The Graying of Rural America: Community Engagement and Health Promotion Challenges.

BACKGROUND: Although social participation has been linked to positive physical and mental health outcomes, elderly people in rural areas remain highly disengaged. Also, few studies have examined community residents' perceptions of the barriers and opportunities for the elderly to participate in community activities. PURPOSE: This article highlights the perceptions of rural community residents regarding their understanding of the following: (1) community leadership, (2) barriers and opportunities for the elderly to engage in leadership, and (3) potential community-based solutions for promoting more social participation. METHOD: Individual interviews were conducted with 16 community members. Content analysis was used to analyze the data. Researchers immersed and familiarized themselves with the data prior to developing codes. Coding was initially done manually and later using NVivo. FINDINGS: Four major themes emerged: conceptions of community leadership, elderly resource inventory, barriers to elderly engagement, and potential solutions. Themes collectively illustrated that residents have a clear understanding of the role of community leadership, of available resources for the elderly, and of the barriers encountered when using these resources. CONCLUSION: Our findings highlight a need for health promotion strategies that are informed by community needs and foster healthy lifestyles for all community residents.

Comparing nurse managers and nurses' perceptions of nurses' self-leadership during capacity building.

AIMS: This paper compares the perceptions of nurse managers and nurses about self-leadership of professional nurses while taking ownership of capacity building during unit management. BACKGROUND: The Nursing Strategy for South Africa states that the competency of nurses is dependent upon factors that lead to capacity building. METHOD: A quantitative design was followed by conducting a survey. The target population included nurse managers and professional nurses working at an academic public hospital in the Gauteng Province of South Africa. RESULTS: The findings indicate shortcomings in relation to advising professional nurses about self-direction while taking ownership of their daily pressures and stresses associated with unit management. CONCLUSION: Professional nurses should develop their confidence by focusing on their self-leadership strengths when managing a unit. IMPLICATIONS FOR NURSE MANAGERS: Recommendations are made to promote self-leadership while taking ownership of nurses during capacity building of unit management.

A conceptual framework for cost management training in the Limpopo Province of South Africa.

AIMS: This paper describes the perceptions of nurse managers about their dual role in nursing units as cost centres. BACKGROUND: The tertiary hospital in the Limpopo province is the first institution to appoint nurse managers with a dual role in cost centres. The development of a conceptual framework for a context-specific programme for Cost Centre Managers is the first of its nature in South Africa. METHOD: A qualitative, exploratory, descriptive design was followed. The target population included nurse managers (n = 35) formally appointed as cost centre managers with a dual role of delivering quality care and cost management. A focus group and individual interviews were conducted until data saturation occurred. RESULTS: Personal and professional distress, an empowering potential of being a cost centre manager, and the need for decentralized cost centre management were indicated as barriers for nurse managers that led to a framework for a context-specific training programme. CONCLUSION: There is a need for a context-specific training programme for cost centre managers in a hospital with cost centres. IMPLICATIONS FOR NURSING MANAGEMENT: The training of cost centre managers for their dual role in cost centres could enhance cost effectiveness, quality care and staff satisfaction.

Quality of antiretroviral therapy in public health facilities in Nigeria and perceptions of end users.

AIM: This paper describes perceptions of the end users on quality of antiretroviral therapy (ART) in public health facilities in Nigeria. BACKGROUND: Health care services in Nigeria face challenges of meeting end users' requirements and expectations for quality ART service provision. METHOD: A qualitative design was followed. Unstructured focus group discussions were conducted with end users (n = 64) in six locations across the six geopolitical zones of Nigeria. RESULTS: The findings indicate that end users were satisfied with uninterrupted antiretroviral drug supplies, courtesy treatment, volunteerism of support group members and quality counselling services. CONCLUSION: End users expect effective collaboration between healthcare providers and support group members, to enhance the quality of life of people living with HIV. IMPLICATIONS FOR NURSING MANAGEMENT: A best practice guideline for the provision of end user focused ART service provision was developed for nurse managers.

Male involvement in reproductive health: a management perspective.

