Nurses experiences regarding ideal clinic project implementation in eThekwini district.

Background: The South African National Department of Health introduced the ideal clinic realisation and maintenance (ICRM) programme in response to primary health care (PHC) services and to lay a strong foundation for the National Health Insurance implementation. The progress report 2015-2016 on the implementation of this programme indicated that achieving the 50% target in selected vital areas such as staffing, resource allocation, and utilisation was not achieved. Aim: The study aimed to explore and describe nurses' experiences regarding the ideal clinic project (ICP) implementation. Setting: The study was conducted in 18 PHC clinics in eThekwini district, KwaZulu-Natal. Methods: An exploratory descriptive, contextual qualitative design was employed guided by Donabedian's structure, process, and outcomes model. Data were collected using semi-structured interviews with 24 nurses between 15 September and 25 October 2020 following receipt of ethics and analysed using Tesch's open coding approach. Results: The three themes that emerged included structural limitations, processes involved in running the clinic, and support offered to the PHC clinics. These were highlighted as challenges experienced by nurses during the implementation of an ICP. Conclusion: Nurses' negative experiences and perceptions made it difficult for them to accomplish the ICP standards. Contribution: The findings from the study highlighted critical actions by the health care institution management which if instituted, could facilitate improved implementation of the ICP and achievement of the 50% target in selected vital areas.

Nurse managers' experiences regarding the use of key performance indicators in developing work plans.

BACKGROUND: Apart from monitoring and evaluation, key performance indicators (KPIs) are used for planning of quality healthcare services and are essential for ensuring that work plans are strategic. Nurse managers (NMs) are required to use reports on the KPIs from the District Health Barometer to prepare work plans. AIM: The aim of the study was to explore the experiences of NMs regarding the use of KPIs in developing work plans. SETTING: The study was conducted in one of the four local municipalities of iLembe district in KwaZulu-Natal. METHODS: A qualitative research design was used. Data were collected through semistructured interviews with 20 NMs from seven primary health care clinics between 16 November 2020 and 24 December 2020; data were then thematically analysed. RESULTS: Nurse managers experienced challenges related to knowledge creation, knowledge sharing and knowledge application regarding the use of KPIs in developing work plans. Possible strategies which, according to NMs, could facilitate the use of KPIs in developing work plans included support in the management role, skills development and orientation, provision of resources and participative management. CONCLUSION: Relevant knowledge management practices, including knowledge sharing, are essential for knowledge creation so that individuals develop task knowledge to fulfil role expectations. In the case of this study, knowledge creation for NMs could facilitate their appropriate use of KPIs in developing work plans.Contribution: It is recommended that NMs receive ongoing training on, and be actively involved in, data management and that mentoring and support be made available for NMs to facilitate the use of KPIs in developing work plans.

Perceptions of student accoucheurs regarding gender inequality in midwifery training at Free State maternal healthcare institutions.

BACKGROUND: Worldwide, gender inequality has been a dominating factor in the training of student accoucheurs in most maternal healthcare institutions. This poses challenges for the maternal healthcare institutions where student accoucheurs are placed for clinical practice as most women become reluctant or refuse to accept their services. Gender inequality has a negative impact on the training of student accoucheurs as most of them become demotivated which could lead to a high attrition rate. OBJECTIVES: This study explored and described the perceptions of student accoucheurs regarding gender inequality in midwifery training at the Free State maternal healthcare institutions. METHOD: An explorative and descriptive qualitative research design was undertaken. There were 40 student accoucheurs that formed 10 focus group discussions. Each focus group discussion had four participants. Tesch's eight-steps of data analysis was used to analyse data. RESULTS: Three major themes emerged during data analysis: meeting the training requirements in midwifery, women's autonomy in a choice of healthcare provider versus student accoucheurs' autonomy to be trained in midwifery and staff establishment to render maternal healthcare. CONCLUSION: The participants perceived prejudice, rejection and resistance by women in maternity units as a contributing factor to gender inequality, which has a negative impact on their training in midwifery. The study recommends that health directorates, nurse managers and training institutions should consider revising maternal healthcare policies regarding the recruitment and placement of willing accoucheurs in maternity units in order to address gender inequality.

Guidelines for student accoucheurs' acceptance in maternal healthcare.

PURPOSE: The quality of maternal healthcare training is the most optimal degree of health in the delivery of effective, efficient and quality healthcare in midwifery discipline. Student accoucheurs studying at the Free State School of Nursing are faced with resistance, discrimination, rejection and unacceptability by pregnant women during their clinical placement at the Free State maternal healthcare institutions. This results in poor quality of training of student accoucheurs in maternal healthcare. Considerable studies have been conducted on males in midwifery nursing, but no guidelines have been developed to facilitate student accoucheurs' acceptance and improvement of the quality of training in maternal healthcare, hence the purpose of this study. DESIGN/METHODOLOGY/APPROACH: A descriptive, explorative qualitative design was used in this study. Qualitative focused group discussions (n = 32) were conducted through purposeful sampling method. Data was analysed thematically. FINDINGS: Three main categories emerged: student accoucheurs' related factors with social interactions and relations as a theme; maternal healthcare users' related factors with transcultural diversity and socio-economic status as themes; nurse training institutions and maternal healthcare institutions service providers-related factors with gender inequality in the work place as a theme. Ultimately, the guidelines to facilitate acceptance and improvement of quality training of student accoucheurs in maternal healthcare institutions were developed and recommended for implementation. ORIGINALITY/VALUE: The paper developed guidelines to facilitate acceptance and improvement of quality training of student accoucheurs in Free State maternal healthcare institutions.

