</strong>: This research utilised a quantitative approach with a prospective, descriptive survey design. A convenience sample comprising registered Baccalaureus Curationis nursing students (n = 202) was utilized. Participants completed a 34-item, paper-and-pencil questionnaire to determine their knowledge, personal use and attitude toward complementary medicine modalities.<br><strong>Results</strong>: Questionnaires were completed by 126 nursing students with 119 questionnaires included for analysis. Despite a reported lack of knowledge regarding complementary medicine and limited personal use, participants had an overall positive attitude towards complementary medicine. Almost half of the participants reported enquiring about its use in history taking and were willing to refer&nbsp; patients to a complementary medicine practitioner.<br><strong>Conclusion</strong>: A positive attitude towards complementary medicine modalities might suggest a willingness from students to improve their knowledge of the various modalities and to refer to a complementary medicine practitioner when indicated.</p> Renaldi van Rensburg Radmila Razlog Janice Pellow Copyright (c) 2021-09-21 2021-09-21 25 Traditional birth attendants’ experiences during the provision of post-natal care in Mopani District, Limpopo province of South Africa <p><strong>Background</strong>: South African maternity care guidelines stipulate that post-natal patients can be discharged within 6 h after delivery,&nbsp; provided that the condition of mothers and neonates do not require medical, surgical or obstetric attention. Hence in many instances&nbsp; post-natal care is rendered at home by traditional birth attendants (TBAs). Traditional birth attendants play a crucial role in the care of women during pregnancy, birth and puerperium within communities.<br><strong>Aim</strong>: To explore and describe the experiences of TBAs during the provision of post-natal care to mothers and their neonates in order to make recommendations to improve the quality of post-natal care delivered at home.<br><strong>Setting</strong>: The community hall of a selected rural traditional community was used as a setting for data collection.<br><strong>Methods</strong>: A qualitative, exploratory and descriptive design was used. Three focus groups were held with 26 TBAs whom were purposively selected. Data were analysed using qualitative content analysis.<br><strong>Results</strong>: The study confirmed two categories that included: lack of supportive working relationships between TBAs and midwives and lack of respect of TBAs, by post-natal women.<br><strong>Conclusion</strong>: It is evident that the TBAs experienced negative experiences. Therefore, initiation of teamwork, empowerment and&nbsp; confidence development are crucial to improve the working experiences of TBAs during the provision of post-natal care. Quality post-natal care might reduce maternal and neonatal morbidity and mortality rates. Teamwork between TBAs and midwives might be initiated.&nbsp; Continuity of care for post-natal women might be improved.</p> Roinah N. Ngunyulu Fhumulani M. Mulaudzi Mmampheko D. Peu Copyright (c) 2021-09-21 2021-09-21 25 Towards community-based nursing: Mothers’ experiences caring for their preterm infants in an informal settlement, Gauteng <p><strong>Background:</strong> Pregnant women who experience preterm labour rush to public hospitals closest to the informal settlement in which they reside. Preterm infants are discharged when they reach a certain weight. Mothers take their preterm infants to their homes inside the&nbsp; informal settlements. Yet, preterm infants have special needs and require specific management. Research confirmed that nurses working in community clinics near informal settlements are unaware of the challenges faced by such mothers. Community nurses are at the heart of nursing, they work closest to the community and have a distinct opportunity to provide contextual, community-based care and support to these mothers, to promote good health and prevent diseases.</p> <p><strong>Aim</strong>: This article aims to enhance community nurses’ insight about the mothers’ experiences in caring for their preterm infants post-hospitalisation.</p> <p><strong>Setting:</strong> The study was conducted in an informal settlement in Midvaal, Gauteng.</p> <p><strong>Methods</strong>: A qualitative, exploratory, descriptive and contextual research design was used. Indepth, phenomenological interviews were conducted with 10 purposefully sampled mothers to explore their experiences in caring for their preterm infants in an informal settlement. Data were analysed using Giorgi’s coding method. Ethical approval was received from the University of Johannesburg. Measures were applied to ensure trustworthiness.</p> <p><strong>Results</strong>: Three themes emerged: mothers experienced intrapersonal responses, interpersonal responses and numerous physical&nbsp; challenges in taking care of their preterm infants.</p> <p><strong>Conclusion</strong>: Study findings revealed that mothers experienced several responses in caring for their preterm infants. Sharing their&nbsp; experiences can enhance community clinic nurses’ insight to provide contextual health education.