Philosophiae Doctor - PhD (Nursing)

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A conceptual framework for nurse educationalists and professional nurses to facilitate professionalism among undergraduate learner nurses for nursing practice in the Western Cape
(University of Western Cape, 2017) Bimray, Portia Benita; Jooste, K.
Learner nurses are socialised into the professional nursing culture through a formal undergraduate nursing programme, where the professional values of nursing are instilled in them throughout their four-year training. During the four years, learner nurses are prepared by nurse educationalists (nurse educators and clinical supervisors) and professional nurses to become professional to render a quality nursing service. This is in spite of the pressures and challenges related to the ever-changing socio-economic and political climate that influence the health context within which these nurses practice. The researcher became aware of a growing number of complaints from various stakeholders in the nursing profession in the Western Cape about the unprofessional conduct of learner nurses. Nurse educators and professional nurses in practice also complained that learner nurses had not developed professionalism by the end of their 4th years of the nursing programme. Perceptions of nursing professionals were that graduate nurses did not conduct themselves in a professional manner after they had completed the formal undergraduate nurses training programme. From these problems, it became evident that a clear framework for professionalism should be developed for nurse educationalists and professional nurses to facilitate professionalism in undergraduate learner nurses for nursing practice in the Western Cape. The purpose of this study was to develop a conceptual framework for nurse educationalists and professional nurses with which they can facilitate professionalism in undergraduate learner nurses of the nursing practice in the University of the Western Cape. The study departed within the paradigm of the professionalism taxonomy of Brown and Ferrill (2009) and Dickoff, James and Wiedenbach (1968).
A contemporary work performance management framework for the Assistant Nurse Manager in the provincial health-care setting
(University of the Western Cape, 2017) Swartz, Beryldene Lucinda; Jooste, Karien
Performance management (PM) in a work setting is seen as process within the broader human resource management (HRM) system that involves people in the attempt to secure the best work performance from the individuals, the working groups and that of the entire work society. Various factors play a role in the performance of nurse managers in South Africa. Since the determination and the simultaneous implementation in 2007 of the occupational specific dispensation (OSD) job descriptions for nurses working in the government setting in South Africa, the understanding of what the required work performance for the Assistant Nurse Manager (ANM) was, remained unclear, as there was no PM framework that directed the work performance of the ANM in the Western Cape Province (WCP).
A human resource strategy to facilitate competencies of assistant nurse managers in the public health facilities in the Western Cape
(University of the Western Cape, 2017) Makie, Vatiswa Veronica; Jooste, K.
The health workforce provides the most important input to any health system. There are estimated to be 59.2 million full-time paid health workers worldwide. The workforce has a strong comprehensive impact on the performance of the health system. Competent nurse managers are needed, particularly in countries such as South Africa, which places nurses at the epicentre of the health delivery system. During the implementation of the Occupational Specific Dispensation in 2007, the post of Assistant Director of Nursing was amended to Assistant Nurse Manager on a higher managerial level and newly appointed ANMs were expected to be competent. A generic human resources strategy was initiated in 2010 because of complaints about the competencies of nurse managers in the South African public health sector. This attempt excluded assistant nurse managers. The aim of this study was to develop a human resources strategy for facilitating the competencies of ANMs at the public health facilities in the Western Cape.
A model for the integration of spiritual care into the nursing curriculum in Nigeria
(University of the Western Cape, 2018) Afolayan, Joel Adeleke; Frantz, José
Man is a bio-psycho-social-spiritual being, and his needs are informed by all these elements. The need for spiritual care in nursing education and practice is no longer a new concept in developed countries, nor even in some developing countries. However, in Nigeria, there is no consistent evidence of how spirituality is taught within the nursing curriculum nor how it is practised. The literature review also confirms that no existing set of rules or models for integrating spiritual care into the curriculum of nursing exists in the country. If nursing care is to be holistic, concerted attention must be paid to spiritual care, and to the training of nurses so that they can provide spiritual care within the context of holistic care for patients in the healthcare system. The main purpose of this academic work was to develop a model for the integration of spiritual care-giving into the nursing curriculum. This cross-sectional study used adapted modified Intervention Mapping (IM) strategies with a mixed method approach, to collect in-depth information.