Circulating soluble fms-like tyrosine kinase-1, soluble endoglin and placental growth factor during pregnancy in normotensive women in KwaZulu-Natal, South Africa.

BACKGROUND: Based on the increased pre-eclampsia and HIV antenatal incidence in South Africa, we determined the angiogenic profiles due to its mechanistic link in preeclampsia development, throughout uncomplicated pregnancies in HIV positive and negative women. OBJECTIVE: To determine the angiogenic profiles throughout uncomplicated pregnancies in HIV positive and HIV negative women. We explored possible correlations between angiogenic serum levels and selected maternal characteristics (HIV status, gestational age, maternal factors, and pregnancy outcomes). METHOD: This study was conducted at a primary health care facility in Durban, South Africa. Forty-six pregnant women aged 18-45 years, were enrolled at 10-20, 22-30 and 32-38 weeks' gestation, respectively through convenient sampling. Serum samples were collected and quantitatively evaluated using ELISAs. Clinical and epidemiological data were analysed using STATA (version 14). A probability level of p < 0.05 was considered statistically significant. RESULTS: Of those enrolled, 28.3% were nulliparous, 82% were HIV positive and none developed pre-eclampsia. Systolic and diastolic blood pressure increased slightly throughout pregnancy. Fluctuating angiogenic and anti-angiogenic levels were demonstrated during pregnancy. CONCLUSION: This study contributes to the current angiogenic knowledge in normotensive pregnancies, and may assist as a reference range against which these factors may be compared in HIV complicated pregnancies.

Challenges faced by student accoucheurs during clinical placement at the free state maternal health care institutions.

BACKGROUND: Anecdotal evidence suggests that student accoucheurs studying at the Free State School of Nursing in South Africa are faced with resistance, discrimination, rejection and unacceptability by pregnant women during their clinical placement at the Free State maternal health care institutions. OBJECTIVE: The aim of the study was to explore and describe the challenges faced by student accoucheurs regarding the maternal health care services they render to women. METHODS: An explorative, descriptive, and qualitative research design was employed to conduct the study. Purposive sampling was used to select student accoucheurs who met the inclusion criteria. Focus group discussion was used to collect data from the selected student accoucheurs. Data were analysed thematically, and the findings were triangulated with the integration of Peplau's Theory of Interpersonal Relations as a theoretical framework that guided the study. RESULTS: The findings in relation to the research question were synthesised under four themes: transcultural diversity, socio-economic factors, social interactions and relations, and gender inequality in the work place. CONCLUSION: The study is a contribution to the emerging education and training of student accoucheurs body of knowledge in the Free State Province and to the global existing body of knowledge regarding the phenomena.

Financial management roles of nurse managers in selected public hospitals in KwaZulu-Natal province, South Africa.

BACKGROUND: The public health sector in South Africa has been facing severe financial cutbacks and financial constraints in recent times. The nurse manager (NM) is faced with the task of managing and reducing expenditure in the nursing sector without compromising the quality care. This requires skills and understanding of financial management. AIM: This study aimed to explore the financial management roles of NMs and to identify financial management development needs necessary for NMs' practice. SETTING: The study was conducted in KwaZulu-Natal. A total of eight hospitals from the five health districts were included. METHODS: The study used the naturalistic paradigm with a constructivist grounded theory approach. Interviews were used to initially gather data from six NMs who were purposively selected. Theoretical sampling was used to further recruit financial managers, chief executive officers, assistant nurse managers and operational managers. The final sample consisted of 18 participants. RESULTS: Financial management of the hospitals is the primary function of the financial managers and the chief executive officers. However, the role of NMs extends to the performance and participation in various activities relating to the financial functioning of the hospital. These include financial planning, financial monitoring, financial decision-making and financial control. CONCLUSION: Nurse managers have a financial management function in public health care organisations but lack the necessary skills, knowledge and competencies to function in this role and require additional training. Recommendations included that a competency framework be developed to improve the financial management competencies of NMs.

The influence of peer mentoring on critical care nursing students' learning outcomes.

