Between a rock and a hard place: Ethics, nurses' safety, and the right to protest during the COVID-19 pandemic.

AIM: In this paper, we critically discuss the ethics of nurses' choice to strike during the COVID-19 pandemic, considering legal and ethical arguments, overlaying the Ubuntu philosophy, an African ethic. BACKGROUND: The recent unprecedented coronavirus disease pandemic and the increased reports on the absence of personal protective equipment in South Africa places many health workers' lives at risk. Nurses spend most of their time with patients, which exposes them to fatal risks as they work in unsafe environments. RESEARCH METHODS: Exploratory literature review was conducted using Pubmed, CINAHL, Google Scholar and Science Direct) and law cases repository. FINDINGS: Nurses thus may be justified in striking to protect their safety. State healthcare entities are obliged to ensure safety and protect the health of professionals during the pandemic. According to their Code of Practice and Pledge of Service, they are ethically obliged to put patients first, and as a result, they are legally barred from engaging in strike action. CONCLUSION: We conclude that there may be constitutional human rights arguments to support strike action. We also find that ethical principles alone do not provide clear direction to guide nurses in making justified and ethical decisions regarding service provision in an environment threatening to compromise their safety.

Factors facilitating trained NIMART nurses' adherence to treatment guidelines: a vital matter in the management of TB/HIV treatment in South Africa.

BACKGROUND: Globally, the burden of tuberculosis or human immunodeficiency virus (TB/HIV) is at 24% and this alarming rate compelled the World Health Organization (WHO) to declare the African region as a critical workforce shortage area. To facilitate adherence to treatment guidelines, WHO recommended a strategy of task shifting for countries with high health workforce shortages. The strategy aimed at the redistribution of health care tasks to available workers. The study aimed to determine the factors facilitating nurse-initiated management of antiretroviral therapy (NIMART) trained nurses' adherence to TB/HIV treatment guidelines. METHODS: The study employed an exploratory-descriptive design. The study was conducted in Ugu and Ngaka Modiri Molema Districts of KwaZulu-Natal (KZN) and North West (NW) Provinces of South Africa. The population comprised of 24 participants who were purposively selected. The in-depth focus group discussions were conducted and ATLAS T.I. was used for data analysis following the basic steps of notice-collect-think (NCT) analysis. Trustworthiness and adherence to ethics were ensured. RESULTS: The singular theme of factors facilitating NIMART trained nurses' adherence to treatment guidelines which included positive attitudinal needs and positive behavioural change emerged from raw data. CONCLUSION: Continuous training, support supervision, and improved relationships with colleagues need to be enhanced to enable NIMART trained nurses to adhere to treatment guidelines.

Barriers to tuberculosis and human immunodeficiency virus treatment guidelines adherence among nurses initiating and managing anti-retroviral therapy in KwaZulu-Natal and North West provinces.

BACKGROUND:  Nurses, as front-line care providers in the South Africa's health care system, are called upon to deliver integrated interventions for tuberculosis and human immunodeficiency virus (TB and HIV) including nurse-initiated management of anti-retroviral therapy (NIMART) and anti-TB treatment. Adherence to treatment guidelines and factors associated with non-adherence to treatment guidelines among nurses remain under explored. PURPOSE:  To explore and describe barriers to treatment guidelines adherence among nurses initiating and managing anti-retroviral therapy and anti-TB treatment in KwaZulu-Natal and North West provinces. DESIGN:  This study employed a qualitative exploratory descriptive design. METHODS:  Four semi-structured focus group interviews were conducted during 2014 each consisting of four to eight NIMART trained nurses. Audiotaped interviews were transcribed verbatim and analysed using Atlas T.I. software. FINDINGS:  During data analysis, two themes emerged: (1) NIMART trained nurses' distress about TB and HIV guidelines adherence that is inclusive of lack of agreement with guidelines, poor motivation to implement guidelines, poor clinical support and supervision, resistance to change, insufficient knowledge or lack of awareness and (2) exterior factors inhibiting nurses' adherence to treatment guidelines which incorporated organisational factors, guidelines-related factors and patient-related factors. CONCLUSION:  This qualitative study identified that nurses have substantial concerns over guideline adherence. If NIMART trained nurses' barriers inhibiting adherence to treatment guidelines cannot be remedied, patient outcomes may suffer and South Africa will struggle to meet the 90-90-90 targets.

