How do family members perceive re-integration of male state patients into their families in South Africa? A qualitative analysis.

BACKGROUND: State patients are admitted to a psychiatric hospital after being declared as such by the magistrate courts as a result of not found fit to stand trial for the offence they had committed. After successful rehabilitation of state patients at the psychiatric hospital, they need to be re-integrated into their families. Family members' perceptions regarding re-integration of male state patients are not largely explored in the scientific body of knowledge. AIM: The aim of the study was to determine the perceptions of family members regarding reintegration of male state patients into their families. SETTING: This study was conducted in Vhembe District of Limpopo province, South Africa. METHOD: A qualitative approach using explorative, descriptive and contextual designs was adopted. In-depth interviews were conducted with 10 family members who were purposefully sampled, and data were thematically analysed using Tech Open Coding method. RESULTS: Three themes emerged, namely, family members understand re-integration; family members' expectations from a mental healthcare user; and threat to re-integration as perceived by family members. CONCLUSION: Data revealed that family members have varied perceptions regarding re-integration. These perceptions were based on the behaviour displayed or an offence committed by the mental healthcare user before admission and how participants experienced it. The study recommends that an investigation is to be conducted on the kind of support family members need regarding re-integration of state patients into their families.

Factors Related to the Implementation of Preconception Care Recommendations in Selected Districts of Limpopo Province: A Qualitative Study.

Preconception care (PCC) is the provision of biomedical, behavioural, and social health interventions to women and couples before they fall pregnant. The World Health Organization (WHO) developed PCC recommendations in 2013, which were included in the South African maternity care guidelines in 2016. The purpose of PCC is to lessen behaviours and environmental factors leading to maternal ill-health, thus reducing maternal and perinatal mortality rates. OBJECTIVE: To determine the implementation of PCC recommendations at health facilities in the selected districts of Limpopo Province and the associated factors. METHODS: A qualitative exploratory design was used. Nonprobability, purposive sampling was used to sample 29 professional nurses (PNs), and 51 women of childbearing age (WCBA) (19-35 years) from clinics and community health centres (CHCs). Data were collected through in-depth interviews with the professional nurses and focus group discussions with the WCBA. Data analysis was performed through open coding. Measures of trustworthiness were adhered to. Permission to conduct the study was obtained from relevant stakeholders, participation was voluntary and participants signed a consent form prior to data collection. RESULTS: The findings of the study revealed that there was partial implementation of the PCC recommendations in the selected districts of Limpopo Province, PCC provision was dependent on clients' initiation, a knowledge gap regarding PCC recommendations was identified from the professional nurses, and a lack of awareness regarding PCC from the WCBA. CONCLUSION: The preconception period is an important determinant of the pregnancy outcome; therefore, focus should be redirected to the pre-pregnancy period and not only to when the woman is already pregnant. However, to achieve this, professional nurses and WCBA should be empowered regarding PCC and its benefits.

The psychosomatic experiences of women who had intrauterine foetal death in rural South Africa.

BACKGROUND:  Intrauterine foetal death (IUFD) is a traumatic event leading to substantial grief reactions with a variety of experiences in an expectant woman. After delivery, these experiences have shown to impact the mother's psychological well-being, where she experiences post-traumatic stress, sadness, anxiety and depression. The psychosomatic experiences before labour commenced are not known. OBJECTIVES:  This study explored the psychosomatic (mind-body connection) experiences of women who had an IUFD before labour commenced in rural areas of Limpopo province, South Africa. METHOD:  A qualitative approach with an explorative descriptive design was carried out among all 10 consented participants who were selected using a purposive sampling technique. The sample consisted of women who delivered an IUFD as reflected by the hospital register from the selected hospitals. Data were collected at the participants' homes through in-depth individual interviews guided by one open-ended central question as follows, 'Please share with me your experiences of IUFD before you went into labour', and analysed using Tesch's open coding method. RESULTS:  Two themes reflecting the psychosomatic (mind-body connection) experiences of women who had an IUFD emerged from the analysis. The themes are danger alerts and emotional responses. CONCLUSION:  This qualitative study revealed that women could relate a lack of or decreased foetal movement as the danger alert or warning sign that the baby was in danger before labour commenced. Upon noticing that something was wrong with the baby, a message was sent to the women's minds, which equally affected and activated their emotional dimensions. An investigation regarding the kind of support needed by women after being informed of an IUFD is recommended.