Acceptance and commitment therapy in the prevention of mother to child transmission of HIV program among pregnant women living with HIV in South Western States of Nigeria
(University of the Western Cape, 2017) Ishola, Adeyinka Ganiyat; Chipps, Jennifer
The objective of this study was to determine if introducing acceptance and commitment therapy in the prevention of mother to child HIV transmission (PMTCT) program using weekly mobile phone messages would result in improved mental health status of HIV-positive, pregnant women in Nigeria. The study used a quantitative approach using a Solomon four-group (two intervention and two control groups) randomised design to evaluate the impact of an acceptance and commitment therapy program. The study population was 132 randomly selected (33 per site), HIV-positive pregnant women attending four randomly selected PMTCT centres in Nigeria. Two were Intervention and two were Control sites which functioned as Intervention and Control groups. The intervention groups were exposed to one session of acceptance and commitment therapy with weekly value-based health messages sent by mobile phone for three months during pregnancy. The control groups received only post-HIV test counselling.
Advisory framework to inform the development of a micro-curriculum for a new bachelor of nursing degree programme offered at a University of the Western Cape
(University of Western Cape, 2021) van der Berg, Lindy Sheryldene; Daniels, Felicity
Curriculum review can ensure that nurses develop appropriate competencies to respond to market demand. Regular revision and updating of curricula are in line with recommendations of the WHO to scale-up health professionals' education and training. Introducing transformative changes in education provides an opportunity to review the strengths and weaknesses of the current systems. The nursing profession was the first of the health professions in South Africa to transform its legislative framework, which led to the development of new qualifications.
The affordances of mobile learning for an undergraduate nursing programme: A design-based study
(University of the Western Cape, 2018) Willemse, Juliana; Bozalek, Vivienne
The global use of mobile devices, and their connectivity capacity, integrated with the affordances of social media networks, provides a resource-rich platform for innovative student-directed learning experiences. Technology has become embedded in the daily lives of students, who become more approachable when technology is used within the higher education context. In 2014 the Educause Centre for Analysis and Research partnered with 213 higher education institutions across the United States of America. It was established that 86 percent of undergraduate information technology students owned a smartphone and half of that percentage owned a tablet. A systematic review on mobile learning in higher education focusing on the African Perspective in 2017 concluded that there was an increase in the use of mobile learning in higher education. Higher education institutions continue to move away from traditional, lecture-based lessons towards new, innovative teaching and learning methodologies to facilitate emerging pedagogies and strategies, thereby enhancing student learning. The adoption of technological innovation could promote the unfolding of a social process that over time could enhance social connectedness among young students and their older adult educators. Mobile learning is fundamentally defined as “learning with mobile devices” and it has the potential to extend the philosophies of learning through innovation It was identified that research in the field of m-learning can be divided into four areas, namely: pedagogy; administrative issues and technological challenges; ensuring sustainable development in education using m-learning; and the impact of new applications. With the increased need for nursing professionals, promoting the quality and effectiveness of nursing education has become crucial. It is thus important to establish learning environments in which personalised guidance and feedback to students regarding their practical skills and the application of their theoretical knowledge within clinical learning environments is provided.
Analysis of the implementation of an antiretroviral treatment programme in KwaZulu- Natal province
(University of the Western Cape, 2019) Sengwana, Manyeke Jeanivive; Phetlhu, Deliwe
The rapid expansion of the ART programme in South Africa has placed an additional service demand on an already stretched public health infrastructure. The main aim of this study was therefore to analyse the implementation of the ART programme in KwaZulu- Natal province using the Donabedian Model of structure, process and outcome in order to develop an ART delivery model. Ethical approval to conduct this research was issued by the University’s Senate Research Committee. The first phase of the study used a descriptive quantitative approach to review existing data from government departments to analyse the ART programme. A checklist with the list of indicators for the three elements of the study; the structure, process and outcome were used to collect data. A pilot study was conducted and the Cronbach Alpha test was used to determine the rigour of the study. In the second phase, a systematic review of studies on implementation of the existing models of ART programme was conducted using quantitative descriptive approach. The Quality Appraisal Tool was used to determine the validity of the research findings from the literature. In phase 3, both qualitative and quantitative approaches were used to conduct the Delphi study which included a group of experts in the field of HIV and ART programme. Responses from the participants were modified to determine the reliability of the study. The study found that there were structural problems such as shortages of antiretroviral drugs and delays in the return of laboratory results. The systematic literature review found that there were only two community-based ART models in South Africa, namely; the adherence clubs and community-based adherence clubs. These two models of ART delivery were implemented only in Cape Town.
