Psychiatric emergencies during pregnancy and puerperium in low - And middle-income countries.

Pregnancy and puerperium are critical points in women's health, and various psychiatric emergencies may worsen or manifest (for the first time) during this period. In the presence of a psychiatric emergency, the pregnancy and puerperium outcomes may be compromised. In addition to the mother being at risk, the health of the fetus and the newborn may also be compromised if the psychiatric emergency is not managed appropriately. Early detection and collaborative approaches between mental health practitioners and obstetricians are of utmost importance in women who are at risk and those living with psychiatric illnesses during pregnancy and puerperium. Practitioners should also ensure that women with impaired capacity due to psychiatric disease are treated in a non-judgmental and respectful manner, even if their autonomies have been overridden.

Nurse managers' perceptions of patient-centred care and its influence on quality nursing care and nurse job satisfaction: Empirical research qualitative.

AIM: To explore nurse managers' perceptions of patient-centered care (PCC), its influence on quality nursing care, nurse job satisfaction, and to provide baseline data for a context-driven PCC model. DESIGN: The study utilized a qualitative, phenomenological design, employing individual in-depth interviews to collect data on nurse managers' PCC perceptions until data saturation. METHODS: Sampling involved purposive selection of Northern Ghana, random selection of the tertiary hospital cluster with the three participating hospitals, and purposive sampling of the nine nurse managers. Data analysis employed thematic analysis based on a six-phase framework. Methodological trustworthiness was ensured through various strategies including prolonged engagement, supervisor discussions and crosschecking with interviewees. RESULTS: Three main themes emerged from the study including nurse managers' conceptualization of PCC, perceived patient-centred practices and its influence on nursing quality and job satisfaction. The findings emphasized the patient's individuality, cultural values, holistic care, the importance of strong nurse-patient relationships and a patient-centric environment. The nurse managers perceived PCC as positively influencing quality nursing care and nurse job satisfaction. The findings offer nuanced insights into nurse managers' perspectives on patient-centeredness and highlight areas for improvement.

Intimate partner violence, adverse childhood experiences and prenatal substance use in South Africa.

Background: Intimate partner violence (IPV) is one of the most pressing public health conditions among women worldwide, particularly in sub-Saharan Africa. Intimate partner violence in South Africa, along with human immunodeficiency virus (HIV), is an epidemic that is closely linked to trauma and substance use in women. Aim: This study aimed to identify factors associated with IPV among pregnant women, with a specific focus on adverse childhood experiences (ACE), prenatal substance use, and HIV status. Setting: A large public general hospital in the KwaZulu-Natal province. Methods: The sampled study participants included 223 adult postpartum women (18 - 45 years) based on convenience sampling who recently gave birth. Four separate logistic regression models were fitted to examine the role of ACE, perinatal substance abuse and HIV against threat (model 1), physical violence (model 2), sexual violence (model 3) and any IPV (model 4) outcomes (threat and/or physical and/or sexual violence). Results: The prevalence of threat, physical violence, sexual violence and any IPV were 19.7%, 16.6%, 1.8% and 20.2%, respectively. The total ACE scores ranged from 0 to 11 (of 13 possible events) with a mean of 3.28 (standard deviation [s.d.] = 2.76), where 14.4% reported using substances during pregnancy (n = 32) as well as 47.1% (n = 105) of participants living with HIV. The authors found that the presence of family support was protective against IPV physical. Conclusion: It is essential that obstetric services screen and address potential risk factors along the life course pathways from early adversity to adult maternal health that drive IPV, particularly in young women who may lack family support during pregnancy. Contribution: This research gives insight into the dynamics between IPV, HV, ACE and perinatal substance use facing young women in South Africa.

Developing and testing unconditional cash transfer strategies among young adults with first-episode psychosis in South Africa: a study protocol for a pilot randomised control trial (PRS-FEP trial).