PURPOSE: The purpose of this paper is to explore the influence of peer mentoring on critical care nursing students' learning outcomes in critical care units. DESIGN/METHODOLOGY/APPROACH: A qualitative exploratory research design was used to conduct the study. Ten critical care nursing students were recruited from critical care units in the five private and two public hospitals. Descriptions of their experiences were gained through individual face-to-face interviews. FINDINGS: The study reinforces peer mentoring as a vital strategy in helping the critical care nursing students to attain their learning outcomes. However, peer mentoring was not consistent in all hospitals and there were no structured support systems to ensure that peer mentoring was formalized. Making peer mentoring a vital component in the registered nurses core competencies would enable efficiency and guarantee the viability of peer mentoring. RESEARCH LIMITATIONS/IMPLICATIONS: Mentors for the critical care nursing students were not included in the study. PRACTICAL IMPLICATIONS: The study identified a need for incorporating a formalized mentorship programme into the core competencies of all qualified critical care nurses, the unit mentor to familiarise themselves with the prescribed learning objectives of the critical care nursing student and an allocation of supernumerary time for the critical care nursing student and mentors to allow for formal mentoring responsibilities to take place. ORIGINALITY/VALUE: The study reinforces peer mentoring as a vital strategy in helping the critical care nursing students to attain their learning outcomes and conscietises registered nurses of their responsibility as mentors.

Perceptions of young men at the Free State School of Nursing with regards to teenage pregnancy.

BACKGROUND: Teenage pregnancy is a socio-economic challenge and a serious public health problem for communities in South Africa. It is, therefore, imperative that effective interventions and programmes be implemented to address this problem. A number of research studies have been conducted on teenage pregnancy in South Africa, but their focus was mainly on teenage girls excluding young men's involvement in teenage pregnancy. AIM: The aim of the study was to determine the perceptions of young men between the ages of 18 and 23 years towards teenage pregnancy. METHODS: A qualitative, explorative semi-structured interview descriptive design was used toconduct the study. The study was guided by the Johnson's Behavioral System Model. Purposive sampling was used to select 10 participants with whom semi-structured interviews were conducted. Thematic analysis of data were performed. SETTING: The study was conducted in Free State School of Nursing's two main campuses. RESULTS: The findings of this study revealed that young men were not involved in reproductive health programmes aiming to prevent teenage pregnancies. Father and son's poor communication on issues related to sex and teenage pregnancy contributes to unprotected sexual intercourse resulting in teenage pregnancy. Cultural and traditional practices such as the withdrawal method, not using contraceptives, and misleading teachings at the initiation schools contribute to risk factors of teenage pregnancy. CONCLUSION: There is still a gap in reproductive health that needs to be filled by involving young men to reduce teenage pregnancies. Involving young men in reproductive health programmes could lead to a decreased number of teenage pregnancies. Factors, such as cultural and traditional practices, and father and son sexual health education, need to be taken into consideration to prevent teenage pregnancies.

Challenges regarding the implementation of the basic antenatal care approach in eThekwini District, Kwazulu-Natal.

AIM: The aim of the study was to investigate the challenges experienced by midwives during the implementation of the Basic Antenatal Care programme. BACKGROUND: The National Department of Health recommended that all primary health care facilities in South Africa start to implement the Basic Antenatal Care programme by the end of 2008. In her work as coordinator of the Maternal Child and Women's Health programme for the eThekwini Municipality, the researcher observed the slow progress in implementation of the programme in the eThekwini district. METHOD: A descriptive qualitative design using questionnaires was used to assess the challenges being experienced by midwives during the implementation of the programme. RESULTS: The challenges identified included: shortage of staff, lack of cooperation from referral hospitals, lack of in-service training, problems with transportation of specimens to laboratories, lack of material resources, unavailability of Basic Antenatal Care programme guidelines and lack of management support. CONCLUSION: The challenges were the possible cause of the slow progress in the implementation of the programme. IMPLICATIONS FOR NURSING MANAGEMENT: The successful implementation of the new programme is dependent on support and guidance offered by the nurse manager to the staff at operational level. The manager should monitor and develop strategies to address and overcome challenges that hinder implementation of the Basic Antenatal Care programme.

Factors influencing successful implementation of the basic antenatal care approach in primary health care facilities in eThekwini district, KwaZulu-Natal.

BACKGROUND: In a move to alleviate the burden of consistently high maternal and perinatal mortality rates, the South African National Department of Health (DoH) introduced Basic Antenatal Care (BANC) in all Primary Health Care facilities that were providing antenatal care services. However, not all facilities in the eThekwini district have successfully implemented the approach. The aim of the study was to identify the factors that influence successful implementation of the BANC approach. OBJECTIVES: The objectives were to identify facilities that had successfully implemented the BANC approach and the factors that influenced successful implementation of the BANC approach, in order to make recommendations on these factors. METHOD: A descriptive quantitative design was used. Firstly, primary health care facilities that were successful in implementing the BANC approach were identified through a retrospective record auditing. A total of 27 facilities were identified, of which 18 facilities were included in the study. This was followed by data collection from 59 midwives in order to identify the factors that influenced successful implementation of the BANC approach. The data was analysed using version 19 of the Statistical Package for the Social Sciences. RESULTS: The positive factors that influenced successful implementation of the BANC approach included: the availability and accessibility of BANC services, policies, guidelines and protocol; various means of communication; a comprehensive package of and the integration of primary health care services; training and in-service education; human and material resources; the support and supervision offered to the midwives by the primary health care supervisors; supervisors' understanding of the approach and the levels of experience of midwives involved in implementation of the BANC approach. CONCLUSION: The success that the facilities had achieved in implementing BANC approach was attributed to these positive factors.