Challenges and barriers to adolescents' post-abortion care services: Implications for reproductive health policy in Nigeria
(University of the Western Cape, 2017) Onasoga, Olayinka Abolore; Arunachallam, Sathasivan
The prevention of abortion related complications and mortality is dependent on the availability, accessibility and usability of emergency post-abortion care (PAC) throughout the health care system. Unfortunately, abortion is not legal in Nigeria and Nigerian women, especially adolescents, are often unable to obtain adequate post-abortion care services due to a variety of reasons. A review of literature shows that adolescent PAC patients receive worse care than older women seeking PAC services. There is widespread recognition of the need to overcome these barriers and make it easier for women to obtain the PAC services they need. Therefore, overall aim of this research study was to provide empirical information on the barriers and challenges to adolescents' PAC and develop a policy document to inform reproductive health services for Nigerian hospitals. To develop this policy document, the study specifically sought to assess knowledge of reproductive-health and related post-abortion care services among health care providers; describe the adolescents' perception of post-abortion care received; determine the service providers' perspectives on adolescents' post-abortion care challenges and barriers; analyze the challenges and barriers faced by adolescents in obtaining post-abortion care services; explore ways in which the knowledge about challenges and barriers to adolescents' post-abortion care can be used to inform policy; develop policy document and make recommendations in key areas to improved PAC services in Nigeria as part of working towards improving reproductive health services.
Developing a culturally congruent continuous labour support framework for women in South-West Nigeria
(University of the Western Cape, 2017) Ibitoye, Olabisi Fatimo; Phethlu, Deliwe
Childbirth is a multifaceted experience that is usually influenced by several factors that could result in an unsatisfactory or satisfactory childbirth experience. These factors include quality of support during labour of which Continuous Labour Support (CLS) is a part; it has been identified as a positive contributor to maternal health. Although CLS has been recommended by the World Health Organization (WHO), lack of a framework has also been an impediment to its implementation in Nigerian hospitals. The purpose of this study is to develop a culturally congruent Continuous Labour Support framework for women in Nigeria. The study adopted a concurrent mixed method design to gain information from various dimensions for the study. The study populations included pregnant women, nurse-midwives and health policy-makers in Ondo state, Nigeria, who were selected through simple random sampling using computer-generated tables for the quantitative strand of the study. For the qualitative strand, participants were selected using a purposeful sampling method. The study was conducted in two phases. Phase 1 focused on the assessment of the perceptions, attitudes and preferences of all groups of participants. Collected quantitative data was analysed using descriptive and inferential statistics through the use of the Statistical Package for Social Science (SPSS) Version 21. Qualitative data was analysed using Tesch's Method of Content Analysis. Findings the study shows that the pregnant women had positive perceptions and attitudes towards CLS from a familiar, close and trusted person, in public health facilities. Findings from the midwives revealed that pregnant women's family members are not usually involved in women's care during labour in public health facilities. However, nurse-midwives expressed satisfaction with the few occasional/discretional occasions on which the practice had been implemented, and the majority showed positive perceptions and attitudes to the introduction of CLS from a person of the woman's choice, in public health facilities. Findings from interviews with the policy-makers affirmed family support system during labour as a cultural expectation and a traditional practice at home but alien to the hospital. The policy-makers also expressed a positive standpoint on the introduction of CLS by persons of the woman’s choice from her social network, in the public hospital. Phase 2 of the study involved the development of the culturally congruent Continuous Labour Support framework for women in south-west Nigeria. The framework was developed using the Model Development Approach by Walker and Avant (2005, 2011). Findings from processes with all stakeholders in Phase 1 of the study were synthesised with literature review, using concept identification and classification. The concepts in this study were identified, described and developed through synthesis of data from questionnaire, the focus group and individual interviews of all stakeholders. Concept classification, description and validation was achieved through the six vantage points of surveying activity listed by Dickoff et al, (1968) in consultation the selected expert reviewers in maternal and child care. The developed framework was followed by a detailed description, and validation of the framework was done through consensus agreement with four experts.