INTRODUCTION: Access to mental health services is a challenge, especially for young people who are over-represented in the unemployment and poverty index in South Africa. Therefore, continuing care is a problem after hospital discharge for young people with first-episode psychosis (FEP) due to a lack of clinical engagement and follow-up, for which they need support, including financial, to improve their outcomes. This pilot randomised control trial (RCT) aims to assess the feasibility and acceptability of financial support, in the form of an unconditional cash transfer (UCT), among young patients with FEP to prevent relapse. METHODS AND ANALYSIS: This study will use a 1:1 ratio two-arm open-label pilot RCT of 60 young participants (18-29 years) with FEP in remission, who will be recruited from specialised psychiatric facilities in KwaZulu-Natal Province, South Africa. This study will implement an UCT and assess its feasibility, acceptability and preliminary clinical outcomes (ie, medication adherence, relapse, quality of life, personal and social function). The follow-up time will be 3 months, the outcomes being measured at baseline, months 1 and 3. Descriptive and conventional content analysis will be done for quantitative and qualitative data, respectively. ETHICS AND DISSEMINATION: The study obtained provisional approval from the Biomedical Research Ethics Committee at the University of KwaZulu-Natal(#BREC/00004117/2022). Also is registered on the South African National clinical trial registry (#DOH-27-092022-5894) and approved by the KwaZulu-Natal department of health (#NHRD Ref: KZ_2002209_033). The results from this investigation will be actively disseminated through peer-reviewed journal publications, conference presentations and stakeholder engagement. TRIAL REGISTRATION NUMBER: DOH-27-092022-5894.

Erratum: Analysis of Patient Safety Incident reporting system as an indicator of quality nursing in critical care units in KwaZulu-Natal, South Africa.

[This corrects the article DOI: 10.4102/hsag.v25i0.1263.].

An assessment of Nurses' knowledge, attitude and practice of emergency care related to road traffic accident victims at three selected hospitals in Rwanda.

INTRODUCTION: Quality emergency nursing care is an important variable in reducing death and disability due to road traffic accidents (RTA), yet little is known about emergency nursing care within the Rwandan context. This study aims to describe the knowledge, attitude and practice (KAP) of nurses of the emergency care of RTA patients. METHOD: We employed a cross sectional design to survey the full cohort of nurses working in Accident and Emergency (A&E) units in three selected Rwandan hospitals (N = 51). RESULTS: This study revealed that the knowledge and practice of nurses is either high or very high and the majority of them (73.657%) had a positive attitude towards emergency management of RTA patients. Being trained before working in A&E units was associated with a significant increase in the likelihood of being at the level of practice which is (1) very high (OR = 5.35, 95%, CI = 5.20-5.50), (2) high (OR = 1.60, 95%, CI = 1.17-2.19) (3), moderate (OR = 5.35,95%, CI = 4.15-6.88) and (4) low (OR = 1.33,95%, CI = 1.33-133) and it decreased more than 99.9% the likelihood of being at low level of practice in all levels. DISCUSSION: The study showed that training had a significant effect on practice and this is supported by previous studies. Training interventions to improve the management of RTA patients by nurses working in A&E should be regularly audited to ensure ongoing quality of care.

Analysis of Patient Safety Incident reporting system as an indicator of quality nursing in critical care units in KwaZulu-Natal, South Africa.

BACKGROUND: 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. AIM: To analyse Patient Safety Incident reporting system, including the evidence of types, frequencies, and patient outcomes of reported incidents in critical care units. SETTING: The study was conducted in the critical care units of ten hospitals of eThekwini district, in KwaZulu-Natal, South Africa. METHODS: A quantitative approach using a descriptive cross sectional survey was adopted to collect data from the registered nurses working in critical care units of randomly selected hospitals. Self-administered 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. FINDINGS: 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]). CONCLUSION: This study's findings indicating 1017 Patient Safety Incidents of predominantly serious nature, (47% considering moderate, major and catastrophic) are a cause for concern.

Perceptions of professional nurses regarding the National Core Standards tool in tertiary hospitals in KwaZulu-Natal.