A model of collaboration between nursing education institutions in the North West Province of South Africa.

BACKGROUND: Professional nursing in South Africa is obtained through a 4-year diploma offered at nursing colleges, or a 4-year degree in universities, and the South African Nursing Council (SANC) registered both for professional nursing. New SANC legislation now requires a bachelor's degree for registration as professional nurse. OBJECTIVES: The aim of the study was to explore and describe perceptions of nurse educators and stakeholders to develop a model of collaboration for joint education and training of nursing professionals by colleges and universities through a bachelor's degree. METHOD: A mixed methods approach was used to explore perceptions of nurse educators utilising a questionnaire, and perceptions of other nurse training stakeholders through interviews, about a model of collaboration between the college and the university. RESULTS: Themes that emerged from the interviews included identifying collaboration goals, establishing a conducive environment, maximising exchange of resources, role clarification and perceived challenges. Quantitative results showed high agreement percentages (84.13%-100%) on most basic concepts and themes. A model of collaboration was developed indicating a framework, agents, recipients, procedure, dynamics, and terminus. CONCLUSION: A model of collaboration was acceptable to the majority of nurse education stakeholders. Other implications are that there was a need for the improvement of scholarship among nurse educators and clinical mentors, sharing rare skills, and addressing perceived challenges.

A model of collaboration for the implementation of problem-based learning in nursing education in South Africa.

BACKGROUND: The idea of collaboration between key stakeholders in nursing education for the implementation of problem-based learning (PBL) may have far-reaching implications for the institutions and students. MAIN OBJECTIVE: To develop a model of collaboration to facilitate the implementation of PBL in nursing education. METHODOLOGY: An exploratory sequential design was used. Qualitative data were collected from purposively recruited nurse educators from three universities in South Africa offering PBL and nurse managers from all the three hospitals in North West Province where PBL students are placed for clinical learning. A questionnaire was used to obtain data from respondents who were conveniently recruited. Model development, concept analysis, construction of relationships, description and evaluation were followed. RESULTS: This model has six elements: higher education and nursing education (context), institutions initiating PBL, clinical services, colleges affiliated to PBL universities, students and healthcare users (recipients), champions in PBL (agents), effective implementation of PBL (terminus), collaboration (process) and commitment, communication, trust and respect (dynamics). CONCLUSION: Collaboration in implementing PBL can be a functional reality in the delivery of quality educational experiences and has far-reaching implications for the institutions and students. The implementation of the model in South African nursing education institutions may be necessary for the light of the revision of the preregistration qualifications. RECOMMENDATIONS: Managerial commitment, training of collaborators on PBL and collaboration skills, memorandum of agreement, monitoring and evaluation are critical. More research is required to pilot the model and evaluate collaboration in implementing PBL at different levels of operations.

Guidelines for support to mothers of sexually abused children in North-West province.

BACKGROUND: South Africa is reported to have the highest rate of sexual assault in the world with over 40% of cases occurring among children. Children who are sexually abused have support programmes and policies to assist them in coping, but there are no support programmes for mothers or caretakers. Caretakers need support for themselves and assisting them will incrementally benefit children under their care. Often mothers of these children experience shock, anger, disbelief and suffer secondary trauma such as depression and post-traumatic stress disorder (PTSD) following their children's sexual abuse disclosure and yet there are no guidelines for support to these mothers within North-West province (NWP)Objectives: The study seeks to develop guidelines for support to mothers of sexually abused children in NWP. METHODS: Concurrent convergence triangulation mixed method design was employed in this study. The population consisted of mothers of sexually abused children (SAC) (n = 17 participants for the qualitative component and n = 180 participants for the quantitative component). A sample of mothers of SAC was purposely selected. RESULTS: The participants indicated significant levels of depression because of lack of support by stakeholders. Guidelines for support to assist mothers cope with their secondary trauma were developed based on the literature review, study findings as well as an ecological model of the impact of sexual assault on women's mental health. The results also showed extreme PTSD (47.8%), little support (38.8%), not coping (76.1%) and depression (36.1%). CONCLUSION: The stakeholders should consider a positive approach to support mothers whose children are sexually abused.

