Prof. Jennifer Chipps (School of Nursing)

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https://hdl.handle.net/10566/1657

Prof. Jennifer Chipps
Position:	Associate Professor
Department:	School of Nursing
Faculty:	Faculty of Community and Health Sciences
Qualifications:	BSc Nursing Hon (WITS, South Africa)
	BSc Psychology Hon (UNISA, South Africa)
	Grad Dip Nursing Administration (WITS, South Africa)
	Grad Dip Nursing Education (WITS, South Africa)
	Masters in Public Health (UNSW, Australia)
	Grad Dip Applied Epidemiology (VETAB, Australia)
	PhD (Telemedicine) (UKZN, South Africa)
	My publications in this repository
Tel:	+27 21 959 3923
Fax:	+27 21 959 2679
Email:	jchipps@uwc.ac.za

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Now showing 1 - 20 of 36

Admission rates as an indicator of the prevalence of severe asthma in the community
(Wiley, 1998) Jalaludin, Bin; Chey, Tien; Holmwood, Marvin; Chipps, Jennifer; Hanson, Ralph; Corbett, Stephen; Leeder, Stephen
BACKGROUND: A reliable indicator of the prevalence of severe asthma in the community is needed to monitor population-based asthma control strategies. We examined the potential use of asthma admissions to hospital as such an indicator. METHODS: We recruited subjects from the Emergency Department (ED) of a children's hospital. The attending doctor completed the 'physician questionnaire' which included questions on the patient's asthma severity and interval severity/chronicity of asthma. The parent/guardian completed the 'parent questionnaire'. It included questions on demography, asthma knowledge and attitudes, asthma history and social support. We performed univariate and multiple logistic regression to determine predictors for hospital admission. RESULTS: Interval severity of asthma, pre-treatment severity of wheeze and low post-treatment pulse oximetry best predicted whether children presenting with asthma were admitted. Demographic variables, factors associated with access to health services and factors related to the asthma history and management were not significant predictors of admission. DISCUSSION: At the population level, it may be possible to utilise routine hospital admission rates as an indicator of the prevalence of severe asthma in the community, especially within the context of monitoring trends in asthma prevalence. Our study was conducted in a metropolitan tertiary paediatric hospital. The reliability of hospital admission rates as indicators of the prevalence of severe asthma in other hospital settings, in different population groups and over time remains to be established.
Depression in older adults: prevalence and risk factors in a primary health care sample
(MedPharm Publications, NISC (Pty) Ltd and Informa UK Limited, 2017) Padayachey, U.; Ramlall, Suvira; Chipps, Jennifer
BACKGROUND: Depression in the geriatric population has been identified as a significant problem in view of the associated negative outcomes regarding poor functioning, increased perception of poor health and increased utilisation of medical services. Significantly associated with increased morbidity and mortality, depression has been found to be an independent cause of disability as well as adding to disability due to primary physical illnesses. Early identification and treatment of depression reduces medical costs and lessens caregiver burden. Epidemiological data and prevalence rates of geriatric depression in Africa are limited, although such data are vital to mobilise and plan government mental health initiatives aimed at screening and early intervention. OBJECTIVE: To determine the prevalence of depression and associated clinical and socio-demographic factors amongst older adult patients attending a primary health care clinic in the Ethekwini District in Kwa-Zulu Natal, South Africa. METHODS: The 15-item Geriatric Depression Scale and a socio-demographic questionnaire were administered in English to 255 geriatric outpatients, randomly selected, at a local community clinic in Durban. DATA ANALYSIS: Data were analysed using SPSS version 23®. Descriptive statistics were used to summarise the sample demographics and response rate and non-parametric statistics were used to test for associations and differences. RESULTS: A Cronbach’s alpha for the GDS was calculated (p = 0.793). Some 40% of participants screened positive for depression. Female gender, widowhood and a negative subjective health status rating were significantly associated with depression and marriage appeared to be protective (p < 0.001). Participants with a poor subjective health rating were 21 times more likely to be depressed and widowhood conferred an almost fourfold increased risk of being depressed, with widows at greater risk than widowers. No association between depression and specific medical conditions was identified. CONCLUSION: There is a high rate of undetected depression among the elderly attending a local primary health care clinic with widowhood and poor subjective health being strong predictors of mood disorders. The findings warrant replication in bigger samples.