BACKGROUND: Internationally, healthcare providers share a common goal of providing safe and high-quality care to every patient. In South Africa, the National Core Standards (NCS) tool was introduced to improve the quality of healthcare delivery. OBJECTIVES: This article is aimed to determine the perceptions of nurses concerning the use of NCS as a tool to measure quality care delivery in tertiary hospitals in KwaZulu-Natal. METHOD: This was a cross-sectional descriptive survey, where a purposive sampling technique was used to select hospitals. Six strata of departments were selected using simple stratified sampling. In each stratum, every second ward was selected from the provided list of wards using a systematic random sampling. The population of professional nurses in selected departments was 3050, from which 437 participants were selected by systematic random sampling. The collected data were analysed using Statistical Package for the Social Sciences (SPSS®) version 25. RESULTS: The study indicated that 53.5% respondents believed that the NCS tool allows them to identify areas of weakness, pointing to risks in basic human rights. However, only 49.7% respondents believed that the NCS tool allows staff inputs to identify relevant innovations. The study recommends improvement in the organisational climate and adoption of strategies that add value to patient care. CONCLUSION: Professional nurses perceived the NCS tool as a good tool for improving quality of healthcare delivery, but there is a need to improve environmental practice and involvement of all healthcare establishments to increase its effectiveness.

The Role of Adverse Childhood Experiences on Perinatal Substance Use Behaviour in KwaZulu-Natal Province, South Africa.

The role of risky sexual behaviour has been widely investigated across the sub-Saharan African HIV hyperendemic setting, with few studies having focused on the behaviour attributed to the deep-rooted, neurodevelopmentally-driven adverse childhood experiences (ACE) that sustain the endemic. We investigated the role of ACE on perinatal substance use outcomes in KwaZulu-Natal Province, South Africa, with 223 women being interviewed within one-week post-partum at a general hospital. Our secondary outcome was the occurrence of preterm birth delivery, which is understood to be linked to ACE. Study results suggest that the most common perinatal substance use was alcohol (n = 27, 12.11%), followed by tobacco (n = 18, 8.07%), with the prevalence of preterm birth delivery being 8.97% (n = 20, 8.97%). Regression analyses indicated increased ACE being significantly associated with perinatal alcohol (aOR = 1.45, 95% CI 1.22-1.72), tobacco use (aOR = 1.56, 95% CI 1.23-1.97) and preterm birth delivery (aOR = 1.21, 95% CI 1.03-1.43), independent of socio-economic status. When the model was further adjusted by HIV status, suppressed viral load was more significantly associated with lower odds of preterm birth delivery (aOR = 0.06, 95% CI: 0.01-0.24) than an unsuppressed status. Risk-behaviour reduction strategies should address the role of ACE on substance use and viral load, and hence possibly ART adherence, in HIV hyperendemic settings.

Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review.

BACKGROUND:  There is overwhelming evidence that the quality of health care in South Africa has been compromised by various challenges that impact negatively on healthcare quality. Improvement in quality care means fewer errors, reduced delays in care delivery, improvement in efficiency, increased market share and lower cost. Decline in quality health care has caused the public to lose trust in the healthcare system in South Africa. OBJECTIVES:  The purpose of this study was to identify challenges that are being incurred in practice that compromise quality in the healthcare sector, including strategies employed by government to improve the quality of health delivery. METHOD:  Literature search included the following computer-assisted databases and bibliographies: Medline (Medical Literature Online), EBSCOhost, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google, Google Scholar and ScienceDirect. Furthermore, websites were used to source policy documents of organisations such as the National Department of Health in South Africa and the World Health Organization. RESULTS:  Seventy-four articles were selected from 1366 retrieved. These articles quantify problems facing quality care delivery and strategies used to improve the healthcare system in South Africa. CONCLUSION:  The findings revealed that there were many quality improvement programmes that had been initiated, adapted, modified and then tested but did not produce the required level of quality service delivery as desired. As a result, the Government of South Africa has a challenge to ensure that implementation of National Core Standards will deliver the desired health outcomes, because achieving a lasting quality improvement system in health care seems to be an arduous challenge.