A longitudinal study of the aftermath of rape among rural South African women.

OBJECTIVE: Sexual assaults against women are a global health crisis, with alarmingly high rates in South Africa. However, we know very little about the circumstances and the aftermath of these experiences. Further, there is limited information about how factors specific to the rape (e.g., fighting back) versus those that are specific to the individual-and potentially modifiable-influence mental health outcomes. This study examined how situational characteristics of rape as well as individual and situational factors confer risk for symptoms of depression, posttraumatic stress disorder (PTSD), and dysfunctional sexual behavior at 12-month follow-up. METHOD: Two hundred nine (N = 209) South African women were recruited from rural rape clinics in the Limpopo Province (LP) and North West Province (NWP) of South Africa. Interviews were conducted at baseline (within 6 months of the rape incident) and at 6 and 12 months by trained staff at the clinics in English or the women's native languages. Women were interviewed after services were provided in a private room. RESULTS: One hundred thirty-two (n = 132) women were lost to follow-up at 12 months, resulting in 77 women with interview data for all time points. Undermining by the survivor's social support system and an increased belief in myths about rape were associated with increased dysfunctional sexual practices and symptoms of depression. CONCLUSIONS: These findings demonstrate the need for interventions that address the most pervasive effects of rape over time. These behaviors can increase risks for revictimization and reduce psychological well-being in the aftermath of rape. (PsycINFO Database Record

Guidelines for support to mothers of sexually abused children in North-West province

Background: South Africa is reported to have the highest rate of sexual assault in the world with over 40% of cases occurring among children. Children who are sexually abused have support programmes and policies to assist them in coping, but there are no support programmes for mothers or caretakers. Caretakers need support for themselves and assisting them will incrementally benefit children under their care. Often mothers of these children experience shock, anger, disbelief and suffer secondary trauma such as depression and post-traumatic stress disorder (PTSD) following their children's sexual abuse disclosure and yet there are no guidelines for support to these mothers within North-West province (NWP)Objectives: The study seeks to develop guidelines for support to mothers of sexually abused children in NWP.Methods: Concurrent convergence triangulation mixed method design was employed in this study. The population consisted of mothers of sexually abused children (SAC) (n = 17 participants for the qualitative component and n = 180 participants for the quantitative component). A sample of mothers of SAC was purposely selected.Results: The participants indicated significant levels of depression because of lack of support by stakeholders. Guidelines for support to assist mothers cope with their secondary trauma were developed based on the literature review, study findings as well as an ecological model of the impact of sexual assault on women's mental health. The results also showed extreme PTSD (47.8%), little support (38.8%), not coping (76.1%) and depression (36.1%).Conclusion: The stakeholders should consider a positive approach to support mothers whose children are sexually abused

A model of collaboration for the implementation of problem-based learning in nursing education in South Africa

Background: The idea of collaboration between key stakeholders in nursing education for the implementation of problem-based learning (PBL) may have far-reaching implications for the institutions and students.Main objective: To develop a model of collaboration to facilitate the implementation of PBL in nursing education.Methodology: An exploratory sequential design was used. Qualitative data were collected from purposively recruited nurse educators from three universities in South Africa offering PBL and nurse managers from all the three hospitals in North West Province where PBL students are placed for clinical learning. A questionnaire was used to obtain data from respondents who were conveniently recruited. Model development, concept analysis, construction of relationships, description and evaluation were followed.Results: This model has six elements: higher education and nursing education (context), institutions initiating PBL, clinical services, colleges affiliated to PBL universities, students and healthcare users (recipients), champions in PBL (agents), effective implementation of PBL (terminus), collaboration (process) and commitment, communication, trust and respect (dynamics).Conclusion: Collaboration in implementing PBL can be a functional reality in the delivery of quality educational experiences and has far-reaching implications for the institutions and students. The implementation of the model in South African nursing education institutions may be necessary for the light of the revision of the preregistration qualifications.Recommendations: Managerial commitment, training of collaborators on PBL and collaboration skills, memorandum of agreement, monitoring and evaluation are critical. More research is required to pilot the model and evaluate collaboration in implementing PBL at different levels of operations

Experiences of patients having tuberculosis (TB) regarding the use of Directly Observed Treatment Short-Course (DOTS) in the North West Province, South Africa.