Developing telepsychiatry services in KwaZulu-Natal - an action research study
(OMICS Publishing Group, 2012) Chipps, Jennifer; Ramlall, Suvira; Madigoe, Thebe; King, Howard; Mars, Maurice
OBJECTIVE: In 2009, the Departments of Psychiatry and Telehealth of the University of KwaZulu-Natal (UKZN) initiated a three year project to develop telepsychiatry services in KwaZulu-Natal. This paper describes the challenges and opportunities of this project. METHOD:This was a collaborative, in situ health service project and an action research framework was adopted. Over the three years, following a needs assessment and an e-health Readiness Assessment, two action research cycles were completed. Cycle 1: The preparation, implementation and evaluation of educational material, technical requirements and clinical guidelines and clinical support materials. Cycle 2: Preparation and evaluation of educational and clinical outreach sessions. RESULTS: Videoconference education sessions were beneficial to health staff without post-qualification psychiatry training. A flexible format for education improved knowledge outcomes. Clinical sessions are feasible, but require administration and technical support for facilitation. With facilitator training, 128Kbps is a suitable bandwidth for education but 384Kbps is preferred for clinical consultation. CONCLUSION: Telepsychiatry offers tremendous potential to facilitate the three strategies suggested by the World Psychiatric Association to address the treatment gap, save time and costs and improve access to the small pool of specialist psychiatrists in resource constrained environments.
Effectiveness and feasibility of telepsychiatry in resource constrained environments? A systematic review of the evidence
(OMICS Publishing Group, 2012) Chipps, Jennifer; Mars, Maurice
OBJECTIVE: A review of systematic reviews of the effectiveness and feasibility of videoconference-based telepsychiatry services for resource constrained environments was conducted. Specifically with the aim of producing an evidence-based review of the effectiveness and feasibility of videoconference-based telepsychiatry services in resource constrained countries like South Africa. METHODS: Eight key questions on telepsychiatry effectiveness and feasibility were identified and inclusion and exclusion criteria were developed. Review of citations from 2000-2011 from CINAHL, Medline, Pubmed, PsycInfo, EBSCOhost, SABINET, Cochrane Database of Systematic Reviews (CCTR), Cochrane Controlled Trial Registry (CCTR), Database of Abstracts of Reviews of Effectiveness (DARE), unpublished abstracts through NEXUS and internet search engines (Google/Google scholar) was conducted. RESULTS: Ten systematic reviews were included for review. Despite the methodological limitations and heterogeneity of the systematic reviews, there appears to be good evidence of effectiveness (reliability and improved outcomes) and feasibility (use, satisfaction, acceptability and cost) for videoconference-based telepsychiatry internationally. The application of this evidence in lower middle income countries is dependent on the integration of telepsychiatry into local health system contexts. CONCLUSION: Based on the evidence, resource constrained countries such as South Africa should be encouraged to develop telepsychiatry programs along with rigorous evaluation methods.
The effectiveness of cultural competence training for health professionals in community based rehabilitation: a systematic review of the literature.
(Wiley, 2008) Chipps, Jennifer; Brysiewicz, Petra; Simpson, Barbara
Aims: To find and review studies in which investigators evaluated cultural-competence training in community-based rehabilitation settings; critique study methods, describe clinical outcomes, and make recommendations for future research. Background: A review of the effectiveness of cultural-competence training for health professionals in community-based rehabilitation settings was conducted. Data Sources: Research citations from 1991–2006 in CINAHL, Medline, Pubmed, PsycInfo, SABINET, Cochrane, Google, NEXUS, and unpublished abstracts were searched. Methods: Searching, sifting, abstracting, and assessing quality of relevant studies by three reviewers. Studies were evaluated for sample, design, intervention, threats to validity, and outcomes. A meta-analysis was not conducted because the studies did not address the same research question. Results: Five studies and one systematic review were evaluated. Positive outcomes were reported for most training programs. Reviewed studies generally had small samples and poor design. Conclusions/Implications: The paucity of studies and lack of empirical precision in evaluating effectiveness necessitate future studies that are methodologically rigorous to allow confident recommendations for practice.