AIMS: The present study outlines the perceptions of participants on male involvement in reproductive health (RH) from a management perspective. BACKGROUND: Namibia is one of the African countries affected by cultural and socio-economic influences that have persuaded gender roles in a way that hinders male-partner involvement in RH. METHOD: A qualitative, exploratory, descriptive design was followed. The target population included all male and female partners attending a health facility and all nurse managers (registered nurses in charge) that provided RH services in the health facility in a northern region in Namibia. Individual interviews were conducted until data saturation occurred. RESULTS: The results indicate that the management principles, policy and legislation, as well as resources to facilitate male involvement in RH, were indicated as barriers for nurse managers to facilitate male involvement. CONCLUSION: Male involvement in RH care is needed for an interpersonal and interactive partnership. IMPLICATIONS FOR NURSE MANAGERS: Recommendations are made to establish a partnership within the current health care framework in which reproductive health is provided.

Self-management guidelines for youth who have lost a family provider through HIV/AIDS.

Background: When parents die from HIV/AIDS-related causes, children often experience emotional instability and are given additional obligations, such as caring for siblings. Youths may react in a variety of ways, including increasing alcohol consumption, and their relationships with their siblings may be altered positively or negatively. Aim: The purpose of this article is to examine the lived experiences of youths in managing themselves after losing a family member to HIV/AIDS and suggest developed guidelines for nurses to advise youths on self-management after losing a family member to HIV/AIDS. Setting: Khayelitsha, Western Cape province, South Africa. Method: A descriptive phenomenological design for this study was followed. The researcher conducted 11 semi-structured interviews with participants. The study was conducted with participants that were youth aged between 18 and 25 years. Results: The study revealed that the death of a family provider can be difficult for the youth left behind to deal with the changes in their daily lives. Conclusion: The findings demonstrated that the death of a family member has a significant impact on the family. One of the more senior family members must assume charge and remain strong to help their siblings focus on the future. The death of a family member might result in a cascade of forced changes that necessitate new behaviours to maintain stability. Contribution: This study's context-based data focuses on how the Community Health Centre (CHC) may assist young people in managing themselves after a family provider has died from HIV/AIDS, using the developed guidelines.

Support measures for the next of kin who has experienced the unexpected loss of a family member to HIV/AIDS.

BACKGROUND: Passing of a close family member is one of the foremost traumatic occasions in a person's life. The way in which this misfortune unfolds, shifts from individual to individual, and depend on how close you were with the deceased. It was unclear on what were the support measures provided to youth after the loss a family member to HIV/AIDS. AIM: The aim of this article is to understand the support measures for the youth following the unexpected loss of a family member to HIV/AIDS. SETTING: Khayelitsha, Western Cape province, South Africa. METHOD: A descriptive phenomenological design was followed, with an accessible population of youth who lost a family member to HIV/AIDS. Individual semi-structured interviews were conducted with 11 purposively selected participants after obtaining written informed consent. The sessions held with an interview schedule, did not take longer than 45 minutes to conduct until data saturation was reached. A digital recorder was used and field notes held. Open coding followed after transcribing interviews. RESULTS: Youths did not know how to manage themselves as a result of a lack of therapeutic sessions, which could provide emotional support and help them with their healing process. CONCLUSION: Support measures for the next of kin were needed. Grieving influenced the emotions of an individual who experienced the burden of not having someone to speak to about their feelings. CONTRIBUTION: The context-based information in this study addresses the important of support measures to be provided or implemented for the next of kin after they had lost a family member.

A South African perspective: current position and challenges in health care service management and education in nursing.

AIM: The present study discusses the current context of South African nurse managers' working environment, exploring the challenges of disease demographics, service change and development, and educating a nursing workforce to meet healthcare delivery demands. BACKGROUND: Post-apartheid South Africa has a legacy of inequalities in access to healthcare; increasingly poor morbidity and mortality demographics; and inadequate numbers of qualified nurses to provide a service to meet the Millennium Development Goals outlined by the Government in 2010. EVALUATION: The present study discusses the current position and developments pertaining to nursing management relating to both healthcare challenges and educating a nursing workforce. KEY ISSUES: Collaborative action by various stakeholders in the development of nursing management will ensure a nursing workforce and service environment fit-for-purpose in delivering the healthcare outcomes envisaged in the transformed South Africa in the future. CONCLUSION: Different role players are involved in critical issues regarding the management and education of nursing in South Africa. Nurse managers are central to the success of service redesign, delivery and education. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to influence policy decisions regarding nursing service design and delivery, and the education required to prepare the next generation of practitioners for these new services.