</p> Alida S. du Plessis-Faurie Marie Poggenpoel Chris P.H. Myburgh Wanda O. Jacobs Copyright (c) 2021-09-21 2021-09-21 25 Work-related musculoskeletal disorders amongst undergraduate nursing students at the University of Johannesburg <p><strong>Background</strong>: Work-related musculoskeletal disorders (WRMSDs) present as pain or discomfort in the musculoskeletal system that individuals experience from work-related activities. Substantial research evidence exists on qualified nurses with WRMSDs, but there is a distinct lack of research regarding nursing students and their work environment in South Africa.<br><strong>Aim</strong>: The primary aim of this study was to establish a baseline prevalence of musculoskeletal disorders (MSDs) amongst undergraduate nursing students. The secondary aim was to identify the role of certain occupational and biopsychosocial factors in the development of MSDs.<br><strong>Setting</strong>: The University of Johannesburg, Health Sciences Faculty, Doornfontein Campus, Johannesburg, South Africa.<br><strong>Method</strong>: A cross-sectional quantitative study conducted through a questionnaire (from 24 June to 29 July 2019) was initiated amongst the undergraduate nursing students at the University of Johannesburg, South Africa. All 250 undergraduate nursing students were given the opportunity to participate by completing the Nordic&nbsp; Musculoskeletal Questionnaire-Extended (NMQ-E). A total of 125 questionnaires were collected and used in the study. Data analysis consisted of frequencies, descriptives and custom tables. The Chi-square test for&nbsp; association was used to test the associations between variables.<br><strong>Results</strong>: The study found an 83% prevalence of MSDs. Musculoskeletal disorders occurred most commonly in the lower back (81.1%), neck (65.9%) and shoulder (63.6%) regions. Factors that showed associations with overall MSDs were female gender (p = 0.002), height (p = 0.009) and studying at home (p = 0.040). Stress and tablet or smartphone use had significant associations with certain body regions.<br><strong>Conclusion</strong>: The findings indicate a high prevalence of MSDs in undergraduate nursing students in this sample, substantially higher than in other similar studies in which lower back disorders were most prevalent.</p> Malany Moodley Fatima Ismail Armand Kriel Copyright (c) 2021-09-21 2021-09-21 25 Information-seeking in first visit pregnant women in Khayelitsha, South Africa <p><strong>Background:</strong> The quality of the decisions made by women during pregnancy, especially their first visit, depends on their health needs, their health-seeking behaviour and the type of information available to them.<br><strong>Aim:</strong> This study describes the health education needs, information barriers and health information-seeking behaviour of pregnant women on their first visit to antenatal clinics in a low-income setting in the Western Cape.<br><strong>Setting:</strong> The setting was two antenatal facilities in Khayelitsha Health District facilities in South Africa.<br><strong>Methods:</strong> A quantitative descriptive survey was conducted. A systematic random sample of 261 antenatal first visit attendees between May and July 2016 was selected. Data were collected using a researcher-administered questionnaire and was analysed using descriptive statistics, 95% confidence intervals and non-parametric tests.<br><strong>Results:</strong> The response rate of the study was 92% (n = 240). Pregnant women attending an antenatal clinic for the first time reported high information needs with low health information seeking behaviours and high information barriers. Doctors, nurses (2.2, ±1.0), family and friends (2.0, ±0.6) were the most frequently used sources of health information, while watching television or listening to the radio (1.5, ±0.9) were the least used sources of health information. Having a medical diagnosis ( p &lt; 0.001) and being of an advanced maternal age ( p = 0.005) were predictive of higher health-seeking behaviour. The reliance on passively receiving information from health sources may indicate low levels of health literacy and its inverse relationship to health promoting behaviours which should be the subject of further investigation.</p> Thabani M. Noncungu Jennifer A. Chipps Copyright (c) 2021-09-21 2021-09-21 25 A psycho-educational model for university lecturers to facilitate the constructive management of aggression <p><strong>Background</strong>: Experienced workplace aggression is a lingering phenomenon and comprises an extensive body of knowledge. Experiences of workplace aggression require constructive intervention and support. These interventions and support must aim to assist university lecturers to constructively manage experiences of aggression.<br><strong>Aim:</strong> The aim of this article is to describe the process followed to develop, describe and evaluate a psycho-educational model for university lecturers that could be used as a conceptual framework of reference to&nbsp; facilitate the constructive management of experienced aggression.<br><strong>Setting:</strong> The model is applicable in universities where the university lecturers work and experience aggression. This study was conducted in a specific college at a university in Johannesburg in South Africa.