Research Articles (School of Nursing)

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Suicide mortality in NSW: clients of mental health services.
(CSIRO, 1995) Chipps, Jennifer; Stewart, Gavin; Sayer, Geoffrey
This article examines suicide by clients of mental health services in NSW. Since April1992 the Mental Health Branch of the NSW Health Department has operated an incident monitoring system which requires all public mental health services in NSW to report unexpected deaths, including suicides, of current or former clients. Part I of this article describes the information collected through this monitoring system, and Part II estimates mental health service clients' risk of suicide, compared with that of the NSW population.
Suicide mortality in NSW: geographic variation.
(CSIRO, 1995) Stewart, Gavin; Chipps, Jennifer; Sayer, Geoffrey
This is the first of a series of articles on the epidemiology of suicide in NSW. We examine pooled suicide mortality data for Area and District Health Services from the time of the introduction of the ICD9-CM cause of death coding in 1979 to the most current complete year for which death data are available (1992).
Suicide attempts in NSW: associated mortality and morbidity.
(CSIRO, 1996) Sayer, Geoffrey; Stewart, Gavin; Chipps, Jennifer
This article is the fifth in a series on suicide in New South Wales by the Mental Health Epidemiology Group. Its aim is to provide a quantitative account of suicide attempts and the associated mortality and morbidity in NSW during 1992 (the most recent year for which data were available) as context for consideration of the overall problem of suicide in NSW.
Suicide mortality in NSW: an introduction to clinical audits.
(CSIRO, 1996) Stewart, Gavin; Chipps, Jennifer; Sayer, Geoffrey
This article is an introduction to the use of clinical audit to identify possible preventive approaches to suicide. We examine the ethical issues, techniques and feasibility of this method for collecting information on suicides. A more detailed report on the practicalities of clinical audit is being prepared3. For more than three decades psychological autopsies and modified psychological autopsies have been employed worldwide to study risk factors for suicide. The term psychological autopsy most commonly refers to interviews with family and friends of the victim to reconstruct the circumstances of the suicide'. Sometimes the term is limited to the determination of the mental state of the individual, and at other times the modified psychological autopsy or clinical audit includes all the investigations relevant to the suicide, including the review of medical records and the physical autopsy4. Clinical audit in this article encompasses both the psychological autopsy and the physical autopsy, and any other relevant investigations. We prefer to use the term clinical audit to stress that interviewing bereaved people requires clinical skills and because attention should be given to the potential role clinical services may play in prevention.
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.
Suicide in New South Wales: the NSW suicide data report.
(CSIRO, 2001) Ansari, Guncha; Chipps, Jennifer; Stewart, Gavin
The NSW Suicide Prevention Strategy has identified suicide prevention as a high priority for government and the community. Death by suicide is a relatively uncommon event; however, more people in NSW now die from suicide than road injury. Nationally, two per cent of all deaths were attributed to suicide in 1998. This article describes the Suicide in New South Wales—The NSW Suicide Data Report, which has been developed and produced by the Centre for Mental Health, and presents improved information on suicide, hospitalisation following attempted suicide, and risk of suicide, both at a state and an area health service level.
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.
What is it that matters most in the practice of nursing children?
(Pub med, 2003) Coetzee, M
This article discusses the results of a workshop designed as an action research cycle to ascertain what matters most in the practice of nursing children in South Africa today. The workshop was convened at the University of Cape Town (UCT), in order to guide and direct the newly established post- basic, children’s nursing pathway in the Bachelor of Nursing for Registered nurses [BN(RN)] programme. The participants were eight experienced paediatric nurses, currently practising in a variety of settings in the Western Cape. The results show that the participants move from their original task- and procedure - based perspective to a more processive one in which the focus of the learning is relational, emphasising the family and culture of the child.
Service-learning in nursing: Integrating student learning and community-based service experience through reflective practice
(University of Johannesburg, 2005) Julie, Hester; Daniels, Priscilla; Adonis, Tracy-Ann;
Domestic violence is a pervasive problem in South Africa. The School of Nursing at the University of the Western Cape has responded to the challenge of training sensitive, knowledgeable and skilled health personnel by developing a Management of Gender-Based Violence (GBV) module. The purpose of this paper is to describe the professional and personal development of nursing students in this programme through their service-learning experience in the GBV module based on the analysis of the description of the students’ reflective journals, group project reports and a focus-group discussion as the primary data sources. Analysis showed that students gained critical thinking skills and developed an understanding of the supportive role health professionals can play through developing skills of caring, advocacy and a commitment to civic engagement, which promotes collaborative relationships. Some of the lessons learnt from this experience include realistic planning in terms of outcomes, time frames, and available resources as well ensuring support from colleagues for the effective implementation of the programme.