Self-leadership of nurses in a critical care outreach service: The development of a conceptual framework.

Background: Globally, critical care outreach services (CCOS) were implemented in health care facilities; however, compliance with guidelines is poor. The authors have noticed that a gap exists in the literature on how self-leadership might influence nurses' implementation of CCOS. Self-leadership is about leadership applied to oneself. Critical care outreach services assist nurses with the nursing care of a patient whose health is declining. Leadership is needed for the successful implementation of CCOS. Aim: This article aims to outline the method the authors followed for developing the conceptual framework for how self-leadership amongst nurses influenced the functioning of CCOS. Setting: The research was conducted at a private hospital in Pretoria. Methods: A qualitative approach was followed to provide an accurate description of nurses' experiences on their self-leadership in a CCOS. The practice-oriented theory of Dickoff (1968) was the reasoning map for developing and constructing the conceptual framework. Results: Bedside nurses experienced the following self-leadership strategies: constructive thought patterns, natural rewards and behaviours focused on their implementation of CCOS. Conclusion: The conceptual framework was part of another study and provided the authors with a rationale that guided the authors with the development of self-leadership strategies in a CCOS. Contribution: The conceptual framework provided the authors with an understanding of how nurses' self-leadership influenced the implementation of CCOS. The conceptual framework can also assist in developing training programmes for nurses to improve their self-leadership and ultimately improve nurses' competence in providing quality nursing care to patients.

Self-management experiences of youth following the unexpected loss of a family member to HIV.

Background: Death of a close family member is one of the most traumatic events in a person's life. The way, in which this loss unfolds, varies from person to person and depends on how close you were with the deceased. It was unclear how youths experienced it to manage themselves during different stages of the bereavement process, after losing a near-family member to human immunodeficiency virus (HIV). Aim: The aim of this study was to understand the self-management of youth following the unexpected loss of a family member to HIV. Setting: Khayelitsha, Western Cape province, South Africa. Methods: A descriptive phenomenological design was followed, with an accessible population of youth who lost a family member to HIV. Individual semi-structured interviews were conducted with 11 purposively selected participants after obtaining written informed consent. The sessions, held with an interview schedule, did not take longer than 45 min to conduct until data saturation was reached. A digital recorder was used and field notes held. Open coding was followed after transcribing interviews. Results: Individuals had different experiences during different stages of the bereavement process, not necessarily similar or following the same sequence. Individuals had to manage their guilt of being unable to do more before the family member passed away, struggling to realise that they have a future purpose, and hardship having fond memories. Conclusion: Youth find it difficult to view death as a natural loss of life and to manage themselves after the loss of their loved one to HIV. Contribution: The context-based information in this study confirms the importance of youth and self-coping and self-continuation to plan, organise and direct their future after the loss of a family member.

Experiences of nurses practising mindfulness during self-leadership in delivering a rapid response system for general wards in a private hospital in Gauteng.

BACKGROUND:  The increased complexity of the nursing care needs of patients and acuity in general wards present nursing care challenges for nurses. Self-led nurses are attentive, taking responsibility for activating the rapid response service when a patient is starting to deteriorate. OBJECTIVES:  The purpose of this article is to describe nurses' experiences practising mindfulness during self-leadership in delivering a rapid response system (RRS) in a private hospital in Gauteng. METHOD:  A qualitative, exploratory, descriptive and contextual design was followed. Homogenous purposive sampling was used and a total of eight focus groups were conducted. Focus groups durations were between 45 min and 60 min. The data analysis was carried out through open coding on Atlas.ti using the noticing things, collecting things and thinking about things (NCT) approach. An independent coder met with the researcher during a consensus meeting and finalised the analysis. RESULTS:  The findings indicated an underlying theme of nurses being mindful in their self-leadership through the development of self-motivation and self-direction in the RRS. Three categories with six subcategories emerged from the data analysis, namely self-motivation in an RRS by the team, self-direction through role-modelling to peers and training. CONCLUSION:  Nurses practised mindfulness during self-leadership, utilising behavioural and natural reward approaches and constructive thought patterns. These findings could assist management with developing training programmes for nurses.