Engagement with Medication Among Kidney Transplant Recipients - A Descriptive Cross-Sectional Study.

The aim of this study was to determine the level of engagement with medication among kidney transplant recipients in South Africa. A descriptive cross-sectional study design with random sampling was used. Data were collected through structured face-to-face interviews. Total engagement with medication scores among kidney transplant recipients ranged from 60% to 100%, with a mean score of 80%. Although over half of the participants (55%) scored above the mean, only 19% had high levels of engagement with medication. Engagement with medication was significantly associated with race (Chi-square value = 66.225, df=42, P=0.010) and years post-kidney transplantation (Chi-square value = 415.423, df=364, P=0.032).

Motivators of adherence to integrated management among patients with chronic kidney disease: A qualitative study.

The integrated management of chronic kidney disease (CKD) demands significant changes, as patients need to adhere to dialysis, medication, and dietary and fluid restrictions. Therefore, there is a need to identify the motivators of adherence to improve the quality of life of these patients. The aim of the present study was to explore the motivators of adherence to integrated management among patients with CKD in South Africa. A phenomenological design was used. A sample size of 12 participants was selected according to data saturation. The purposive sampling method was used to select the participants. Data were collected with the help of a semistructured interview schedule developed from the literature. A thematic framework analysis was conducted to identify the motivators of adherence to integrated management; these were found to be family support, anxiety about eligibility for kidney transplant, support of other patients, awareness of complications associated with non-adherence to integrated management, and fear of being removed from the CKD program. Identified motivators could be used to develop specific interventions that address or foster adherence behavior as a requirement for integrated management.

Adherence to Hemodialysis and Associated Factors among End Stage Renal Disease Patients at Selected Nephrology Units in Rwanda: A Descriptive Cross-Sectional Study.

INTRODUCTION: Worldwide, End Stage Renal Disease (ESRD) has become a public health concern increasing the number of patients maintained on hemodialysis prior to renal transplantation. Nonadherence to hemodialysis continues to impact on the care of ESRD patients, causing high increase in morbidity and mortality. PURPOSE OF THE STUDY: The purpose of this study was to determine the level of adherence to hemodialysis and the associated factors among End Stage Renal Disease (ESRD) patients in selected nephrology units in Rwanda. METHODS: This was a descriptive cross-sectional design involving 41 participants. Participants were recruited using a purposive sampling technique. Demographic and adherence to hemodialysis data were collected with the use of structured interview schedules. Descriptive statistics were used to describe the demographic variables and the level of adherence to hemodialysis. Inferential statistics of chi-square was used to establish factors associated with adherence to hemodialysis. RESULTS: Twenty-one (51%) of ESRD participants adhered highly (scores < 80%) to HD. Seventeen (42%) adhered moderately (70-79%) to HD while three (7%) had low level of adherence to HD (below 70%). The factors associated with adherence to hemodialysis were age (mean = 27; 95% CI 26.76-29, 17; p = 038) and religion (95% CI 26.29-60.12, p = 003). Frequencies of education of health care workers about the importance of not missing dialysis (95% CI 26.71-42.56, p = .000), perceived relative importance of hemodialysis (95% CI 20.44-27.76, p = .020), and experiencing difficulties during the procedure (95% CI 20.80-28.36, p = .004) were significantly associated with adherence to hemodialysis. Conclusion. Adherence to hemodialysis is still a public health concern in Rwanda. Health care providers and particularly nurses should continue to advocate for adherence to HD for better health outcomes. Further research is needed to identify the barriers to HD in Rwanda.

Perceptions of caregivers regarding engagement with integrated management of chronic kidney disease patients in selected public hospitals of KwaZulu-Natal region, South Africa.