Developing a framework for a district-based information management system for mental health care in the Western Cape
(University of Western Cape, 2013) Bimerew, Million S; Adejumo, Oluyinka; Korpela, Mikko
A review of the literature has shown that there is a lack of mental health information on which to base planning of mental health services and decisions concerning programme development for mental health services. Several studies have indicated that the use of an evidence-based health information system (HIS) reduces inappropriate clinical practices and promotes the quality of health care services. This study was aimed at developing a framework for a district-based mental health information management system, utilising the experiences of health care providers and caregivers about a district mental health information system (DMHIS). Activity Theory was used as the philosophical foundation of the information system for the study. A qualitative approach was employed using semi-structured individual interviews, Focus Group Discussions (FGDs), systematic review and document analysis. The intervention research design and development model of Rothman and Thomas (1994) was used to guide the study, which was conducted in the Cape Town Metropole area of the Western Cape. A purposive, convenient sampling method was employed to select study participants. Ethical clearance for the study was obtained from the University of the Western Cape, and permission to use the health facilities from the Department of Health. The data collection process involved 62 individual interview participants, from mental health nurses to district health managers, health information clerks, and patient caregivers/families and persons with stable mental conditions. Thirteen caregivers took part in the FGDs. Document review was conducted at three community mental health centres. The data were analysed manually using content analysis. Core findings of the interviews were lack of standardized information collection tools and contents for mental health, information infrastructure, capacity building, and resources. Information processing in terms of collection, compiling, analysing, feedback, access and sharing information were the major problems. Results from document analysis identified inconsistencies and inaccuracies of information recording and processing, which in turn affected the quality of information for decision making. Results from the systematic review identified five functional elements: organizational structure; information infrastructure; capacity building; inputs, process, output and feedback; and community and stakeholders’ participation in the design and implementation of a mental health information system (MHIS). The study has contributed a framework for a DMHIS based on the findings of the empirical and systematic review. It is recommended that there is a need to establish a HIS committee at district health facility level for effective implementation of the framework and quality information processing. There is a need to ensure that staffs have adequate knowledge and skills required for effective implementation of an information system. It is recommended that higher education institutions include a course on HISs in their curriculum. It is suggested that the South African Mental Health Policy be reviewed to include an MHIS and ensure involvement of the community and stakeholders in this system as well as adequate budget allocation.
Developing a model for integration of core competencies related to HIV and AIDS into undergraduate nursing curriculum at the University of the Western Cape
(University of the Western Cape, 2015) Modeste, Regis Rugira Marie; Adejumo, Oluyinka
The HIV epidemic is in its third decade, and there is still neither a cure nor an effective vaccine in sight. Although the number of new HIV infections and AIDS-related deaths has decreased since the early 2000s, the number of people living with HIV remains high. Sub- Saharan Africa carries the burden of the epidemic, and South Africa has the highest number of people living with HIV globally. In South Africa HIV and AIDS is one of the health priorities, and nurses’ role in the fight against HIV infection is crucial, as nurses form the bulk of health care professionals in the country. The South African Government has increased its efforts in the fight against HIV infection, with the introduction of various policies and guidelines. For these policies to be implemented effectively and able to fight the HIV epidemic successfully, nurses’ training needs to provide adequate preparation for nurses to attend to people living with HIV and AIDS upon graduation. The literature highlights various shortfalls in nurses’ training related to HIV and AIDS care and management; in-service training has been the main training model so far, with limited emphasis on pre-service training. The purpose of this study was to develop a model for integration of HIV and AIDS nursing competencies into the undergraduate nursing programme at the University of the Western Cape. The study’s objectives include identification of HIV and AIDS-related core competencies for a nurse in South Africa, then integration of the identified competencies into the undergraduate nursing programme, supported by the Competency, Outcome, Performance, Assessment framework, within a constructivist paradigm. Applying the intervention research: design and development approach, the study was conducted in three phases. Data collection was carried out using nominal group technique, interviews, systematic research synthesis as well as workshops, and data were analysed qualitatively. The 112 participants included nurse educators, people living with HIV and AIDS, registered nurses in clinical practice, recent graduates, South African Nursing Council representatives, lecturers that teach in the nursing programme as well as nurse experts on HIV and AIDS in South Africa, with 12.8% of them participating in more than one phase of the study. Three competency categories covering seven core competencies were identified, namely: foundation (knowledge); supporting pillars (ethics, policies, interdisciplinary approach, personal and professional development); and performance (health education, holistic safe practice). Furthermore, four structural requirements were identified, namely teaching and learning strategies, learning opportunities, service readiness and staff development, forming the HIV and AIDS nursing core competency framework. Vertical and horizontal integration of the core competencies was completed, highlighting how they can be integrated into the undergraduate nursing programme, and this was validated by experts through a workshop. The integration model which was developed is flexible, allowing further adoption into any other undergraduate nursing programme, and provides the potential to assist in the systematic integration of HIV and AIDS into the nursing curriculum. This would enhance new nurse raduates’ competencies in the provision of HIV and AIDS-related care and management upon graduation.