Implications for nurse managers arising from immigrant women's experience of midwifery care in a hospital.

AIM: This paper focuses on implications for nurse managers to support midwives in delivering nursing care to immigrant mothers in some government hospitals in Gauteng, South Africa. BACKGROUND: Immigration and poverty in Africa has led to midwives providing nursing care to immigrant mothers in a culturally sensitive environment. This necessitates an environment in which nurse managers should support midwives in caring for these mothers as unique individuals. METHOD: An exploratory, descriptive phenomenological design was followed. The target population included nine immigrant mothers living in the inner centre of Johannesburg who, for the first time, attended, had antenatal clinics, laboured and gave birth at a Government Hospital in the Gauteng province of South Africa. After purposive sampling, phenomenological interviews were conducted until data saturation occurred. RESULTS: The findings indicate that nurse managers should ensure that midwifery care of immigrant mothers comply with the ethical-legal context of the South African constitution. Actions should be taken in combating issues related to impaired maternal-midwife relationship, lack of cultural sensitivity and psychological distress. CONCLUSION: The delivery of maternity care to immigrant mothers is below the standard expected in the South African context. IMPLICATIONS FOR NURSING MANAGEMENT: The nurse manager should support midwives to ensure an environment to care for immigrant mothers in maternity wards.

Rural voices: A social-ecological perspective on factors influencing youth substance use in rural South africa.

BACKGROUND: Youth can be a positive force for development when provided with the knowledge and opportunities they need to thrive, yet they continue to experience insurmountable challenges, such as poverty and absentee fathers, that prompt them to resort to risk behaviours such as substance use. In rural South Africa, women tend to be the breadwinners and more involved with parenting than men. OBJECTIVE: The primary objective of the study was to explore perspectives of rural youth on factors influencing youth participation in substance use. The secondary objective was to obtain the perspectives of adult women on factors influencing substance use among young people. METHODS: The qualitative study, informed by a social-ecological framework, utilised a semi-structured interview protocol in focus group discussions in rural South Africa. Seven focus group discussions, each with between 8 and 15 individuals were conducted with 79 youth. The eighth discussion was with nine adult women. Data were audio recorded and transcribed verbatim, manually coded and further analysed into themes using NVivo 12. FINDINGS: Four themes emerged: hopelessness and lack of motivation, lack of adult role models such as father, lack of built environment for recreational activities and lack of educational opportunities. The social-ecological model provided a useful framework to understand the findings. In line with this model, rural youth in South Africa described a variety of factors that influenced youth substance use and other risk behaviours. These related to the individual, relationships with others, community and societal norms and values factors of the social-ecological model. CONCLUSIONS: The broadening spectrum of substances available to an increasing youth population bulge in Africa suggests a strong threat of social and disease burden due to substance use disorders. Given this threat, this study provides awareness to a multi-systems approach needed to support the rural South African youth.

Operational nurse managers' perceptions on the competence of community service nurses in public settings in the Western Cape.

BACKGROUND: Community service nurses placed in the Western Cape Government public health facilities render essential healthcare to underserved populations. Anecdotal evidence from operational nurse managers indicated concerns that community service nurses may lack competence in basic required nursing competencies. OBJECTIVES: To investigate operational nurse managers' perceptions of the competence of community service nurses in public health facilities in the Western Cape. METHOD: A quantitative survey was conducted with an all-inclusive sample of 297 operational nurse managers in the Western Cape. A self-administered questionnaire with 65 questions with a 4-point rating scale was used to rate perceived competence of community service nurses across the South African Nursing Council (SANC) competencies. Descriptive and inferential statistics were calculated per competency domain. RESULTS: The survey (response rate: 59%) showed that the operational nurse managers perceived the community service nurses to be competent in the clinical patient care domain and mostly either developing proficiency or proficient in the SANC competencies of legal framework and ethical practice, interprofessional relationships, leadership, quality management and management competency domains. CONCLUSION: Community service nurses were found to be competent in the clinical patient care, possibly because of the integration of theory and practice focus of work-integrated learning in the programme. Education and practice supportive strategies for community service nurses should be developed to support the successful transition from students to community service nurses, especially around the development of research and critical thinking skills.

A framework for recognition of prior learning within a Postgraduate Diploma of Nursing Management in South Africa.