BACKGROUND: Tuberculosis (TB) management remains a major challenge despite the implementation of Directly Observed Treatment Short-Course (DOTS). Some of the challenges include defaulting treatment, low TB cure rates and relapse after patients had been treated under DOTS. OBJECTIVES: This study explored and described experiences of patients having TB regarding the use of DOTS in Doctor Ruth Segomotsi Mompati District of North West Province, South Africa. The study describes and recommends support required by patients having TB who are using DOTS. METHODS: A qualitative, exploratory, descriptive and contextual design was used. The population consisted of all patients having TB under DOTS who had taken treatment for 2 months and more in one of the community health centres in Doctor Ruth Segomotsi Mompati District. Purposive sampling technique was applied to select participants receiving DOTS service. In-depth unstructured individual interviews were conducted, and data saturation occurred after having interviewed 15 participants. Ethical considerations were ensured throughout the study, and data were analysed using Tesch's method of coding and analysis. RESULTS: Two themes emerged from data and these are discussed as concerns related to ineffective use of DOTS and lack of resources as contributory factor to ineffective use of DOTS. Among other categories, poor nurse-patient relationships and difficulties in accessing the community health centre emerged as consistent themes related to default and inconsistent use of DOTS. CONCLUSION: Ineffective use of DOTS contributed to TB treatment default and low cure rate. Therefore, recommendations focused on strengthening effective use of DOTS for the management of TB.

Concept analysis of collaboration in implementing problem-based learning in nursing education.

OBJECTIVES: The purpose of this concept analysis was to better understand and define collaboration as it relates to the implementation of problem-based learning (PBL). METHODS: The process of concept analysis was conducted in three phases; namely, theoretical or literature review, empirical or fieldwork; and analysis phases. Rodgers' evolutionary approach was used to clarify the attributes, antecedents, surrogate, related terms and consequences of collaboration in implementing PBL. The search key terms were 'collaboration', 'problem-based learning', 'nursing' and 'nursing education'. The search was performed in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and PsycINFO databases. The articles were reviewed for trends that would reflect the current knowledge for collaboration as a concept. Descriptive qualitative study was used to collect data purposively from participants of three universities offering PBL in Republic of South Africa and three hospitals where PBL students are placed. RESULTS: Collaboration in implementing PBL is described as using the following terms: interpersonal, interactive and personal process, shared goal and governance. The antecedents of collaboration include commitment and support; common goal; formal agreement; training and development; and monitoring and evaluation of tools and mechanisms. Consequences of collaboration in implementing PBL are as follows: information, resource and expertise sharing; personal development and mentoring; creation of supportive and nurturing environment; professional socialisation; improved students' outcomes; and effective utilisation of resources. CONCLUSION: Effective collaboration within nursing education and with other healthcare professionals to achieve quality outcomes in an increasingly interdependent higher education system continues to grow in importance.

Experiences of mothers of sexually abused children in North-West province, post disclosure.