An evaluation of a multidisciplinary patient centred type 2 diabetes self-management education programme in Edo State, Nigeria
(UNISA Press, 2015) Afemikhe, Juliana A.; Chipps, Jennifer
Diabetes is on the increase globally, especially in African countries. Nigeria in particular has a high prevalence of diabetes type 2. There is evidence that improved type 2 diabetes outcomes are related to self-management and improved health education. The purpose of the research was to pretest whether a structured multidisciplinary patient centred self-management education programme for type 2 diabetes would improve selected primary and secondary diabetes outcome measures. The setting is diabetes outpatient clinics in one tertiary and one secondary health facility in Edo State, Nigeria. The study design is quasi-experimental, a two group before and after study. Two groups of participants (n=28) were selected using quota sampling from alternate day clinic attendances, 15 for the intervention group and 13 for the control group. A multidisciplinary patient centred diabetes self-management education programme was developed and implemented over 5 weeks in October 2014.
Fluid use in mountain bikers – self-reported practices.
(Health medical publishing group (HMPG), 2007) Rose, S; Chipps, Jennifer; Peters, E
BACKGROUND AND OBJECTIVES. Little is known of the fluid replacement habits of participants in mountain bike (MTB)endurance events. This survey set out to determine the current perceptions and practices of this group of endurance athletes. Method. Four hundred and twelve participants in the 3-day 2006 Sani2C (MTB) race completed questionnaires that elicited information regarding their regular fluid intake practices during competitive MTB endurance events. This included their general approach to fluid replacement, their fluid intake practices (type, amount and frequency), urine output and hydration status. RESULTS. While 70% (N = 290) reported that they based their fluid intake practices on personal past experiences, less than half the group (N = 177, 43%) were aware of official sport-specific guidelines. Although 86% (N = 354) reported making use of commercially available sport-specific drinks, consumption of water alone was reported by 34% of respondents (N = 140). The majority (N = 225, 55%) of the mountain bikers reported drinking every 16 - 30 minutes during an endurance ride, while 35% (N =144) reported drinking every 0 - 15 minutes. Fifty-three per cent (N = 182) of the male respondents and 45% (N= 23) of female respondents reported a routine intake of ≥ 750 ml per hour during endurance rides. This included 2 women who reported regular intakes of between 1 500 and 2 000 ml/hr. Only 7 (2%) reported receiving medical care for dehydration following their participation in previous MTB rides. CONCLUSIONS. This survey indicates that although more than half of the mountain bikers did not acknowledge specific awareness of the official fluid replacement guidelines, over 80% reported drinking regularly during a race, and 52% (N = 212) reported a usual intake of ≥ 750 ml/hr during endurance races. Until scientific studies have carefully examined the hydration status and fluid replacement needs of mountain bikers, MTB cyclists are cautioned against the practice of over-hydrating.
Global and diverse evidence: challenges in application to lower middle income countries
(2012) Chipps, Jennifer; Brysiewicz, Petra
Informal mobile learning in nurse education and practice in remote areas-a case study from rural South Africa
(Elsevier, 2014) Pimmer, Christoph; Brysiewicz, Petra; Linxen, Sebastian; Walters, Fiona; Chipps, Jennifer; Gröhbiel, Urs
BACKGROUND: With the proliferation of portable digital technology, mobile learning is becoming increasingly popular in nursing education and practice. Most of the research in this field has been concentrated on small-scale projects in high income countries. Very little is known about the ways in which nurses and midwives use mobile technology in remote and resource poor areas in informal learning contexts in low and middle income countries. OBJECTIVES: To address this gap, this study investigates whether nurses use mobile phones as effective educational tools in marginalized and remote areas, and if so, how and why. SETTING AND METHODS: In rural South Africa, 16 nurses who attended an advanced midwifery education program, facilitators and clinical managers were interviewed about their use of digital mobile technology for learning. Techniques of qualitative content analysis were used to examine the data. RESULTS: Several rich “organically-grown”, learning practices were identified: mobile phone usage facilitated (1) authentic problem solving; (2) reflective practice; (3) emotional support and belongingness; (4) the realization of unpredictable teaching situations; and (5) life-long learning. CONCLUSIONS: It is concluded that mobile phones, and the convergence of mobile phones and social media, in particular, change learning environments. In addition, these tools are suitable to connect learners and learning distributed in marginalized areas. Finally, a few suggestions are made about how these insights from informal settings can inform the development of more systematic mobile learning formats.