AIMS: The present study focuses on the development of an initial framework to guide educators in nursing management in designing a portfolio for the recognition of prior learning for accreditation of competencies within a postgraduate diploma in South Africa. BACKGROUND: In South Africa, there is a unique educational need, arising from the legacy of apartheid and previous political regimes, to facilitate educational development in groups previously unable to access higher education. Awareness of the need for continuous professional development in nursing management practice and recognition of prior learning in the educational environment has presented the possibility of using one means to accomplish both aims. EVALUATION: Although the content of the present study is pertinent to staff development of nurse managers, it is primarily written for nurse educators in the field of nursing management. KEY ISSUES: The findings identify focus areas to be addressed in a recognition of prior learning portfolio to comply with the programme specific outcomes of Nursing Service Management. Further work to refine these focus areas to criteria that specify the level of performance required to demonstrate achievement is needed. CONCLUSION AND IMPLICATIONS FOR NURSE MANAGERS: Managers need to facilitate continuous professional development through portfolio compilation which acknowledges the learning opportunities within the workplace and can be used as recognition of prior learning.

A spotlight on the surfacing of self-management of employees with diabetes seen by professional nurses in selected occupational health clinics in Cape Town.

BACKGROUND: Diabetes is considered one of the largest global health challenges of this century and one of the top 10 causes of death across the world. Studies indicate an increased economic burden in relation to diabetes, not only on government revenue but also within private industries. Exploring the perceptions of employees with diabetes mellitus as related to their self-management practices could assist in encouraging behaviours that are associated with positive management outcomes. AIM: The purpose of this study was to explore and describe the perceptions of employees with diabetes mellitus, seen by professional nurses in selected occupational health clinics, about the self-management of their disease. METHODS: A qualitative, exploratory, descriptive contextual design was followed through 17 individual interviews with 17 employees working in various industries in Cape Town, using a semi-structured interview schedule. Open coding of the data followed, and four themes emerged. Measures to ensure trustworthiness were also adhered to in the study, and approval for the study was granted. RESULTS: The study findings gave insight into the manner in which employees perceived their behaviour changes in terms of their self-management practices. Various emotions were expressed by employees relating to the disease as well as the lifestyle adaptations required for self-management thereof. Employees noted that knowledge acquisition and greater understanding of the motivators for lifestyle changes could improve aspects of their day-to-day living as well as the disease outcomes. CONCLUSION: Employees expressed an awareness of the changes and lifestyle adaptations needed but found aspects thereof to be an ongoing challenge. The areas of challenge varied amongst employees. A consciousness of the possible consequences of poor self-management practices and self-modification behavior to address these was observed.

Perceptions of nurses on access to structural empowerment in a hospital in the Western Cape.

BACKGROUND: Structural empowerment is an ever-evolving concept interpreted and applied in many different ways as it focuses on the structures in a healthcare organisation to allow competent nurses to manage empowering opportunities in a professional manner. At a public hospital in the Western Cape, nurses complained about a lack of access to structural empowerment in a hospital, including structures of power, such as clear information, to partake in important decisions. OBJECTIVES: The purpose of this study was to describe how nurse managers could support nurses in accessing structural empowerment through power resources. METHOD: A quantitative design was followed with a survey. The accessible population in this study was different categories of nurses of professional, enrolled and assistant nurses (N = 200), which were on duty at the time of data gathering. The sample was selected by means of probability sampling (n = 110). An existing instrument based on a five-point Likert scale was distributed that took 45 minutes to complete. Descriptive and inferential statistics were calculated, and the chi-square was used to indicate statistical significance differences among the nursing categories on the items (p 0.05). RESULTS: The general results indicated that the majority of nurses had challenges to access structural empowerment through power sources (information, support and resources). Significant differences were found between nurse categories for having the necessary supplies for the job (p = 0.043) and rewards for unusual job performance (p = 0.023). Those aspects on which no significant differences were found are of utmost importance, as they indicate the urgency of addressing limitations in power sources for all categories of nurses. CONCLUSION: Empowerment can be achieved by enabling access to structural empowerment through power sources (i.e. opportunities, information, resources and support) at different levels for all categories of nurses.

Professionalism experiences of undergraduate learner nurses during their 4-year training programme at a Higher Education Institution in the Western Cape, South Africa.