A descriptive study to evaluate the effect of guidelines used by counsellors to improve adherence to antiretroviral therapy in the private sector
(University of the Western Cape, 2006) Marais, Melanie; Nikodem, Cheryl
INTRODUCTION: To achieve a virological outcome to antiretroviral therapy, a high adherence level is required. OBJECTIVE: To implement and evaluate guidelines that will be used by treatment support counsellors in an attempt to increase client adherence to antiretroviral treatment. METHODS: A quasi - experimental comparative study was used to assess whether a structured treatment support guidelines can improve client adherence to antiretroviral therapy. The treatment outcome of two groups was compared: one group received the adherence guidelines and the other group was a historical group where no adherence guidelines were applied. The main outcome measure was whether adherence guidelines improved adherence to ART. PARTICIPANTS: Forty clients were exposed to the adherence guidelines and 34 were not. SETTING: Clients that subscribe to Aids for Aids . Intervention: A structured guideline used by counsellors with regular contact. RESULTS: Specific guidelines used by counsellors to improve adherence to antiretroviral therapy has shown that significantly more clients in the intervention group had their CD4 blood tests done after six months and adhered to regularly claim their medications. In addition were there more clients in the intervention group who had viral loads of less than 400 copies I ml after six months. CONCLUSION: Specific counselling using effective guidelines improve adherence to antiretroviral treatment.
Managing cultural diversity in the classroom
(University of the Western Cape, 2006) Khanyile, Thembisile
INTRODUCTION: This article focuses on the cultural issues challenging health professional academics in this era of transformation in South Africa. OBJECTIVES: The objective is to discuss various concepts of cultural diversity and the management thereof. METHODS: Review of literature on the management of cultural diversity. CCONCLUSION: The education and training programs for health professionals should lead to affirmation of cultural diversity and promote respect for the person while leading to tolerance of different views and ideas.
A systematic review evaluating the effects of bilateral tubal ligation on menorrhagia and dysmenorrhoea (post-tubal ligation syndrome)
(University of the Western Cape, 2006) Muntanga, V. L.; Nikodem, Cheryl; Daniels, Felicity M.
INTRODUCTION: The complaints about the tubal sterilization surgery leading to post-tubal ligation syndrome first surfaced in the 1950s. With the introduction in the 1970s of laparoscopy, which was a less invasive surgery, more women choose tubal ligation as a family planning method, and reports of complaints of tubal-ligation syndrome increased. Changes in menstrual flow, dysmenorrhoea, menorrhagia and change in cycle length after tubal sterilization have been reported in several studies since 1970. The term "post tubal ligation syndrome" has been used to refer to these changes. Often studies have failed to account for the cause in the menstrual changes other than tubal ligation.Objective: The primary objective of this research project was to evaluate the long-term risks associated with female tubal ligation by executing a systematic review. SEARCH STRATEGY: An electronic search of available search engines was used to draw literature relevant to bilateral tubal ligation. SELECTION CRITERIA TYPES OF STUDIES: All randomized controlled, quasi-randomized or clinical controlled trials that mention an experimental and comparison group (own controls were allowed), reporting on long-term risks associated with changes in the menstrual cycle after female sterilization were included in the review. TYPES OF PARTICIPANTS: Women in their reproductive years who had a tubal ligation compared to women who did not have a tubal ligation. TYPES OF INTERVENTION: Tubal sterilization (by macro- or micro-surgery, laparotomy, minilaparotomy or laparoscopy). TYPES OF OUTCOME MEASURES: Outcome measures relevant to post-tubal sterilization long-term risks concentrating on: Dysmenorrhoea, menorrhagia and duration of menstruation period. DATA ANALYSIS: The reviewer extracted the data unto a data collection sheet. Thereafter it was captured onto a computer. Review Manager software program was used for analyses. RESULTS: The results showed that women who have a tubal ligation have an increased risk to experience dysmenorrhoea and menorrhagia after the procedure. They may also be at risk to experience an increase in the duration of their menstruation period.