Mental health legislation: does it protect the rights of people with mental health problems?
(SU LIS, 2012) Simpson, Barbara; Chipps, Jennifer
The International Federation of Social Work places a concern with human rights and social justice at the core of its definition of social work. Social work values are based on “respect for the equality, dignity and worth of all people” (IFSW, 2000), and social work practice has a special concern for vulnerable and oppressed people. People with mental health problems are amongst the most vulnerable members of society and in South Africa they comprise a considerable proportion of our society. According to the South African Stress and Health Survey (Herman, Steyn, Seedat, Heeringa, Moonal & Williams, 2009), the lifetime prevalence for any mental health problems in South Africa is 30.3% and neuropsychiatric disorders rank third in their contribution to the burden of disease in South Africa (Bradshaw, Norman & Schneider, 2007).
The mental health outcomes and assessment training project: creating the foundations for improved quality of care
(CSIRO, 2002) Chipps, Jennifer; Raphael, Beverley; Coombs, Tim
The NSW Mental Health Outcomes and Assessment Tools Training Project (MH-OAT) is a collaborative and consumer-centred project that aims to strengthen the assessment skills of the mental health care workforce. MH-OAT does this through training that supports the introduction of a process of standard documentation of clinical practice along with measures of outcomes and potential ‘case mix’ (a method of describing the different types of patients treated by the health system, which recognises that different patients require different levels of resources.
Mild cognitive impairment and dementia in a heterogeneous elderly population: prevalence and risk profile
(OMICS Publishing Group, 2013) Ramlall, Suvira; Chipps, Jennifer; Pillay, Basil; Bhigjee, Ahmed
OBJECTIVE: To describe the demographic, clinical and risk profile of Mild Cognitive Impairment and dementia in a sample of elderly South Africans within a residential setting. METHOD: One hundred and forty participants residing in a group of residential homes for the elderly were assessed by psychiatrists and assigned diagnoses of dementia or Mild Cognitive Impairment (MCI). Participants diagnosed with dementia were also offered haematological investigations and a CT scan of the brain. RESULTS: The sample consisted of 140 participants comprising 46.4% White, 29.3% Coloured, 20% Asian and 4.3% Black participants. There were 97 (69.3%) females and 106 (75.7%) participants had less than 12 years of education. Eleven (7.9%) dementia and 38 (27.1%) MCI cases were diagnosed. Increasing age was associated with cognitive impairment (MCI and dementia) (p=.020) but there was no association between gender and cognitive impairment (p=.165). MCI was significantly associated with a lower education level (p=.036) and no association was found between depression (current-p=.646; past-p=.719) and dementia or MCI. The presence of vascular risk factors (n=140) ranged from 66.4% (hypertension) to 14.3% (stroke). Subjective memory complaints were significantly associated with cognitive impairment (p=.001). Except for the use of the telephone (p=.225) and the television (p=.08), impairment in all domains of instrumental activities of daily living that were assessed were significantly associated with a dementia diagnosis. CONCLUSION: The study showed that cognitive impairment was associated with increasing age and low education levels. The presence of vascular risk factors places this population at risk for future cognitive decline.
A Model for Telepsychiatry for South Africa
(2012) Chipps, Jennifer; Ramlall, Suvira; Mars, Maurice
The access of rural Mental Health Care Users in South Africa to specialist psychiatrists and quality mental health care is currently sub-optimal. Health professionals and planners working in psychiatry lack a well-defined and feasible outreach model to facilitate the delivery of services to remote and rural areas. In response to this challenge, a three-year action research telepsychiatry study was undertaken by the Departments of Psychiatry and TeleHealth at the University of KwaZulu-Natal, to develop a telepsychiatry outreach model based on local research and international evidence. The Model draws on needs and infrastructure assessments of the designated psychiatric hospitals in the province, a review of the published international evidence on telepsychiatry and videoconference-based education, and an evaluation of local clinical and educational telepsychiatry implementations in KwaZulu-Natal. The Model proposed is “virtual”, i.e. not bound to provincial or district referral patterns, aims not to add to the burden on the current workforce and is intended to be integrated into psychiatry outreach services and policy. The Model should be subjected to in situ testing for validation and implementation. It is hoped that an implementation of this Model will improve the access of Mental Health Care Users to specialist psychiatry care.