Developing an effective classroom and clinical teaching strategy in Malawi nursing colleges
(University of the Western Cape, 2018) Dzimnenani, Mbirimtengerenji Noel; Daniels, Felicity
Nursing is the largest healthcare profession in Malawi with more than 11,000 registered Nurses (RNs) and Nurse Technicians and Midwives (NTM) practicing in hospitals and other settings like nursing colleges nationwide. Nursing tutors in all the nursing colleges use numerous types of teaching aids in student preparation. There are numerous teaching strategies that suit pedagogical learning, however not all can yield the desired outcome and are properly applied in both classroom and clinical areas. Therefore, identifying the new teaching strategies for nurse tutors is very critical in nursing education hence this study concentrates on teaching competence, interaction and performance on the use of the strategies. Nurse tutors must encourage teaching and learning discovery through deliberate interactive teaching actions. However, some outcome actions, competences and performance or interactive behaviour of the nurse tutor are much to be desired in most nursing colleges in Malawi. Nurses need to possess classroom and clinical teaching competences to perform the role of a tutor properly.
Developing an effective classroom and clinical teaching strategy in Malawi nursing colleges
(University of the Western Cape, 2018) Dzimnenani, Mbirimtengerenji Noel; Daniels, F.M.; Martin, P.D.
Nursing is the largest healthcare profession in Malawi with more than 11,000 registered Nurses (RNs) and Nurse Technicians and Midwives (NTM) practicing in hospitals and other settings like nursing colleges nationwide. Nursing tutors in all the nursing colleges use numerous types of teaching aids in student preparation. There are numerous teaching strategies that suit pedagogical learning, however not all can yield the desired outcome and are properly applied in both classroom and clinical areas. Therefore, identifying the new teaching strategies for nurse tutors is very critical in nursing education hence this study concentrates on teaching competence, interaction and performance on the use of the strategies. Nurse tutors must encourage teaching and learning discovery through deliberate interactive teaching actions. However, some outcome actions, competences and performance or interactive behaviour of the nurse tutor are much to be desired in most nursing colleges in Malawi. Nurses need to possess classroom and clinical teaching competences to perform the role of a tutor properly.
Developing strategies to enhance implementation of early Kangaroo Mother Care (KMC) guidelines in health care facilities in Edo State, Nigeria
(University of the Western Cape, 2018) Esewe, Roselynd Ejakhianghe; Phetlhu, Deliwe Rene
The number of healthcare institutions that has embraced Kangaroo Mother Care (KMC) as an effective and efficient method of neonatal care especially in Edo State, Nigeria has not multiplied even after more than a decade of its recommendation by the World Health Organisation (WHO) in 2003. Nigeria ranks seventh among the ten African countries where newborns have the highest risk of dying with over 700 newborn deaths per10, 000 live births. This is worrisome because Edo State is one of the 36 states in Nigeria that contribute about 6,700 neonatal deaths to the 255,500 mortality rate recorded in Nigeria annually. This has led to a concern about the knowledge and attitude of the key drivers in neonatal care of simplified methods aimed at reducing neonatal mortality despite previous training efforts. The development of a strategy to enhance the early implementation of the WHO KMC guidelines in all healthcare facilities across the state was therefore conceptualized. Strategies to increase implementation are considered important to the success of KMC because reducing neonatal mortality rate is contextual. This research aimed to explore and describe the application of the KMC guidelines by the nurses, administrators and parents of preterm infants in the care of premature babies and to develop strategies to enhance its early implementation in healthcare facilities in Edo State, Nigeria.