Perceived Consequences of COVID-19 Restrictive Visitation Policy on Family Members at Rural Hospitals in Vhembe District: A Qualitative Study.

From a public health standpoint, a stringent visitation policy was necessary during the COVID-19 pandemic, but it had unforeseen communicative and emotional health consequences for family members. This study explored family members' experiences regarding implementing a restricted visitation policy when a patient was admitted with COVID-19 at public hospitals in the Vhembe district. Researchers used an exploratory, descriptive, and contextual qualitative technique. Twelve family members made up the population. Unstructured telephone interviews were used to obtain the data, and open coding was used to analyse data. Ethics were consistently followed. Before taking part, participants provided verbal informed consent, acknowledging that they could withdraw from the study if necessary. Three themes emerged: inadequate measures for temporary communication channels and techniques, the mental health effects of COVID-19 admission, and poor/lack of standardised visitation policy during the COVID 19-pandemic. There was a need to balance safety from contracting COVID-19 infection and promoting family-centred care. Virtual visits through telecommunication solutions could reduce fear and anxiety as the family could be updated on the progress of the hospitalised relative. Alternatively, hospital managers must allocate a dedicated person in the unit to update families when they call and enquire about the conditions.

Expectations of learner nurses in sampled clinical areas of the Limpopo province, South Africa.

Background: Nurse training in South Africa requires placing learner nurses in real-life setting for them to gain practical experience. To complete their training and be competent practitioners, learner nurses must have expectations and aspirations when they go for practice. Aim: This study sought to understand learner nurses' expectations at clinical learning areas during placement. Setting: Four clinical learning areas in the Limpopo province were purposely sampled. Tertiary, regional and district hospitals were sampled to obtain information from different levels of care. Methods: A qualitative, descriptive and contextual design was used to explore the expectations of learner nurses during clinical placements. Permission to conduct the study was obtained from various bodies and ethical considerations were ensured. Nonprobability purposive sampling was used, and six focus groups were formed. Each focus group discussion (FGD) had six to eight participants. The FGDs were according to level of study, with the third and fourth levels each having two FGDs because of the number of participants. Results: The following three themes emerged: milieu in the clinical learning areas, learning in the clinical areas and self-actualisation. Conclusion: The clinical learning areas are institutions of promoting learning through practice. They should promote learning and offer support to learners so that learners meet their expectations, which may prevent discouragement and attrition. Contribution: This study adds to the body of knowledge in nursing education and practice because when students' expectations are met, their training outcome might be positive leading to competent professional nurses.

'Not my dream': Mother's challenge of raising intellectual disability child in Vhembe district.

Background: The birth of a child with an intellectual disability in a family brings confusion, depression and frustrations, especially to the mother. Activities required by these children place a heavy burden on mothers in terms of support and care, as most mothers are the ones who take full care in the well-being of a child, regardless of whether a child has an intellectual disability or not. Challenges include feeding, bathing, dressing, finance and assisting with elimination, especially when the child is a teenager, where one expects the child to be able to do everything for himself or herself. Aim: To explore and describe the challenges experienced by mothers of children with intellectual disabilities. Setting: The study was conducted in the selected hospitals of the Vhembe district in Limpopo province. Methods: A qualitative, exploratory, descriptive and contextual research design was adopted. A nonprobability purposive sample comprised 13 mothers of children with intellectual disabilities such as down syndrome and cerebral palsy. Data were collected through unstructured interviews until saturation was reached. Data were analysed by the open-coding method. Results: Study findings revealed that mothers of children with intellectual disabilities experienced feelings of fear, embarrassment and financial burdens because of children's special needs and initial awareness of the diagnosis. Conclusion: It is imperative that mothers of children with intellectual disabilities be supported by family, relatives, health care professionals and the community. Contribution: The study's contribution was to strengthen psychological intervention and support to mothers and awareness to accept children with intellectual disability.

Family Perspectives Related to Caring for Mental Health Care Users: A Case Study in the Long-Term Mental Health Institutions of Limpopo Province, South Africa.