BACKGROUND: Chronic kidney disease (CKD) patients rely on non-professional health care providers, namely caregivers to manage their long-term condition. Despite the growing literature on CKD patients, little is known about the perceptions of caregivers regarding integrated management of CKD. AIM: The aim of the study was to explore the perceptions of caregivers with regard to integrated management of CKD patients. SETTING: The study took place in selected public hospitals of KwaZulu-Natal Province, South Africa. METHOD: A qualitative case study design was used. A purposive sampling method was used to select the study participants. Data were collected through a semi-structured interview schedule developed from the literature. Data were analysed through thematic template approach using Health Belief Model constructs. RESULTS: Hypertension and diabetes mellitus were risk factors that worsen progression of CKD. Unemployment, lifestyle changes and limited social interaction were revealed as negative effects of CKD. Caregivers were aware of consequences of non-engagement with integrated management. The revealed positive benefits of integrated management were mainly physiological and system-related. Barriers to engagement with integrated management were side effects of diet and haemodialysis, hot weather, unemployment, false perception of good health and shortage of kidneys for transplant. CONCLUSION: Chronic kidney disease patients require caregivers support to help with necessary changes to cope and adapt with integrated management of the disease. These caregivers experience effects of CKD, consequences of non-engagement and barriers to integrated management. Identification of caregivers perceptions offers healthcare workers a better understanding and formulation of strategies that can offer adequate support to this population.

Perceptions of newly-qualified nurses performing compulsory community service in KwaZulu-Natal.

BACKGROUND: Compulsory community service (CCS) for nurses commenced in South African January 2008 after it was legislated in the new Nursing Act (Act No. 33 of 2005). Nurses completing their registered nurse programme are registered as community nurse practitioners (CNPs) during the CCS period and make up the largest number of health professionals serving CCS. Whilst health institutions have welcomed CNPs as additional resources for the shortage of nursing staff, no structured guidelines have been provided at a regional level as to how these nurses should be utilised or managed during the CCS year. To date, no large-scale study has been conducted on nurses carrying out CCS in order to generalise the findings. OBJECTIVES: To establish the perceptions of newly-qualified nurses carrying out CCS in KwaZulu-Natal, South Africa. METHOD: A quantitative survey design was used to obtain data from a randomly selected sample of the 2012 cohort of nurses carrying out CCS in KwaZulu-Natal. RESULTS: CNPs have a positive attitude toward CCS and perceive themselves as being well prepared for the year of community service in terms of knowledge, skills and ability to administer nursing care. They identified positive benefits of the year of community service.The concerns raised were limited orientation and support; and a few CNPs experienced problems of acceptance by the nurses with whom they work. CONCLUSION: It is recommended that all health institutions who receive CNPs develop structured orientation and support for these nurses in order to promote their development, thereby enhancing their benefit to the communities they serve.

Appraisal of observance of behaviour change communication programme for maternal and child health at first level of midwifery practice in kaduna state Nigeria.

BACKGROUND: Behaviour Change Communication (BCC) is a key component of the roadmap adopted by the Nigerian government to address the high maternal and child mortality in the country. OBJECTIVES: The purpose of the study was to appraise the participation of midwives in BCC at the first level of health care in Kaduna State, Nigeria before planning a context specific and sustainable BCC capacity building programme. MATERIALS AND METHODS: In-depth interviews were conducted with nine midwives selected by maximum variation technique across Kaduna State. Content analysis of the interviews was performed using a priory codes derived from the integrative framework. RESULTS: The integrative framework provided a comprehensive appraisal of BCC in the facilities. Health talks were unplanned, difficult and more task-oriented than being behaviour change focused. The required skills, integrated services to enhance behaviour change by clients, and enabling environment, were missing. The findings were used, in collaboration with the midwives to develop and implement a context specific and efficient capacity building programme. CONCLUSIONS: The framework was adequate in identifying the gaps in the BCC activities of midwives at the facilities. There is a need to understand and support midwives with their BCC activities. Government policies should be brought closer to frontline staff who would implement them, by engaging such staff all through the process of developing the policies.

Client education experiences and expectations of women at the first level of maternal and child care in Kaduna state, Nigeria.