<br><strong>Method</strong>: A theory-generating, qualitative, exploratory, descriptive and contextual design was applied to develop a psycho-educational model. The process included four steps: concept analysis, relationship&nbsp; statements, description of the model and evaluation of the&nbsp; developed model. The criteria of clarity, simplicity, generality, accessibility and importance were used during the evaluation of the model.<br><strong>Results</strong>: The central concept in this study was to facilitate constructive management. The psycho-educational model as the conceptual framework of reference for facilitating the constructive management of experienced aggression was described and evaluated. University lecturers’ destructive management of experienced aggression formed the basis for the psychoeducational model.<br><strong>Conclusion</strong>: The psycho-educational model provides a conceptual framework of reference for university lecturers that may assist them to constructively manage experiences of aggression in their places of work.</p> Rika R. Toerien Chris P.H. Myburgh Marie Poggenpoel Copyright (c) 2021-09-21 2021-09-21 25 The effect of sacroiliac chiropractic adjustments on innominate angles <p><strong>Aim</strong>: The aim of this study was to determine whether or not a measurable change in the angle of the innominate bone could be identified after a chiropractic sacroiliac adjustment using a ‘PALM PALpation Meter’. Secondly, if a change in the angle of the innominate bone was identified, what was the degree of change in the angle of the innominate bone, induced by the sacroiliac joint (SIJ) adjustment.</p> <p><strong>Method</strong>: This was a true experimental study that consisted of 100 participants who met the inclusion criteria. The participants were&nbsp; randomly allocated to either the treatment or control group. Each group had 50&nbsp; participants: 25 females and 25 males. Informed consent was obtained from participants prior to&nbsp; commencement of treatment. The treatment group received a chiropractic adjustment based on their specific SIJ dysfunction. The control group was treated with detuned ultrasound therapy (sham treatment).</p> <p><strong>Procedure</strong>: Treatment consisted of a once-off treatment. The angles of the innominate bones were measured bilaterally pre- and post-treatment in both groups. Objective data were collected using the PALM PALpation Meter. Once the dysfunctional SIJ was identified, participants in group 1 were treated with specific chiropractic adjustment techniques based on the restriction. Group 2 participants were treated with detuned ultrasound only.</p> <p><strong>Results</strong>: The results of this study showed that a specific chiropractic adjustment resulted in a measurable change in the angle of the innominate bone (p ≤ 0.001). The change in angle was evident bilaterally; however, the side that was adjusted shows the greatest degree of change. The mean change in angle for the treatment group was 2.25° on the side of dysfunction.</p> <p><strong>Conclusion</strong>: The results of this study showed that a specific chiropractic adjustment can have a positive effect on the angles of the&nbsp; innominate bone, resulting in the tilt of the pelvis levelling into what is considered to be its correct anatomical alignment.</p> Moodley Malany Craig Melanie Copyright (c) 2021-09-21 2021-09-21 25 Self-management of persons living with diabetes mellitus type 2: Experiences of diabetes nurse educators <p><strong>Background</strong>: The global pandemic of diabetes mellitus type 2 (DM2) is the direct cause of significant health and economic problems for both governments and individuals owing to the high level of morbidity and mortality. South Africa has the second highest incidence of DM2 in sub-Saharan Africa.<br><strong>Aim</strong>: This article describes the experiences of diabetes nurse educators in relation to self-management of DM2 of persons living with DM2.<br><strong>Setting:</strong> This article involves nurse educators working in diabetes clinics in public and private hospitals in Nelson Mandela Bay Municipality, South Africa.<br><strong>Methods:</strong> A semi-structured interview guide was used to collect data from a focus group interview comprising three participants and two individual interviews. The interviews were recorded with the permission of participants, transcribed and then coded using Tesch’s model of data analysis. Themes were agreed upon with the consensus of the researcher, two supervisors and an independent coder.<br><strong>Results:</strong> Three themes were identified: (1) diabetes nurse educators have clear perceptions about the importance of self-management of DM2 of persons living with DM2, (2) there are factors that affect persons living with DM2 with respect to self-management and (3) there are ways in which professional nurses can assist persons living with DM2 in the self-management of their condition.<br><strong>Conclusion:</strong> This article identified factors that diabetes nurse educators experienced in either assisting or hindering patients in self-management of their DM2. The diabetes nurse educators voiced their views on how professional nurses can provide support to the&nbsp; patients living with DM2.</p> Coleen O’Brien Dalena van Rooyen Esmeralda Ricks Copyright (c) 2021-09-21 2021-09-21 25 Job satisfaction of registered nurses in a private critical care unit in the Eastern Cape: A pilot study <p><strong>Background</strong>: Job satisfaction is influenced by factors that are interpersonal (between nurse and colleagues), intrapersonal (within the nurse) and extra-personal (external to the nurse).