Developing strategies to improve support for grandparents caring for aids orphans in the western cape
(University of Western Cape, 2021) Akimanimpaye, Furaha; Phetlhu, Deliwe René; Bimerew, Million
Literature evidence on challenges facing the grandparents caring for AIDS orphaned children has shown inaccessibility to health care services, inability to afford basic needs, absence of social security provisions (with the exception of the pension scheme) and lack of attention from the government and Non-Government Organizations (NGOs). In South Africa, there is insufficient documented evidence of available sustainable approaches to supporting grandparents caring for AIDS orphans in all health dimensions. This study aimed to develop strategies to improve support for grandparents caring for AIDS orphans in the Western Cape Province of South Africa.
Developing strategy to improve the implementation of comprehensive sexuality education policy in Oyo state secondary schools in Nigeria
(University of the Western Cape, 2022) Yinyinola, Makinde Olufemi; Bimerew, Million
Sexuality education is a globally emerging social issue leading to discourse among stakeholders in the school system and public health arena. Comprehensive sexuality education (CSE) has emerged as an effective method of preventing teenage pregnancy. However, attempts to implement CSE policy in Nigeria since 2002 have not been successful. Teenage pregnancy is increasing in Oyo State, leading to rising school dropout rates. The aim of this study was to develop strategy to improve implementation of the CSE policy aimed at reducing teenage pregnancy at secondary schools in three LGAs in Oyo State, Nigeria. An explanatory sequential mixed methods design was employed to conduct data collection and analysis in Phase One. Target populations for survey were learners, parents and teachers.
Development of a clinical nursing education model for Nigerian universities
(University of Western Cape, 2017) Anokwuru, Rafiat Ajoke; Daniels, F. M.
Globally, nursing education has moved from a hospital-based education to a university-based education. Though this change resulted in the improvement of the quality of nurses it has also presented its own challenges. Clinical education, one of the major components of nursing education, was adversely affected by the reduction in the amount of time and the quality of clinical placements. In order to combat these challenges, innovative models on clinical education were developed with the objective to produce nurses that can deliver quality care to patients in an evolving health sector.
Development of a framework for health care professionals to lead youth victims of violence towards wellness in the Genadendal community of the Western Cape
(University of the Western Cape, 2015) Ahanonu, Ezihe Loretta; Jooste, Karien; Waggie, Firdouza
The Wellness Leadership White Paper states that leadership is needed in a supportive environment with the purpose of guiding clients to lasting wellness. Wellness can be defined as an active process that enables an individual to become aware of all aspects of the self and to make choices in terms of a more healthy existence by means of balancing and integrating various life dimensions. Health care professionals are leaders who play an important role in creating an environment that contributes to wellness. Their leadership is, therefore, viewed as a wellness strategy. Leadership has been identified as an essential role of health care professionals with a responsibility to attend to the needs of their clients, such as youth victims of violence, with the aim of leading them towards wellness. The Provincial Nursing Strategy of the Western Cape in South Africa emphasises the need for health care professionals to demonstrate their leadership capacity in practice. In the communities of the Western Cape Province of South Africa, many youth victims of violence report for treatment at the health care facilities; it places a high burden on the health care system. Even though health care professionals provide treatment to this group of youth, it is not clear how health care professionals lead them towards wellness after an incidence of violence. The purpose of this study was to develop a conceptual framework that can be implemented by health care professionals to gain a better understanding about the important role they play in leading youth victims of violence towards wellness in a rural community in the Western Cape Province of South Africa. This research study applied a qualitative, exploratory, descriptive and contextual design. The study population who were selected by means of a purposive sampling technique consisted of youth attending a high school and who had been victims of violence and of health care professionals (professional nurses, medical doctors and social workers) working at the health care facilities in the community where the study was conducted. The study was conducted in four phases. Phase 1 of the study focused on the exploration and description of the expectations of the youth victims of violence about how health care professionals should lead them towards wellness. Focus group discussions (FGDs) were conducted at a high school at the study site. Phase 2 explored and described the experiences of health care professionals who were supporting youth victims of violence at the health care facilities in the community of study. The execution of this phase comprised of unstructured individual interviews. The total number of the FGDs and unstructured individual interviews conducted in this study was determined by data saturation. Data analysis of the data collected involved transcription of the voice recordings of the all the interviews and writing up of field notes. The steps of Tesch’s coding technique were used at the end of Phases 1 and 2. To ensure trustworthiness of the collected data, Guba and Lincoln’s strategies of credibility, transferability, dependability, confirmability and