PURPOSE: to explore the client education experiences of women at first level maternal and child health-care facilities in Kaduna State Nigeria. The lack of access to appropriate information to assist women in making decisions about their health and utilize available services is recognized as a major contributory factor to the unabated high maternal and child mortality rates in Nigeria. DESIGN: a qualitative descriptive study was conducted. Nine focus group discussions were held with 65 women across the three senatorial zones of Kaduna State, Nigeria. Participants were recruited using maximum variation sampling technique. Audio recordings of the discussions were transcribed and the content analysed. The themes were determined by a priory approach and findings compared across groups through manually developed data matrices. FINDINGS: midwives were the major source of useful health information to the women who wished the midwives could cover more issues. The information provided by the midwives was skewed towards children and postnatal care, and some midwives ignored, or considered some of the women's questions interrupting. The harshness of midwives in emphasizing the need for prompt care, to women who came late to register or deliver, kept some women away. Women who never delivered in the facilities were not aware that the 'nurses' at the clinics were midwives, and desired to know more about midwifery in the facilities being tired of traditional birth attendants. CONCLUSION: the desire of women for more information and to know the 'midwife' suggests a gap between what the women expected and what they were provided. IMPLICATION FOR PRACTICE: it is important to expand the scope of client education to include critical pregnancy and labour related issues and friendly midwifery practices in the facility.

Symptoms experienced by HIV-infected Individuals on antiretroviral therapy in KwaZulu-Natal, South Africa.

Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those living with the disease. Although the goals of treating the numbers living with HIV/AIDS have not yet been achieved, availability of antiretroviral therapies (ARVs) has been expanded to many clinical settings in KwaZulu-Natal, the epicenter of HIV infection in South Africa. The South African Department of Health (2007) estimates indicate that 5.54 million South Africans are living with HIV/AIDS, whereas UNAIDS (2007) estimates suggest that 18.8% of the population in South Africa is affected. Because the symptom experience may influence adherence to ARVs and quality of life, this study focused on the prevalence of symptoms reported by patients (N = 149) diagnosed with HIV/AIDS and adherence to medications and appointments. Self-report data were obtained from this community-based sample of HIV-infected patients who received care in outpatient clinics in Durban, KwaZulu-Natal, South Africa. With an average of three side effects, the most frequently reported by the study participants were fatigue/tiredness (41%), rashes (40%), headaches (32%), insomnia (31%), sadness (24%), disturbing dreams (23%), numbness (22%), pain (22%), and self-appearance (20%). On a scale of 1 to 10 (10 being worst possible), those with symptoms reported an average intensity of 4.2 (SD = 2.0), and the degree to which symptoms affected activity levels was 3.2 (SD = 2.2). Although intensity of symptoms and effects on activity levels were strongly correlated (r = .78, p < .001), there were no significant relationships between adherence and the intensity of symptoms or the relationship of symptoms with activity levels. Logistic regression analyses indicate that the presence of a greater number of symptoms was not associated with greater adherence (odds ratio = 2.27, 95% confidence interval = 0.60-8.70, ns). However, those who reported higher adherence were 1.5 times more likely to report greater physical health than low adherers (p = .04). High adherers were also 1.6 times more likely to report greater psychological health than low adherers (p = .03). This suggests that further study is needed to investigate adherence motivations for those living with HIV/AIDS in South Africa because adherence seems not to be linked to the frequency of symptoms or limitations on activity related to symptoms.

Fulbright Scholar opportunities for global health and women's health care in HIV/AIDS in sub-Saharan Africa.

This article addresses global health opportunities related to HIV/AIDS and women's health care in sub-Saharan Africa through Fulbright Scholar and Fulbright Student Awards. Although many universities offer a gateway to the J. William Fulbright awards, some disciplines and areas of specialization, including nursing and women's health, have had fewer scholars or students as recipients of these awards. Resource-limited countries, including the countries of sub-Saharan Africa, offer rich opportunities for cross-cultural exchange and advancement of global health. Amidst the context of the shortage of health care workers, the increasing prevalence of HIV/AIDS and other infectious and chronic diseases in sub-Saharan Africa, and the challenges of public health, this article addresses an example of partnerships in global nursing that can be developed through the Fulbright programs.