<br><strong>Aim:</strong> The primary objective of this study was to explore and describe factors influencing the job satisfaction of registered nurses in a particular private critical care unit. The second objective was to make recommendations to enhance the job satisfaction of registered nurses in this private critical care unit.<br><strong>Setting:</strong> The population consisted of registered nurses in a private critical care unit in the Eastern Cape.<br><strong>Methods:</strong> This study utilised a quantitative descriptive design. Self-administered questionnaires were distributed amongst registered&nbsp; nurses in the critical care unit. Data were analysed and illustrated through tables.<br><strong>Results:</strong> Altogether, 39 registered nurses took part in the study. The majority of the participants (82%; n = 32) indicated that they enjoyed working with their team members. In addition, it was apparent that the majority (79%; n = 30) felt that they were sufficiently trained. Staff members felt that they had management support and felt satisfied at their workplace. Areas of concern included salaries, leave, debriefing and recognition.<br><strong>Conclusion:</strong> The majority of the registered nurses in this private critical care unit were extremely satisfied with their job. However, there were areas where this could be improved. The high levels of satisfaction at this single critical care unit lead to the question whether this situation is common throughout the Eastern Cape, which opens the path for further research in this regard.</p> David Morton Candice Bowers Lauren Wessels Angelique Koen Juanita Tobias Copyright (c) 2021-09-21 2021-09-21 25 Implementing a psycho-educational model to increase university lecturers’ effectiveness to constructively manage experienced aggression <p><strong>Background</strong>: The authors developed a psycho-educational model as a conceptual framework of reference for university lecturers to&nbsp; facilitate the constructive management of experienced aggression. The model must be implemented in a workshop and in practice to confirm the if the model is effective.<br><strong>Aim</strong>: This article describes the implementation of a psycho-educational model in a workshop and in practice, as well as the evaluation of the effectiveness of the psychoeducational model.<br><strong>Setting</strong>: This study was conducted in a specific college at a university in Johannesburg in South Africa.<br><strong>Method</strong>: This study followed a qualitative, exploratory, descriptive, contextual and theory generating research design. The psycho-educational model was implemented in three phases during a workshop and then for three months in practice by university lecturers. A purposive sample of university lecturers was applied. The&nbsp; effectiveness of the psychoeducational model was evaluated during and directly after the workshop, 1 week after the workshop and 3 months journal entries. Final evaluation was in a focus group after 3 months of implementation of the model in the workplace.<br><strong>Results</strong>: The participating university lecturers found the implementation of the psychoeducational model, as a conceptual framework of reference to constructively manage experiences of aggression, effective, helpful and important. The model increased their understanding of aggression in their places of work and increased their effectiveness to constructively manage experiences of aggression in their workplace.<br><strong>Conclusion</strong>: The implementation and evaluation of the psycho-educational model underscored the need for affective and effective&nbsp; facilitative support for university lecturers to be able to constructively manage experienced aggression.</p> Rika R. Toerien Chris P.H. Myburgh Marie Poggenpoel Copyright (c) 2021-09-21 2021-09-21 25 The perspectives of healthcare practitioners on fall risk factors in older adults <p><strong>Background:</strong> Accidental falls could have severe and far-reaching consequences for older adults, their families and society at large.&nbsp; Healthcare practitioners’ (HCPs) perspectives on fall risk factors in older adults could assist in reducing and even preventing falls.&nbsp; Currently, no universal tool exists for this purpose. The World Health Organization’s globally accepted International Classification of Functioning, Disability and Health (ICF) was used.<br><strong>Aim</strong>: This study aimed to (1) describe the perspectives of HCPs on fall risk factors in older adults in South Africa and (2) link these factors to the ICF.<br><strong>Setting</strong>: Eighteen HCPs participated in two focus groups.<br><strong>Methods</strong>: Using a qualitative research design, an inductive thematic analysis allowed for the identification of important themes, which&nbsp; were linked to the ICF.<br><strong>Results</strong>: The factors mentioned by participants were categorised into 38 themes, which were linked to 142 ICF codes, of which 43% (n = 61) were linked to the Body Function category, 23% (n = 32) to the Environmental Factors category, 18% (n = 26) to the Body Structure category and 16% (n = 23) to the Activities and Participation category. HCPs revealed two relevant factors that were not captured in existing fall risk assessment tools (FRATs), namely ‘muscle-power functions’ and ‘mobility-of-joint functions’, which directly relate to the ability to execute mobility activities. Combining HCPs’ perspectives with other stakeholders and with literature provides a holistic picture of fall risk factors in older adults.