A report of a South African university's management of undergraduate nursing students' teaching and learning following the COVID-19 interruptions.

The coronavirus disease 2019 (COVID-19) pandemic exposed an absence of blueprints to avert an education disaster. In South Africa, in line with Alert Level-5, adhering to lockdown restrictions, higher education institutions (HEIs) closed, necessitating the transition to online teaching and learning. The HEIs, inclusive of the nursing discipline, needed to develop comprehensive plans and a rigorous follow-up scheme in order to ensure that faculty and students made proper use of virtual platforms and simultaneously met regulatory body requirements, thus ensuring that 'no student and faculty were left behind'. The responses varied from one HEI to another. The objective of this study was to present how a South African nursing education faculty managed teaching and learning following COVID-19-related interruptions. This included an HEI in KwaZulu-Natal, South Africa. Donabedian's tripartite model, comprising structure, process and outcome, provides the organising structure to present the faculty and university's approach to meet the desired outcome of saving the 2020 academic year. The Structures' and Processes' components of Donabedian's tripartite model influenced both intended and unintended outcomes. In 3 months, what might have been argued as impossible, a 4-year undergraduate nursing programme was transitioned from a traditional approach to fully virtual remote teaching and learning. Thus, the 2020 academic year was saved. Contribution: This article offers guidance to HEIs on how to continue teaching and learning in contexts where education is interrupted.

Distanced behind the mask: The use of non-verbal communication when counselling the elderly during the COVID-19 pandemic.

The stressors caused by the coronavirus disease 2019 (COVID-19) pandemic have influenced both the physical and the mental health of the elderly, increasing their vulnerability. Counselling by the mental healthcare nurse is a critical protective factor in mitigating the mental health effects of COVID-19. However, counselling is unintentionally interrupted by the effects of the mask as a barrier to non-verbal communication. This commentary aims at conscientisation of mental healthcare nursing practice interruptions to non-verbal communication, brought upon by the pandemic. Practice recommendations focus on mask-wearing becoming less of a stressor to offset the challenges experienced by both the elderly and the mental healthcare nurses. CONTRIBUTION: The authors conclude that a need exists to revisit the fundamentals of counselling, and show initiative to addressing the practice challenges created by the wearing of masks yet simultaneously contribute to #flatten_the_mental_illness_curve.

Newly qualified midwives' perceptions of their level of midwifery clinical competence during community service in KwaZulu-Natal, South Africa.

BACKGROUND: There are links between the inadequate numbers of competent midwives and high maternal mortality ratios and neonatal mortality rates which highlights the significance of job-ready, newly qualified midwives who can display clinical competence. The South African Nursing Council regulated mandatory community service, as a supportive year to develop clinical competence. AIM: To explore and describe newly qualified midwives' perceived level of midwifery clinical competence during community service. SETTING: Both the event of the pandemic and the distribution of the potential participants across various geographical settings necessitated planning for data collection in real and online settings convenient to them. METHOD: Non-probability purposive sampling was utilized to select and invite the post community service, newly qualified midwives (N = 65), of the select university, who underwent community service in 2018 and experienced exposure to maternity care settings in the eThekwini District (n = 23). Data were collected through five focus groups and analysed through Elo and Kyngas' content analysis. RESULTS: Three categories emerged: transitioning from the sheltered education environment to the real practice world, support in practice: disparate realities and interception of mentorship. Six subcategories accompanied the categories. CONCLUSION: Newly qualified midwives' clinical confidence and competence transitioning from the safe academic environment to the authentic accountable clinical setting hinges on mentorship and welcoming, non-stigmatising supportive relationships that facilitate the integration of previous learnings into community service practice. CONTRIBUTION: The study allows for audibility and awareness of the transitioning midwives' perceptions highlighting the significance to maternity staff and policy makers, of supportive relationships and structures.

Stress and coping - Perceptions of final year nursing students returning to clinical practice during the COVID-19 pandemic, South Africa.

BACKGROUND: The novel nature of the coronavirus disease 2019 (COVID-19) pandemic places challenges on nursing students as they try to complete the clinical requirement of their training. Nursing faculties need to understand these challenges to support and equip nursing students to enter the workforce. AIM: To explore and describe the anticipated and subsequent perceptions of final year Bachelor of Nursing students returning to clinical practice during the COVID-19 pandemic in South Africa. SETTING: The study was conducted at two universities in the Western Cape and KwaZulu-Natal, South Africa. Both universities offer 4-year Bachelor of Nursing programmes accredited by the South African Nursing Council and were in 'hot spot areas' for SARS-CoV-2. METHODS: A qualitative study with focus groups discussions of final year undergraduate nursing students from both universities were conducted. Data were analysed through content analysis using Lazarus and Folkman's Stress Appraisal Coping Model. RESULTS: Five focus groups discussions with a total of 25 participants were conducted. Three themes with eight sub-themes emerged, the key themes being: primary appraisal and anticipation of returning to clinical practice; contextual influence on primary appraisal and reappraisal to facilitate positive return to clinical practice. CONCLUSION: Primary perceptions of returning to clinical practice revolved around uncertainty and stress. However, through preparation and the process of reappraisal, participants were able to adapt and cope with the challenges in returning to clinical practice during the pandemic. CONTRIBUTION: It is important to recognise the role of faculty in supporting nursing students' transition into situations of uncertainty such as the pandemic.

Midwives' perceived role in up referral of high-risk pregnancies in primary healthcare settings, eThekwini district, South Africa.

BACKGROUND: South African maternal and neonatal mortality rates remain unnecessarily high, which are considered avoidable through timeous identification, treatment and referral. An efficient referral process of high-risk pregnant women is dependent on the midwives' ability to respond with relevance to the maternal and neonatal healthcare needs. The attainment of improved maternal and neonatal outcomes commences at the primary healthcare level, with the midwife, recognised as the first person responsible and accountable for pregnant women's healthcare. AIM: To explore midwives' perceptions of their role in the referral of high-risk pregnant women from primary health care clinics to expert-centred sites. METHODS: A qualitative, exploratory, descriptive in nature approach, underpinned by a social constructivism paradigm, guided the methodology. Purposive sampling was used to select both the primary health care clinics in the feeder zone and the registered midwives working in these clinics. Data were collected through four focus group discussions and analysed using content analysis. The principles of trustworthiness were observed. SETTING: Department of Health primary health care clinics in the eThekwini district, South Africa. RESULTS: The midwives understood their role in the up referral of high-risk pregnant women but experienced many interruptions in its execution. Four categories emerged from the data, namely, enhanced by team support in the clinics, restrictions in transfer to expert-centred sites, impeding social determinants and midwifery competence facilitates referral process. CONCLUSION: Global initiatives cannot guarantee maternal and neonatal health because of the challenges experienced by the midwives in the execution of their roles as they interface with the healthcare team.