Practice guidelines for videoconference-based telepsychiatry in South Africa
(OMICS Publishing Group, 2012) Chipps, Jennifer; Ramlall, Suvira; Mars, Maurice
Telepsychiatry, the practice of psychiatry over distance using information and communication technologies is, after teleradiology, the most practiced form of telemedicine in the world. As with any new technology, clinical service, or intervention in medicine, it is prudent to have guidelines for the safe and efficacious use of the technology in clinical practice. Guidelines facilitate best practice and provide both clinicians and patients with a set of standards and procedures that serve to protect their interests. Protection is particularly important when dealing with vulnerable groups.
Readiness of health-care institutions in KwaZulu-Natal to implement telespsychiatry
(2012) Chipps, Jennifer; Mars, Maurice
We assessed the preparedness of health districts and designated hospitals in the KwaZulu-Natal (KZN) province for proposed telepsychiatry services. An e-health readiness questionnaire for developing countries was administered to managers of health districts and managers of designated psychiatric hospitals by telephone interview. Ten of the 11 district managers and managers/medical officers of 45 of 58 designated hospitals were interviewed. Notwithstanding some concerns regarding the tool, low levels of e-health readiness were found. District managers recorded e-health readiness scores of 137–217 out of 300. This was similar to the hospital managers, who recorded readiness scores of 121–260 out of 300. For telepsychiatry to succeed in KZN, an awareness programme will be required to facilitate the necessary change management.
Research in lower middle income countries – recommendations for a national mental health research agenda in South Africa.
(2012) Chipps, Jennifer; Ramlall, Suvira
In the current mental health environment in South Africa, the development of a relevant mental health research agenda poses several challenges. This paper provides a brief overview of the current state of published research in mental health and, using a translation research framework, makes recommendations for five strategic directions to be considered in the development to be considered in the development of a national mental health research agenda.
Resource tiered reviews – a provisional reporting checklist
(Elsevier, 2014) Van Hoving, D. J.; Chipps, Jennifer; Jaquet, G.
AFJEM is committed to publishing review articles that will benefit acute care providers, independent of the resources available to them. As a result we have compiled a checklist aimed specifically at best evidence in the resource-restricted setting (Table 1). The aim is to guide authors in producing a report which is a combination between a clinical guideline and a systematic review. Best available evidence, using a transparent and systematic approach to find and evaluate relevant studies, is still key; but with additional focus on resource availability. In effect it will be more rigorous than a narrative review but less time-consuming than a systematic review or meta-analysis. In order to apply the content to different resource levels, authors are advised to start by describing the very best evidence available; then assume the resources for this level are not available and describe the next tier of evidence until all options are exhausted. For example, if we return to our patient with chest pain: the recommended treatment for a patient with STEMI is primary percutaneous coronary intervention; if this treatment is not available, then thrombolytics should be considered; if that is not available then antiplatelet therapy and anticoagulation should be used, and so on and so forth.
Role analysis of the nurse/midwives in the health services in Sub-Saharan Africa.
(John Wiley & Sons, 2013) Uys, Leana; Chipps, Jennifer; Kohi, Thekla; Makoka, Dickson; Libetwa, Miriam
AIM : The aim of this paper is to describe the actual current roles and tasks of nurses in Sub- Saharan African health services. BACKGROUND: The current roles of nurses and midwives in the African region of the World Health Organization have not been empirically established, with only two country studies found (South Africa and Mozambique). This makes it difficult to establish whether current nursing education programmes and nursing regulations adequately address the needs in the health services. METHODS: This was a descriptive quantitative study using two survey questionnaires, a 120 task Hospital Questionnaire and a 153 Primary Health Care task questionnaire. Nurses from nine African countries (five Anglophone and four Francophone) completed a hospital or Primary Health Care task questionnaire - a total of 927 respondents from both hospital and Primary Health Care settings. Data was collected between June and December 2010. Results: The highest role functioning in both settings was found in the role “General Care”. The lowest role functioning in both settings was found in the role “Maternal and Child Health” and in “The Provision of Mental Health Care”. The role performance in Anglophone countries was significantly higher than in Francophone countries and this was also reflected in regional comparisons. CONCLUSION: The development of competency in nursing roles other than medical surgical roles (general assessment and care) should receive more attention in curricula. Special attention needs to be given to Francophone countries, where the professions of nursing and midwifery are poorly developed.