An assessment of the adherence to guidelines for the management of asthma exacerbations in selected primary healthcare facilities in the Western Cape
(University of the Western Cape, 2006) Brickels, Vernon; Nikodem, Cheryl
INTRODUCTION: Asthma is described as a chronic inflammatory disorder of the airways. Recurrent episodes of "acute attacks" or exacerbation may occur in susceptible individuals. The onset of these episodes maybe associated with external stimuli such as cold or pollen. Asthma could be a controllable disorder and most people with asthma should be able to lead a normal, productive life if their asthma is managed effectively. A review of literature recommend that adherence to uniform guidelines on asthma management can reduce the frequency of acute attacks. Guidelines for the management of asthma have been implemented in health care facilities in the Western Cape for more than a decade. OBJECTIVE: The objective of this study was to investigate the extent to which doctors adhere to the prescribed asthma guidelines. METHOD: Record review. PARTICIPANTS: Forty records were reviewed. SETTING: The study was conducted at four Primary Health Care (PHC) centres in the Western Cape. INTERVENTION: A review of patient records was done to examine adherence to the implementation of the recommended guidelines. RESULTS: The results are in line with the literature which shows that adherence to the asthma guidelines is sub optimal. CONCLUSION: It is recommended that authorities should regularly follow health care facilities to evaluate to what extend guidelines are adhered to and ongoing training should be given to make health workers aware of these guidelines.
The effectiveness of in-hospital psychosocial intervention programmes for families of critically ill patients - a systematic review.
(Health and Medical Publishing Group, 2006) Brysiewicz, Petra; Chipps, Jennifer
Background. A review of in-hospital psychosocial intervention studies for families with a relative in a critical care unit was conducted. Purpose of review. To review the literature on studies addressing the topic, discuss research methods critically, describe clinical outcomes and make recommendations for future research efforts. In doing so, empirically tested interventions producing positive outcomes may be applied to support families who have a relative in a critical care unit. Data sources. Research citations from 1991 to 2006 from CINAHL, Medline, Pubmed, PsycInfo, SABINET, Cochrane and SCOPUS databases, Internet search engines and unpublished abstracts through NEXUS were searched. Review methods. Citations were reviewed and evaluated for sample, design, intervention, threats to validity and outcomes. Review studies were limited to those that evaluated in-hospital interventions in family members of patients in a critical care unit. Results. Six studies were reviewed. Positive outcomes were reported for all of the intervention strategies. All but one of the studies reviewed studied small samples and single critical care units, and were poor in design. Conclusions. The paucity of interventional studies and the lack of systemic empirical precision to evaluate effectiveness of these interventions necessitate that future studies be methodologically rigorous.
Reflections on nursing students’ e-learning experiences
(University of the Western Cape. Faculty of Community & Health Sciences, 2006) Fakude, Lorraine; Julie, Hester
Introduction: E-learning has been integrated into the curriculum of the School of Nursing (SON) because it supports the principles of the case-based approach adopted by the SON. Aim: The primary aim was to gather baseline data on e-learning by exploring the perceptions and experiences of the first pilot group of undergraduate nursing students who were exposed to this strategy. Methods: A descriptive cross -sectional quantitative design was used to collect data regarding the students’ understanding and value of e-learning, the benefits and skills gained, challenges experienced, by means of a structured, open-ended questionnaire. Convenience sampling was used because the questionnaire was distributed to the 87, third year undergraduate nursing students who completed the Primary Mental Health Care module in June 2006. Microsoft Excel software was used for the capturing and analysis of the data. Results: The findings indicate that 19.5% did not have an accurate theoretical understanding of e-learning in spite of being exposed to at least two sessions of KNG training. The data confirmed that e-learning affords convenience, flexibility and improved access to digital resources. Initial confusion and system down times were cited as important challenges. Conclusion: Although some students struggled initially, the majority (87.8%) succeeded finally in mastering e-learning and regarded the experience as valuable in that 90% rated it as beneficial enough to be recommended to other students.