</p> Hendrika de Clercq Alida Naude Juan Bornman Copyright (c) 2021-09-21 2021-09-21 25 Sonographers’ experiences of being a caring professional within private practice in the province of Gauteng <p><strong>Background</strong>: Medical imaging has been driven by technological advancements. However, the concept of caring has now become a&nbsp; significant element in the healthcare profession. Within a South African context, there are principles that emphasise the importance of people and service delivery: the Batho Pele Principles and Ubuntu. Now more than ever, there is a greater need for a patient-centred caring environment. Therefore, there is an expectation for sonographers to be adaptive to this new environment.</p> <p><strong>Aim:</strong> The purpose of this study was to explore and describe the sonographers’ experiences of being caring professionals.</p> <p><strong>Setting:</strong> Sonographers who work within private practices in Gauteng were part of this study.</p> <p><strong>Methods</strong>: A qualitative, exploratory, descriptive, contextual, phenomenological research design was used. Focus group interviews were conducted with qualified sonographers registered with the HPCSA. Thematic analysis was used to code data into themes and categories.</p> <p><strong>Results</strong>: Four themes emerged: the effects of a caring relationship between a sonographer and a patient; circumstances limiting a sonographer in being a caring professional; sonographers’ approach to caring; educational readiness of sonographers to be caring professionals.</p> <p><strong>Conclusion</strong>: The participants in this study explained and shared their understanding of being caring professionals. They shared many&nbsp; stories regarding trusting relationships with patients. However, as a caring professional, many challenges were encountered, both physically and emotionally. Recommendations such as reflective journals and the practices of Jean Watson’s theory of transpersonal caring are cited to focus on the practice and education that may improve caring among sonographers.</p> Leah van der Westhuizen Kathleen Naidoo Yasmin Casmod Sibusiso Mdlethse Copyright (c) 2021-09-21 2021-09-21 25 Maternal and neonatal factors associated with perinatal deaths in a South African healthcare institution <p><strong>Background</strong>: 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.<br><strong>Aim</strong>: 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.<br><strong>Setting</strong>: The maternity unit of the largest district hospital in the specific district in the Free State Province of South Africa.<br><strong>Method</strong>: 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&nbsp; 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.<br><strong>Results</strong>: 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.<br><strong>Conclusion</strong>: Quality maternity care is not the only cause of perinatal mortality rates; maternal and neonatal factors are also contributors.</p> Nthabiseng S. Malinga Antoinette du Preez Tinda Rabie Copyright (c) 2021-09-21 2021-09-21 25 Peer-mentees’ challenges in an undergraduate peer-group clinical mentoring programme in a nursing education institution <p><strong>Background</strong>: Clinical competency and professional growth amongst nursing students is the cornerstone of a nursing education&nbsp; programme. The demanding and complex training of nursing students requires various clinical teaching and learning strategies such as peer-group clinical mentoring.<br><strong>Aim:</strong> The objective of this research was to explore and describe the challenges that peermentees experience in an undergraduate peer-group clinical mentoring programme in onespecific nursing education institution in the North West Province.<br><strong>Setting:</strong> The study was conducted at a nursing education institution in North West Province.<br><strong>Methods</strong>: A qualitative, retrospective case study research design was used. Two separate World Café sessions following a semi-structured schedule based on Gibbs Reflective Cycle were conducted with 51 peer-mentees who were mentored in clinical practice. Four levels of qualitative thematic data analyses were employed to analyse the data.<br><strong>Results</strong>: Five themes emerged from the findings of the study, namely, poor implementation of the peer-group clinical mentoring&nbsp; programme, ineffective undergraduate peer-group clinical mentoring programme, undesirable attitudes of the mentors, mentors unprofessional conduct as well as communication challenges. Ten sub-themes emerged from the findings. Literature control was done to support the findings.<br><strong>Conclusion</strong>: The findings showed that undergraduate nursing students faced a diversity of challenges in the effective learning and teaching of peer-mentees in a clinical context. Limitations and recommendations of the study were given. Recommendations were given for nursing practice, education and research.</p> Tshepo A. Ntho Abel J. Pienaar Leepile A. Sehularo Copyright (c) 2021-09-21 2021-09-21 25