BACKGROUND: Sexual violence against children is increasing at an alarming rate in South Africa. In 2010 the South African Police Service (SAPS) reported 21 538 rape cases of children under 18 years. In the North-West province (NWP) 5039 incidents of rape cases were reported in 2009. Mothers often experience emotional pain following child sexual abuse disclosure. It is seldom acknowledged that these mothers experience trauma and need support, post disclosure. The researcher has no known evidence of research conducted on the experiences of these mothers in NWP. OBJECTIVE: The objective of the study was to explore and describe the experiences of mothers of sexually abused children post disclosure of the abuse. METHOD: The research design was qualitative, exploratory, descriptive and contextual. Purposive sampling was used to select mothers of sexually abused children aged 23 to 59 years whose children ranged from 0 to 16 years. Permission to conduct the study was sought from the Provincial Department of Health and informed consent was obtained from the mothers. Interviews were conducted with a sample of n = 17 until data saturation. Data were collected through in-depth interviews using a voice recorder and field notes to enhance triangulation. Tesch's method of open coding was used to analyse data. RESULTS: Findings indicated that mothers experienced emotional pain post sexual abuse. They expressed shock, anger and guilt for not noticing the abuse. They showed significant depression as a result of lack of support by stakeholders. CONCLUSION: Mothers experienced secondary trauma that poses social and psychological challenges with far-reaching implications.

Knowledge and uptake of occupational post-exposure prophylaxis amongst nurses caring for people living with HIV.

BACKGROUND: Nurses caring for people living with HIV (PLWH) are at higher risk of exposure to the human immunodeficiency virus (HIV) by needle sticks, cuts, getting body fluids in their eyes or mouth and skin when bruised or affected by dermatitis. OBJECTIVES: To determine knowledge, insight and uptake of occupational post-exposure prophylaxis (OPEP) amongst nurses caring for PLWH. METHOD: A cross-sectional descriptive design was used in this study. Stratified random sampling was used to sample 240 nurses. The study was conducted in a regional hospital in Limpopo province. Both parametric and non-parametric statistics were employed to analyse data. RESULTS: A total of 233 nurses participated in the study. Sixty per cent (n = 138) of all nurses had a situation at work when they thought that they were infected by HIV and 100 (43%) nurses had experienced the situation once or more in the past 12 month. Approximately 40% did not know what PEP (post-exposure prophylaxis) is, and 22% did not know or were not sure if it was available in the hospital. Only few participants (n = 68, 29%) had sought PEP and most (n = 37, 54%) of them did not receive PEP when they needed it. There was a significant association between the knowledge and availability of PEP (r = 0.622). CONCLUSION: The study recommend an urgent need for policy makers in the health sector to put in place policies, guidelines and programmes that will rapidly scale up PEP services in health care settings, so that preventable occupationally acquired HIV infection can be minimised amongst nurses.

Level of job satisfaction amongst nurses in the North-West Province, South Africa: Post occupational specific dispensation.

BACKGROUND: Job satisfaction and burnout have been recurring problems amongst nurses in the Republic of South Africa (RSA). As a result, nurses are still leaving the rural public sector in search of lucrative work at the urban and private sectors and in developed countries. Accordingly, Occupational Specific Dispensation (OSD) was introduced as a strategy to ircumvent the problem. However, since the implementation of OSD in 2007, there have been no studies conducted regarding the level of job satisfaction amongst nurses after the implementation of OSD in the North-West Province, especially because each province has its own challenges that are unique to the area. OBJECTIVES: The study had two objectives: to describe the level of job satisfaction amongstprofessional and other category nurses (OCNs) at a public hospital in the North-West Provinceand describe the perceptions of nurses about OSD and their intention to continue working inthe hospital. METHOD: A quantitative descriptive cross-sectional design was used. Stratified random sampling was used to select a sample of 92 professional nurses (PNs), 90 enrolled nurses and enrolled nursing assistants (Nursing Act 2005), which made a total of 182 participants. For the purpose of the study, the enrolled nurses and enrolled nursing assistants were referred to as OCNs. Data were collected using the Minnesota Satisfaction Questionnaire-short form and OSD statements and analysed with Statistical Package for Social Science (SPSS, version 18). RESULTS: The majority of PNs (79.3%, n = 73) and OCNs (86.7%, n = 77) were dissatisfied with the working conditions and salary: PNs (80.4%, n = 74) and OCNs (87.8%, n = 79). The nurses mostly discredited the current state of the OSD implementation. Majority of the PNs (84%, n = 77) and OCNs (91%, n = 82) disagreed with the statement that 'level of job satisfaction has improved after the implementation of OSD'. CONCLUSIONS: The National Department of Health should consider a holistic approach to address all work-related conditions for nurses in order to curb the attrition rates. Policy makers and unions should urgently review OSD for all categories of nurses.