Comparative analysis of recognition of prior learning vs traditional entrance to a nursing program
(University of the Western Cape, 2007) Khanyile, Thembisile
INTRODUCTION: Recognition of prior learning (RPL) is one of several methods to measure the equivalence of access entry criteria into an educational program for mature adults. This study presents the reader with the results of a comparative analysis of the performance of students who accessed a basic nursing program through the process of recognition of prior learning (RPL) and those students who accessed the same program through the traditional routes of entry. AIM: The overall aim was to establish a RPL program that could be implemented to allow students an alternative method of access to nursing programs. METHODS: Stuffelbeam's Product evaluation was used to guide this phase of the research project. Two groups of samples were drawn, one from students who accessed the nursing programme through RPL and the others through the traditional route in each of the three Nursing Education Institutions in Kwa-Zulu Natal. The mean scores of the two groups were compared for significant differences using the Mann-Whitney U test. RESULTS: There were no significant differences in the performances between groups of candidates. Once in the basic nursing programs, the RPL candidates performed as well as the other candidates. CONCLUSION: Mature adults who access educational programs via RPL are capable to perform at an equivalent level as those candidates who access educational programs via the traditional route.
Student evaluation of a Clinical Self-Study Laboratory
(Elsevier, 2007) Saakane, Keetsemang; Mugarurwa, John; Shahidi, Timothe'e; Maputhege, Maphosa; Chipps, Jennifer; Brysiewicz, Petra
INTRODUCTION: Being clinically competent is an essential component of any nursing curricula to ensure that on completion the nursing graduates are able to practice safely and effectively as a nurse. Clinical Self-Study Laboratories have become increasingly popular in nursing education in recent years as a way of ensuring a variety of skills are taught to the nursing students. These clinical skills laboratories are used to teach communication and interpersonal skills, psychomotor skills, promote the development of collaborative skills required in nursing as well as being able to help integrate theory and practice [Morgan, R., 2006. Using clinical skills laboratories to promote theory–practice integration during first practice placement: an Irish perspective.However, it is essential that these programs be subject to routine quality assurance and effectiveness evaluation. METHODOLOGY: The purpose of the study was to conduct a process evaluation of the implementation of the Clinical Self-Study Laboratory (CSSL) in the School of Nursing, University of KwaZulu-Natal. The process evaluation included a descriptive quantitative satisfaction survey of first and third year Bachelor of Nursing students, a checklist to assess the quality of the CSSL equipment and a retrospective record review of utilisation of the CSSL by students. RESULTS: The CSSL appears to be well implemented and utilized by students. Students reported that it was accessible and that the equipment in the laboratory was of a reasonable quality. A few students reported dissatisfaction with some of the equipment and requested that more equipment and trained personnel be made available.
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.
Service learning: A creative means of teaching nursing
(Faculty of Community and Health Sciences, University of the Western Cape, 2007) Julie, Hester; Khanyile, Thembisile
This article is informed by a retrospective study conducted by the first author, and a limited literature review on service-learning in South Africa. It attempts to give the reader a clearer understanding of service-learning by contextualizing service-learning within current debates about community engagement in higher education institutions in South Africa. A few dominant definitions of SL are described to espouse the underlying pedagogy of SL. Service –learning is then differentiated from other forms of clinical practice currently in use in nursing, based on the conceptual framework of Furco (1996). The latter discussion thus provides a backdrop for the brief description on how SL has been incorporated into the nursing curriculum at the University of the Western Cape (UWC). Lastly the challenges related to the implementation of SL are discussed.
Alzheimer's disease: a nursing-perspective
(University of the Western Cape, 2007) Splinter, A.
INTRODUCTION: Alzheimer's disease presents a challenge for nursing, nurses, formal and informal carer's of person's with Alzheimer's disease. Theoretical knowledge provides insight and understanding into the bio-psycho-social dimensions of behaviour exhibited by the person with Alzheimer's disease. Theoretical knowledge alone, cannot prepare nurses and family members as carers, for the practicalities and coping skills required on an ongoing daily basis. Family members and carers may at first deny the symptoms they observe and pass it off as part of the ageing process. Cognitive decline is progressive as standards of hygiene, self care and independent living becomes more evident and interferes with activities of independent, daily living. The bio-psycho-social-safety and security needs are individualized and unique to each personality with Alzheimer's disease. This provides a challenge to all nurses and carer's of persons with Alzheimer's disease. This literary study aims to provide practical insights and humane coping skills for family members as carer's and nurses both formally or informally trained, as carer's of persons, with Alzheimer's disease. CONCLUSION: Living with, and caring for an Alzheimer's parent or person draws every bit of physical and emotional strength from the family and carer's.

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