BACKGROUND: Professional socialisation of student nurses needs to be integrated into the formal teaching and learning during the nursing programme. Embedded in the training programme are professional values that are used synonymously with nursing professionalism. Professionalism is the conduct, qualities, values, vision, mission and/or goals that characterise a profession, and describes behaviours that are expected within the profession's members. However, one's values are shaped by one's experiences, influence one's behaviour and interactions with others, and are manifested in many aspects of professional behaviour. New nurses to the profession are expected to display behaviours of professionalism, thus requiring nurse training schools to help students internalise these behaviours. Nurse educators therefore carry a responsibility to shape future nurses' growth towards professionalism. OBJECTIVES: This article reports on the experiences of undergraduate student nurses regarding nursing professionalism during their 4-year training programme at a Higher Education Institution in the Western Cape, South Africa. METHOD: A qualitative, exploratory and descriptive design was applied. Eight focus group discussions were conducted with first- to fourth-year student nurses registered for the undergraduate nursing programme. Data were transcribed verbatim and analysed using open coding. Ethical principles and trustworthiness were maintained throughout the study. RESULTS: Six main themes indicated that undergraduate student nurses experienced issues with role modelling, language barriers, their own understanding of professional behaviour, reasons for students and practitioners' unprofessional behaviour, prejudice towards degree students and students' professional or unprofessional behaviour experienced as contributing to the image of the profession. CONCLUSION: Student nurses received mixed messages leading to emotional turbulence. They needed clear guidance from role models to demonstrate how to behave professionally.

Experiences of undergraduate nursing students on an authentic mobile learning enactment at a higher education institution in South Africa.

BACKGROUND: Mobile technology has infiltrated our day to day existence through provision of inexhaustible access to communication and information. In education, mobile devices are not only used as tools to reinforce information, motivate and accentuate engagement, but it additionally enables the delivery of course content. The adoption of authentic technological innovations using the variety of distinguishing attributes available on mobile devices could potentially promote a mobile learning enactment. OBJECTIVE: The purpose of the study was to explore the experiences of undergraduate nursing students who participated in an authentic mobile learning enactment aimed at enhancing their learning experiences. DESIGN: This study used a qualitative contextual design. SETTING AND PARTICIPANTS: Undergraduate nursing students, of a School of Nursing in a Faculty of Community and Health Sciences at a university in South Africa, were the study participants. All students (n = 101) registered for the primary care and clinical skills module were invited to submit reflections based on their experiences on an authentic mobile learning enactment using WhatsApp Messenger. METHOD: Students submitted electronic reflections after every two-week cycle of the enactment. The data collected was categorised into emerging themes as analysed by the researcher guided by Tesch's (1990) systematic process. An independent coder reviewed the data and, through consensus, themes identified were confirmed. RESULTS: One hundred and one participants (n = 101; 100%) submitted online reflections on their experiences during the authentic mobile learning enactment. Seven themes were identified which included: mobile devices afforded a learning platform; mobile learning enactment enhanced engagement; learning within a group made learning easier; flexibility in time allocated to complete tasks; challenges experienced with data/airtime/Wi-Fi; impaired communication due to poor network access and use of mobile devices in practice perceived as unprofessional. CONCLUSION: The study provided valuable insights into students' experiences of the authentic mobile learning enactment, as well as suggesting ways to enhance the effectiveness of such an enactment.

Scars of disengagement: perspectives on community leadership and youth engagement in rural South Africa.

Given the emerging global youth disengagement epidemic, anticipated population growth, and the threat of continued rural-urban migration among young adults, recent research has focused on community leadership practice and the factors that influence youth engagement at the local level. Studying these practices and factors can elicit interventions that can improve youth engagement and youth health. This study engaged South African rural community leaders in interviews to collect perceptions and experiences on community leadership and factors that influence youth engagement and their health behaviors. Content analysis was used to analyze the data. Emergent themes are categorized into four domains: conceptualizations of leadership, current youth behaviors, barriers to youth engagement, and youth leadership opportunities and potential solutions. Findings demonstrate a clear grasp of the concept of community leadership among community leaders, and an awareness of the complex interplay of social, economic and environmental factors on youth disengagement and the potential interventions to promote more youth participation.