Family involvement in long-term mental health care is a significant therapeutic aspect in managing mentally ill patients. This study aimed to determine the perspectives of family members about caring for mental health care users at selected long-term mental health institutions in Limpopo Province. A qualitative explorative and contextual descriptive design was used. Purposive sampling was used to select family members with mental health care users admitted in long-term health institutions in Limpopo Province. Data were collected with in-depth individual interviews aided by an audio recorder and field notes. Data were qualitatively analysed. Trustworthiness and ethical considerations were ensured. Two themes yielded from the interviews: Perspectives of family members about their involvement in the care of mental health care users and difficulties in caring for mental health care users at home when granted leave of absence or discharged. Sub-themes: Caring for mental health care users leads to an understanding of mental illness; Lack of skill and inability to monitor mental health care users at home; Mental health care users abuse substances during leave of absence which makes family reluctant to request them for visit; Caring for mental health care users at home viewed as a difficult task and stigma from the community. The challenges experienced by family members contribute to poor interaction with mentally ill patients. We recommend that family members of mental health care users be educated about mental illnesses and encouraged to participate in the care of the patients.

The Roles of Obstetrics Training Skills and Utilisation of Maternity Unit Protocols in Reducing Perinatal Mortality in Limpopo Province, South Africa.

Perinatal mortality has been associated with poor maternal health during pregnancy and intrapartum periods. This study was conducted to determine the effects of obstetrics training programmes and the utilization of maternal unit protocols in the management of obstetric complications in reducing neonatal mortality rate in selected public hospitals in the Vhembe district of Limpopo province, South Africa. A quantitative, descriptive design was used and a non-probability purposive sampling method was used to select midwives with a minimum of two (2) years of working experience in maternity wards of selected public hospitals. A total of 105 completed questionnaires were analysed using SPSS version 23. Most of the respondents were within the age group of 40-59 years (74.3%) and with professional experience of more than 10 years (76.8%). More than half (63.8%) had qualified as midwives at a diploma level. Only 44.8% indicated that the protocols were always utilised, even though the majority (70.5%) believed that the protocols are helpful in managing obstetrics complications. The obstetric skills are helpful in reducing neonatal mortality, however, utilisation of the protocols is not encouraging in the studied health facilities. We recommend that efforts should be geared towards the enforcement of the protocol's use, and all midwives should be encouraged to undergo the trainings.

Knowledge, attitudes and practice of secondary school girls towards contraception in Limpopo Province.

Unplanned teenage pregnancy constitutes an important health problem, whilst contraceptive services are free throughout South Africa and the number of Termination of Pregnancy (TOP) services is increasing. The purpose of this study was to assess the knowledge, attitudes and practices of secondary school girls towards contraception in Thulamela Municipality of Limpopo Province, South Africa. A quantitative descriptive study design was used and respondents were selected by convenience sampling from a population of secondary school girls, the sample consisting of 273 girls in Grades 10-12. A self-administered questionnaire was used to collect data and analysed by computing frequencies and percentages using the Statistical Package for Social Sciences. Findings showed that respondents were aware of different contraceptive methods that can prevent pregnancy. However, most did not have knowledge of the emergency contraceptive, intra-uterine device and female condom. Pressure from male partners, fear of parental reaction to the use of contraceptives, reluctance to use contraceptives, poor contraceptive education and lack of counselling were seen as the main causes of ineffective contraceptive use and non-utilisation. Possible modalities of intervention deal with providing contraceptive counselling and care to empower these school girls to make informed choices on reproductive health. 

Problems experienced by pregnant student nurses in the Republic of South Africa.

The purpose of this quantitative exploratory descriptive survey was to determine which problems pregnant student nurses experienced in the Northern Province (NP) of the Republic of South Africa (RSA). Questionnaires were completed by 93 pregnant student nurses in this province, indicating that the majority of them became pregnant because they lacked knowledge about contraceptives, emergency contraceptives, and termination of pregnancy (TOP) services (legalized in the RSA since 1996). They delayed seeking prenatal care and experienced tiredness, dizziness, and vaginal bleeding during the first trimester. Most pregnant student nurses encountered academic problems as a result of their pregnancies. These and other results indicate a dire need to educate the student nurses about contraceptives and about accessing reproductive health care services. If the students do not utilize the available services themselves, it is unlikely that they will advise their clients to utilize such services.