Experiences of women who reported sexual assault at a provincial hospital, South Africa.

BACKGROUND: Sexual assault poses a serious health problem to both the survivor and the health system. Experiencing sexual assault requires women to seek medical and psychological assistance as part of their journey towards recovery. This study examined the experiences of women who received post-sexual assault services from a specialised care centre within a provincial hospital. METHODS: A qualitative, exploratory and contextual design was used to explore and describe experiences of women. Data were obtained through individual in-depth interviews from a total of 18 women aged between 18 and 55 years. Interviews were supplemented by the researcher's field notes and audiotape recordings. RESULTS: Findings yielded two main themes: Women expressed their lived experiences of sexual assault characterised by different forms of trauma. The second theme was an expression of a need for safety and support. CONCLUSION: Women who experience sexual assault are left with devastating effects such as physical and psychological harm and social victimisation. There is also a need for safety and support towards the recovery of these women. This study recommends that professional practitioners involved in the management of sexual assault be sensitised regarding the ordeal experienced by women and stop perceiving survivors as crime scene 'clients' from whom only medico-legal evidence has to be collected. Professional practitioners and family members must be supportive, non-judgemental and considerate of the dignity of survivors. The establishment of sexual assault response teams (SART) is also recommended. There should also be inter-professional education for better coordination of services rendered to sexually assaulted women.

Comparison of Trauma on Survivors of Sexual Assault and Intimate Partner Violence in Limpopo

Background: Gender-based violence is a challenge in South Africa; despite available interventions. Caring for the survivors of both forms of violence is critical for ensuring their speedy recovery. Objectives: To compare the effects of trauma on female survivors of sexual assault versus those experienced by survivors of physical assault by their intimate partners.Method: A quantitative cross-sectional comparative study design was used to compare 30 sexually-assaulted women and 30 physically-assaulted women regarding depressive symptoms; posttraumatic stress disorder and coping styles three months after the incident. Semi-structured interviews were conducted with the survivors of both types of assault and the Beck Depression Inventory posttraumatic stress disorder checklist and Brief COPE Inventory were administered in order to obtain quantitative data. Both parametric and non-parametric statistics were employed. Ethical measures were adhered to throughout the research process.Results: A significantly-higher proportion of sexually-assaulted women disclosed the incident to family (p = 0.021). The majority of sexually- (90) and physically- (86) assaulted women were likely to recall the incident. Sexually-assaulted women had a significantly-higher mean for avoidance/numbness (p 0.001) and physical-assaulted women in arousal (p 0.051). About 41 of sexually-assaulted participants reported severe depression. Findings confirmed that sexual assault is more personal whilst physical assault is more interpersonal. If physically-assaulted women were removed from the perpetrators they recovered faster than sexually-assaulted women. Their stay with the perpetrators may perpetuate the violence.Conclusion: The need for counselling and support for the survivors of both traumas was recommended. All stakeholders should be educated to provide support to survivors of both traumas

Family experiences of home caring for patients with HIV/AIDs in rural Limpopo Province, South Africa.

The increasing rate of patients with HIV/AIDS brings a burden to the already weakened health care delivery systems in Limpopo Province, South Africa. Hospitals alone cannot deal with the needs of AIDS patients effectively; the patients are discharged to be cared for at home. A qualitative study was conducted to explore and describe the experiences of the family members that are caring for patients with HIV/AIDS at home. Interviews were conducted with 12 participants who were purposively selected as the caregivers of patients suffering from AIDS at home. Ethical measures were adhered to for the protection of the participants. The findings revealed that the family members experience negative feelings, characterized by sadness, pain, anger, depression, and frustration, as they care for their loved one within the context of extreme poverty. Quality care was compromised in situations where basic resources were not available. Guidelines to assist families in caring for their loved one with HIV/AIDS at home were developed.