authenticity were applied. Phase 3 of this study entailed the development of a conceptual framework for health care professionals to lead youth victims of violence towards wellness. It was based on the findings from Phases 1 and 2 of the study; Phase 4 of the study involved peer debriefing and validation of the developed conceptual framework. In Phase 1 of the study, a total of nine (n = 9) FGDs were conducted among fifty eight (n = 58) youth participants between the ages of 15 and 19 years. Each group consisted of 6 to 8 participants and the interviews did not last more than an hour per session. The data analysis in this phase showed that the youth victims of violence did have expectations from the health care professionals in guiding them towards wellness. They shared their interpretation of the term wellness and were also quite aware of the challenges in their community. Four categories emerged from the data in Phase 1: Category 1 - Dimensions of wellness as it related to healthy body, mind, spirit and positive interactions: The findings of this category revealed that youth participants described wellness as a holistic concept that comprised healthy living, self-care and a healthy personality and mind (emotional, psychological) as well as spiritual well-being. They did not necessarily consider wellness as the absence of sickness or illness, Category 2 - Common problems among youth in the context of the community: They articulated that drug abuse, teenage pregnancy and violent behaviour were important issues of concern to them in their community. Category 3 – Building a sound and trusting relationship: They expressed their need for health care professionals to have a positive attitude towards them, to be respectful and to provide them with accurate information, as well as confidential and supportive services. Category 4 - Guidance of youth to wellness: The youth also proposed strategies that they believe could be used by the health care professionals while guiding them towards wellness. These strategies were: Provision of information / health education, school and community outreach programmes, provision of counselling services and role modelling. For the second phase, seven (n = 7) health care professionals were interviewed. Two (n = 2) were professional nurses, three (n = 3) medical doctors and two (n = 2) social workers. The findings of the individual interviews indicated that the health care professionals recognised the fact that wellness is very important. However, they felt that guiding youth victims of violence toward wellness was a challenging process. Three categories emerged from the data in Phase 2: Category 1 - Different points of view about the concept of wellness: The health care professionals described wellness as the holistic wellbeing of a person, an absence of illness or disease and living a healthy lifestyle. Category 2 - Barriers to leading youth victims of violence towards wellness: The health care professionals reported challenges while attempting to lead youth victims of violence towards wellness which included low socioeconomic status of families, unsupervised youth, violent behaviour, drug and substance abuse, a lack of resources in the community, negative staff attitudes, inadequate physical infrastructure and human resources as well as the absence of a process of guiding youth victims to wellness. Category 3 - Guidance to leading youth victims to wellness: The health care workers proposed strategies for guiding youth victims towards wellness. Those strategies included the provision of support in the form of counselling services, use of support groups, family and community support; recreational activities, dedicated staff to work with youth victims of violence and a multidisciplinary team approach. The findings from the first two phases were triangulated during the third phase of this study with the purpose of developing a conceptual framework. The survey list of Dickoff, James and Wiedenbach formed the foundation of the reasoning map for the development of the framework. The unique contribution of this study is the development of an original, participative leadership framework that provides health care professionals with information for leading youth victims of violence towards wellness in a rural community in the Western Cape. This study was conducted in a single rural community of the Western Cape Province of South Africa. Despite this limitation, the framework could be evaluated for use in similar settings. Finally, guidelines to implement the framework and recommendations for improving community health care practice, nursing education and nursing research were suggested based on the findings from the study.
The development of a framework to align theory and practice to improve midwifery education in the Western Cape
(University of the Western Cape, 2017) Phiri, Wendy Augusta; Daniels, Felicity
Midwives play a critical role in the care of pregnant women from the first antenatal visit, through to the delivery and the postpartum period. The education of midwives has however become a concern, not only in South Africa but in many countries for a multitude of reasons. Evidence suggests that South Africa is devoted to reducing the maternal mortality rates as reflected in the Negotiated Service Delivery Agreement, signed in 2010, which identifies reductions in maternal and child/neonatal mortality rates as key strategic outcomes for the South African Health sector. However, by 2015 the set Millennium Development goals, specifically goal 4 (to reduce child mortality) and 5 (to improve maternal health) were not met and were replaced by Sustainable Development Goals, specifically goal 3 (to ensure healthy lives and promote wellbeing for all at all stages). This lag in meeting the indicators for improving the health of the population is associated in some respects to the education and training of health professionals.

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