Screening a heterogeneous elderly South African population for cognitive impairment: the utility and performance of the Mini-Mental State Examination, Six Item Screener, Subjective Memory Rating Scale and Deterioration Cognitive Observee
(OMICS Publishing Group, 2013) Ramlall, Suvira; Chipps, Jennifer; Pillay, Basil; Bhigjee, Ahmed
OBJECTIVE: The aim of this study was to report on the prevalence of cognitive impairment, and to assess the performance and utility of subjective, objective and informant screening tools in a heterogeneous community sample. METHOD: A sample of 302 elderly participants (>60 years) living in residential homes in a large city in South Africa were screened for the presence of cognitive impairment using objective (Mini-Mental State Examination [MMSE] and Six Item Screener-[SIS]), subjective (Subjective Memory Complaint [SMC]and Subjective Memory Rating Scale [SMRS]) and informant (Deterioration Cognitive Observee [DECO]) screening tools. All tools were compared to the MMSE and the influence of demographic variables on the performance on these tools was considered. RESULTS: Significantly lower MMSE scores were found in participants aged 80-89 years (p=.023) and those who had 8-11 years of education (p=.002). For every one additional year of education, participants were 0.71 times less likely to screen positive on the MMSE. Differential item functioning on various components of the MMSE was demonstrated due to the effects of education, race and gender. There was significant differential performance between the recommended and alternate attention/concentration items (p<.001) with the alternate item favouring better performance. Based on the MMSE cutoff score of < 23, the prevalence of cognitive impairment was 16.9%; the prevalence yielded by the remaining tools ranged from 10.5% using the DECO to 46% as determined by the presence of a SMC. Using the MMSE as the reference standard for the presence of cognitive impairment, the SIS, SMC, SMRS and DECO had sensitivities of 82.3%, 54.6%, 17.0% and 37.5%, and specificities of 71.3%, 57.6%, 87.4% and 96.7% respectively. Age and race influenced performance on the MMSE, SIS and SMRS. CONCLUSION: Different types of cognitive screening tools yielded varying sensitivities and specificities for identifying cognitive impairment when compared to the MMSE. The influence of race, age and education on test performance highlights the need for suitable, culture-fair screening tools. Locally, the alternate item for attention/concentration should be preferred.
Sensitivity and specificity of neuropsychological tests for dementia and mild cognitive impairment in a sample of residential elderly in South Africa
(Health & Medical Publishing Group, 2014) Chipps, Jennifer; Ramlall, Suvira; Pillay, Basil; Bhigjee, Ahmed
BACKGROUND. Neuropsychological tests can successfully distinguish between healthy elderly persons and those with clinically significant cognitive impairment. Objectives. A battery of neuropsychological tests was evaluated for their discrimination validity of cognitive impairment in a group of elderly persons in Durban, South Africa. METHOD. A sample of 117 English-speaking participants of different race groups (9 with dementia, 30 with mild cognitive impairment (MCI) and 78 controls) from a group of residential homes for the elderly was administered a battery of 11 neuropsychological tests. Kruskal-Wallis independent sample tests were used to compare performance of tests in the groups. Sensitivity and specificity of the tests for dementia and MCI were determined using random operating curve (ROC) analysis. RESULTS. Most tests were able to discriminate between participants with dementia or MCI, and controls (p<0.05). Area under the curve (AUC) values for dementia v. non-dementia participants ranged from 0.519 for the digit span (forward) to 0.828 for the digit symbol (90 s), with 14 of the 29 test scores achieving significance (p<0.05). AUC values for MCI participants ranged from 0.754 for controlled oral word association test (COWAT) (Animal) to 0.507 for the Rey complex figure test copy, with 17 of the 29 scores achieving significance (p<0.05). CONCLUSION. Several measures from the neuropsychological battery had discrimination validity for the differential diagnosis of cognitive disturbances in the elderly. Further studies are needed to assess the effect of culture and language on the appropriateness of the tests for different populations.

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